Health—at What Price?

11/16/20 • 31 min

Imagine if the airline industry did not post prices for flights in advance. What if instead of posting fares on travel sites, airlines argued they could only bill you after the flight, because they didn't know what the fuel price will be that day; whether or not you would consume a beverage; if the flight might be diverted or delayed; whether that pilot would have to work harder and bill more in their coding of the flight after they land? And yet, this is exactly what happens in healthcare. Despite the cost crisis in healthcare, we still don't talk about prices—prices for procedures, for visits, for services. But in January 2021, thanks to new regulation, that will change. In this episode, a16z General Partner Julie Yoo talks with Dr. Marty Makary, surgical oncologist at Johns Hopkins University School of Medicine, health policy expert—and a longtime advocate for transparent pricing in the healthcare system. Makary argues that making prices obvious will change all kinds of behaviors in the healthcare system, not just allowing consumers to "shop" for the best value of different healthcare services, but will drive higher quality standards; minimize things like surprise billing and incentives towards volume; increase the rigor of analyzing the medical appropriateness of certain clinical decisions (do we need this elective procedure or not? is it good longterm value?); affect even how we choose our doctors; and much more.

Previous Episode

Journal Club: Defeating Type 1 Diabetes

Type 1 Diabetes is an autoimmune disease with no cure and challenging treatment regimes. The disease is characterized by self-reactive immune cells that attack and destroy cells in the pancreas that produce insulin and are essential for regulating metabolism, called beta cells.

Since the advent of stem cell technology, scientists have dreamed of curing Type 1 Diabetes by replacing the beta cells lost to disease with lab grown, stem cell-derived beta cells. However, it wasn't until recent work from Ronald Evans' lab at the Salk Institute that this dream started to become a reality. First, in 2016, Evans and colleagues identified a critical genetic switch needed to activate stem cell-derived beta cells. Second, in the article we discuss today, they figured out how to produce not just the beta cells from stem cells, but their entire cellular compartment, called the pancreatic islet. They call these synthetic islets HILOs (human islet-like organoids). Even more importantly, they devised a way to shield the HILOs from the immune system. This molecular shield, which they learned about from studying how pancreatic cancer cells evade the immune system, is the key to the long term survival of the HILOs despite this chronic autoimmune response.

In this conversation, host Lauren Richardson and Dr. Evans cover these key breakthroughs, the next steps for moving this proof-of-concept research into the clinic, and how these HILOs might represent a curative treatment for this devastating and life-long condition.

Next Episode

Journal Club: Decoding Developmental Disorders

Approximately half of all severe developmental disorders are caused by de novo (new, not inherited) mutations in protein-coding genes. But which genes? In this episode of the Bio Eats World Journal Club, Vineeta Agarwala (@vintweeta) and Lauren Richardson (@lr_bio) discuss a recent article finding new genes linked to developmental disorders and highlighting how many still need to be decoded.

Vineeta Agarwala, physician and a16z general partner, and host Lauren Richardson discuss the Nature article "Evidence for 28 genetic disorders discovered by combining healthcare and research data", its key implications, and how this work can impact patients and parents.