In this week’s episode, we speak with Maria Aspan, senior writer for Fortune, where we discuss the risks and sometimes fatal results stemming from breast augmentation surgery, and we explore where the responsibilities lie for protecting the millions of woman who have had this surgery and educating those women who are exploring the surgery for the first time.

Click here to read more about Maria’s eye-opening article in Fortune

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Healthcast by RooneyPartners. I am your host Jeffrey Friedman. 

Jeffrey: Our guest this week is Maria Aspan. Maria is a senior writer for Fortune Magazine, and prior to coming to Fortune she is written for Inc. Magazine, Reuters, and American Banker. Maria just wrote an incredibly interesting investigative feature in Fortune Magazine’s June-July issue about the decades of problems with breast implants and there sometimes fatal health problems for women. Now to give some context and to place some scope on this issue as to why it is so serious. More than eight million American women have undergone breast related plastic surgeries since 2000, and in 2018 alone more than four hundred thousand women had breast surgery for either cosmetic or reconstructive reasons. Breast augmentation is the most popular cosmetic procedure in the United States, and that is tracked by the American Society of Plastic Surgeons. Maria will discuss her article with us and talk about the big business behind the surgical procedure. We will talk about the potential danger it poses and what options women have if they are considering breast augmentation surgery.

Jeffrey: Maria, thank you for joining us today.

Maria: Hi, Jeffrey. Thanks so much for having me.

Jeffrey: Well first let me say, you know, I read your article and it is very thorough. It is an incredibly interesting piece on the issues surrounding breast surgery. I personally I did not realize how large an industry this is. So can we start out by framing this for our listeners? It is not just the manufacturers that are making money here.

Maria: Absolutely. It is not just the manufacturers who are making money and whatever sort of image you might have in your head about the sort of person or patient who might go for breast plastic surgery, it is probably not only devoted to that sort of woman neither. This is an industry that has served some eight million women since 2000. There are in 2018, which is the latest figures that were available, there were about 400,000 women who had a breast related plastic surgery. A hundred thousand of those women were getting reconstructive surgery, which is most often done after someone has a mastectomy for cancer related reasons. In terms of financial impact, we can say from a manufacturing side of things, it is probably under a billion dollars annually, but from an overall, including doctor fees and health insurance costs we are talking a multi billion dollar industry. Breast augmentations can cost up to twelve thousand dollars according to the American Society of Plastic Surgeons and there were three hundred thousand of them alone last year which which we are talking like three point six billion dollars from that alone.

Jeffrey: It is I mean that is mind-boggling because especially because the history and the risk behind breast implants and augmentations history. Augmentation surgery, the risk has been known for decades, and it is always been deemed as controversial right? For example in 1995 Dow Corning had over twenty thousand separate lawsuits related to the implants. What happened there? What was the outcome?

Maria: Yeah, highly controversial and also highly litigated in all senses of the word. So breast implants have been on the market since the 1960’s. They have been regulated to some extent since the 1970s. And by the 1980s women were starting to complain about about pains and illness and other side effects of their implants. Dow Corning which was a joint venture of Dow Chemical and Corning, was one of the biggest makers of silicone breast implants and by 1995 had filed for chapter 11, because it was the subject of so many complaints. Of those twenty thousand lawsuits that you mentioned, ultimately there  were more than four hundred thousand women with complaints against the manufacturer. By 1998 it had agreed to set it up a thre point two billion dollar settlement fund. Meanwhile, there were three other big manufacturers of silicone implants, Bristol-Myers Squibb, Baxter Healthcare and 3M, that set up a separate multi billion dollar settlement fund. And incidentally the Dow Corning settlement fund, that only just expired last year. Women were able to file claims for it up until June 2019. But the outcome of all of this was muddy and again controversial, but even the controversy was controversial. The science was highly disputed. The FDA had in 1992 asked for a moratorium on the sale of most silicone breast implants and lessen in certain cases, especially again for for cancer patients. So most implants were becoming saline. 

Maria: There was a highly influential study or a panel rather, that in 1999 a panel of scientists that was convened by The Institute of Medicine concluded that silicone implants did not cause any major disease, even though the panel did not really do their own research. They relied on a lot of research submitted by other entities including manufacturers and surgeons who are involved in this industry. And public health advocates pointed out at the time and still point out that some of those findings were obviously conflicted. And there was also some legitimate criticism of the sort of Gold Rush of lawsuits against the manufacturers. The idea that plaintiffs attorneys saw that breast implant makers were ripe for the plucking, were a good target of personal injury lawsuits, and that raised some concerns about the legitimacy of perhaps of all of the claims. So you have all of that and there is a lot of bad feeling all around, a lot of awareness that breast implants might not be safe, but little direct conclusion and into this in 2006, the FDA grants approval again to manufacturers, Allergan and Mentor to start selling silicone breast implants again. However, it demands as a condition of these sales that the manufacturers continue to study the impact and the health effects of their implants on patients, and neither one has to the FDA’s satisfaction. We are now 14 years after those approvals were given and the FDA has sent warning letters to all of the manufacturers of silicone breast implants saying, “You have not done what we told you, you had to do in order to sell these things.”

Jeffrey: There is so much going on here. And then it is tough to unpack it all. That is why the article is so good. It is just history has a way of repeating itself. I mean in 2017 Allergan sold about four hundred million dollars worth of implants before they were taken off the market and you mentioned that the FDA still asking them for information. What happened with Allergan? Why was not more done to them about this and are there fines? So what is going on now?

Maria: It is a good question. And again, it is hard to explain briefly, but I will try not to get too into the weeds. So I think it is first of all important to point out that Allergan is still selling some breast implants. But what started to happen actually in the late 90s, but what the FDA became fully aware of and started to warn people about in 2011 is that breast implants were being linked to a new complication, a type of cancer of the immune system that is called Breast Implant-Associated Anaplastic Large Cell Lymphoma, otherwise known as BIA-ALCL. Now these implants– This cancer has been linked to textured implants. So all the manufacturers make either smooth implants or implants that are covered in this more roughly textured silicone shell. There are a couple of reasons why it might be preferred. It allows tissue to grow onto the implant more easily. There is some doctors and patients say that it looks more natural but textured implants were not super popular in the United States. They were very popular in Europe and by the end of 2018, European Regulators were seeing a big surge in cases of BIA-ALCL and starting to get worried about the sale of textured implants and this disease that it seemed like that they were linked to and then it seems like they might be responsible for. So at the end of 2018, European Regulators stopped the sales of Allergan textured implants and later banned them entirely. The FDA in March 2019 convenes a hearing to look into– Two-day hearings actually to look into BIA-ALCL. Some of the other side effects that women are increasingly reporting- have increasingly been reporting of their breast implants, but it is not until last July 2019 that the FDA says alright five hundred seventy three women worldwide have been diagnosed with this cancer, 33 women have died from it. Women with Allergan textured implants, even though all of the manufacturers with textured implants have been linked to the disease, women with Allergan textured implants are six times as likely to contract BIA-ALCL. So Allergan, we are asking you to take your textured implants off the market, which the company did. The FDA later increased that recall to a class one designation, meaning that use of these devices could cause serious injury or death. So, it was a very– It seemed from the outside perhaps if you were not paying attention to these issues, like a very sudden withdrawal, but the awareness of these issues, the awareness of this disease had been around for years by then, and the FDA was taking action several months after Europe did.

Jeffrey: All right. Well, it is just with all the controversy, with all the awareness, it is still a billion dollar industry. All right. So let us move away for right now. Let us not talk about the economics. But let us talk about the humanistic side and in particular in your story you feature many women that have been affected by issues related to their implants and in particularly the story of Paulette Par you wrote about, she was very moving and her husband the work that he was doing. Can you share a little bit about Paulette’s story with us?

Maria: Absolutely. This was a really difficult story to tell and a very sad one. And I do have to say I am so grateful to all of the women who did talk to me or their families, in Paulette’s case, her husband because this is maybe from the outside seen as kind of a niche and taboo subject, you know, this is breast implants. This is feminine sexuality and kind of shallow plastic surgery. This is lady business, and kind of gross, and kind of silly, and not that serious. And a lot of the women that I talked to said that they had to kind of get over their own feelings of shame or the external judgement of you know, “Oh you got these things for vanity and now they gave you cancer. Are you happy?” You know, “You deserve this.” is what more than one woman told me that she had been told by family members or friends after after developing BIA-ALCL. In Paulette’s case, her story really kind of follows the history of breast implants. She lived in Missouri. She was a young mother of two children in the 1980s when she got her first set of breast implants, you know, as she wanted to feel better about her body after childbirth and nursing. And they were mostly okay. They were silicone. She was worried about the health impact when all of the news about lawsuits and the FDA moratorium on silicon implants came out, but you know, they were fine until around 2000-2001 she noticed that they were leaking and so she got– Her plastic surgeon did replace them with the first set of implants made by a company that Allergan later required. These were the textured bio cell implants that were eventually recalled due to their linkages to this cancer of the immune system. Paulette had one set of these biocell textured implants until 2010. Then there was another leak and she had them replaced with another set of biocell textured implants, and she was you know, in 2018, she was she was 67. She had just retired. She had worked in the administrative offices of her local hospital for decades. She and her husband were restarting– Her husband had retired a couple of years. before, and they were looking forward to traveling some more together and just you know, enjoying the start of their retirement together. And in the fall of 2018, Paulette noticed that she had a small pimple sized growth and she went and got it checked out and eventually was told, “Oh, you have this new rare cancer that has been linked to your type of breast implants.” A few sessions of chemo and you will be fine. And unfortunately the really, the just horrible and sad story is that over the course of the next year, she had her chemo during the Spring, as the FDA was holding hearings on breast implants, as Europe had banned the textured implants from their market, and the chemo did not work and her cancer metastasized and she wound up being hospitalized and growing weaker and weaker. And 29 days after the FDA banned her implants or asked Allergan to recall them, she passed away. 

Jeffrey: Now, the implants are deemed medical devices. So, what type of testing is done? And is the oversight just on the- you know by the FDA over these manufacturers? And how much oversight is done? It seems to be a recurring theme.

Maria: It is a really good question. It is. It is a recurring question. Medical devices in general have come under all sorts of scrutiny for the sort of lack of testing and regulation that they are subject to. I have to give a shout out to the International Consortium of Independent Journalists, which did an amazing series of articles called the Implant Files, that looked into- starting in 2018 it looked into some of the failures of regulation and study of all types of medical devices. Whether we are talking pacemakers or artificial hips or ventilators, which have been in the news so much with COVID-19. So breast implants are a specific subset, but by no means the only sort of medical device that is subject to some of these questions about the regulation and testing. For breast implants specifically the FDA now does regulate them as class 3 devices, meaning that they are the highest category of risk. And so they are subject to what is known as pre-market approval processes. They have to undergo clinical testing done by the manufacturer. But again, there is still some question about the adequacy of that testing and the data submitted. For example with Mentor, which is now owned by Johnson & Johnson, and Allergan which is now owned by AbbVie, when the FDA in 2006 gave them both approval to start selling silicone implants again, they base that improval on three or four years each of study and then required the additional study that the manufacturers have not fully complied with. 

Jeffrey: So as we said history does repeat itself. Unbelievable! All right, before we go, is there anything else you would like to warn or discuss with someone that is considering the surgery

Maria: So I think one thing that is important to point out and in that maybe does not come across in all of the discussion of the negative side effects and very serious and sometimes fatal consequences is that, I did speak to many women who are grateful to have implants as an option, including it has to be said, a lot of women who have been affected by cancer. Whether they are women who are cancer victims themselves who have undergone mastectomies to treat cancer or women who are the children of people who have been affected by breast or ovarian cancer, who have undergone preventative mastectomies and remove their breasts to remove their high risk of developing cancer. Many of these women say that they are grateful for the options, that the choice to have breast implants have given them. So I would not necessarily want somebody to come away from this thinking that all breast implants are absolutely bad, but I would conclude from all of my reporting that the breast implants that are on the market just have not been adequately tested or studied and that for women to have options they deserve to have fully studied, vetted choices that have- and to be clearly informed about the risks which many women said they had not been, whether it was the fault of their doctors, or the fault of the manufacturers not adequately communicating the risk to their doctors, or in some cases even hiding or not fully reporting the adverse events in the malfunctions of their devices. It is just there is been a lack of clear information given to women who might want to consider these medical devices.

Jeffrey: That is great advice and research and research and research is key. So Maria, thank you so much for your time today. This was incredibly interesting and enlightening and informative. Thank you.

Maria: Jeffrey, thank you so much. It was my pleasure.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Healthcast.

In this week’s episode we speak with Brian Bremner, Executive Editor, Global Business at Bloomberg, where we talk about the global aspects of the Covid-19 pandemic and the politics behind finding a cure, creating a vaccine and ultimately could government policy effect the global distribution of that vaccine.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by Rooney Partners. I am your host Jeffrey Friedman. Despite its worldwide spread, the global pandemic is not being met with global cooperation. At a time of trade wars between the US and China, and at a moment in time when the US has dramatically scaled back its commitment to the European Alliance and scaled back its commitment to the World Health Organization, and at a juncture in history when nationalistic forces have been on the rise, the environment conducive to a coordinated global effort to defeat the coronavirus is simply absent. To help us understand how we got to this place in world history and what we should expect the geopolitical state of play to be in in the age of the coronavirus, we are very fortunate to have with us today, Brian Bremner. Brian, good afternoon and thank you for joining us today. 

Brian Bremner: It is terrific to be here.

Jeffrey: Brian, your role for Bloomberg News includes overseeing the global coverage of the coronavirus. You are based in London, now. You were a journalist in the US for many years. Right before coming to London, you were the executive editor for Bloomberg in Asia. It would seem your career and background were tailor-made for this assignment now.

Brian: Yeah, in some ways it is. I spent about 20 years in Asia for Business Week Magazine and then Bloomberg. I lived through the SARS epidemic which you might recall happened in the early 2000s, which in many ways kind of foreshadowed what is going on right now, although the current pandemic is bigger in scale. It is wreaking more economic damage. But in a weird way, this is kind of closing a circle for me at that journalistically. 

Jeffrey: Yeah, I bet. What comes around goes around. It is a circle. Now, at Bloomberg, you and your colleagues have done extraordinary reporting on the coronavirus. Before we turn to geopolitics, I want to start with the beginning, with Wuhan, China, which is generally viewed as the source of the SARS-CoV-2 virus. Suspicions about the coronavirus leaked from a bioresearch lab. What is your take on that Brian?


Brian: Well, you know from the very beginning, I think a number of people in the intelligence world, particularly in the US did notice that there was a biosecurity lab in Wuhan which turned out to be the first epicenter of the coronavirus epidemic. A lot has happened in the intervening months since this broke in late December. In the last several weeks, particularly as the epidemic is deepened in the United States, there have been some theories about the origin of the virus being tied to the biosecurity lab. There are basically two competing theories. One, that the virus was man-made, in other words, it was designed in the lab intentionally. The other theory is that the virus may have started in the wilds of Central China. But a sample was taken into the lab and then was accidentally released and set off this chain reaction that we are all living with today. I think the scientific consensus is that the first theory is pretty much unfounded. If you look at the genetic sequencing of the virus, there are telltale signs that one would find that it was kind of splice together. There seems to be no evidence that took the case. Even I think the China Hawks, the most intense critics do not give terribly much credence to that theory. Whether it was accidentally released is plausible. However, there is no hard evidence that actually occurred, so that is a bit of a mystery still. I do think the US is kind of backed off some of the rhetoric that you heard a few weeks ago with Secretary of State Pompeo basically saying that there was overwhelming evidence that this had taken place. I think he is backed off of that. If you talk to professional virologists and people who do this for a living, the reputation of the Wuhan facilities is pretty good. They have done some landmark work in coronavirus research. Yeah, there have been accidents that have happened over the decades all over the world with virus samples. But I think the reputation is pretty good and it is far from proven or even a strong case has been pulled together that that is what happened, that there was an accidental release.


Jeffrey: There is still a sense of mystery around this. China said international experts are not going to be allowed into China to investigate the origins until the world secures an unspecified final victory against the virus. Those are their words, final victory. What is that about? Is final victory even possible with something like this?


Brian: Well, let us put that apart. I mean, the first issue is the access on the ground to finding out the virus origins. So there was a World Health Organization scientific mission that went in in February. Now, this was in the darkest moments of China’s own experience with the epidemic. The hospitals were flat out, people were getting sick at massive levels. So they were not able to do a tremendous amount of forensic work, I mean the kind of disease analysis to go back to the origins of it and therefore protect us, you know, going forward. They were not able to do that at that time. They want to go back to what the World Health Organization does and just this week, China seemed to indicate that they were open to that. Now, what the ground rules are going to be and how deeply they can go into China and re-interview patients, look at virus samples, really do a lot of fieldwork, that remains to be seen. The question of what will the end looks like, it is really hard to say. This coronavirus which had its origin in the bat populations of China, the genetic sequencing seems to show that it kind of started in that population. It is somehow, and you know, the world does not know the answer to this, made that leap from rural China into a megacity like Wuhan, and then took off around the world from there. So the big unknown is whether there was a secondary animal host. If you look at previous outbreaks in this family of viruses, the SARS virus and its cousin, the MERS virus which is the Middle East Respiratory Syndrome. They both had kind of intermediary animal hosts. MERS had camels and the SARS epidemic back in the early 2000ss. Although they do not know this conclusively, they are pretty sure that there was an animal called a civet cat, which is this mammal that is used in wild exotic dishes in China was the carrier into the human population. There is also a big concern about wet markets in China but also in other parts of the world where you have wildlife trade, kind of co-mingling meats. Depending on the quality of the wet market, these scenes can become very unsanitary and breeding grounds for pathogens. So yeah, these are all unanswered questions that another scientific mission, another group of experts from all around the world are going to have to piece together. It may be quite sometime before we know the exact origin of the story. So the other question that you ask is what does success looks like? So we do not know whether we have an effective vaccine yet. There are a lot of very interesting crash programs in the United States, in Europe, in China, in the UK, the Oxford Group. These vaccines are in various stages of development and have to go through human trials. If we get really lucky and there is an effective vaccine that can be ramped up commercially, I mean in terms of production and distributed to big chunks of the human population, that could be one path to protection. Then the question is, is this going to be one of those viruses that linger from year to year and that we need some kind of additional protection from in vaccine form. The other path to the end of this is what is sometimes called herd immunity. This is the idea that sometimes viruses are pathogens. If they reach enough of the population, it is usually around 60%, then you have got enough people who have survived it and have natural immunity and the viral dynamics change. It becomes less, you know, something that will race through the population and it can be more isolated and dealt with. So that is another scenario that we may be living with for a while. So those are the broad diameters of where this might go. 

Jeffrey: So I guess the bottom line is we do not know enough and it is way too early at this point. 

Brian: That is right. There is a lot of really important infectious disease detective work that needs to be done. It probably has to be done in China. That is why you are seeing this kind of international pressure on China and on the World Health Organization to get in there. Because if we do not know which animal species is that secondary carrier, then we are vulnerable to second and third waves. You are already seeing kind of a mini outbreak in northeastern China which is worrisome. Even though Wuhan and the central part of the country have calmed down and are opening up, the Chinese authorities are already having to deal with the secondary outbreak. That is obviously a big issue in the West, in Europe and in the United States which start to open up again.

Jeffrey: So Brian, Europe has been the site of some very terrible hot spots with where you are in the UK and Italy having the most fatalities in Europe. What is your assessment? Why? Why those two countries?

Brian: Well, I think in the case of Italy, unfortunately, the Chinese experience with the epidemic coincided with their lunar holidays, the Chinese New Year holidays which were in late January, early February. China, because of the size of its population has an enormous impact on global tourism and that series of holidays is actually the biggest human annual migration every year. Unfortunately for Italy, a lot of Chinese tourists, probably infected, may be asymptomatic, gather in a place, they went to Venice and they went to Milan during their holidays and completely blindsided the Italian health care system. People just were not aware at that point in time, late January, early February just how stealthy this virus is. What is unique about this coronavirus as supposed to SARS is that when you get SARS or MERS, you get sick right away. There is just nothing nuanced about it. In a weird way, although the fatality rates are higher for these other diseases, they are actually easier to manage because it is obvious to everyone that someone is sick. Then you are more likely to quarantine them, more likely to get medical help. This virus, you can walk around for weeks and not really feel it all differently but be very contagious. So it hit Italy really, really hard and then kind of took off from there. The British experience is interesting because there might have been compounded by a policy error. I think early on, the scientific consensus was very much in that herd immunity mentality that I talked about a few minutes ago. Maybe the best way to handle this since it is not terribly lethal is to keep things going as normal and then we will deal with the older patients who get sick. But a lot of people are going to experience this as a flu or something, slightly worse than that. They will be fine, they will get immune, and then gradually, the society will build up as collective immunity and it did not work out that way. It got really bad, really fast. Because again, we started to learn that this virus, although it is not as lethal as Ebola or SARS, it is pretty lethal. If you infect enough people, the vulnerable parts of the population are going to get seriously ill. The big irony is that Prime Minister Boris Johnson became seriously ill and had to be put in intensive care because of this. So then, that experience led to a rethinking that you had a more proper lockdown in the UK and you are starting to that the curve bend. Now things are starting to slowly reopen.

Jeffrey: So Brian the economic pain caused by this virus has been staggering. So in the US for instance, over 30 million workers have filed unemployment claims in the past six weeks. I think that represents about 15% of the workforce. So developed countries like the US and those in the EU are using fiscal stimulus plans to provide a measure of relief for its citizens. If this is the case in developed countries, can you talk about what is happening in emerging market countries? It must be unbearable. 

Brian: Well, this is going to be a kind of global experience, unfortunately. I mean, no one doubts that we are heading into a pretty meaningful global recession. When you have that kind of set up, the emerging markets in Asia, Latin America, Eastern Europe are going to feel the full brunt of it and you are right. They do not necessarily have the fiscal and monetary cushion to unload big stimulus packages to hold things together. So it is probably going to be a very, very difficult economic experience for emerging markets. It is not going to be much fun for developing markets. Basically, people have made the analogy to medically-induced coma, as we have kind of put the global economy into because of the public health concerns. It is going to take a while for the patient to get back up to fighting speed. There are all sorts of negative feedback loops that can become embedded and prevent you from that sharp recovery. I mean, one hopes that that happens but I think most economists view that this is going to be a very, very long kind of convalescence. Certainly well into 2021, the unemployment rate really starts to come back down meaningfully and the economy really starts to rub up again.

Jeffrey: Okay. So before I ask why we do not have a global response to support each other, I would like you to compare the macro-political climate today with that of the last crisis, the Great Recession of 2008 and 2009. I mean, the world was a different place then. Can you please remind us how the world’s leaders responded to that financial threat?

Brian: Well, I think what is interesting about the financial crisis is that it did not take long to understand exactly the source of it and then the dimension of it. It was pretty obvious that there was a structural imbalance in the housing market in the US, and to a lesser degree Europe and that you know, through a number of events, some of the biggest banks in the world had made very highly risky bets on mortgage-back securities when the housing market went down. Those went down and then you had this cascading effect around the financial world that was very scary. It was very economically destructive. But at least you could kind of get your mind around the nature of the problem. So I think the policy response, although even to this day, there is a debate about whether enough was done to this sting, it was pretty clear what needed to be done by the major central banks and the US, UK, EU governments, and China as well. So even though that was a long recovery back, this different because first of all, this fully global in scope. The virus raced around all around the world to every economy and the requirement is like a full-blown stoppage of economic activity. So that is different. The nature of the problem and then the time it took to fully get your mind around the problem. Early on, when it looked like it was just China and maybe possibly other parts of Asia, the US Stock Market was bounding from strength to strength because it did not seem like it was a systemic risk around the world. Then when this thing went into Europe and then started to flare up in the US in a serious way, all the financial markets reacted. I think what else is different is the intensity of the US-China rivalry. I mean it certainly existed back in 2008. But I think it has been heightened and it has intensified and the economic and geopolitical rivalry is so much more intense these days. So that is complicating the international policy response to the virus because everything, well, the science is getting politicized. There is a lot of you blaming each other. It is a kind of a toxic political environment and that makes smart decisive policy action a lot more difficult. 

Jeffrey: Do you think that this economic crisis similar to back in 2008, is a bump in the road? Do you think that this is going to be business, as usual, back when we come out of this in 2021? Or do you think the world is going to learn a little bit, there is going to be massive changes because of this?


Brian: Well, I think a couple of things are pretty clear and some of these trends pre-existed the virus, the pandemic and it just been intensified by other trends seem newer and are unexpected. But once they getting grained or going to be hard to reverse, I mean an obvious one is just the state intervention in economic life. If you look at the scale of the Central Bank interventions and lending, and then also the fiscal side of it where you are seeing governments lend big amounts of money and maybe even taking equity stakes in the airline industry, in the small business sector, in hospitality and leisure, anything with a strategic national interest like a Boeing or an Airbus. There is just going to be far more government interaction in our economic life than anyone probably would have predicted a year ago. Other trends about telemedicine, telecommuting, these things were kind of out there but I think a lot of companies are waking up to the idea that this does not happen in every instance. But some companies have been able to function at a pretty high level with most of their workforce at home. What is that going to mean for the way we organize ourselves in our corporate working lives but also the commercial real estate markets. If companies start to rethink their commitments to long-term expensive leases in the major business centers of the world what is that going to look like? Who is going to win? Who is going to lose? There are going to be big changes I think in consumer behavior. Are we going to bu much more mindful of the microbe world? Are we going to you know change the way we consume and entertain ourselves as a result of this experience of the lockdown? The very real possibility that in a highly globalized world where human populations are growing and encroaching on wildlife, we could be facing more of these kinds of breakouts in the future. How we are going to prepare ourselves for that? Then finally, I have to think that this epidemic has been so destructive to people’s lives certainly. The economic toll has been so high that there will be a very serious rethink about how can we organize ourselves internationally so if there is an outbreak, we are much faster on the scene and getting the right resources in place to manage these crises and maybe even avoid them. One area that is really interesting is vaccine development. That was a very sleepy part of the big pharma world until this crisis. Now, you have got all these crash programs and of course, a lot of money flowing in. But that is because you a gun is on our head. Should we rethink that after this crisis is past, do we have to think about vaccine development like we do weapons programs? In other words, they are heavily subsidized. You do not use them right away but can we start to think about full-spectrum vaccine development that would get us close to the mark if a new virus came on the scene. At least we would be better prepared to speed up that vaccine, turn around time, and put us in a much better place than we are right now.

Jeffrey: Brian, Bloomberg took about vaccines. Bloomberg reported a couple of days ago that the US moderne side, US was likely to obtain the vaccine from the French company Sanofi. So in a world of rising nationalism, one would have thought that France would have had the first rights to this vaccine. So we talk about global coordination, can you explain what is going on and why would the US State claim there?

Brian: Well, right now you have got this outbreak of vaccine nationalism, right? I mean all the countries, they want to protect their own people. Some of them have major global pharmaceutical companies operating within their borders, some do not. A lot of money is, you know, emergency funding is being spent to place bets on various crash programs around the world. In the case of Sanofi, they are getting a fair amount of US funding and the CEO of the company said that means that the US will get some preferential treatment which upset the French very much. The question also becomes, what if the Chinese, what if their crash program finds the price first, how would that work. Xi Jinping this week at the World Health Organization governing assembly said that if the Chinese do find a vaccine that works, it will be a public utility. In other words, it would be available to the rest of the world. So it is a bit of a mess, but it kind of speaks to a point I just made is that you know, this is a very chaotic way to approach a pandemic. In theory, you would have fought through these things, you know, war game, get out. So these viruses come along and they come along pretty regularly particularly in this century. It is not a secret that this could happen. We have agreements, we have understandings about how we would finance a pandemic shot and distribute it around the world. How you scale it up. It is clear that we are not there and that is why there are all these friction points and name-calling that is going on in the political world. Instead of pointing fingers, we need to work on that global coordination.

Jeffrey: Brian, thank you so much for your insights today. Your thoughts and experience on the global stage are certainly fascinating and thought-provoking. I would love to have you back on our podcast in the near future to discuss this global coordination, and hopefully, that will happen, the global coordination very soon. Thank you again and stay safe. 

Brian: Thank you.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at rphealthcast@rooneyco.com, or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us and share us with your friends and colleagues. Thank you and we hope you enjoyed the RP Health Cast.

In this week’s episode, we speak with Tiernan Ray, a freelance journalist who writes for ZDnet, the Street.com and other publications, about healthcare technology innovation including the power of artificial intelligence – its pace of development and where it may lead us in the 21st century and beyond.

TRANSCRIPT

Jeffrey Friedman: Hello, and welcome to the RP health cast by Rooney Partners. I am your host Jeffrey Friedman. Our guest this week is Tiernan Ray. Tiernan’s been covering emerging technology and business for almost twenty-five years. He was most recently the technology editor for Barrens where he wrote The Daily Market coverage for the Tech Trader blog as well as feature stories, cover stories, and a weekly print column. Prior to that, Tiernan was a reporter for both Bloomberg and for Smart Money today. We will be talking to Tiernan about some of the recent stories he has written on healthcare technology both in medical technology and in artificial intelligence.

Jeffrey: Tiernan, welcome and thank you for joining us today. 

Tiernan Ray: Thanks for having me Jeffrey. 

Jeffrey: Right. Now, you are a veteran technology reporter. And in Baron’s you wrote daily market coverage for the Tech Trader blog for nearly a decade, while at the same time, you were writing their feature stories, their cover stories, in a weekly column all on Tech for the print magazine. Now, will you continue to write about tech your increasingly — we noticed, more focused on healthcare technology. So, what is that transition been like?

Tiernan: I had to really go back and try and reinvent my skills Jeffrey, because I spent so much time focusing on semiconductors in networking and I was talking to public companies and I noticed that when I left Barons in twenty-eighteen, I really needed to go back into areas of research and challenge myself to figure out what are things that are going on and say artificial intelligence in life sciences and to dig into basic research going on and to school myself, really. So, it was kind of job retraining of a sort, for me. 

Jeffrey: Now, it is interesting because as you started with semiconductors and they were doubling, you know, capacity every couple of days, right. Technologies always move fast. Developments now in healthcare technologies is kind of similar. It is related right now, especially COVID related once. 

Tiernan: Yes. 

Jeffrey: So, they are moving even faster, you know, every moment. Can you lend a little insight into what it is like to keep up with everything as you are talking about retraining? How do you identify what you are going to cover in such a crowded and fast-moving health tech news environment? 

Tiernan: Yes. I felt I was in a position Jeffrey at Barons for years where public companies came to me and wanted to tell me stuff. And when I decided I would have to broaden my knowledge and find out about areas of life sciences. For example, that I did not know about I started to dig in places where I had previously looked and one of the things that astounded me was this whole field of preprint publications. So, the process is, you know, you go on Twitter and you see somebody says, hey, we just released our paper on archive, which is the Cornell-operated preprint server. Anyone can go and download the PDF and there is just tons as hundreds of papers on a daily basis that show up from researchers. These are things that have not been peer-reviewed. They are the kind of thing that will eventually show up in nature magazine or science magazine. 

But some of them are amazing kinds of discoveries in all fields in artificial intelligence, in physics, in life sciences. And so I discovered this, I had no idea while I was at Barons with this whole phenomenon had popped up in the preceding decade or so where you just go to this server and there are tons of stuff and it is just like kid in a candy store, if you like to research. And so, it is also to use another metaphor drinking from the fire hose. So, I had to have — kind of a learning curve, where I just started reading stuff I found on artificial intelligence, in genetics, on the archive preprint server and got into this rhythm of constantly checking. And it is the kind of thing that I continue to do for the last year and a half since Baron’s — just every single day. I will go and check out what new research has been posted and it is not just me Jeffrey, you see stuff in the New York Times, from the post in the Boston Globe and Financial Times that is pulled from a preprint server where basically every journalist is trying to get ahead of the curve in what is the latest COVID research. 

And so they are going on archive or versions of it called bio-archive or meta archive and they are pulling down the latest report from Harvard that is not yet in publication, that just been thrown up there and it is kind of amazing, front kind of moving wave, you know, leading edge of research from these labs. 

Jeffrey: That is really interesting. So, is it like one of those old school bulletin board servers that people are just posting?

Tiernan: It does not have the social interaction yet, Jeffrey. The social interaction component appears to happen to an extent on Twitter where a scientist will post something, there will be a thread of discussion about it. These are really bare bones. I compare it more to FTP, file transfer protocol, in the early days where you just cannot believe that there is a resource. You have broken into some folder, and there is just stuff there and it is like, oh my God, this is amazing.

Jeffrey: Wow. So, as an example, I think when one of your stores, last month in New York, right. Now, New York last month — we were like in Dire Straits, right. Our healthcare leaders were looking to source as many ventilators from around the world as we could.

Tiernan: Right.

Jeffrey: And you wrote a story about a team of a hundred astrophysicists who were working together from quarantine to develop a super simple cheap ventilator that they hope to make in order to help patients with COVID-19. You know, is this the type of things that you were finding? 

Tiernan: Yes. Amazing. Just amazing. I stumbled upon this report and I just saw, they have a name, Mechanical Ventilator Milano. And so that is the kind of thing where you see that in an article on a preprint server and you say that is fascinating, wonder what that is because they already have some kind of branding. I do not know if it means anything. And I dug into it and as I read it, I saw, “Oh, my God, this is kind of incredible”. These are people who are — you know, start to follow the author citation. So, the lead author is a gentleman named Christian Galbiati who is a physicist at Princeton University. And full disclosure, I went to Princeton. So, I am kind of intrigued as soon as I see a Princeton reference. So, I started tracking it down and I said, “Okay. He has been working on something called Dark Side, which is this detector to try and pick up traces of dark matter in the universe that is built in a tunnel several miles underground under the Gran Sasso mountain range”, which is a kind of a belt across the middle of Italy. He has been working on this for years with a huge team of physicists. 

And so, suddenly he is popping up here with over a hundred authors, on a paper about a ventilator and second reading it started digging into it, and I reached out to him and they were kind enough to respond to me. And this is just sort of one of those gems that shows up where you are just sort of kind of wandering through the preprint server and you stumble upon, “Oh, my God, there is like just an incredible piece of fully-developed research an incredible team of people and it’s right there”. And you feel that, “Wow! I am the first person”. I know Jeff, seamless. 

Jeffrey: And I mean, it is such rabbit hole that you may have been, absolutely. But — so, like a story like that, the news is moving so fast and in New York, the infection rate curve has peaked. It is declining. Our need for additional ventilators has gone down. Now, looking back. How did it all turn out? Did they make the ventilators? Is the story still relevant? 

Tiernan: Bill very relevant. I spoke yesterday with Cristiano Galbiati and he said this, “We, all in the physicist at Princeton”. And it was very moving Jeffrey because he told me in sweeping detail about the technical aspects, but he also gave me a perspective on how it came together. You know, they went into lockdown in Italy, in early March. And he said to me we were really kind of feeling at a low point, because in Italy we felt it was just Italy. For a while, you may recall in an early — late February, most of the say, “Oh, it will leave the hot spot”. And it was before things have been implemented even how. And so, they felt alone and he was talking with a friend who runs a gas company that he partners with to develop these dark metal detectors and they said, you know, we since we have no labs to go to at the moment, because we are in lockdown, couldn’t we do something about what is going on? 

And so, he and this friend brainstormed about, you know, building these large detectors for antimatter is — you know, kind of a really complex version of moving air in and out of a chamber. Kind of like what you would do with a ventilator. And so, they just got underway and he and Cristiano sent messages to collaborators at Fermilab in the US and Illinois, and other facilities around the world, and got some of his top people to kind of quickly throw together the diagrams, the technical specifications, and within days they had gotten what was basically shown in this paper that I found on archive just by brainstorming. And he said, you know, this was a way to move beyond feeling frozen. He said I was just four days when the lockdown happened in Italy. I was just frozen. I did not know what I was doing. I could not function. And so, gradually by going back to what he knew how to do and bringing together a team of people and seeing that there were connections around the world, that they were not completely isolated. That there was partnership and friendship. This was something that kind of lifted everyone out of this. 

And so, it was an incredible, been an incredible effort. They are now under, starting volume production, and they hope to get to thousands of units per day. They have a sort of initial run of fifty units if it tests them. They got FDA emergency approval for this ventilator. And so they are kind of on their way now and he does the basic science. He was not in charge of manufacturing runs, but he did indicate that this is still a current need. And one of the things he is concerned about is, there could be as many people say a second wave and the fall. And so, as far as he is concerned, building ventilators is still a critical thing to do.

Jeffrey: Well, what started out as a cathartic exercise is lifesaving. 

Tiernan: And could be — yes. And could be something you really still want again depending on the shapes of these curves in many nations of the world. 

Jeffrey: Yes. That is great. One of the topics — another topic you have been reporting on as a contributor for ZDNet has been the significance of healthcare modeling. And you recently wrote about the concept of super spreaders, and that’s really been in the news lately, especially with that nightclub guy. Maybe got to talk to a paddock, but in terms of healthcare modeling, do these one-off super spreaders, you know, can you talk about how that may affect the modeling and what is modeling being used for to track the virus? 

Tiernan: Yes. Everyone is trying to figure out how can we do better than what has been the — known as the susceptible infectious recovered model, which has been around for over a century. That is the main model that you hear about from Oxford and from up in Seattle, from Bill Gates’ group. All of these models that are used by public policy experts and by governors to decide what do we think is the shape of the curve and how can we flatten the curve? The problem with them is a very generic and they are very abstract. And so they do not capture a lot of real-world data. There are people doing what is called Curve-fitting, where they take some parameters to try and guess what they think will happen with the spread of the infection, with the doubling of cases. 

And so, everyone has been trying to get — do better than this and one of questions now becomes — that is tied to these models is, how do you do testing to fill in real-world data as opposed to simply mathematical exercises? And so, one of the things again that showed up in just amazingly preprint, is a bunch of authors from Google. One of whom is a off your right, who is a data scientist at Google. He had a couple of colleagues with help from Tel Aviv University. They put out this paper and they said, “You know, everyone’s talking about testing now. You do not want to go out and mass test everyone because it is just not practical”. What you should do is you should follow the super spreaders, and the super spreaders are maybe index patients, first patients, who appear to have been able to, for whatever reason, spread the disease to more people than what is the average transmission rate of a disease. And these are again statistical terms because we do not know the mechanism. 

But it does seem to be that in any kind of epidemic or pandemic, you can actually find individuals who, if you trace all their contacts, have led to more infections than what you mathematically model. And so, as being the average — and so, they are saying, “Go and do contact tracing”. And this could be something you can imagine as the Google or Apple kind of Bluetooth tracing system on a smartphone. It could be using GPS signals. There are no people talking about using GPS signals. And it could be plain old-fashioned contact tracing where there is a kind of like the intake interviews on a hospital, someone in hospital, who after someone test positive, you say, “Okay. Who have you been in contact with?”. 

So, there’s all kinds of forms of this, but it shows you that we are still trying to fill in the blanks with these very abstract kind of rigid models that have been around for a hundred years that are statistical that do not reflect the details of spread of disease. And two, we are trying to decide how we are going to use testing when we are in a testing constrained environment? We do not have the number of tests. We should have, we have stumbled in the US in getting testing rolling. It is because we have to make these choices, decisions about how to use resources and what is going to be most effective.

Jeffrey: Yes. I guess it is fascinating and so important and that brings us to another topic of artificial intelligence, which I know you have been covering for more than a decade. So, what are you seeing now that you find particularly interesting as it relates to AI in healthcare?

Tiernan: I think that combining AI right now with the work of human experts is pretty interesting. I took a look at — there is a lot of attempts, Jeffrey, that you may have seen to try to use AI to look at chest x-rays or CT scans as a basic way to look for COVID and there has been a lot of struggle in this area. I spoke to scientists who worked on this and the problem is that you do not have enough data. It takes time to train AI. And so, in this rush to try and implement AI, I think we are seeing people saying we need — we are realizing the gap — one of the gaps — the big gaps is implementing AI and machine learning and deep learning with human processes, with human systems, where experts are working. The model, when things were, you know, kind of casual, before the world change was to say, you know, we are really impressed with what the machine does. 

And we are just writing everyday about what the machine does. And I think, when systems suddenly are stressed and you see human beings rushing into the breach with their skills, be they radiologists, who can look at an x-ray or first responders. You say, “Oh, okay. This is what it means to really be able to handle situations”. And maybe you need to take these machine learning models if you have been building and have them actually integrate with human expertise because human expertise makes quantum leaps. That is what happens in times of stress and you cannot spend the next decade, sort of leisurely training a system. You might want to add in some of this expertise.

Jeffrey: Yes. I mean, I think last year or two years ago, IBM’s Big Blue did that experiment on breast cancer? 

Tiernan: Right.

Jeffrey: Right. And they — you want to talk about that?

Tiernan: Yes. So, the IBM Big Blue experiment with breast cancer, and similar experiments with radiology, Jeffrey, always come down to a kind of obsessed highly abstracted model of diagnosis where you know a probability after a fact, just by virtue of how things you train that this diagnosis would have been something that would have led to — you know, the correct procedure for the patient, it is all after the fact. And so, the consistent flaw and these kinds of you know, AI does better than a human expert kind of thing is, they are always looking retrospectively at what has been gleaned and they are not true to the actual scenario, which is you are a female patient, you come to your doctor and you get a certain diagnosis and there is a level of uncertainty. And this human being in front of the doctor has to actually be given advice and it has to be a procedure pursued. And this is the moment of decision and you can be helped by statistical tools, which is what machine learning is generally. But there is still a choice about a person and what is the proper standard of care for that person? 

And so, I think this is actually another instance where all of these models, despite being kind of remarkable science, have to be — they have to be integrated into the work of human experts and people in fields. And we have seen this across the healthcare landscape. We saw it with DeepMind working in British hospital system in diagnosis as well. That there was only — there was a limit about what could be achieved with these AI models because at some point, you sort of have a connect with actual clinical practice. And so there is this big challenge of how do you get these systems to work with the reality of a clinician and what they have to do with uncertainty, rather than simply statistically modeling what you know long after the fact by looking at case series.

Jeffrey: All right. So clearly, you feel we are not there. There needs to be human interaction. All right. So, for the tough question then, if you were to pull out your crystal ball, where do you see AI taking us in five to ten years from now? You know — also do you think it is a good place for mankind or will it be a scary one? 

Tiernan: It is going to focus; I think it is going to focus on language principally because it is the area we have seen the most progress and that progress is still unfolding Jeffrey. The Transformer, which is a seminal breakthrough in two thousand seventeen from Google that has informed all of natural language processing and language translation by machine learning has continued to pay dividends and some of the things that are happening with just even chat Bots and with natural language translation between French and Spanish and Hindi and Yiddish and Chinese and being whose giant capabilities are incredible and there is a kind of, you can see there is an industry within AI of just the language stuff. 

And so, I think that you are going to see, for a while, a concentration of achievement and breakthroughs in the area of language and that is no small thing, because if you have increasingly sophisticated models of using language, they can flow through to lots of other tasks that have to do with describing things seen in pictures. Tests that have to do with how you respond to speech online, writing social. And there is a qualifier, which is that more and more these large companies that dominate AI like Facebook and Google, will combine language capabilities with other kinds of signals, be the images with a sound, to do what is called multimodal learning and that will enhance, I think, the language part. But I feel like the language part is going to be pretty profound revolution as it flows into the world because text writing can travel so quickly and we have yet to see the full impact of that because we have yet to see all of the technological breakthroughs that will happen in that area of AI.

Jeffrey: Well, as the speed of technology changes, I am sure we will see it pretty quickly. Tiernan, thank you so much for your time today, especially with everything out there. 

We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at rphealthcast@rooneyco.com or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us, and share us with your friends and colleagues. Thank you, and we hope you enjoyed the RP health cast.

Business Insider’s Lydia Ramsey shares how she covers the pandemic while living in one of its epicenters, the way hospital systems are handling the crisis, and new forms of doctor/patient communication.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP Healthcast by RooneyPartners. I’m your host, Jeffrey Friedman.

Jeffrey: Certainly, the biggest health care story we have is the continuing pandemic. We now have over a million and a quarter American sick with the virus and over 72,000 that have died from it. While the news for the most part has been grim, there have been several stories of hope and perseverance that have been coming to light, especially here in New York, which has been through so much these past few months. To talk a little bit about this, our guest this week is Lydia Ramsey. Lydia is the senior health care reporter for Business Insider. She joined BI in 2015 and covers everything from science to healthcare mergers to drug pricing and to healthcare startups. She’s also in charge of a great weekly health care newsletter called Dispensed.

Jeffrey: Today, we’ll be talking with Lydia about her recent coverage on the coronavirus and her coverage on how hospital systems are faring in the face of the pandemic. We’ll also talk about other ways patients are communicating with their doctors outside of hospitals.

Jeffrey: Hi, Lydia. Thank you for joining us today and actually for taking time away from arguably the biggest health care story of our lifetime, so thank you.

Lydia Ramsey: Of course, happy to be here.

Jeffrey: To start, why don’t you talk about your personal experience covering the pandemic? What’s it like being a journalist covering the business of healthcare at this time, especially living in New York? You live in New York City, Brooklyn. How are you choosing which stories to report on?

Lydia: Yeah, it’s been an interesting ride. I think we all had our world’s turned upside down in March when we started to realize that this was going to be a reality we were all going to be living through, and in my case, reporting through as well. It kind of took a few weeks to figure out where I best fit in. It’s one of those things where I have a pretty broad health reporting background both from a scientific perspective and from a business perspective. In those early days, I tried my best to figure out what stories I could best tell based on my skills. A lot of that was looking at the inside of the hospitals on the front lines here in Brooklyn. I was hearing ambulance sirens all the time. I’m sure everyone else in Manhattan and elsewhere in the city of New York was hearing the same thing for a lot of March and the early April. That kind of drove a lot of my reaching out to hospitals around the city, nurses, doctors, other caregivers. I really tried my best to get a sense of what was going on inside. As a reporter, I wanted to make sure I was getting the full story but I wasn’t myself going to be able to get inside the hospital without freaking out my family, so I tried my best to figure that out, and it has been really interesting. It’s one of those stories where before this, I could cover a health topic and it would be really in the abstract. It’d be talking about an experience and having to think about some condition. That was something that had never affected me.

Lydia: In the case of COVID-19, this is a very real disease and it’s something that’s affecting practically everyone around the globe and social demographic wise be damned. Young, old, everyone is involved. Some of our reporters even seem to have gotten it, things like that. It was really a new experience for me to see like, “Oh, wow, this is something that personally affects me and it’s something I’m covering professionally.” That took a few weeks to figure out how exactly to handle that because it is a bit of a adjustment.

Jeffrey: Lydia, in healthcare business, hospitals and healthcare systems are among the hardest hit. Both because the flood of COVID-19 patients they have to treat but also because of the hits they’re taking at the revenues which you wrote about one of your recent stories. Can you talk about what you’re seeing here? Are these hospitals really expected to recover revenue once their broader operations are back up?

Lydia: Yeah, that’s going to be the big question. I think a lot of hospitals are understanding that that initial wave of patients we saw that that led to elective procedures being postponed and delayed across the country, that first wave seems to be hitting, we’re past that here in New York. We’re seeing that hit elsewhere in the country right now. Beyond that, it’s not like there’s going to be a magical point at which there’s not a single COVID patient in a hospital. Hospitals have to really figure out, “How do I go back to some semblance of normal and bring those procedures back online?” Because really I was talking to one health system and and the vibe I got was if these kind of money-making procedures, this normal business operation doesn’t come back online within the course of May, a lot of hospitals won’t be around to keep caring for COVID patients, which is kind of frightening to think about. These are pillars of our communities. They’re there to serve the communities. If financially they can’t make it work, they’re in a tough spot. That’s unfortunately the case for a lot of folks.

Lydia: To your point, it’s one of those things where you think about hospitals as nonprofit organizations. That’s typically how they’re structured, but they really are huge business operations. If that money dries up either from procedures or from people just deciding they don’t want to come back to the hospital just yet because they’re worried they might get COVID-19, that’s a really big issue. That’s not going to go away anytime soon.

Jeffrey: At the same time, you have other business verticals like telehealth really taking hold. A lot of people have never had a remote doctor’s visit and now it’s becoming a norm. Where do you see this settling for the telehealth players? Are there particular features that are expected to determine the winners or is it all about first-mover advantage?

Lydia: Yeah. It’s one of those things that I’m curious to get the answer to that and I think only time will really tell. It’s been really interesting for me to speak with some of the big telehealth companies. Last week, I was hosting a webinar with the CEO of Amwell and we were talking about just the types of visits that are happening right now. At first, it was a lot of COVID. I’m really nervous I might have the novel coronavirus but I don’t want to go to the ER. What should I do? Those kind of visits were happening virtually first, but now we’re seeing a lot more visits, more chronic care, and hey, I might have a lung condition that I want checked out but I can’t go in person. It would just be a bad idea. I can do it remotely. We’re seeing a lot more of those visits take hold. I’m going to be really curious if we see how something like Zoom really took over and became the video conferencing platform of record. I’m going to be really curious to see if there is a telemedicine winner here. We’ve seen a lot of places basically overnight set up video services either for their own practice or epic [inaudible] a bunch of other big IT players are doing it. I’m really curious to see if someone can crack the code on this and do it really well because I think it’s quite easy to set up a video system. I think it’s harder to set up an entire functioning, you’re basically trying to replicate what goes on inside the four walls of a hospital or a doctor’s office online to some degree. We’re talking billing. We’re talking about waiting rooms, things like that. I’ll be curious to see if someone can come in and and sweep the world, but right now, where I sit, it’s pretty fragmented. It’s based on who you were working with before, what they’re very good at, what kind of pain points do you have right now, what kind of patients do you need to be seeing?

Jeffrey: Yeah. It’s an interesting business story. I mean, WebEx was around forever, but it took a pandemic to really come out with Zoom and a real leader. I have to imagine as well that from a telehealth point of view, that should be around the corner, but with everything we know in healthcare in formal marketing, it takes a little bit longer. That’s your business hat. We’re going to ask you to take that off and maybe put your science hat on for a second. There’s a lot of discussion about how to treat COVID-19 and a lot of talk about existing drugs being repositioned as a treatment, Gilead’s remdesivir – it’s getting the most attention as a drug – just received emergency approval. There are other drugs though; 40, 50 drugs that are getting approval for initial testing. You wrote about a heartburn drug that’s being considered as a treatment. There’s a company I work with out of Florida using amniotic fluid. As part of a treatment, Pfizer just made an announcement about a new program yesterday that’s getting a lot of attention as well. Do you think there is ultimately going to be multiple treatments for the condition or is the industry thinking, “We’re going to have one treatment of standard of care?” Are these just band-aids until we come up with some sort of vaccine program which could be years away?

Lydia: Yeah. They’re all good questions. I think that the shortened [inaudible] of it is nobody quite knows. I think a lot of it will depend on how prolonged this virus kind of sticks around. I think we saw a lot of drugs get kind of shelved as pandemics or epidemic started to recede. We saw that with SARS and MERS to a degree, but I think one of the big things I’m learning a lot about as I cover COVID-19 is just how many different ways it can affect people. We’re seeing everything from symptoms like COVID toes, which is just like a frostbite-type symptom showing up in otherwise asymptomatic younger adults, often teens, and then you’re seeing blood clotting showing up in either severe cases of COVID or people who were sick enough to go to the hospital but got sent home after a couple of days but were not in a ventilator but they still got really sick. We’re just seeing so much showing up that I can’t imagine a world where there’s going to be one cookie cutter, great solution out there for everyone. Maybe there will be. Maybe there’ll be some great antibody out there that really works.

Lydia: I had a doctor at a hospital here in Brooklyn kind of really explain it to me really clearly that I thought was a really interesting theory. He basically bucketed out the disease into three groups. You’ve got the viral infection and that’s where something like an antiviral like remdesivir might come in handy, then you’ve got the clotting issue and luckily we’ve got a lot of stuff already out there to treat that. We’ve got blood thinners. We’ve got some clot-busting medications that are being developed, things like that. They already exist but they’re being explored for their use in COVID-19. Then, you’ve got this immune response that seems to be really wreaking havoc on people, especially those who have been sick for quite some time or are on a ventilator in the ICU. For those patients, something like an antibody treatment which a bunch of pharmaceutical companies are developing, and then there’s instances like convalescent plasma and some other ways of kind of triggering the immune system to mount a response to the virus in a different way. Those are where we might be able to see those work. It’s really interesting to me. I’ll be curious to see if his theory holds out. Those are ultimately the three buckets of disease areas where we’re worried about and kind of symptoms we need to treat, but I think everyone’s holding out hope for some kind of vaccine. Maybe the whole populations here in New York got it. That’s what some of the antibody surveys are suggesting that about a fifth of people got it here in the city. For someone who hasn’t felt symptomatic from COVID yet, I would be really optimistic and really happy to see a vaccine come online.

Jeffrey: Absolutely. I’m in the same boat. I’m not ready to walk down the middle of Times Square yet. I think every day we’re learning more about this disease. To think that there is this one silver bullet, I think it’s way too early. I agree with you to think that. All right. Shifting gears just a little bit. Back to business. Are you seeing an impact on the fundraising environment for healthcare or biotech companies? Some are benefiting, right? They’re saying they’re going down the COVID path but other’s clinical trials are drawing up because patients aren’t coming in. How have investors changed the way they evaluate new opportunities either public or private? What are you seeing?

Lydia: Yeah. It’s been one of those things where I think that we saw this hit a lot of other industries early into the pandemic. Retail was clearly an instance where there’s going to be a lot of issues and those showed up almost immediately. We saw a lot of layoffs. Same with the technology industry as we saw a lot of layoffs happening there and we’re still seeing it with companies like Airbnb. I think for the most part, the impact to biotech and and healthcare in general has been a little delayed with the exception of the hospitals because their financials are really taking an early hit. To your point, it is a really curious question. This question of what is going to happen now that clinical trials are put on hold. I really wouldn’t be surprised to see a number of fledgling biotechs who are in their early days and have the funding runway for one set of clinical trials over a set period of months. How does someone stay afloat like that? It’s a big question for me. I think a lot of people are trying their best to figure out how to be useful at a time like this. I think about the healthcare industry as a whole as either being sidelined or on the front lines. If you can find a way to be on the front lines, I think you’re going to find a way to be an integral piece of this and you’re going to find ways to get funding and things like that. The fundamentals of the business haven’t really changed. It’s just that we threw a pandemic into everything. It’s going to be interesting. I think it’ll depend almost entirely on who your backers are to some degree, how they did on their other investments. I’m going to be curious if we’re talking a year from now and realize there wasn’t that much of an impact on biotech actually because it’s been weird. I’ve been seeing in the health insurer space especially, they’re having a pretty good year so far. It’s a little jarring to hear.

Jeffrey: Right. Well, tying into that, last question. What do you see bubbling up to the top in the stories that you’re covering? Something that might grab everyone’s attention once we have a bit more normalcy in our lives. I mean, you put out a weekly newsletter, Dispensed, which I love and and you write every day, but once we have more normalcy in our lives, what do you think is going to be there?

Lydia: Yeah. I think personally, I have this beat before the pandemic hit that I was covering, the changing way you go to your doctor’s office. That was everything from urgent care to online visits to what CVS is doing, with the health hubs, what Walmart’s doing, things like that. I think in a lot of ways, my beat has completely changed on its head. Maybe health hubs are still an important piece of that but maybe they are a lot more virtual, things like that. I think figuring out the fallout is going to be the big health care story of the year. Who are the winners and losers? Who was able to come out of this stronger than ever? Who completely faltered? I think we’re noticing that in a lot of other companies. Taking Airbnb, for example, it does seem like laying off 25% of the company is almost exclusively connected to the fact that nobody is traveling at the moment and probably won’t be for quite some time. In other cases, I think the pandemic really exposed a lot of where things were going wrong. You see some parts of the pharmacy model already being in jeopardy; that kind of front store part of the store, that hasn’t been a good business for a while and I think something like this, a pandemic, only exacerbates that. I think it’ll be really interesting to see where people land. Can you survive this moment? Can you not?

Jeffrey: Unfortunately, you’re absolutely right, it is. I hope that in a few months when all this is a bit more normal and we get to see some of the shakeout and some winners, we can have you back and we could discuss this a little bit more and do a retrospective as to what occurred.

Lydia: Absolutely. That’d be great.

Jeffrey: Thank you so much for your time. We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at RP Healthcast at rooneyco.com or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us, and share us with your friends and colleagues. Thank you. We hope you enjoyed the RP Healthcast.

In this episode, we speak with Edward Baig, a veteran technology journalist and former USA Today columnist about new technology, Contact Tracing, that will enable America to get back to work as we come out of the grips of this pandemic.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by Rooney Partners. I’m your host Jeffrey Friedman.

As certain parts of our country have reached a plateau in terms of their infection rates from the coronavirus. We’re turning our eyes towards returning to work and achieving some sort of normalcy in our daily lives. But how can we do this? How could we return to work without having a vaccine or without faith that when we emerge from our homes that we’re going to be safe or that we won’t harm the most vulnerable in our society.

Our Guest this week is Edward Baig. Ed was the National Tech Journalist for USA Today for over twenty years and prior to that wrote for business week, U.S news and World Report and Fortune Magazine. Today we’re going to be talking to Ed about ways in which the country can get back to work. We’ll talk about the intersection of healthcare and technology and new applications being developed for contact tracing and we’ll discuss what contact tracing is all about.

We’ll also talk about what sort of privacy concerns are there with this new technology concerns between the public and private sectors and what are employers responsibilities and rights. It’s all very fascinating. New questions and issues that we’re going to have to deal with that we never thought we’d have to deal with.

Ed, welcome and thank you for joining us today. 

Edward Baig: Good to be with you.

Jeffrey: Great. Now before we get started with today’s topic, which I’m really fascinated about. I want to talk about you for a second. Now, you’ve been a business journalist for I say forty years, right? And if–

Edward: Yeah, I started when I was seven.

Jeffrey: But for thirty years of that you’ve been covering technology and the developments and over the past thirty years it’s incredible. You’ve witnessed up close and reported on really the technology Revolution. I mean what a career. Now who among like the technology Business Leaders? I’m such a geek about technology here. So I love this stuff. Who have you interviewed and watched and written about that you admire the most and why?

Edward: Well there’s, it’s probably the obvious list of the biggest names that are out there. I’ve talked to Steve Jobs. I’ve talked to Bill Gates. I’ve talked to Jeff Bezos, you know, I’ve talked to people like Richard Branson a lot, you know, a lot of well-known people who I’ve interacted with through the years. You know, it’s not going to surprise anybody that these probably in their names because since in working certainly at USA Today for twenty years and being a personal Tech columnist and reviewer, you know, I was among the initial four people who got the iPhone ahead of everybody else back when it was first introduced. So I’ve interacted with all those leaders, you know, I remember talking to Jeff Bezos when their Kindle came out, the first Kindle. Certainly through the years in talking to Bill Gates about lots of things Microsoft did before he moved on and others as well. Sure, I’m forgetting people but you know, they’re the big names for a reason and their companies have obviously made a huge impact for a reason. Not always good but a lot of.

Jeffrey: I would have loved to have been a fly on the wall with that. And now that we’re on like iPhone 11, 12, 13 that was a while ago. 

Edward: Yeah. It’s amazing time flies. But I mean I certainly you know, I was well like a lot of people were by the initial iPhone, but you know, I would be lying if I knew it would have the impact that it ended up having you know.

Jeffrey: Well technology has changed and it’s the adaptation and what’s interesting. So we’re Healthcare podcast. I head up medical communications so that the ability to combine this technology and healthcare technology is a professional passion. So I love what I do. And obviously this is a very timely topic the convergence of healthcare and technology. So given the efforts underway right now to harness a credible digital process for surveilling against the coronavirus. I’d like to develop our time that we have to explore some of the technological solutions being developed and deployed to identify either identify people with Covid-19 or to identify hot spots in different areas. Now last month Google and Apple they announced plans to develop an API for contact tracing. 

Edward: Yep.

Jeffrey: Big word right now, contact tracing. I guess that’s two big words. Can you explain what this is and how it works? 

Edward: Yeah. Well, I should probably say right off the bat that both Apple and Google would rather you talk about it as exposure notification because contact tracing sounds kind of scary and you know, big brother-ish and all that. But basically what’s going on here is these two big rivals are teaming up Apple and Google and they’re developing as you mentioned solution that is trying to determine basically who has the virus and who might have been exposed by it. Basically, what it’s doing is it’s using Bluetooth wireless technology that were most of us are familiar with to sent nearby smartphones. So if you happen to come in contact with anyone else who might have been exposed to the virus over the past two weeks, you’ll get a push notification that you know you or they’ve been potentially exposed. Now, this is completely voluntary and I’m sure we’ll get into this but you know, there’s all sorts of privacy security questions raised not only about what Apple and Google are doing but about what everybody else is doing here because there are other Solutions, but basically that’s what’s going on here. It’s using Bluetooth to sense nearby smartphones to see you know, if you may have test, you know, if you test positive you enter the results. Hopefully the person other people you come in contact with have done the same and you may get a notification that you potentially been exposed. 

Jeffrey: So, there starting out with an app right now. If you download for the phone and it’s obviously completely voluntary that if you download it. But I understand that they’re building into the iPhones and the Google Android phones basically into the operating system. This technology. So, you know, you said they didn’t want to talk about it said it sounded you know in a certain way because it sounded big brotherly. But at the end of the day it is Big brotherly, right? I mean the data privacy protection. That’s yucky stuff. Right? 

Edward: It’s very tricky. I mean this is going to raise all sorts of trade-offs. Let’s face it. You know, we’re fighting obviously a devastating virus and people can have to make that decision for themselves. Am I willing to give up some privacy potentially or not? And again Apple and Google have been very good about this in terms of talking about privacy and insisting this privacy encryption and is involved here. We mentioned its voluntary, but you know, there are questions and certainly around the world, you know, we’re seeing efforts in China and elsewhere where the government’s asking people to you know download these apps or what have you so you know back in February and New York Times reported that China began requiring residents in two hundred cities to download this healthcare code app that automatically would tell the locals whether they needed to quarantine or not. Now you can argue both sides of that. Okay, it helps tame potentially the spread of the virus, but what are you giving up? So those questions are always going to be their sort of right, you know, it’s right there. It’s a trade-off.

Jeffrey: Well, it’s a trade-off of the public need versus an individual need.

Edward: Correct. Right? So it’s you know a definitely a public health situation. 

Jeffrey: Now, what about even private to private? So if you are a large employer, can you man that mandate this for employee safety concerns? 

Edward: That’s another tricky one. I know, you know price Waterhouse has been beta testing, you know an enterprise great system that they’re adding to corporate apps uses Bluetooth as well as Wi-Fi to determine sort of as I understand it, you know literally where employees would be within a building in terms of proximity to other employees. That’s a tricky one. You know, I can only imagine that there’s potentially a backlash here again, I think everybody’s sort of in this boat, right? We’re all concerned about this. So I think most people probably will be willing to I don’t want to say give up their privacy, but at least maybe a little bit more wiggle room on some of this stuff. But also at the same time where you know, do you want your boss? Do you want your bosses to know your health history? I don’t think so, you know or are people going to get you know, put in different groups. There’s been efforts about you know different tiers. Well, you’re at risk because you’re above a certain age or you’re at risk because you have some underlying health condition. Do you want your bosses to know all that? You want your colleagues to know all that and then what happens when you leave the building, you know, there’s all sorts of okay, it’s great. You can track me and he’ll corporate headquarters or wherever you are what happens on the subway on the way to work or when you’re out of the building, you know are you know, I don’t think they’re going to trace you there. But you know, it’s just a big can of worms here with a lot of this stuff. 

Jeffrey: Yeah, I think you know in terms of baby steps right for we have these electronic key cards that we open our door with that tells management where we are and what doors we went through and so we’ve already given up I guess a little bit of that privacy in terms of the location aspect, but this certainly takes it to the next level.

Edward: Yeah, and that’s you know, what happened after 9/11 things changed, you know, you now have to show your ID when you go into a corporate setting or walk, you know, go through one of these with your key card as you mention or whatever so, you know, that changed our lives and for the most part we’ve all gotten accustomed to that. My question, let’s say some of these, you know enterprise systems are implemented in some way or another what happens when we finally get past the pandemic? Is this going to be permanent, you know, do we go back to the way it used to be or some combination? I suspect we don’t go back to whatever was quote unquote normal before if I’m the full way.

Jeffrey: If the technology is built into the operating system to the phone so we’re not going to take it out. 

Edward: Oh, they’re not going to take it out. And your employer is probably going to show you know what, I like knowing where someone so is during the day is he or she really working? I don’t know again. I don’t want to you know, assume the worst here. But again, I think people will be on edge and I think privacy Watchdogs in particular will be keeping a close eye on the stuff.

Jeffrey: Definitely an interesting discussion and debate about your rights as an individual versus the rights of the society. And even take it one step further. You know, I know that there’s a company in Israel called Wave Guard and they’ve taken this privacy or knowing where you are even to the next level. So if you are determined to have the coronavirus you are then supposed to be you know, quarantined. So what they’re doing is they’re tracking kind of correct me if I’m wrong, but they are tracking these quarantine people and real time to ensure that they’re quarantined and they’re not leaving their space.

Edward: That is my understanding anyway, and again I don’t know not close enough to it to know what’s going on in terms of the reaction from from the locals there about this stuff again comes back to this core discussion that we’re having about how much freedom people have or are willing to give up and again, you know, I think people will self-quarantine if they’re in a situation where they need to. But you know, there’s a difference between I guess self-quarantining and being told you better do this. It’s just tricky stuff.

Jeffrey: All for the better good of society. I assume.

Edward: That’s the goal. I mean, we all want to do what we can to keep safe keep our family safe and obviously defeat this thing. 

Jeffrey: Absolutely. Now, moving away from contact tracing apps a little bit based on your experience and your recent research and just being in the field. What else is out there in terms of technology or health tech that you find interesting right now? 

Edward: Well, I think a lot of the efforts, you know, one of you know, we keep talking about the cell phone and Apple for example has done a lot with the built-in health capabilities of not only the cell phone but the Smartwatch, their Apple watch, you know, they’ve done some interesting heart studies the app. The watch has an ECG or EKG depending upon how you refer to it that can detect a fib, you know, which is basically an irregular heartbeat. It’s got limitations, but they’ve done studies with Stanford as I believe and certainly with Johnson & Johnson. So we’re seeing now this, you know, the stuff that a lot of us wear everyday certainly the phone in our pocket, wearables and such you’ve seen more and more of a link there in terms of health, you know.

So that’s one thing. The other thing that’s going on with the coronavirus in this is not going to come to surprise with anybody is all the Telehealth stuff. You know that people are doing now because you can’t visit the doctor and person unless it’s a real dire situation. So everybody’s doing telemedicine and so we’re relying more and more on technology and personal technology for a variety of health reasons and it’s interesting that it’s being actually coordinated with the studies, with universities and with companies like Johnson & Johnson and others. 

Jeffrey: Now being that you’ve been there from the beginning, you know certain apple and the iPhone not the beginning of time.

Edward: Yeah. I was going to say, it wasn’t there with Adam and Eve. I don’t think they have an iPhone then.

Jeffrey:  All right. How about Apple and Eve? [crosstalk] You were there for the first iPhone. The acceleration in, I guess the technological advancements have been astounding right so you know that we used to make the analogy of chip sizes shrinking, you know and half every few months type of thing. Can you make any bold predictions of anything that we’re going to see in the future, near future? 

Edward: Oh gosh. Well, there’s a lot of certainly interesting efforts being done with everything from artificial intelligence to you know, something called Quantum Computing and all of this. Making predictions only gets you in trouble. So, you know, I will say this I think that you know, I had a story called now a couple of years ago, Pew Agenda Big Study on AI and would the human race basically be better off through artificial intelligence by the year. I think it was 20-30 which isn’t as far away as it once sounded now that we’re 2020. So ten years out would we be better off or not based on you know advances in AI  and they asked all these experts, you know from business and Academia and what have you and basically two thirds of the people thought we would be better off but a good solid one-third were concerned. And actually, it ties back into our earlier discussion. They’re concerned about some of the things we’re talking about privacy and security and what are we giving up if anything along those lines so but I think the benefits if I was if they ask me to take that survey, I would probably lean more on the positive side of it as well. I think for the most part we have ways we will work these things out as a society as long as we’re careful and I think you know certainly health and health care will be a big area. It’s already benefiting from advances in AI and some of these other technologies machine learning and whatever and I think that’s only going to accelerate and continue in the future. So and you know, one of the questions that I had asked even talking to IBM about this technology called Quantum Computing, which is basically it’s kind of hard to explain but the shorthand is it’s you know, exponential advances in computing. Could this have somehow help solve Covid-19 kind of before it got to this point. I don’t know that it could but you do question or question in a good way can some of these advances in technology help deal with the future pandemics. And I think there’s real potential there for breakthroughs. But again, there’s no Panacea unfortunately either with technology.

Jeffrey: That’s very true. And I’d love to actually, you know, have you back in a few months and we’ll talk about more of the convergence between technology and healthcare and hopefully before the computers take over.

Edward: Sure and hopefully by then we’ll be in a better state with covid-19 in this situation. We’re all in right now. 

Jeffrey: Yeah from your lips. I hope so. So thank you so much for your time. This has been so informative and interesting. So thank you very much.

Edward: Absolutely.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions comments, or a future story suggestions, please reach out to us on social media or email us at RP health cast at rooneyco.com, or visit us on our website at rphealthcast.com. Additionally if you like what you hear please follow us, review us and share us with your friends and colleagues. Thank you and we hope you enjoyed the RP health cast.

An interview with Kevin Chupka, Executive Producer at Yahoo Finance. We talk to Kevin about the differences and power of the Internet as a news media, with viewers expectations of a real-time, always-on reporting and coverage cycle versus how that may differ from other media, and how very important this is during a pandemic.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to The RP HealthCast by RooneyPartners. I’m your host, Jeffrey Freedman.

Over the past couple of weeks, we’ve been speaking with journalists about our current health care crisis. We took a look at the coverage from the perspective of all different types of media, whether that was from a print journalistic point of view, from The New York Times and Barons or from live television, from MSNBC. This week, we’re going to take a look at the health care coverage from a different media point of view, from the internet. Our guest this week is Kevin Chupka. Kevin’s the Executive Producer at Yahoo! Finance. He’s also worked as a producer for several other news desks including MSNBC, CNN, and ABC News. Today, we’ll be talking to Kevin about the differences in power the internet as a news media. With fewer expectations of a real time always on reporting and coverage cycle versus how that may differ from other media.

Hi, Kevin, welcome and thank you for joining us today. 

Kevin Chupka: Thanks for having me. 

Jeffrey: Now, before we get started, I want to ask you how everyone’s doing at Yahoo! Finance both physically and emotionally? I understand your team was personally affected by the coronavirus. One of your colleagues actually I heard lost several family members and we want to express our sincere condolences over that. How are you guys doing?

Kevin: Yes. Well, thank you for that. By and large, we’re doing well. We have weekly check-ins with our folks as a group and then my boss and I, the senior executive producer of the live team, we’re going through and slacking people, texting people, calling people, jumping on Hangouts, making sure everyone is kind of all there. I also think that to some degree the work is helping, right? It gets you on a schedule, it gets you up, gets you showered if that’s your thing, breakfast and something that you can do every day, but at the same time we’ve also tried too. We’ve been very understanding as you mentioned the colleague who lost several family members. We had another colleague who tested positive, bounced back amazingly fast. So all well there, but the company from the top down has been very understanding which has helped.

Jeffrey: That’s great and you really have to be in this time. That’s great to hear. All right, Yahoo! Finance. You are the executive producer in charge of your video content. Where does Yahoo! Finance sit within Yahoo, as the portal to BMS? So, what is it that Yahoo! Finance and in certainly, yet the video content Yahoo! Finance? Can you explain to everybody what that is? 

Kevin: Sure. So, I’ll try and briefly give a little history of how we got to where we are because that will inform this a little bit, but when I started almost, I guess, nine years ago, video was just a– it was all VOD, there was no live. We did a few minutes a day and put it in articles and what grew out of that at scale was this interest the traffic month after month and so, we then launched one hour, well, it started to 10 minutes live and then an hour and now about, well, a year ago this past January. So a year and a half ago, we went eight hours bell to bell coverage to essentially offer some online only competition to the CNBC’s Fox Businesses, Bloomberg’s of the world. What makes this unique even in that competition is the fact that we are a website first and so, whereas perhaps for others and I’m not going to speak for them, but they are terrestrial first and they have a website, we are a website and top to bottom. So, the video and the live video particularly that I helped oversee is just one part of what makes Yahoo unique and what makes Yahoo successful. We have a large team of people who are text first. We have a team that is events first. We have a team that’s VOD first and we work closely with all of them. So, we take the events team and put their stuff on our live air. We take the VOD team and the video that they produce that predominantly and specifically goes as a video on demand product, but we run that on our live and we use the reporters and the text first people as our on air talent, as our reporters on frontlines. So we’re set up a little differently than many others in the media space and I think that’s part of why we’ve been so successful. 

Jeffrey: Yes. That’s so interesting. With what I do, in health care marketing and health care education, a lot of times– now, a lot more than we did historically we take an internet first approach and the way we do that is very, very different than the way we used to do in a print approach, right? Because our consumers have a different expectation on an internet first consumption, right? So, can you talk about what you think your viewer’s expectations are in this internet media consumption versus other types of channel? 

Kevin: Yes. I mean, I think there’s a balance between all the people that come to Yahoo! Finance, a lot of them– maybe probably most of them are coming for stock quotes to look at the portfolio that they built on the site and we are there front and center when you get there. We, meaning the entire content team, all those different arms that I just mentioned. So, I think we have those people that come there and they just want to see their portfolio and then they want to read about, the stocks that they have in it or the stocks that they’re thinking about adding to their portfolio. We have people that come there and then want to watch lots of video, I hope. We’ve got people that just are there to discover new stories, new ideas, and we provide it all, within the utility of their portfolio that they’ve built which is very unique. 

Jeffrey: Yes. I mean, you’re truly surrounding that viewer and serving them whatever it is that they’re requesting and that’s it. That’s the great thing about internet media is that you’re able to serve them what it is they’re exactly looking for. Is that, right?

Kevin: Yes. I think there’s a balance even within that of the people that want to see what’s going on right now, which is predominantly where I sit right? The eight hours, you commit– you know 12:16 PM, and you want to know what’s happening at 12:16 PM and we’re there for that. But then there’s also and I’m sure there’s an overlap the Venn diagram must be a mess, but people that see that and then want to dig deeper and we’ve got first rate, first in class reporters that are digging into these stories and offering 500, 5,000 words on the topic that maybe we’re talking about for two or three minutes.

Jeffrey: Yes, no that’s great. That’s the power of that internet portal. So, you said about a year and a half ago, you guys went from one hour, two hours to a full day reporting on financial media and I understand they built you a beautiful state of the art studio down in the village, down in the East Village in New York. I haven’t been there yet, I hope to go, but I heard it’s very impressive. 

Kevin: We hope to have you.

Jeffrey: Well, I’m looking for to it. As soon as I can get out of the house.

Kevin: Exactly. 

Jeffrey: Right. So that here we are, right. We’re in a pandemic. So how’s the work environment changed since the onset of the coronavirus? Now, with social distancing requirements, can you use this state of the art studio?

Kevin: Yes. Right now it’s gathering dust, really, that’s what it’s come to. Back in the middle of March, we saw the writing on the wall days before it got here that something drastic had to happen for us to continue doing our work and the supportive company, Verizon really from the top down said, “If your people aren’t comfortable coming to work then they shouldn’t come to work,” and we’re open to that. As the days went on, more and more of our team were kind of like, “I don’t want to ride the subway in, I don’t want to have to commute in on Long Island Railroad and NJ Transit and Metro-North,” all viable fears. So, we very quickly tried to figure out how we could make it happen that we could work from home. So we went from a little more than a hundred people coming into the office at the beginning of one week and by the end of the week, we were I think to one person. That one person is still there. There’s still someone, one human being who goes in to make sure that the equipment is up and running but we’ve found ways to remote access the computers that run our control room and have been leaning on Google Hangouts and are broadcasting via Google Hangouts. They’ve been incredibly supportive. We’ve had a great working relationship with the folks at Google to give us the best of the best within their product and we’ve made it work. It’s been incremental. Day 1, March 16th, I think it was looked a lot different than it does today. The amount of graphics we could play, the amount of video B-roll we could play, the amount of sound bites we could play. They were essentially zero, essentially on day one and now we found ways to get quite close to having the screen look the way it looked, in January.

Jeffrey: Now, the great thing about the internet you have immediate feedback, right, immediate data and analytics. Now, how has the demands changed for or I should say not to man the consumption of the media on the platform with everybody working from home now has that changed?

Kevin: Yes. I mean our numbers have skyrocketed and I think a lot of the news media and the financial news media and specifically has seen similar jump in numbers. If that is fantastic and we like it, we wish that that happened because of something good, not something bad, but it is what it is. We also, the difficulty in that is figuring out what our programming impact is on that. The decisions we make day in and day out, it’s getting a little bit easier now because it’s become a new normal, even if it’s a temporary new normal and so you can see fluctuations in the data now based on decisions, but for a long time, it was just a massive new people coming and the numbers were sky high and you had no idea if what you did on a day-to-day basis was making an impact in those numbers for the good or bad higher low. So we’re starting to be able to look at that. The other question mark is what becomes of this a year from now? Are we at a new– is this the new normal for our numbers or do we go back to where we were? We hope that we don’t go back to where we were. We hope that people flock to us to get their information and that a lot of them stick around because they see that we do a really good job, and that we offer something that other outlets might not and we have new loyal viewers. Again, we wish that it was because awesome things were happening, but it is what it is.

Jeffrey: That’s the Holy Grail, right? You get this bolus of viewership and it’s trying to keep them and serving them what it is they’re looking for. You certainly have the advantage on the internet side of, the portal side because you’re seeing exactly in real time where they’re going for. I want to talk about content changes, but back to operational changes that you have with going from a hundred to one in the office right now. A lot of adaptations. Do you think any of these changes that you’re making today? Although, I’ll be a– because the pandemic are actually better for the company. Do you think any of the changes you’ve made now are going to be permanent changes in how you develop produce and broadcast your content? What do you think the life at Yahoo! Finance is going to look like? You know, in a post Corona goals.

Kevin: Yes. We’ve gone back and forth with what the new business as usual. I believe is the term that that Verizon is been using and honestly we still don’t know, but that aside what we’ve learned is that we are extremely adaptable that we can do a lot more without being tethered to a control room in a studio. We want to get back to the controller in the studio, it’s more stable, there’s more you can do, but I think things like being able to stand up a show remote which we don’t do a whole lot that, maybe our terrestrial brothers and sisters do because they’ve got bigger staffs and they have been working with satellite truck since the dawn of satellite trucks and we just don’t operate that way but now we’ve found ways to be able to originate shows without needing a home office. Again, I don’t think that would become the everyday, but now, oh there’s a really cool event and we want to do our entire day from there and we don’t want to spend hundreds of thousands of dollars that a network would have to, well, now we know how.

Jeffrey: Right. So you just plug in. That’s great. That blood into your thinking, so it’s definitely a huge positive. Now, what about the content changes that you were talking about?

Kevin: Yes. Is…

Jeffrey: Yes, go ahead. I mean, has daily programming changed? Are you more Covid related or are you still strictly following the financial media?

Kevin: So we were, I’d say a hundred percent Covid. I mean, it was all what is Covid doing to this stock, this company, this market, that what when have you, but we were for a long time from middle of March to even just a couple of weeks ago, all Covid all the time. Everything that we talked about is related to that because that’s just life right now. So we’re even if you have a liberal view of things, we’re probably still almost a hundred percent Covid, but we also know that there’s a fatigue that has said in with that news and so we don’t want to hammer it home, put too fine a point on it. We still know that people want to know what else is going on, but again, you talk about a company and supply chains. Well, you talk about supply chain, you can’t talk about that without discussing the impact of Covid because that is what the supply chain is right now. So it’s hard not to do it and I guess with the point that we’re at now is finding a balance so that we don’t drive people away, who do have that fatigue and finding some more silver lining stories, the positive things people are doing and we’ve been doing that all along but doing that even more so and also looking at the road to recovery which we’re going to be hammering home a lot more, what, how do we get back to some semblance of normal? What does that look like? What does that impact on not just the company’s in the markets but your daily life and how you do things?

Jeffrey: Yes. We’re all looking forward to that part, of course, getting back to normal life. Now, you lens a very interesting perspective to this, right? I mean, you join Yahoo! Finance a while ago in 2011, but before that, you worked in TV, right? You had seven or eight years, you worked at NBC, ABC, CNN, MSNBC and your background was more of a focus on politics and the environment rather than Wall Street. So this is, I don’t want to say it’s a whole new world for you, but how is that transition both from television, traditional television media and politics and environment now focusing on to this thing called the internet in 2011 and more Finance Wall Street?

Kevin: Well in 2011, I was talking with friend who is at Yahoo. I was at MSNBC at the time and I was saying, I really think I need to get into digital because I don’t want to be 50 years old with a kid and I didn’t have a kid at all the time, but with a kid or kids that were going off to college and having someone say to me, “Oh, you’ve been in television your entire career and we’re all digital now, so you got to get out of here. We don’t have a job for you anymore.” So I was thinking playing a very, very, very long game at that point. This friend said, “Well, there’s an opening over here for finance.” At the time, it’s kind of very reticent to move into a financial news because I didn’t understand it. Honestly, if I needed to make that jump today with the infrastructure that we’ve built in the expertise, we’ve built at Yahoo! Finance. I don’t think I’d be able to cut it. But at the time they were taking baby steps into video and they were willing to take– to let me take baby steps and learn financial news. I knew what a stock was. I didn’t know what an ETF was. Someone had to tell me that. You know, bought stock markets for dummies and was reading Investopedia and just picked up the Wall Street Journal for the first time in my life that now is a daily read and so that was a big change and I still there’s– I’m surrounded by people much, much, much smarter on topics of markets and stocks than I, but I’m confident. I know what’s an important story and what’s not, I think that’s the point that– that’s kind of my job now that and managing the staff so I’m very comfortable with that. It’s all of a love for all that other stuff, but then to the mechanics of terrestrial versus digital, they’ve all kind of mashed up into one now, especially that we have been doing this eight hours of programming. The lines are very blurred and so that’s good that we– and I think that’s where the whole digital space is going. You’re going to have a lot more people trying to get in on the– I’m going to do a full day coverage 24/7 or whatever it maybe on digital and so having that tool kit that I had from TV has certainly helped. Then all the other stuff, the changes, the differences in digital came because when I got here we were going, like I said, with three minutes of VOD, 9 minutes of VOD a day and in those nine years, we ramped up and I feel like I figured it out along the way.

Jeffrey: I’d say, absolutely. I mean, you definitely had a vision, you played the long tail and that’s fantastic and exciting and great for you. Now, what do you think in the next 10 to 20 years? What do you think this media coverage is going to be and what’s next step forward?

Kevin: Yes. I wonder a lot about the people that have been saying for a long time that the likes of NBC Nightly News is going away. Right the 6:30 broadcasts are going away or that, 24/7 TV, TVs going away because millennials and xennials don’t watch TV. The thing is that they’re all watching TV. They’re just watching it on their iPads or their iPhones. So I continue and have always found it hard to believe that 30 Rock goes away because they don’t need studios. We’re a perfect example of that, right? That Yahoo! Finance built a brand new studio 18 months ago, actually less the studio itself is even newer than the broadcast. So I don’t see it going anywhere. I see the way we consume it being different and there being a lot more– a lot of other options, you already see it. You don’t get 20 million people watching a sitcom anymore. You’re just okay with that. There’s lots of different people watching lots of different things and I do think that you have all these streaming products just going to be a consolidation. I don’t think they can all survive forever, but there’s an appetite for everything that’s out there and so it’s just more about the consumptions.

Jeffrey: So round peg for round holes, as long as there’s enough the people out there. They’re going to find out something they like. That’s great. Now, RP HealthCast, we are a health care focus podcast. So question on health care. Based on what’s going on in the world right now with the Coronavirus and how you all at Yahoo! Finance, we’re getting the love right now, Corona every day, health care coverage that type of stuff. How do you think that’s going to change in the future? What sort of permanent changes do you think health care will remain a hot topic of coverage? Now, I don’t want to say in the near future obviously, well, in the near future, but it’s huge.  

Kevin: Well, I think for starters to be– networks have long had health care correspondence, doctors on their payroll, and so perhaps some of that just grows as interest grows. I think you’ve seen that since the beginning of media, right. Or when it goes where the interest goes. I feel like this is going, this has legs. This story has legs. This topic has legs. We, you know, a year and a half ago didn’t have a health care reporter, it was kind of, get people from the outside to come and come in, have our anchors just bone up on all this stuff. We before this all happened hired a fantastic health care reporter who’s been very, very busy as you can imagine. So I think you know expanding your health care expert roster whether it’s on staff or outside is a smart thing for any media company to do because I feel bad saying this, but I don’t think this is– whenever this ebbs I don’t think it’s the last we’ve heard of this virus and potentially not the last we’ve heard of another virus or another sickness or another epidemic that tears through our society, which is unfortunate. But health care joins up with so many of the other topics we talked about and so I don’t think it’s going away anytime soon. I mean, it’s connected to climate change. It’s connected to politics. It’s connected to your money and through the way the government budgets and all this stuff that, means perhaps the light wasn’t shown so brightly on it before and maybe that’s what happens now that everyone was a wait. This is actually important and the media companies follow so by focusing on it more.

Jeffrey: Kevin, this is been great. Thank you so much for joining us today and I hope to speak with you back here again soon.

We hope you enjoyed this week’s podcast. If you have any questions, comments or future story suggestions, please reach out to us on social media or email us at RP HealthCast at rooneyco.com or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us and share us with your friends and colleagues.

Thank you. We hope you enjoyed the RP HealthCast.

Interview with Eric Savitz of Barron’s.

In this week’s episode, we speak with Eric Savitz of Barron’s about some of the recent stories he’s written on the effects of the pandemic on the financial markets – as well as on companies that are innovating and creating technology to better enable us to work more effectively from home.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by Rooney Partners. I’m your host Jeffrey Freedman. The RP HealthCast is a weekly podcast series on the stories around the latest news and innovations in medicine and healthcare. To learn about these stories, we hand over the microphone to those who are actually building and writing about the future. Therefore, we either speak with leaders of companies behind the latest breakthroughs in medicine and technology or with journalists to discuss their stories on important issues surrounding the healthcare ecosystem. 

Everyone and every product has a story to tell. The goal of our podcast is to help tell that story and to tell our listeners why that story matters. Our guest this week is Eric Savitz. Eric is associate editor for technology at Barron’s. He’s also worked for Forbes, The Industry Standard, Smart Money, the Brunswick Group, and Roku. Today we’ll be talking to Eric about some recent stories is written on the financial effects of the pandemic in relation to the financial markets, as well as his stories on companies that are innovating and creating technology to better enable us to work effectively from home.

Eric, welcome and thank you for joining us today. 

Eric Savitz: It’s my pleasure. Thanks for having me.

Jeffrey: Eric, as a journalist for Barron’s, you’re located in Silicon Valley, and your coverage is technology. With this pandemic, almost all companies have been getting crushed. But one of the few financial or Wall Street darlings during the pandemic has been Zoom. And for those that don’t know, Zoom is a video chatting software and technology; it’s been around for a long time. A lot of people didn’t know they needed it until they were quarantined and stuck at home. 

You’ve written a lot about the company and some of the issues that they weren’t prepared for during the massive growth opportunity right now for them. You also just wrote that Facebook and how Facebook’s going to try and compete against. Can you talk a little bit about Zoom and Facebook and this technology? 

Jeffrey: So Zoom is a fascinating story. Zoom came public last year. The time they came public they were growing close to 100% per annum and were profitable. They had a lot of appealing characteristics as an investment. But what’s happened in the current crisis is that everyone has shifted meetings to the web and there are some characteristics of Zoom’s platform – the simplicity of it makes it very powerful. And then the other element is that it has some nice features, like the, let’s say, 25 faces at the same time, which is something that some of the other platforms don’t have, is a nice feature. So what’s happened is Zoom was really originally targeted at small business and then enterprise businesses, but it’s been widely adopted by students and people using it for virtual cocktail parties and things like that. So a lot of consumer use. 

It’s a little unclear whether Zoom in the long run is going to be able to monetize a lot of that additional traffic. A lot of the users are using free versions of… I think the entry of Facebook into this market, they’re offering a product that you know will do up to 50 simultaneous users and with some security controls things like that, is interesting. I think it’s mostly a consumer-driven product at this point, even the way they’ve positioned it so far, like, “This is a great way to do your book club,” and things like that. It remains to be seen whether that’s going to have a big impact on Zoom. 

So far, nothing is stopping Zoom. Zoom, maybe a week or so ago, announced they had hit 300 million users. That was up from 200 million at the beginning of April. The growth of this thing is unbelievable. I think the really interesting question here, though, is what happens when we return to what’s next, right? I think they say we go back to normal in the sense that it looks like the world before COVID-19 isn’t realistic, but we are going to go back to something a little less restrictive. I think one of the things that happens is people will rely on those kinds of tools much more than they did before, but we’ll see how it plays out. I do think that a large chunk of that extra traffic that Zoom is seeing is coming from consumers and students and people who eventually will just probably not use it nearly as much as they are. That is a fascinating situation. Their stock is up like a hundred and fifty percent year-to-date. It’s been an amazing, amazing ride for their investors. And I hope the listeners have all bought it a long time ago [chuckle]. 

Jeffrey: To me what’s also incredible is they were able to change vocabulary and what that means to me is… Like the word ‘Band-Aid’ right? Band-Aid is a brand, you know what is, and you know you need a Band-Aid. Six months ago, we all went on WebExs, right? Business. For our business we’re going to do WebEx, and everybody knew what that was. It was going to be a video meeting or a shared meeting or whatever. You don’t hear that anymore. Everybody’s going on a Zoom, right? So not only did they come out with the technology, but they changed our way of thinking. 

Eric: Yes, you know you’re doing something right when your company name becomes a verb, right? It’s like making Xerox copies. It’s funny because a lot of companies get irritated when you do that, right? Like don’t call it Kleenex, call it tissues – that’s an old marketing problem [chuckle]. I think in this case, they’re having a truly remarkable marketing moment. I’ve written about this a little bit. The the idea that you are a relatively small, relatively obscure technology company and suddenly everyone on Earth is using the name of your company as a verb is astonishing. And that’s a gain in perception that won’t wear off, right? That’s a permanent change in the way we think about that. 

You’re right, it is fascinating that it’s not WebEx and it’s not Skype. It’s not Microsoft Teams. There’s a bunch of other perfectly good platforms by which you can do this, it’s not even Google Hangouts, right? There’s a lot of options, but this is the one that has really caught fire. And again, I think a lot of it is about user views. 

Now I think part of the problems that they’ve had on security are kind of related to the views, right? So I think what they’ve had to do is take a platform that was really targeted an enterprise user and that has been adopted in widespread with the consumers, and that adoption has brought with it some unexpected sort of security issues – the Zoom bombing and things like that that they’re having to deal with. But it doesn’t seem to have slowed their growth, so it’s a remarkable story. 

Jeffrey: It really is and it’s a great product. So another topic that you write about that I’m very interested in talking about – it’s been in the news all over, you did a great job and we’ll talk about why you did such a great job – It’s the SoftBank Vision Fund. Alright, for those that don’t understand. From a very high level, let’s start out. Can you explain the SoftBank Group? 

Eric: Sure. SoftBank Group is a Japanese company, it’s really a holding company. They own a bunch of assets, so the things that, they own a lot of assets, but just as a few key pieces, they own about a quarter of the stock of Alibaba, the large Chinese e-commerce company; they own about two-thirds of a Japan-based wireless company, which is also called SoftBank; they own Arm, which is semiconductor design company that they bought a few years ago; and a few other things, they own a Japanese league baseball team, various other things. They also created in 2016, so really about three and a half years ago, they created a venture fund called the SoftBank Vision Fund, and they did it in a sort of spectacular style. They raised about $100 billion – that is an amazing thing on its own because a hundred billion dollars, that’s about what the venture capital industry invests in an average year, so that’s a huge amount of money. They raised most of that money from two Middle Eastern country wealth funds – one from from Saudi Arabia and from Abu Dhabi put in about 60 billion dollars of the total, some of the money came from SoftBank itself, and then there’s a few other, a few billion here and there from a bunch of tech companies.

What you ended up with is what is by far, by an order of magnitude, the largest venture capital fund ever. And their philosophy here has basically been, first of all, they’re huge believers in– Masayoshi Son, it was the founder of SoftBank, and the CEO of the company, is a big believer in artificial intelligence. He’s a big believer in technology. He’s also a big believer that you think big and you plan far into the future. And he’s making some unbelievably outsized bets. Part of their philosophy is flood companies with money to accelerate their growth and then you will reap returns faster and get bigger returns. Now the problem is, and one of the reasons they’ve been in the news a lot, is they’ve made some unfortunate bets, most famously they are the largest investor in WeWork. Not only are they large investor of WeWork, but they they basically rescued WeWork from financial oblivion after the WeWork IPO failed to close. They’ve also made big bets in other things that have been troubled. Some of them in the ride-sharing business – they are the world’s largest investor in ride-sharing, so they own a big stake in Uber and big stakes and three other ride-sharing companies around the world, including DiDi, which is the Chinese ride-sharing company, it’s probably the largest one in the world, but that’s a terrible business right now. You only have to look at Uber’s stock to realize in a world where there’s basically no one traveling, the need for ride-sharing services is a lot lower than it was. 

They are really struggling to make this fund to success and downturn is not helping them. They’re also a big investor in DoorDash, which is trying to go public, but is really finding it difficult in the current environment. They’re a big investor in a company called Oyo Rooms, which is basically a hotel business based in India that is having big problems. And then they’ve made I think even hurting the more, although maybe a little less financially, they’ve invested a few things that just seemed silly. They did an investment in a company called Wag, which is basically a dog-walking service. They lost about $90 million on their investment in Wag, and they’ve had a few things that have just folded. They were invested in a company called Brandless, which was a personal products company, cosmetics kind of thing, and that company just simply folded and they lost their whole bet there.

They’ve struggled and fairly recently, they’ve announced they have very large write-offs related to the holdings in their funds. They’ve now basically lost money for the life of the fund, which is not something you want to do as a venture capital fund. It’s raised real questions about their approach and Masa’s decision making and in the future of SoftBank, so it’s a tough situation. 

Jeffrey: Your article you wrote, I think your words were, “The fund has been the subject of a series of headlines about strategic missteps and failed investments.” Now, what’s interesting to me, it’s most of those missteps and failed investments, you were able to tell that even before the pandemic. Now with the pandemic, everything is just compounded. The whole WeWork thing was before the pandemic. The ride-sharing, the Uber – before the pandemic. Now, everything is like falling off a cliff, it seems, for these guys. The write-off that you talked about was about $17 billion. Now that’s a hell of a lot of money just to vanish. I mean 17 billion gone. So what do you do? You call those investors the next day and you say, “Got some bad news.” What are those conversations like? 

Eric: Those are tough conversations [chuckle]. I think there’s a couple of offsetting elements. One is they had previously returned about $10 billion in capital to investors from some more successful investments that they’ve made in the past, they had a stake in Nvidia that paid off pretty well, they owned a big position in an Indian e-commerce company called Flipkart that was acquired by Walmart. So there have been a few things they’ve done that have really worked out. But you’re right, that’s a tough situation. I think one way that it’s hurting them is they had intended to raise a second fund, the Vision Fund 2, which Masayoshi Son famously said was going to be even bigger than the first fund, and that is now not on the cards. There are a few investments that they’ve made through what they call Vision Fund 2, but all the money is from SoftBank, they have no investors, and clearly their Middle Eastern partners are not eager to provide them with more capital. 

Now, I think one thing that SoftBank will say is this a long-term bet. This is a 10- or 12-year lifetime on this fund and we think there are going to be some huge exits out of the portfolio. And they’ve had some good exits, a few of them in the healthcare space. There’s a company called 10x Genomics that has done very well. There’s a company called Vir Biotechnology that’s been a hot stock lately. But those things are not making up for the problems they’re having in some of their other holdings. And I think there’s a certain risk that they’ve painted their brand in a way where having an investment from SoftBank, whilst it’s nice to have a capital, being associated with them hasn’t been one of the keys. That makes them angry when you say that, and I think there’s some truth in that. They’ve angered a lot of people in the Valley, right? The rest of Santa Road, the rest of the venture capital industry tends to look at them as having warped pricing in the market, that they over inflated prices, and that they’re now reaping what they sowed, so there’s a little bit of schadenfreude. I think people are happy to see them have problems. But to your point, that’s a tough thing.

It’s not so easy to hit the undo button on a venture fund. You can’t just decide, “Yeah, we’re done. This didn’t work out, so we’re just going to shut this thing down.” That’s not an option. So you own stocks, I think they currently have 88 things in the portfolio, some of which will end up doing fine, some of which won’t, but you kind of have to play it out. Their investors in SoftBank are going to live with each other for a while and we’ll see where it goes. Now I would say there is one other odd element which they are venturing, which is that SoftBank Group, the parent company’s shares, traded a fairly steep discount to the value of their assets. The value of SoftBank Group’s stake in Alibaba alone – again, they own about a quarter of Alibaba – that’s a [inaudible], and that’s kind of weird. The company is trying to do something about that, they’ve promised to sell off a bunch of assets and buy back stock and pay down debt and do some things to try and fix that problem. But I think among other things, it’s just a reflection of the fact that the market’s not entirely trusting of Masa right now. That’s going to take some time to fix. He did some damage along the way with some of the things that have happened in the fund.

Jeffrey: As I read, you know in your article, over 40% of the portfolio is in logistics and transportation. So that’s not necessarily coming back so quickly during this pandemic time, so it will take a while and that that could probably be some of the discount as well. Now you mentioned that the the leaders of the fund, they’re visionaries, right? They’re thinkers of the future and what’s going to happen down the road. You would think that would lend itself to more healthcare and health-related companies and stories, but according to your article, about 6% or less is in the healthcare industries. Why do you think that is? Why do you think they’re kind of staying away?

Eric: Clearly, I’m pretty sure they would rather have more money in healthcare right now than car-sharing services given their options, right? But I think part of what’s at play there is when you talk to people in the venture capital industry, what you tend to see is there are a few funds that do both biotech and software and hardware businesses, conventional technology businesses, but they tend to involve different partners in different disciplines. And for whatever reason, this is a fund that reflects Masayoshi Son’s history and he has been an investor in the technology business for decades. He’s owned lots of things, he was an early investor in Yahoo, he at one point owned COMDEX, the old trade show business. During the bubble period of ’99 to 2001, he owned pieces in almost every brandname internet business on Earth, including a lot of them that didn’t do very well. So his expertise is intact. And I think the fund reflects that. They have had some good exits in biotech, but their commitment there is much lower, and I think it reflects Masa’s focus. He’s a big believer in AI, and he thinks AI, artificial intelligence techniques, are going to solve a lot of the world’s problems. Now that includes in healthcare, but he’s made a much more limited investment there as you say, and I think that was probably miscalculation. I would say that that is probably typical of many Silicon Valley venture funds: most of them tend to do just it or consumer kinds of technology businesses and don’t do a lot of biotech. There’s some specialists that do more, but it certainly looks like a misallocation of assets right now.
Jeffrey: Now, forget about on the SoftBank side, and focusing more on technology, let’s say Barron’s and your writing. You’re technology-focused. Do you think in the future, based on our learnings now on the pandemic, do you think you’ll see a lot more stories or cover more stories and health tech or med tech type of thing. 

Eric: We spent a fair amount of time covering, pharma and biotech and medical device companies and other companies in the healthcare business. I think one thing that you’ll start to see is technology businesses are going to look for more ways to go here. So you’ve seen a little bit lately on– there’s some controversy around contact tracing, for example. I think for all of these businesses, so think about Apple, for example, which had really tried to push both the Apple watch and to some degree even the iPhone more and more as a medical device, or at least a health device, tracking your steps or tracking your sleep patterns and things like that. So I think you’ll see more and more of that. I think from a Barron’s point of view, we and and everyone else in the business journalism world are going to spend a lot of time – have spent and will continue to spend a lot of time trying to figure out how this plays out, who the beneficiaries are, both in the healthcare business and on the tech side and beyond, obviously. Grocers and also some other people benefit.

There is a lot of opportunity there. I think that for me, most of my core coverage involves the large technology companies – the Microsofts and Amazons and Alphabet and companies like that. While they are not on the surface purely healthcare businesses, they are going to have to play more and more of a role, and sometimes it’s indirect. Sometimes they might be taking dollars from healthcare. And, again, in the case of Apple, could be app-related. They’re all trying to figure this out and how they should play a role, and I think we’re going to have to write about all of it. One thing is true is we’re we’re not going to run out of topics to write about COVID-19 any time soon.

Jeffrey: No, unfortunately, we’re not. This has been incredible. Thank you so much for your time today. I’m hoping that we can get you back on with us in the very near future and we can explore further. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at rphealthcast@rooneyco.com or visit us on our website at rphealthcast.com. Additionally if you like what you hear, please follow us, review us, and share us with your friends and colleagues. Thank you, and we hope you enjoyed the RP HealthCast.

Interview with Paul Sullivan of The New York Times

The Economic Impact of COVID-19 on the U.S. Economy

COVID-19 has created havoc within our society from a healthcare point of view, where today we have over half a million Americans with the virus and over twenty-five thousand fatalities. As we are entrenched now for the long-haul, we thought it would be very interesting to hear from someone that has been monitoring the economic fallout from COVID-19 and how it has been impacting companies of all sizes. Our Guest this week is Paul Sullivan of The New York Times. Paul is the Wealth Matters columnist.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP Healthcast by Rooney Partners. I’m your host, Jeffrey Freedman. The RP Healthcast is a weekly podcast series about the latest news and innovations in medicine and healthcare.

To learn about these stories we hand over the microphone to those who are building and writing about the future. We either speak with leaders of companies behind the latest breakthroughs in medicine and technology, or with journalists to discuss their stories on important issues surrounding the healthcare ecosystem. Everyone and every product has a story to tell. The goal of our podcast is to help tell that story, and to tell our listeners why that story matters at the time of this recording we find ourselves still under attack and held captive by the effects of the coronavirus. This pandemic is created havoc in our society and from a healthcare point of view. Today, we have over half a million Americans with the virus and over 25,000 fatalities, almost half of which are here in New York and it’s certainly a scary time here.

As social distancing is being used to help combat the virus, we’ve been temporarily forced to shut down a large percentage of our economy and there’s no escaping the economic impact this is having on our country. From large scale corporations and retailers to our mom-and-pop neighborhood stores and restaurants. Unemployment is reaching record-breaking levels and employees and business owners are trying to figure out how to pay their bills for the next few months of the shutdown. Society’s fear of the economic impact of this pandemic is rivaling the fear of the disease itself.

As we are now entrenched for the long haul, we thought it would be very interesting to hear from someone that’s been monitoring the economic fallout from COVID-19 and how it’s been impacting companies of all sizes. So, our guest this week is Paul Sullivan of the New York Times. Paul is the wealth matters columnist. He’s also the author of The Thin Green Line, The Money Secrets of the Super Wealthy and Clutch: Why Some People Excel Under Pressure and Others Don’t. Paul also writes for Golf Magazine and previously wrote for the financial times for the Conde Nast Portfolio, Fortune, Money, Barons and Bloomberg. We’re very grateful to have Paul with us here.

Jeffrey: Paul thank you for joining us today.

Paul Sullivan: Thanks for having me.

Jeffrey: Before we start to discuss some of your recent reporting, let’s provide some context for our listeners out there. The importance of small companies to the US economies these times are not really appreciated. And, can you talk about some of the key data points that illustrate the scope of the impact these small businesses have on the US economy?

Paul: Sure. The majority of businesses in the United States are small businesses. 99% of them, as defined by the criteria from the Small Business Association, which is any business with under 500 employees, and that’s something like 30 million businesses and they you know, constitute a 45% share of our country’s GDP. You know another is, 500 to most people is kind of big, about half of all people in US works for small business, but their data out from JP Morgan that says, 88% of companies have less than 20 employees. So 88% of the company in America have less than than 20 employees, and those of course are some of the businesses probably most impacted by what’s been going on economically the past couple of months.

Jeffrey: Yeah. I mean that’s scope is completely under appreciated when we hear about this big box world that we live in. Over the last several weeks, your articles in the New York Times and The Wealth Matter Section. You focused on the impact the economic shutdown has had on business and you’ve written about companies of all sizes and companies that have been in families, for generations in fact. The title from one of the articles that you just wrote is ‘For Small Business Owners, Hard Decisions Become Personal’, and what do you mean by that? What do you mean by personal?

Paul: I mean that, so often, the owner of that business really knows the people that work for him or her, and in some of the businesses that I highlighted there is this furniture company outside of Chicago, it was in the fourth generation of owners, but they had three generations of people working for that. There’s a story that one of the owners told me, the grandma celebrated 50 years of working for the company, her son worked for the company and her grandson work for the company. So, their employees obviously, there’s that employer-employee relationship, but because they’re smaller businesses, everyone’s working together, you really know your employees a lot more intimately and it’s just so different than if you’re a company with 10, 20, 30, 40 thousand employees, sure, on some level people are known but not in the same level that they’re known at a small business.

Jeffrey: Yeah, no, that’s that’s true. Do you find this as a common thread? People are people but are there common threads between these businesses that you interviewed?

Paul: I mean, the threads in terms of how they look at their employees or the threads on how they’re dealing with this current economic moment?

Jeffrey: A little bit of both. I mean, there is tons of empathy I’m sure, but they all have to be in the same boat right now.

Paul: They’re all in the same boat and I agree there is a lot of empathy but what are they trying to do? They don’t talk about layoffs, they talk about furloughs and somebody who gets furloughs that doesn’t come back is of course laid-off, it’s a kind of gentler term, but there is this hope, there is this expectation that whenever we emerge on the other side of this pandemic, a lot of these family owned small businesses want to bring these people back and so they’ve really agonized a lot over the immediate choices that they have to make often, letting people go, of course we’re also cutting back on innovation, cutting back on spending and cutting back on non-essential parts of their business, but the wisest ones are the ones who survives all kinds of ups and downs including one company I talk to for this week’s column that survived the Spanish Flu in 1918. They are trying to think, “Okay, how do I stay a bit in business now? When this is over how am I still a business? How have I still made sure that we know what made this a business still exists in a month, three months, a year, whatever it is.”. And that’s why these decisions are so agonizing because some of these people are highly skilled, if you let them go they’re going to feed their families. They may find a different job either, they have to do that. So you got to be careful as to which people you let go now to keep the business alive because you’re going to need to get a lot of them back hopefully when things get better.

Jeffrey: I assume the name is different between being furloughed and being laid-off right? As an employee, it would kind of feel the same. But what’s the difference, what’s the official definition or meaning there?

Paul: I mean, employees are furloughed. You know, it means they theoretically still have a job spot at that company. This used to happen thirty years ago in the Auto Industry. The workers would be furloughed for X number of weeks and there’s the expectation that orders with pick up for XYZ car and they would be brought back and be back on the assembly line, the issue here is we don’t know. We don’t know how we’re going to emerge in X number of months and we don’t know what the demand is going to be and we don’t know what businesses are still going to be viable concern. So, a furlough give somebody hope, but you’re absolutely right, it feels very much the same as being laid-off right now.

Jeffrey: Yeah, and you talked about companies saying we have to make sure that we’re actually an ongoing sustainable business after this. So, in the same article you wrote about Russo’s, which was a hundred year old fruit and vegetable company. They’re a hundred years old, but now they’re trying to adapt and innovate, right? To avoid laying off and losing what they have. So from a Darwinian point of view, I guess adaptation or survival of the fittest, what types of companies do you think have the best chance of survival or what do companies have to do in order to assure themselves of that next stage, post Corona.

Paul: I mean not to be good, but the companies that have the best chance of survival are going to be the ones that have benevolent landlords and very understanding lenders, because people have to cut back. I mean revenue, in the case of Rousseau’s, that business lost half of its revenue in about three days, and that’s because the state of Massachusetts closed the public schools, all the universities and colleges sent home their students and all the restaurants closed. That was half of their business. The other half is the retail side, but you still have half of your workforce that doesn’t have anything to do. Other examples, I’ve talked to some smaller firms, tech firms. Let’s say they were paying ten thousand dollars a month in rent. They need to make sure they have a cash runway of at least a year, and that’s difficult. So, what are they going to do? Hopefully they’re going to go to their landlord and say, “Look, can we work this out? Can we cut the rent in half? Can you make it five thousand dollars a month and then I’ll make it up to you on the back end, and it’s in the landlord’s best interest to negotiate as well because right now nobody’s going to come in and take their space. You don’t have tenants knocking at the door to say I want to lock myself into a five-year lease at X amount of dollars a square foot. And so it’s really that back and forth and one last point, when I mentioned the lenders, what I found is that and sure we’ll touch on this later, but some of the government programs like the PPP loan, if you don’t know your banker well, if you don’t have that existing relationship with a bank, whether it’s a gigantic bank or a small community bank and have already borrowed from them and they know that you’re good to pay that money back, you do your best to pay that money back, those people who have those relationships are going to pair a lot better than those people who don’t, because this is not a time to suddenly get to know your banker when every other customer he has is also reaching out.

Jeffrey: Yeah absolutely and what you’re talking about before is more for the private sector, meaning negotiate with your landlord, negotiate with different things and that’s going to have a complete trickle-down effect throughout the economy because that landlord also has vendors and people they have to pay for. But if we talk about the public sector, and you started to get into that with the PPP, what other types of federal programs, and we hear a lot about the Paycheck Protection Program, the PPP, but as you’re saying, getting to know your banker, I know a lot of business owners that are having a really tough time applying for these programs and putting in claims. So, what’s going out, why is it so hard and are our banks playing favorites?

Paul: Well, why it’s so hard is because in a traditional year, in any other year, small business loans are about 30 billion dollars, 30 billion dollars for an entire year. What the government was asking is for banks to help them lend out 350 billion dollars in three months. So that’s sort of a 40-fold increase in volume and velocity of lending. What happened was a lot of the big banks and a lot of the community banks weren’t already approved to be small by the SBA, to be Small Business Lenders, not hard to do. It’s time consuming, certain criteria you need to meet but now is not the time to try to meet all those criteria and fill out the applications. And so what happened, it’s only been about a week and a half as we’re talking now since the program came into existence, is people rushed to apply but the bankers were overwhelmed, because even if they had a small business lending division. Let’s say that’s 10 people and another 90 people at the bank who do all kinds of other things, those 10 people cannot handle the volume of requests that they’re getting and even if you bring in 50 of the other 90 people work at the bank, they have no experience in this. They were making home mortgages, they’re dealing with lines of credit for a business. They’re doing all kinds of different things and that’s what’s caused this backlog. Our banks “playing favorites”, that’s kind of a loaded term. What are they doing? They’re working with the clients that they already know. These are the people they know first. These are the people that they have a relationship with. These are the people that have already borrowed from them. And this doesn’t necessarily mean the largest, biggest, most prominent small businesses. I talked to a woman who ran a business in New Hampshire that helps and works with autistic kids and she got approved very quickly. She had 17 employees got approved very quickly by a small community bank in her town. And so, she had that relationship there and obviously, the size of her loan is nothing compared to the size of a 500-person firm, but she had that relationship in place.

And so in that sense, she was able to jump ahead of a lot of other people and get approval for what she needed.

Jeffrey: Yeah from the bank’s point of view. I guess the difference between that 30 billion of lending versus now the mega PPP program, is the banks aren’t guaranteeing this, right? The federal government is guaranteeing this?

Paul: They are but the issue is that you know, the guidelines were created so quickly and they are rushed through so quickly that it’s not entirely clear. I mean an entirely new program was created in the span of a couple of weeks. That doesn’t just how it works. If you’re making a mortgage for somebody. Well, we understand Property Law, we understand the structures around a mortgage and even when you go get a mortgage to buy a house, it still takes 4, 5, 6, 8 weeks to get that mortgage approved, even though a bank lends money to buy homes every single day of the week. And so, just imagine, a whole new blown product if used correctly or as the the guidelines say is correctly, can be forgiven being rolled out because what happens if people don’t use it correctly? What happens if these companies still go bankrupt? Who’s ultimately on the hook for that? Is it the Federal Government’s going to pick it up or is the bank going to be accused of not doing it’s due diligence. Well, the flip side of that, how can you do due diligence when you’re supposed to get all this money going out the door in a matter of hours or days, not a couple months.

Jeffrey: Right, incredibly interesting. Thank you. So, that’s the PPP, right? So, what’s the difference between the PPP and— the SBA also has something called the Economic Injury Disaster Loan Program, what’s the difference between that?

Paul: More commonly known as the ‘Idol Program’ and that’s been around for a long long time and historically, what does that use for? You live in South Florida and you have a business and a hurricane comes in and wipes out your town, that is a disaster. And therefore there’s a Disaster Loan Program. And historically, that program has worked very well. You could apply for an immediate grant of $10,000 you put in your bank information, you tell them who you are, you put in your tax ID so they can look up and see that you’re going concern that’s been making money and paying taxes and historically in 3 days, you get that $10,000 grant. That’s a grant, it doesn’t have to be paid back. And then, that puts you into the queue to get a larger loan up to $200,000, doesn’t have to be secured but the loans go up to 10 million dollars. You want to get a 5 million dollars alone, you got to show why you need to find that 5 million dollar. That’s all established and understood. The problem is, we have a disaster in all 50 states. So it’s no longer localized. It’s just not that Hurricane in South Florida, you’re applying for that loan from every state because every business— or not every business, the majority of businesses are suffering some sort of economic injury, economic disaster and that whole program has ground to a halt and what used to be a no-questions-asked $10,000 grant is now, you get a $1,000 per employee up to $10,000, but that money hasn’t gone out. I haven’t talked to anybody who’s actually received that money and nobody received it in 3 days. So, the whole rush for this was around the end of March and people are still waiting for this emergency grant. They can’t get that. They’re not even quite sure what’s going to happen with the loan portion of it that’s supposed to come after that grant arrives in 3 days.

Jeffrey: Right, so do you think there is a bottleneck issue or a real flaw in the design?

Paul: I think there’s a bottleneck issue. Again, it’s not designed for businesses in all 50 states to apply at once, it’s designed for the regional SBA in South Florida to call up Washington and say, “Okay, this is what happened in a fill-in-the-blank greater Miami area. This is what we think the issue is going to be…”. And then the system works and one of the big problems here is that the $10,000 grant, had it been able to go out in 3 days, was super meaningful to these small businesses with less than 20 employees because there’s other data in one of my columns that talks about most of these micro business—super small businesses, don’t have enough cash on hand to make it 30 days. 25% didn’t have enough cash to make it 30 days and another 25% so to bring us to 50% didn’t have enough cash to make it 90 days. So, a loan or a grant that could arrive in your bank account in 72 hours was a huge beacon of light for these very small businesses. And now, it’s just one more layer of uncertainty as business owners try to make rational choices as to what to do. 

Jeffrey: Yeah. I mean it’s as you were saying this affects companies of all sizes, of all ages. For the last couple minutes that we have together, if we could take a minute and talk about the nonprofit’s, right? These are companies that are probably hurting as bad if not worse than all the other for-profit companies. And you wrote recently that the coronavirus is a test of how philanthropists can use their wealth to fill an enormous gap in revenue for nonprofits. How hard if these nonprofits been impacted and how are these billionaires that you speak to and these philanthropists, how were they helping out?

Paul: It’s a great question. If you think about it, you first have two different sort of ways of giving money. You can give film property dollars philanthropy or you can do charity. Philanthropy is something that is planned out months or years in advance. I care about my Alma Mater, I care about this hospital, I care about this food program. Plant Charity is an immediate response to what is happening in the world. There is a hurricane in Haiti, it’s devastating, I’m going to give money. And so, understanding that, these philanthropist usually have a lot of things planned out and they’re going to give to the organization’s but now the pull is to give immediate to food banks, to give immediately to charities really focused on the impact of the coronavirus. Obviously, that’s incredibly important, but what happens is, any people only have a limited amount of money to give—even billionaires, all the money that was supposed to go to these other nonprofits that were for the arts, for music, school. They are now left wondering, “What’s going to happen? Where’s the money that was here?”. And you know the spring for most of these pretty much every nonprofit, the spring is the time to have benefits and these benefits bring in tremendous amount of money. Sometimes 25, 30, 40 percent of a non-profit budget. Well benefits aren’t happening now. So what we have here is kind of a perfect storm for these non-pandemic related nonprofits to wonder how are we going to survive. So, in this column you reference what some of the philanthropist I spoke to were doing was making sure they still fulfilled all of their pledges to the other nonprofits that they had support in so that those groups wouldn’t have to worry, “Can I keep my 20 employees, my 30 employees? Can I continue to do these after-school programs? Are these enrichment programs for kids?”  because that was a huge question mark and I don’t have the number on top of my head but nonprofits are something around eight or nine percent of GDP and they employ a lot of people as well. So that’s not an insignificant part of the economy and an insignificant part of the economy where you have to worry about people still having jobs. 

Jeffrey: It’s incredible, do you feel that speaking with some of the philanthropists, are they pulling forward some of their multi-year thinking and does that put them into different weird tax situation?

Paul: Well, good two part question because yes, they are pulling forward some of their giving. Many give through foundations, so they’ve already gotten the tax deduction when they’ve contributed to their private foundation. Many foundations have this requirement that you give at least 5% a year private foundation, but it’s not limited to that so they could give 10% 20% 25% whatever they want to do. They’re allowed to do that, but you know one provision in the Car Act [?] said, for brand-new cash donations, there used to be a limit as to how much of that cash donation you could deduct from taxes. It was about more or less about 50% if it was cash. Now a 100% of a cash donation could be deducted. So if you make a million dollars and you donate a million dollars in cash you pay no taxes this year, so that was a government program to help accelerate this giving. Now what are these philanthropist going to look like next year? I don’t know how many of them are even thinking about that because if we don’t get through this portion now, that beloved cultural organization in Seattle, is it going to be here right next year? It’s even, take the money. So, better act now while there’s this huge need than, wait and maintain your 5-year giving plan.

Jeffrey: Incredibly interesting, the impact as I said before the trickle-down, but the full economic impact is this having everywhere on businesses large and small new and old. But Paul, thank you so much for our conversation today and hope to have you back on a future episode and talk further about some of the other articles.

Paul: Thanks for having me. I really enjoyed it.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments or future story suggestions, please reach out to us on social media or email us at RPhealthcast@rooneyco.com or visit us on our website at rooneypartners.com/rphealthcast. Additionally if you like what you hear, please follow us, review us and share us with your friends and colleagues. Thank you, and we hope you enjoyed the RP Healthcast.

The series will explore the stories and value propositions of the companies shaping the future of medicine.  To learn about these stories, we thought it best to hand over the microphone to those who are building and writing about the future.

Therefore, we will be speaking with journalists at the forefront of healthcare reporting as well as the leaders of companies behind the latest breakthroughs in medicine and technology, and discuss the impact these companies have in today’s society to see how they benefit or make a difference in people’s lives.