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There’s a ‘Extreme Blood Scarcity’ within the U.S., Purple Cross Says

There’s a ‘Severe Blood Shortage’ in the U.S., Red Cross Says

As many Americans return to prepandemic lifestyles, hospitals are facing a new issue: a desperate need for blood.

Over the past few months, hospitals have seen a rise in trauma cases, organ transplants and elective surgeries, prompting a national blood shortage, the American Red Cross said last week.

The lack of blood is so great that some hospitals are pumping the brakes on the pace of elective surgeries and “delaying crucial patient care,” until blood supply levels rebound, Chris Hrouda, president of Red Cross Biomedical Services, said in a statement.

“The Red Cross is currently experiencing a severe blood shortage,” Mr. Hrouda said, adding that the organization was working to distribute more blood than expected over the past three months. “But we can’t do it without donors. Every two seconds, someone in the U.S. needs blood.”

The demand for blood is not new. There was also a shortage last year when blood donation centers were forced to close because of the coronavirus pandemic.

But in some ways, it seems more dire than before. During last year’s shortage, for example, Brian Gannon, chief executive of the Gulf Coast Regional Blood Center in Texas, said his organization had one or two days’ worth of Type O red blood cells, down from a normal supply of three to four days’ worth.

In recent weeks, Type O blood supply has been down to half a day’s worth, according to the Red Cross, which said there was also an “emergency need” for the donation of platelets, half of which go to patients undergoing cancer treatments.

Dr. Merlyn Sayers, president and chief executive of Carter BloodCare, based in Texas, called the need for blood a “national crisis.”

“Carter BloodCare dreads reaching the point, with blood inventories so jeopardized, that patients needing transfusion cannot be confident that the blood is there for them,” Dr. Sayers said.

The blood shortage is a result of two challenges caused by the pandemic — closing and reopening, Dr. Sayers said.

“In the first place, the pandemic, for more than a year, imposed conditions, such as social distancing, that were inimical to blood donation,” Dr. Sayers said, adding that many businesses that typically supported blood donation campaigns at workplaces had closed. “And now, with the gradual emergence from restrictions, hospital demands for blood have increased dramatically as patients who understandably avoided hospitalization for fear of Covid are presenting for treatment.”

The Red Cross said patients who did not seek care during the height of the pandemic in the United States were showing up in hospitals with “more advanced disease progression,” which in some cases requires more blood transfusions.

In addition to patients who delayed seeking treatment for fear of the virus, another possible reason for the increased demand for blood is that as cities reopen, more people are exposed to potential dangers leaving their homes.

The Red Cross said hospitals across the country had been responding to an “atypically high” rise in trauma cases and emergency room visits. The organization said it had seen demand from hospitals with trauma centers increase by 10 percent this year, compared with 2019.

“Where there’s more people on the road, there’s probably more accidents. We did quarantine for a long time,” said Cameron Palmer, a community development coordinator with the Gulf Coast Regional Blood Center in Houston. “Having more people on the road can cause more accidents, which can cause people to need more transfusions.”

The Gulf Coast Regional Blood Center is still making its collection calls, but hospitals have had a greater need for blood, Mr. Palmer said.

“It’s not really a shortage. It’s more of a usage,” he said. “It’s just that our hospitals are now asking for more than expected.”

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Moody’s on influence of Covid-led disruptions on India’s infrastructure corporations

Moody's on impact of Covid-led disruptions on India's infrastructure firms

A container ship has docked in the Indian Adani Port Special Economic Zone (APSEZ) in Mundra, India.

Sam Panthaky | AFP | Getty Images

India’s second wave of the coronavirus outbreak will affect the country’s infrastructure companies to varying degrees, according to Moody’s Investors Service.

Energy companies and ports are expected to withstand the effects of pandemic disruption compared to airports and toll road operators, the rating agency said in a recently released report.

The South Asian country suffered a devastating second wave as reported coronavirus cases rose sharply between February and early May. As a result, the hospitals were overwhelmed and medical supplies such as oxygen and medication were scarce.

While the central government was reluctant to issue another nationwide lockdown, as it did last year, state authorities tightened local restrictions – including regional lockdowns – to curb the spread of the virus.

“The lockdowns, along with changes in public behavior, are holding back economic activity and mobility, which will affect infrastructure companies in different ways,” said Abhishek Tyagi, vice president and senior credit officer at Moody’s, in a statement.

India’s regional lockdowns resulted in lower electricity demand as well as lower traffic for transportation companies. However, the availability of labor has not yet been significantly affected.

Here’s what Moody’s says about the country’s infrastructure companies:

power

The business models of rated utility companies enable them to handle the current decline in demand and withstand a moderate increase in the cash conversion cycle, which refers to the number of days it takes a company to convert its investments into cash flows from sales. This is because Indian power companies are dependent on state distribution companies, which are likely to find themselves in financial distress due to lower demand.

In the event that demand remains low for longer and there is a subsequent liquidity bottleneck, the electricity companies have good access to liquidity and support, according to Moody’s.

Airports and toll road operators

Moody’s believes that the recovery of Indian airports, some of which are undergoing debt-financed expansion plans, will be further dampened by the second wave and subsequent regional lockdowns. International travel is expected to take even longer to recover due to border closings.

Although domestic and international traffic will increase between October this year and March 2022 – the second half of India’s current fiscal year – Moody’s said the disruption caused by the second wave “will likely result in lower traffic and revenue in fiscal 2022, and potentially for fiscal 2023 compared to our previous projections. “

The rating agency downgraded Delhi International Airport to a B1 rating this month – which is viewed as speculative and high credit risk – and said the airport is likely to need additional debt to complete its expansion due to lower operating cash flow .

An increase in Covid vaccination rates in India could be an important driver for an airport recovery, according to Moody’s.

Prolonged restrictions on movement or repeated blocks will continue to have a negative impact on toll road operators and put their credit quality under pressure, according to the rating agency.

Ports

India’s rated ports performed well in the past financial year despite the economic downturn due to the pandemic and, according to Moody’s, were able to improve their market shares.

Port operators have remained largely unaffected by the regional lockdowns as “goods traffic has remained normal across the country and both ports also have sufficient buffers in their financial profiles to accommodate temporary disruptions,” Moody’s said.

Road to economic recovery

The daily reported Covid-19 cases in India have been on a downward trend since their peak in early May. As the situation gradually improves, many states are easing restrictions to reopen the economy, but experts are warning of an inevitable third wave of infections.

Moody’s pointed out that if vaccination rates are still relatively low, the risk of subsequent waves of infection remains open, which could lead states to introduce further bans.

“The government’s ability to contain the spread of the virus and significantly step up its vaccination campaign will have a direct impact on economic recovery,” the rating agency said.

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The Pandemic Appears to Have Made Childhood Weight problems Worse, however There’s Hope

The Pandemic Seems to Have Made Childhood Obesity Worse, but There’s Hope

But while it has been possible to identify ways that schools can help prevent B.M.I. increases, it has been harder to figure out how to replicate those conditions when classes aren’t in session. For example, only about three million of the 22 million children who receive free or reduced-price lunch during the school year get the meals they’re eligible for over the summer. Those meals are typically more balanced nutritionally than the cheaper, calorie-dense fare that families resort to when food is scarce. Inconsistent access to food can also cause physiological changes that heighten the risk of obesity; school closures and job losses during the pandemic greatly increased the number of children without a stable source of nutrition. In June 2020, more than 27 percent of U.S. households with children were experiencing food insecurity; in about two-thirds of them, there was evidence that the children, in addition to adults, weren’t getting enough to eat — more than 5.5 times the number who reported those circumstances in all of 2018, according to the Brookings Institution. In addition, many families with sufficient resources were buying more ultraprocessed, shelf-stable foods for comfort and in preparation for possible lockdowns or supply shortages.

The crisis did force federal, state and local agencies to improvise novel ways of getting more balanced meals to children outside a school setting. To limit infection risk and reach more students, for instance, the U.S.D.A. offered waivers to what is known as its “congregant feeding” requirement that children eat on-site. This allowed caregivers to pick up multiple days’ worth of meals; some districts converted school buses running along their regular routes into a food-delivery service. The agency also made all children eligible for free lunch through September 2021, eliminating the paperwork required to qualify and the stigma that often comes with it, says Eliza Kinsey, a professor of epidemiology at the Mailman School of Public Health and an author of the Obesity paper. Such “program flexibility,” she points out, “could be applied in other, non-Covid contexts,” such as during the summer or for other disruptions like hurricane and wildfire closures.

It stands to reason that broadening access to nutritious foods would help prevent childhood obesity going forward. But schools also play a central role in the collection of nationally representative health data for children, a process that has been disrupted by school closures. We don’t know yet if the nearly 2 percentage point increase observed in the Philadelphia area will be similar across the country — or how much expanded feeding programs have mitigated the many and varied risk factors for obesity imposed by the pandemic.

Still, other pediatric hospital networks have reported worrying increases not just in obesity but also in the conditions that go with it. In a study published in April in the journal Diabetes Care, researchers noted a sharp increase in 2020, compared with previous years, of the number of children who showed up at Children’s Hospital Los Angeles with a severe form of new-onset Type 2 diabetes called diabetic ketoacidosis. That might be because children were eating poorer-​quality food and moving less, according to the lead author, Lily Chao, interim medical diabetes director at the hospital. It could also be that worries about the coronavirus induced families to delay seeking treatment for their children’s symptoms until they were in diabetic ketoacidosis.

A better understanding of how and why the pandemic affected children — not just physically but also emotionally and academically — would improve the ability of pediatricians, parents and policymakers to facilitate their recovery. Unfortunately, what is clear is that for children whose B.M.I. increased, “there are no magic bullets,” Black says. And, she adds, “it’s not healthy for kids to think about losing weight.” Rather than try to undo a past B.M.I. increase, a better strategy is to try to slow future ones and establish healthy habits. There is some good news in the fact that children tend to experience a growth spurt during puberty, says Risa Wolf, a pediatric endocrinologist at the Johns Hopkins Hospital; this can enable them to redistribute added weight on a taller frame. Wolf suggests parents focus on trying to build physical activity into their kids’ daily routine; the C.D.C. recommends 60 minutes for school-age children. And cutting fruit juice and soda from children’s diets is an easy way to significantly reduce sugar and calorie intake, Chao says.

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Hundreds of thousands might be affected by lengthy Covid, British research suggests

Symptoms, spread and what to look out for

Healthcare workers in North Memorial’s 2019s South Six and South Seven Intensive Care Units treated patients critically ill with COVID-19 on Monday, Dec. 7, 2020 at North Memorial Health Hospital in Robbinsdale, Minn.

Aaron Lavinsky | Star Tribune via Getty Images

A study in England looking at persistent Covid-19 symptoms suggests that around 2 million people in the country may have had the condition known as “long Covid.”

The study, part of Imperial College London’s REACT research which is tracking the virus in England, saw 508,707 people across the country of roughly 56 million asked whether they’d had Covid (confirmed or suspected), and asked about the presence and duration of 29 different symptoms linked to the virus.

Among the 76,155 participants that said they had experienced a symptomatic Covid infection, 37.7% said they experienced at least one symptom lasting 12 weeks or more, while almost 15% of people said they had experienced three or more symptoms lasting 12 weeks or more.

The symptoms of long Covid can vary, with people reporting ongoing fatigue, shortness of breath, memory loss or problems with concentration (dubbed “brain fog”), insomnia, chest pain or dizziness, as well as other symptoms. But it is still poorly understood and scientists don’t yet know why some people continue to have symptoms post-Covid, and others none.

“In this large community-based study of symptoms following Covid-19 among adults aged 18 years and above in England, participants reported high prevalence of persistent symptoms lasting 12 weeks or more,” the researchers at Imperial noted of their latest study.

Extrapolating the findings in the study to the wider Covid backdrop in England, where there have been 4.07 million Covid cases confirmed to date, the study could mean that over 2 million adults who have had the virus in England may have experienced some form of long Covid.

“Estimates ranged from 5.8% of the population experiencing one or more persistent symptoms post-Covid-19 (corresponding to over 2 million adults in England), to 2.2% for three or more persistent symptoms (just under a million adults in England),” the researchers noted.

They said that their estimates of the proportion of people with persistent Covid symptoms were higher than in many other studies, although previous estimates have varied widely.

“Our comparatively high estimate, at 37.7% of people with Covid-19 experiencing one or more symptoms at 12 weeks, may partly reflect the large list of symptoms we surveyed, many of which are common and not specific to Covid-19. However, we asked participants only about symptoms that they related to a confirmed or suspected episode of Covid-19, and not to symptoms more generally.”

Scientists are still investigating long Covid, and experts have urged the British government to address its public health implications; the National Health Service has opened long Covid assessment centers, for example.

“A substantial proportion of people with symptomatic Covid-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long Covid which may require tailored therapeutic approaches,” researchers at Imperial said.

The survey data was collected between Sept. 15 last year and Feb. 8 and the study is a preprint, and has not yet been peer-reviewed or published in a journal. 

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Serving to Drug Customers Survive, Not Abstain: ‘Hurt Discount’ Beneficial properties Federal Help

Helping Drug Users Survive, Not Abstain: ‘Harm Reduction’ Gains Federal Support

GREENSBORO, NC – The skinny young man quietly walked into the room while waiting for the free supplies to help keep him from dying: sterile water and a stove to dissolve illegal drugs; clean syringes; Alcohol swabs to prevent infection; and naloxone, a drug that can reverse overdoses. A sign on the wall – “We stand to love drug users for who they are” – felt like a hug.

It was the first day on which the contact point in a residential area here opened its doors since it was closed due to the coronavirus in spring 2020. “I am very happy that you have all opened again,” the man, whose first name is Jordan, said a volunteer who handed him a full paper bag while heavy metal music played over a loudspeaker in the background. He asked for extra naloxone for friends in his rural county, an hour away, where it was in short supply during the pandemic.

The death toll from overdose rose nearly 30 percent to more than 90,000 in the twelve months that ended in November, according to preliminary federal data released earlier this month – suggesting 2020 beat recent records for such deaths Has. The astounding surge during the pandemic is due to many factors including widespread job losses and displacement; decreased access to addiction treatment and medical care; and an illicit drug supply that became even more dangerous after the country was closed.

But the forced isolation for people struggling with addiction and other mental health issues is possibly one of the greatest. Now, with the nation reopening, the Biden government supports the controversial approach the center is taking here known as harm reduction. Rather than giving drug users abstinence, the main goal is to reduce their risk of dying or developing infectious diseases like HIV by providing them with sterile equipment, tools to check their drugs for fentanyl and other deadly substances, or even a safe place to nap Will be provided .

Such programs have long been under attack to facilitate drug use, but President Biden has made expanding harm reduction efforts one of his drug policy priorities – the first president to do so. The American Rescue Act earmarked $ 30 million specifically for evidence-based harm reduction services, the first time Congress has raised funds specifically for that purpose. Funding, while modest, is a victory for the programs, both symbolically and practically, as they often run on tight budgets.

“It’s a tremendous signal to recognize that not everyone who uses drugs is ready for treatment,” said Daliah Heller, director of drug-use initiatives at Vital Strategies, a global health organization. “Harm reduction programs say, ‘Okay, you do drugs. How can we help you stay safe and healthy and alive in the first place? ‘”

Although some programs like this one, run by the North Carolina Survivors Union, managed to keep holding some supplies – handing them through windows, offering roadside collection, or even mailing them – practically all of them stopped during the pandemic To invite drug users. Many customers, like Jordan, stopped coming and lost a trustworthy safety net.

Some former Greensboro Center regulars have died or disappeared. Many lost their homes or jobs. At the same time, the center was flooded with new customers and is now having problems keeping enough supplies on hand.

“The struggle that people are having right now, unrecognized and unanswered, is really difficult,” said Louise Vincent, Executive Director of the Survivors Union.

Yet many elected officials and communities continue to refuse to provide people with medication for drug use, including recently introduced test strips to screen drugs for the presence of illegally manufactured fentanyl, which appears in most overdose deaths. Some also say that syringes from harm reduction programs litter the neighborhoods or that the programs lead to an increase in crime. Researchers deny both claims.

West Virginia has just passed law making syringe service programs very difficult to operate, despite an increase in HIV cases from intravenous drug use. The North Carolina Legislature pondered a similar proposal this spring, and elected officials in Scott County, Indiana, whose syringe exchanges helped contain a major HIV outbreak six years ago, voted this month to end it. Mike Jones, a local commissioner who voted to end the program, said at the time that he feared the syringes being distributed could contribute to overdose deaths.

“I know people who are alcoholics and I don’t buy them a bottle of whiskey,” he said. “And I know people who want to kill themselves and I won’t buy them a bullet for their gun.”

Many harm reduction programs are carried out by people who have previously or are still using drugs, and their own struggles with addiction, mental illness, or other health problems have also flared up during the pandemic. In Baltimore, Boston, New York and elsewhere, beloved movement leaders themselves have died of overdoses, chronic health problems, and other causes in the past year. Her death left gaps in efforts to continue providing services.

Ms. Vincent, whose own opioid addiction stemmed from a long battle with bipolar disorder, made a brief return to illicit drug use this spring. She was keen to prevent withdrawal, she said after trying unsuccessfully to switch from methadone to another anti-craving drug, buprenorphine. She later learned that the small amount of fentanyl she was using was mixed with xylazine – an animal sedative that can cause weeping ulcers on the skin. She ended up in the hospital with her hemoglobin level so low that she needed a blood transfusion.

At the start of the pandemic, Ms. Vincent said street drug prices soared. Then drugs that were sold as heroin, methamphetamine, or cocaine were trimmed with unknown additives. Fentanyl was ubiquitous – including increasingly in counterfeit pills sold as prescription pain relievers or anti-anxiety drugs. But also substances like xylazine, which appears in illegal drugs from Philadelphia to Saskatchewan.

“It’s just poison,” said Ms. Vincent, who is being treated with methadone again. “The drug supply is like nothing we’ve seen before.”

On the afternoon of the center’s reopening, a young woman asked for a refresher on how to inject naloxone and if Ms. Vincent could explain what a meth overdose looks like. An older man asked if there was anything to eat besides clean syringes; a volunteer put a pastry in the microwave for him.

In addition to running the program here, Ms. Vincent is the executive director of the National Urban Survivors Union, a larger nonprofit, promoting harm reduction services across the country. In 2016, her 19-year-old daughter died of a heroin overdose while she was in an inpatient treatment center where naloxone was not available, she said.

Naloxone is more common now, but Ms. Vincent wants another life-saving tool to be disseminated: drug control programs that would allow people to find out exactly what substances are in illicit drugs before using them. Such programs exist legally in other countries including Canada, the Netherlands and New Zealand. Another type of harm reduction program used in other countries – where people use illicit drugs under medical supervision if they overdose – remains illegal here after a group trying to start one in Philadelphia so far lost in court.

“We cWe could have a real-time monitoring system instead of waiting for death reports from the coroner, ”Ms. Vincent said. “It would change the game, wouldn’t it?”

She found the xylazine in the drugs she recently took with a device called a Fourier Transform Infrared Spectrometer that a donor gave to her group this year. It can determine which substances contain samples of street drugs in minutes.

Jordan, who is 23 years old, had traveled from Stokes County, near the Virginia border, where the pre-pandemic overdose rate was nearly double the national average. His cousin, he said, was hospitalized weeks earlier after overdosing on a “really bad batch” of fentanyl that were found to contain traces of heavy metals in tests.

“At least 50 people in my area were rescued from here by Narcan,” he said, picking up several boxes of 10 vials of the injectable form of the antidote. “Even my grandmother knows how to manage it.”

Many harm reduction programs, including this one, help or sometimes even offer people to put people on drug treatment. But Jordan is one of the many drug users who are not interested in this path, at least for the moment. The next programs are in Greensboro or Winston-Salem, each a healthy drive from home. And treating food cravings like buprenorphine or methadone, which have been shown to save lives, “doesn’t really work for me,” he said.

The county that includes Greensboro, North Carolina’s third largest city, had 140 fatal overdoses last year, up from 111 the year before. The numbers don’t include the people who died from infections caused by injecting drugs, including the fiancée of a woman who walked into the center at dusk on the day of the reopening and called out to Ms. Vincent, “Where’s Louise?”

She met Ms. Vincent when they were both patients in a methadone clinic six years ago and regularly came to the center for injections and naloxone. She and her fiancé had tried to stop drug use during the pandemic, unnerved by the strange new adulterants that were showing up in the stash. But her fiancé started developing a high fever last December and was admitted to a hospital intensive care unit, seriously ill with endocarditis, a heart valve infection that can result from injecting medication. He died just before Christmas.

“Do you all have a meeting tonight?” Asked Ms. Vincent, referring to the self-help groups the center held several times a week before the pandemic.

“You’ll start again soon,” Mrs. Vincent assured her. “Being connected is much more important than any of us thought.”

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Doximity CEO ignored Silicon Valley knowledge, constructed $10 billion firm

Doximity CEO ignored Silicon Valley wisdom, built $10 billion company

Jeff Tangney, CEO, of Doximity at the New York Stock Exchange for their IPO, June 24, 2021.

Source: NYSE

Jeff Tangney launched his first health-tech start-up, Epocrates, in the middle of the dot-com bubble. While the company survived the crash and eventually went public, the endgame was a disappointing acquisition for less than $300 million.

By the time Tangney started his next venture, Doximity, in 2010, he’d learned a few things: Don’t raise too much money. Don’t burn too much cash. Fix a real problem for doctors.

With Doximity, Tangney created a web service that’s both a professional network — think LinkedIn for doctors — and a secure way for medical experts to communicate and share information with patients and colleagues. It now counts 1.8 million medical pros in the U.S. as users, including over 80% of physicians.

On Thursday, Doximity debuted on the New York Stock Exchange, closing the week with a market cap of almost $10 billion after raising around $500 million in its IPO. Tangney’s stake is worth $2.9 billion.

Those are big numbers especially when you consider that, prior to this week, Doximity never showed up on a “unicorn” list of billion-dollar tech companies. Its last financing round in 2014 valued the company at under $400 million. Tangney said that because Doximity is profitable it still hasn’t touched the $50 million it raised seven years ago.

“I did resist some of the Silicon Valley wisdom of, you need to go big, you need to hire 40 more salespeople and do all these things,” Tangney, 48, said in an interview on Thursday, after ringing the bell at the NYSE.

In Doximity’s target market, there’s no point in aiming for rocketship growth, Tangney said. The company generates revenue from drugmakers, who use the site to market treatments to a very targeted audience, and health systems looking to promote content to doctors across the country. It’s also a recruiting tool hospitals and health centers use to fill key jobs.

Tangney recognized early on that he could expand only as rapidly as customer budgets would allow.

“The reality of health care and our clients, who are very staid institutions, a lot of non-profits that have been around for 100 years, is that even if you lean in and hire tons of sales and marketing people, they’re not going to let you grow,” Tangney said.

He’s also not inclined to pay for branding just for the sake of building his profile — another reason why the company has remained largely unknown in Silicon Valley even though it’s headquartered in San Francisco. Doximity’s advertising budget for last fiscal year totaled $2.6 million, or roughly the amount Uber spends on an average day.

Tangney said the best advertising has come from doctors touting the product within their practitioner networks.

Meanwhile, the company generated over $200 million in revenue last fiscal year and produced over $50 million in net income.

Climbing trip at Stanford

Tangney’s journey to Doximity started in the late 1990s while he was living in New York with a trained physician named Richard Fiedotin. From their un-air-conditioned apartment, the pair came up with the idea of creating an app for the Palm Pilot, which had just hit the market, that would allow doctors to get critical information.

Tangney and Fiedotin took that idea with them to Stanford Graduate School of Business, where they met another physician named Tom Lee. The three bonded over the intersection of tech and health care while on a teambuilding climbing trip for students in the program.

In 1998, they started what became Epocrates, and over the next two years raised about $40 million from some of Silicon Valley’s top health investors. As mobile moved to BlackBerry devices and then to iPhones, Epocrates gained traction as a way for doctors to make decisions about prescriptions and patient safety while on the move.

The venture capitalists told Tangney to hire like crazy, so he did. Then came the tech crash and the crisis from the 9/11 terrorist attacks. In 2002, Epocrates was forced to cut a bunch of jobs, Tangney said.

The company held on, but it was a slog. Fiedotin left a few years later, and Lee departed to start One Medical, a chain of primary care clinics that uses technology to improve the patient experience. Tangney stuck around a bit longer, and tried to take Epocrates public. Then came the financial crisis of 2008, and the company had to withdraw its prospectus.

Tangney finally left in late 2009, a year before the eventual IPO and four years before Athenahealth bought the company for $293 million.

“There was a point during the last couple years of my tenure where it felt like we were in this tunnel, marching toward a goal,” Tangney said. “I wasn’t having as much fun. When you’re not in that place of loving what you do, you’re not doing your best work.”

Tangney had spent the past decade selling products to medical centers and talking to doctors about the challenges they faced doing their jobs. He kept those conversations going and learned that communication was a constant point of stress, whether it’s getting in touch with patients, other doctors, administrators or recruiters. In Tangney’s estimation, 80% of communication in the industry “is done via snail mail and fax.”

“Software is indeed eating the world but it kind of choked a little bit on health care,” he said.

Shari Buck had worked with Tangney at Epocrates. She’s one of the first people he approached with the idea of creating a professional network designed for doctors. Buck said she hopped on board “without reservation,” joining as one of the three co-founders, along with Nate Gross, a doctor who is also the founder of health-tech incubator Rock Health.

Doximity co-founders Jeff Tangney (left), Nate Gross and Shari Buck

Doximity

“Before we had an office, Jeff would drive up to Marin to meet me,” Buck said. “We would meet in a workspace above the garage. We used to laugh at how Apple it was,” she said, referring to the storied location where Steve Jobs and Steve Wozniak started their computer company.

Tangney also turned to Lee as a sounding board and advisor. At One Medical, Lee had the perfect test audience for Tangney: A growing base of doctors who were enthusiastic about technology.

At the time, Tangney was not at all focused on revenue, but was rather pursuing an approach more akin to consumer internet start-ups, trying to build a big base of engaged users with the hope that money would eventually follow.

Lee said they batted around ideas for future revenue opportunities. Helping medical recruiters find talent was a clear possibility.

“Recruiting doctors is not a well-defined profession and had been done poorly,” said Lee, who’s now founder and CEO of health company Galileo. “A doctor receives a lot of job opportunities. In classic medical marketing, you’d get these glossy photos of opportunities that were completely outdated, showing glorious pictures of suburban communities and symphony life and fishing.”

Best ideas come over cocktails

For Tangney, product development at Doximity has always been centered around what doctors need. So he created a medical advisory board a decade ago, bringing together a few dozen physicians in the network for a weekend every year.

The group gets together on a Saturday afternoon to provide feedback on new products, learn about updates that could be coming and for some general brainstorming. The talks continue informally over evening drinks and then resume Sunday morning, ending with lunch.

“Software is indeed eating the world but it kind of choked a little bit on health care.”

While Doximity had to skip this year’s gathering because of Covid-19, the event has been held in Napa and at Pebble Beach, and more recently at the company’s San Francisco office.

“It’s been probably the biggest influence on our product roadmap,” Buck said. “We talk about what we plan on building, individual features and new crazy ideas that we have. The best ideas come at cocktail hour on Saturday night.”

Buck said Tangney is known for carrying around little notebooks that he diligently fills up cover to cover over the two days.

Kevin Spain of Emergence Capital attended the Napa weekend in 2012, not long after his venture firm led Doximity’s first investment, a $10.8 million financing round.

Spain was thoroughly invested in Doximity’s success, and not just because of the money Emergence had on the line. He wasn’t yet a partner at the firm but had convinced his superiors to back a pre-revenue business. It was an atypical bet for Emergence, which focuses on early-stage cloud software companies.

Spain said that while board meetings were instructive because he could see signups going in the right direction and engagement on the site increasing, the Napa weekend was much more insightful. He got to hear directly from doctors about what they needed to improve their practice.

“They felt like they had a hand in co-creating this thing Doximity was building,” said Spain, whose firm owns a $1.35 billion stake in the company as of Friday’s close. “I’d never seen that before.”

Some of those doctors ultimately made good money from the IPO. Doximity allocated up to 3.5 million shares to doctors on the platform, representing 15% of the offering. After Doximity’s stock price jumped 115% in its first two days, the value of shares owned by doctors climbed from $91 million to over $195 million.

“Physicians are sort of outsiders in the financial markets and business world,” Tangney said. “Yet in our life and world they’re the insiders, they’re the people we care about most. We’d rather the shares go to them if there’s a pop than to some hedge fund somewhere.”

One challenge for Tangney as he continues to seek expansion opportunities is that there’s a finite universe of users and the core product already reaches the vast majority of them. The company serves more than 80% of U.S. physicians and over 90% of recent medical school graduates. There are only about 1 million doctors in the country.

Still, Tangney sees a decade of revenue growth ahead. There are digital ad dollars to capture as pharmaceutical companies move spending online. And there’s the power of medical referrals, helping doctors get patients to the right places based on where the top experts work and which hospital specializes in treating a particular disease.

Doximity also just entered telehealth, a $4.3 billion market opportunity, according to the prospectus. As a response to the pandemic, Doximity launched a video-based virtual visit service that doctors can use from their existing app and patients can use without having to download anything.

The company said it signed over 150 telehealth subscription agreements with medical systems and served over 63 million virtual visits in the fiscal year that ended in March. Yet the product only accounts for 2% of its revenue.

At the highest level, Tangney said, health care accounts for 18% of the U.S. economy, so there’s no shortage of money available if Doximity’s service continues to add valuable features.

“We’re steadfastly focused on these very busy million people who really take care of the sick all day and aren’t given great tools to collaborate with each other easily and to make care better,” he said.

WATCH: Disrupting Healthcare

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Ei-ichi Negishi, Nobel Prize Winner in Chemistry, Dies at 85

Ei-ichi Negishi, Nobel Prize Winner in Chemistry, Dies at 85

Ei-ichi Negishi, who shared the Nobel Prize in Chemistry in 2010 for developing techniques now ubiquitous in the manufacture of pharmaceuticals, died on June 6 in Indianapolis. He was 85.

His death, at a hospital, was announced by Purdue University, where Dr. Negishi was a professor for four decades. No cause was given.

Dr. Negishi’s Nobel-winning research involved chemical reactions that produce complex organic compounds — large carbon-based molecules used in drugs, plastics and many other industrial materials. Coaxing one carbon atom to bond to another can be difficult, but Dr. Negishi and other chemists figured out that metals, palladium in particular, could be used as intermediary matchmakers.

In these reactions, two carbon-based molecules first stick to the palladium. The palladium then disconnects from them, and the two carbons attach to each other, forming a new, larger molecule. With the palladium working as a catalyst, the organic chemistry reactions can run at lower temperatures with fewer steps, reducing cost and waste.

“It just allows this enormous selectivity,” said James M. Tour, a professor of chemistry at Rice University in Houston, who was a graduate student of Dr. Negishi’s. “When you build molecules, you have to be able to work on one part of the molecule without destroying the other part.”

Chemists had discovered the magic of palladium earlier, and in 1977 Dr. Negishi built on that work by using zinc compounds to ease the mingling of carbon atoms on palladium. That made the process more applicable to a wider range of reactions.

“Without organic compounds, none of us can live,” Dr. Negishi said in a news conference on the day the Nobel was announced. “One of our major dream goals is to be able to synthesize any organic compounds in high yield, high efficiency.”

He gave as an analogy the creating of elaborate Lego formations. “That is a pretty accurate description of what we have been trying to do,” he said.

Traditionally, organic chemists largely limited themselves to molecules using the 10 or so elements found in organic compounds. Dr. Negishi said that he and others had “realized that we should make use of the entire periodic table.”

By expanding to other elements like palladium, chemists in effect increased the number of Lego pieces they could use, and that opened new avenues to synthesize the molecules they wanted to make.

Dr. Negishi shared the 2010 Nobel in Chemistry with Richard F. Heck of the University of Delaware and Akira Suzuki of Hokkaido University in Sapporo, Japan.

Unlike many Nobelists who say they never expected to receive the highest honor in the science world, Dr. Negishi said it was “not a major surprise” to receive an early morning phone call on Oct. 6, 2010, from the Royal Swedish Academy of Sciences, which administers the Nobels.

Dr. Tour said Dr. Negishi had pursued research that he thought was Nobel-worthy. “He dreamed about it,” Dr. Tour said. “He often discussed the Nobel Prize. And what would have to be done to win this.”

To that end, Dr. Negishi could be relentless. “He was extremely exacting,” Dr. Tour said. “He had no trouble pushing people to the point of tears at a blackboard.”

Dr. Tour said Dr. Negishi also had a generous side. “If anybody would walk up to his office door and knock, his door was always open,” Dr. Tour said. “And you’d usually sit down for much longer than you bargained for, because he analyzed the whole project you’re working on, not just the question that you’re asking.”

Ei-ichi Negishi was born on July 14, 1935, in Changchun, China, then known as Hsinking, the capital of the Japanese-controlled part of the country, in the northeast. His family moved to Tokyo after World War II and then to a rural area outside Tokyo, where his father farmed and his mother took care of the family’s five children.

After graduating from the University of Tokyo in 1958 with a bachelor of engineering degree, he worked as a research chemist at the Iwakuni Research Laboratories in Japan. By his account, he realized that he needed more academic training but felt that graduate school was financially out of reach.

His fortunes changed in 1960, however, when he won a Fulbright scholarship to attend the University of Pennsylvania. After finishing his doctorate in 1963, he joined the laboratory of Herbert C. Brown at Purdue. Dr. Brown became the first Purdue faculty member to win a Nobel Prize, in 1979; Dr. Negishi was the second.

“In terms of research, he is my only mentor,” Dr. Negishi said of Dr. Brown in an interview after the Nobel announcement. “I have had other professors, but he taught me just about everything as to how to do research.”

Dr. Negishi moved to Syracuse University as an assistant professor in 1972 and returned to Purdue in 1979 as a professor. He retired in 2019, having been an author of more than 400 scientific papers.

In 2010, Dr. Negishi, who remained a Japanese citizen, received the Order of Culture from Emperor Akihito. He was elected to the National Academy of Sciences in 2014.

Survivors include two daughters, four grandchildren and one great-granddaughter. His wife of 58 years, Sumire, died in 2018.

“When he got his Nobel Prize, he became nicer,” Dr. Tour said. “He’d take his wallet out of his pocket, and protruding from his wallet was the Nobel Prize medallion.”

Dr. Tour said Dr. Negishi would pass the medal around and didn’t mind when someone once dropped it. “You could see the ding in one side of it,” Dr. Tour said. “And he just laughed about it.”

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5 issues to know earlier than the inventory market opens Thursday, June 24

5 things to know before the stock market opens Thursday, June 24

Here are the top news, trends, and analysis investors need to start their trading day:

1. Dow will jump according to economic data ahead of the infrastructure meeting

The New York Stock Exchange welcomes Sprinklr (NYSE: CXM) to celebrate its IPO on June 23, 2021.

NYSE

Dow futures surged more than 150 points after a string of economic data before the bell and renewed hopes for an infrastructure deal at a meeting at the White House later Thursday. The market’s comeback rally paused on Wednesday despite the fact that the Nasdaq managed to hit another all-time high and was expected to rise on Thursday. With a broad group of stocks jumping in pre-trading hours, the S&P 500 should open at new highs as well. The Dow was still climbing out of last week’s hole. Ahead of Thursday’s session, it was 2.6% off its most recent record high in early May.

Andreessen Horowitz announced a new cryptocurrency-focused fund worth $ 2.2 billion on Thursday. The venture capital firm from Silicon Valley, founded by Marc Andreessen and Ben Horowitz, launched its first crypto fund three years ago in the so-called “crypto winter”. This year, Bitcoin’s value is up about 80% from its 2017 highs. The latest fund also comes at another bearish moment for Bitcoin.

2. Three major government economic reports before the bell

3. Bipartisan senators are pushing for a $ 953 billion infrastructure plan

Senator Joe Manchin (D-WV) speaks to news reporters before attending an infrastructure meeting on Capitol Hill in Washington on June 23, 2021.

Tom Brenner | Reuters

A bipartisan group of senators see Biden’s support for a $ 953 billion infrastructure plan at Thursday’s session. Government officials and democratic leaders viewed the proposal as a positive development. The President’s latest offer was a $ 1.7 trillion package. With Republicans opposed to Biden’s proposed corporate tax rate hike, the bipartisan group is looking for other ways to increase revenue. Biden rejected her idea of ​​allowing gas taxes paid at the pump to rise with inflation.

4. Eli Lilly is aiming for accelerated FDA approval for Alzheimer’s drug in 2021

An Eli Lilly and Company pharmaceutical manufacturing facility is pictured on March 5, 2021 at 50 ImClone Drive in Branchburg, New Jersey.

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Eli Lilly’s shares rose 8% in the premarket on Thursday after the US drug maker announced it would file a market application for its experimental Alzheimer’s treatment under the FDA’s accelerated approval process later this year. Lilly said, “The safety, tolerability and effectiveness of donanemab are also being investigated in an ongoing late-stage study.” Earlier this month, three members of a key FDA advisory panel resigned over the agency’s controversial decision to approve Biogen’s new Alzheimer’s drug.

5. Team members vote on a major drive to unionize Amazon workers

The Teamsters will vote on a resolution on Thursday to step up efforts to organize Amazon employees. The e-commerce giant has long been the target of large unions trying to organize warehouse and delivery workers. Amazon defeated a senior union campaign in a huge warehouse in Bessemer, Alabama, in April. However, Amazon founder and CEO Jeff Bezos recently admitted that the company needs to get better from its people. The pandemic, the explosion of protests against Black Lives Matter last summer, and mounting concerns about job security have further fueled interest in the organization of Amazon warehouses.

– Reuters and The Associated Press contributed to this report. Follow the whole market like a pro on CNBC Pro. Get the latest on the pandemic with coronavirus coverage from CNBC.

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Is the Compelled Contraception Alleged by Britney Spears Authorized?

Is the Forced Contraception Alleged by Britney Spears Legal?

Among the astounding claims pop star Britney Spears made this week before a probate judge in Los Angeles as she attempted to end her lengthy conservatoire stint, was one that profoundly shook experts on guardianship and reproductive rights. She said a team led by her father, who is her conservator, prevented her from having her IUD removed because the team didn’t want her to have more children.

“Forcing someone to use birth control against their will is a violation of basic human rights and physical autonomy, just as it would be to force someone to become or remain pregnant against their will,” said Ruth Dawson, Principal Policy Associate at Guttmacher Institute, a research group that supports reproductive rights.

Court-approved contraception is rare in conservatories. But the specter it conjures up – forced sterilization – has a grim, long history in the United States, especially against poor women, women of color, and inmates. In the early 20th century, the state-sanctioned practice was upheld by the United States Supreme Court.

Although the court moved away from this position in the 1940s and the growing consent canon gave rise to consensus that forced sterilization was inhuman, the practice continued to be tacitly tolerated.

Finally, in the late 1970s, most states repealed sterilization authorization laws, although allegations of forced hysterectomies and tubal ligatures in women in immigrant detention remain. As recently as 2014, California formally banned the sterilization of female inmates without consent.

The sparse law on the question at the Conservatory suggests what an outlier the Spears case might be. In 1985, the California Supreme Court denied a petition from the legal guardians of a 29-year-old woman with Down syndrome who wanted her to have tubal ligation.

Usually, a restorer has temporary control over the finances and even medical care of an incapacitated person. Experts emphasized that Ms. Spears’ claim is unconfirmed. But if it’s correct, they said, the most likely rationale, even if suspicious, could be that Jamie Spears, her father, is trying to protect her finances from the father of a baby, possibly her boyfriend who is allegedly at odds with Mr. Spears is.

When a guardian is concerned that a community is making financially ill-advised decisions, “the cure is not to say they cannot reproduce,” said Sylvia Law, a health scientist at New York University School of Law. “It’s ineffable.”

According to fiduciary and inheritance experts, the few cases where a guardian, usually a parent, ordered a court to order contraception concerned severely disabled children.

“Such a child would not understand that a penis and vagina could make a baby,” said Bridget J. Crawford, an expert on guardianship law at Pace University Law School. “And that’s certainly not the case with Britney Spears.”

Eugenics was a major reason for female sterilization. In the Buck v. Bell in 1927, the Supreme Court upheld the right to sterilize a “moronic” woman who had been admitted to a state mental health facility, with Judge Oliver Wendell Holmes notoriously writing: “Three generations of morons are enough. ”

Although the opinion was never formally overturned, Judge William O. Douglas said in a unanimous court in the Skinner v. Oklahoma of 1942, in which the forced sterilization of certain convicted criminals was challenged that the right to procreation was fundamental. “Every experiment that the state carries out is irreparable to it,” he wrote. “He is forever deprived of a fundamental freedom.”

Although Ms. Spears was not sterilized, Ms. Crawford said if she was prevented from having her IUD removed it would be a proxy for sterilization, especially since she testified that she wanted to bear more children.

Melissa Murray, who teaches reproductive rights and constitutional law in NYU law school, pointed to another worrying element in the allegations made by Ms. Spears, who at 39, has been under her father’s tutelage for 13 years. Ms. Murray said Ms. Spears, an adult, appeared to have a legally constructed childhood.

“It’s unusual for her father to make the decisions we would expect parents to make in a teenager,” she added.

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FDA provides warning of uncommon coronary heart irritation to Pfizer, Moderna vaccines

CDC group says there isn't enough data yet to recommend booster shots

Vials with Pfizer-BioNTech and Moderna coronavirus disease (COVID-19) vaccine labels are seen in this illustration picture taken March 19, 2021.

Dado Ruvic | Reuters

The U.S. Food and Drug Administration on Friday added a warning to patient and provider fact sheets for the Pfizer and Moderna Covid-19 vaccines to indicate a rare risk of heart inflammation.

For each vaccine, the fact sheets were revised to include a warning about myocarditis and pericarditis after the second dose and with the onset of symptoms within a few days after receiving the shot.

Myocarditis is the inflammation of the heart muscle and pericarditis is the inflammation of the tissue surrounding the heart. Health officials said the benefits of receiving the vaccine still outweigh any risk.

“The risk of myocarditis and pericarditis appears to be very low given the number of vaccine doses that have been administered,” Janet Woodcock, acting FDA commissioner, said in a statement.

“The benefits of Covid-19 vaccination continue to outweigh the risks, given the risk of Covid-19 diseases and related, potentially severe, complications,” she said.

The FDA update follows a review and discussion by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices meeting on Wednesday. 

There have been more than 1,200 cases of a myocarditis or pericarditis mostly in people 30 and under who received the shots, according to presentation slides from the CDC meeting.

About 300 million shots had been administered as of June 11, according to the CDC. There have been just 12.6 heart inflammation cases per million doses for both vaccines combined.

— CNBC’s Berkeley Lovelace Jr. contributed reporting