The Theranos Story, ch. 48: down to 24 employees in a last ditch before bankruptcy

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]The ground is next. Theranos is down to its last two dozen employees or less, in a bid to buy a few more months of time before bankruptcy, according to a breaking report in the Wall Street Journal.

The announcement was made by Elizabeth Holmes Tuesday to approximately 125 remaining employees at its downscale Newark, California headquarters. (This Editor wonders if she wore a black turtleneck.) Interestingly, Ms. Holmes remains CEO after settling civil charges with the Securities and Exchange Commission (SEC) while a criminal investigation continues out of the US Attorney’s office in San Francisco. 

The WSJ article from the estimable John Carreyrou (who deserves an old-school Pulitzer Prize for his investigative reporting) recaps Theranos’ fall for those who need it. But…there’s more. Theranos received only $65 million of $100 million promised in their last (ditch) funding from Fortress Investment Group late last year, revealed by Ms. Holmes in an investor email this past Tuesday. The remainder is contingent on Theranos achieving an FDA Zika blood test approval using their miniLab. She stated that this test is still having problems and appealed to investors for yet more funding. The layoffs were designed to keep their cash reserve over $3 million until the end of July, below which Fortress is entitled to seize Theranos’ assets and liquidate them. This, as we have previously noted, is Fortress’ specialty–as now fan dancing is Ms. Holmes’.

According to Mr. Carreyrou’s sources, Ms. Holmes is still living large in basic black. “Until Tuesday, Ms. Holmes still had two personal assistants and two security guards who drove her around in a black Cadillac Escalade SUV, according to the people familiar with the matter.” This Editor wonders what happened after Tuesday. Public transit? A used car for a few thousand?

Theranos and the $900 million in lost investment may have also put a wet blanket on 2017 health tech funding, based on what we’ve learned in Rock Health’s report [TTA 5 Apr]. Other companies with real advances and promise may be paying the price for Theranos’ hype and fakery.

Our 47 past chapters and other Theranos mentions are for your perusal in our pages here

The Theranos Story, ch. 36: Their money–and time–are running out

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]A garage sale soon for Theranos? A report in the Wall Street Journal, citing sources on a January investor call, revealed that Theranos has $200 million on hand, but zero revenue in 2015 and 2016. $200 million on hand sounds like–and is–a lot. But Theranos is, once again, oh so special. It’s less than 25 percent of their over $900 million raise. They’ve made no money in the past two years and are likely to make none in 2017 with an unapproved miniLab. Their CEO cannot run a lab by Federal action. They’ve laid off all but 200+ employees, all of whom with any shred of intelligence are job hunting. Then think of all the lawsuits: Walgreens Boots seeking to claw back its $140 million, individual and class actions on behalf of other investors, and the looming Arizona state fraud action. It’s a mere pittance when Theranos has to hire armies of attorneys who charge Billable Hours Galore and will likely lose some if not all of the lawsuits. This Editor is making an educated guess that at least one legal team is working on a bankruptcy filing. Fortune, TechCrunch, Business Insider

Forbes, like TechCrunch once a hyper-overdrive cheerleader for Ms Elizabeth Holmes and Theranos, offers up a profile of John P.A. Ioannidis, MD, DSC who holds the C.F. Rehnborg Chair in Disease at Stanford University and is director of the Stanford Prevention Research Center at the School of Medicine. Dr Ioannidis, according to the article, was the first to raise questions about Theranos’ methodology based on the obvious–that Theranos had published nothing in scientific journals. Theranos’ general counsel then reached out to suggest co-authoring an article with Ms Holmes in a major journal. Per Dr Ioannidis, it would support “the company view that FDA clearance offered the highest possible level of evidence for any diagnostics blood test technology.” They also said, “recant your existing views and writings about these misgivings.” He did neither, to his credit. The article interestingly does not explore the heat he, in as prestigious a position as he was, must have received, based on the close ties this Editor and others have noted between Stanford and Ms Holmes. Hat tip to Bill Oravecz of Stone Health Innovations

“This is the way the world ends/Not with a bang but a whimper.” T.S. Eliot puts a fine point on a Hollow Company, indeed.

See here for the 35 previous TTA chapters in this Continuing, Consistently Amazing Saga.

Rock Health announces its Top 50 in digital health (US)

This Editor observes that digital health is at the state of maturity (so to speak) where entities assemble a Top 50 list and host a dinner to pass out awards. Rock Health, Fenwick & West, Goldman Sachs and Square 1 Bank cast a wide net from investment to startups in their just-released list. (Of course there will be a glitzy dinner, soon, at the kickoff of the JP Morgan Healthcare Conference, 9 – 12 January 2017 in San Francisco. Want an invite?)

Of great delight is an award to John Carreyrou of the Wall Street Journal as Reporter of the Year for his investigative work on Theranos. Other highlights are Validic (clinical/wellness data integrator) as Fastest Growing Company, Evolent Health for Best Performing IPO and BSX Technologies‘ LVL hydration monitor as Crowdfunding Hero (having raised $1.1 million when goal was $50,000). Rock Health website

What is increasingly curious to this Editor is that digital health companies, in nearly all cases, aren’t crossing borders and oceans. Every one seems to stick and be unique to its own country of origin, creatures of their own unique petri dish.

Also in other Rock Health news, having evolved a position as a venture fund/business support provider, they have added to their list of prominent partners kidney care and medical group operator DaVita. Rock Health release.

The Theranos Story, ch. 24: looking for the nadir in Walgreens’ lawsuit

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/11/jacobs-well-texas-woe1.jpg” thumb_width=”150″ /]When will we find the nadir of Theranos’ business practices? Between the excruciating details of the Walgreens lawsuit and the treatment of an employee who knew the truth in 2014 (part 2), the bottom, like Jacob’s Well in Texas at left, may be unfindable.

The first is what is revealed in the public version (filed 15 Nov) of the civil complaint filed with the US District Court, District of Delaware (PDF). While heavily redacted in parts of text and in the exhibits, it is damning if all true–and there is little available information that does not fit Walgreens‘ narrative, though this Editor was left wondering why red flags about Theranos didn’t flap ‘n’ fly at Walgreens much earlier, especially with a reported $140 million investment at stake.

The relationship began in January 2010. A March presentation by Theranos included some astonishing claims: the Theranos finger-stick blood draw lab analysis had been comprehensively validated by ten of the leading fifteen pharmaceutical companies over seven years; that bio-pharma companies, “prominent research institutions, and US and foreign government health and military organizations” had already used the technology; that Theranos was capable of launching it in retail stores by end of 2010. They also represented that they were positioned with FDA to introduce the technology outside of clinical studies. Johns Hopkins, contracted by Walgreens to validate their methodology, could only work with data provided by Theranos.

Did anyone at Walgreens think to check with said pharmas, researchers, government health and military organizations? There was time. The master agreement was not signed until 2012 and pilot stores opened in 2013.  (Pages 5-10, section 24 through 50). Interestingly, pages 11-12 which may deal with the labs, as well as many other parts, are heavily redacted.

In short, there is a gap of at least two years when Walgreens could have double-checked Theranos’ claims and methods, especially in the crucial period before pilot locations were opened. (To be fair, Theranos successfully maintained a veil of secrecy and a wall of PR smoke.) But the repercussions were huge.  It seems that Walgreens only woke up from the dream when the Wall Street Journal published its investigation another two years later in October 2015. In the immediate aftermath of the article, Walgreens learned that Theranos had abandoned the finger-stick draws…and that the head of the Newark CA lab was a full-time dermatologist onsite once a week (page 15).

After that point, the Theranos fan dance with Walgreens accelerates.

  • Theranos concealed the January and March 2016 CMS notices and subsequent reports on its labs to Walgreens until again the WSJ publicly revealed it (pages 17-18, 25). They also attempted to conceal the CMS rejection of the Plan of Correction for its labs (page 24).
  • Theranos accused Walgreens of breaching the agreement and confidentiality to the WSJ , and also cited delay in building out Wellness Centers–in February 2016 (pages 20-21)
  • Walgreens received nothing but evasions from Theranos including no notification of ‘tens of thousands’ voided results, including critical PT/INR coagulation results, until after the WSJ broke that bit of news on 18 May (page 26).

By 12 June 2016, the wheels were fully off (and the world was minding, indeed) and Walgreens called the breach of warranty. But even then, this was not until a final push–lawsuits were filed against both Theranos and Walgreens starting in late May.

One wonders how many reputations are on a stake (to mix two metaphors) at Walgreens Boots. Details in Ars Technica (which obtained the PDF and broke the story) and of course Neil Versel’s acerbic POV in MedCityNews. Hat tip to reader David Albert MD of AliveCor.

See here for the 23 previous TTA chapters in this Continuing Saga.

The Theranos story, ch. 17: closing the barn door after the horse

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /] And it may work, though the horse is in the next county. Late last week, with American eyes elsewhere, Theranos announced that they hired two executives with regulatory responsibility–a chief compliance officer and an VP regulatory and quality–and formed a new board committee focused on same. The CCO is Dave Guggenheim, the former assistant general counsel for regulatory law at HIT/medical distribution giant McKesson. The VP, Daniel Wurtz, comes from a similar senior director position at biotech Thermo-Fisher Scientific.

The country maxim, ‘closing the barn door after the horse has bolted’, applies. In fact, the horse is in town and having a growler of beer at the local tavern. The Newark, California lab is shut and the principals, including the CEO Ms Holmes, are technically prohibited from operating a lab for at least two years (that means you, Ms Holmes) starting in a month. Messrs Guggenheim and Wurtz (or similar) should have been on board years ago. Even small companies in our field realize they HAVE to do this!

This also doesn’t affect the interesting interest that DOJ and SEC have in Theranos. [TTA 10 July]

However, this Editor will take the contrarian view that somehow, some way, the ‘fix’ is being worked out, if not in. Don’t make reservations for the fire sale quite yet. The ban on Ms Holmes won’t take place for another month, minimum. That gives time for David Boies, their legal supremo, and his firm to stall for more time, and time for some calls to ask favors from friends, of which he has many in this administration. More than likely, Boies on behalf of Theranos will appeal the CMS rulings to an administrative judge. Ms Holmes may take the hit, but may get a handsome payday to depart despite her reported control, if the investors can salvage something out of the company.

At HQ, they may be rehearsing saying ‘mea culpa, mea culpa, mea maxima culpa’ three times, kneeling deeply, in preparation to Going Forth And Sinning No More.

The Object Lessons taught by the Theranos Troubles, to us in healthcare tech, continue.

WSJTheranos Hires Compliance, Regulatory Executives  (more…)

Stop the Internet of Things Monster!

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/06/robottoy-1.jpg” thumb_width=”150″ /]A cry from the heart (or aching head) indeed! The overhyped, overheated and overblown Internet of Things (IoT) gets a good and deserved lampooning from tech writer Joanna Stern. If you take seriously a egg tray that tells you when the hen ova are getting few or old, an umbrella that signals you when it’s left home, a connected toilet seat and a juicer that only works when it’s on Wi-Fi, you’ll think the writer is a Luddite. But if you think 95 percent of IoT is ridiculous (save a Few Good Apps) and Overload Reigns in Solving Problems Which Aren’t, you’ll enjoy The Internet of Every Single Thing Must Be Stopped (Wall Street Journal). (Ms Stern would be undoubtedly appreciative of the ‘‘Uninvited Guests’ that nag and spy. And she doesn’t even get into the hackable dangers of Interconnected Everything.)

Nail in the coffin hammers home: Theranos voids, corrects 2 years of test results

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]Tens of thousands of lab results 2013-2015 voided, “corrections” sent. L’affaire Theranos continues, with the not-so-surprising action of Theranos to void all of its Edison machine testing results, from all labs, as well as many processed on conventional equipment during those years.

According to the Wall Street Journal, Theranos told CMS during its lab inspections that they ran 890,000 tests a year, so we are between 1.5 and 2 million tests being, at minimum, voided. The Edison was used for 12 out of 200 tests, at least initially, with conventional machines performing the rest.

The voiding was verified by John Carreyrou of the WSJ by cross-checking his sources with Phoenix-area medical practices (the Walgreens marketing area), which confirmed receiving corrected test reports. One doctor reported that many of the voided results were for calcium, estrogen and testosterone tests. Here is where it cuts to danger levels: “The doctor said one corrected report is for a patient she sent to the emergency room after receiving abnormally elevated test results from Theranos in late 2014. The corrected report from Theranos now shows normal values for those tests, according to the doctor.”

But how can you send corrected results, which would require a rerun, of samples at least a year and perhaps two years old? It’s not clear if this pertains to standard tests run on miscalibrated machines (see below on Siemens) or somehow Edison tests were re-evaluated.

This reads like a last ditch effort to stay out of the Alphabet Monster’s clutches (CMS, FDA, DOJ, SEC), or at least survive their squeeze. COO Sunny Balwani was bid adieu last week, along with the company adding three members with scientific expertise to one of its many boards. Of course, as we previously noted, these boards are Silicon Valley Sock Puppets. The one to watch is legal Attack Dog David Boies (to whom the First Amendment and a free press are so much tissue paper to be ripped) who also sits on the governing board–politically well wired and the kind of bully attorney you call in when you are facing Big Trouble and need Big Defense–or Offense.

Walgreens Boots–reportedly fit to be tied, because Theranos won’t disclose the extent of the corrections, and surely assessing its legal options. Siemens must be equally unhappy that its equipment was 1) miscalibrated by Theranos and 2) Theranos didn’t monitor test water purity; thus they have become inadvertently tainted.

One must wonder if founder Ms Holmes is considering the fit and finish of orange turtlenecks, or residency in a country with no US extradition treaty. For the company, the flat spin above is likely non-recoverable. Sadly, Clipper Theranos will crash down on other, far more honest innovative companies lined up on the runway. Wall Street Journal (if paywalled, copy and search on the headline); Forbes, Ars Technica. Our Theranos dossier here.

‘Silicon Valley Tech Press’ blamed in the Theranos buildup; WSJ threatened

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/04/Yak_52__G-CBSS_FLAT_SPIN.jpg” thumb_width=”150″ /]A fascinating view from an ironic source. Vanity Fair’s short article tags the buildup of Theranos and its founder/CEO Elizabeth Holmes to a purposefully gullible Silicon Valley Tech Press and their moneymaking conferences. While not naming specific publications, it cites TechCrunch’s Disrupt as an early builder-upper of Ms Holmes (drawing blood onstage, how daring!). The operating thesis here is that the tech press vetted her with uncritical and fawning coverage, which led to profiles and shiny articles in the New York Times, the New Yorker and ….Vanity Fair, which also featured Ms Holmes at their 2015 New Establishment Summit. It’s a classic PR strategy to me, one that any skilled marketer has in their playbook (Ed.–it also works in reverse, having mainstream press vet a technology sold B2B), and one that evidently worked.

One would think that writers and editors with some biotech and science knowledge would raise more questions. The author, Nick Bilton, critically outlines the ‘Game of Access’ underpinning the tech press and blogger business model: you say nice things and play ball, you get a preview of the latest gadget or a sitdown with the CEO. If you don’t, you’re shut out. So writers don’t ask tough questions, probe hard enough, or tell the truth about where the facts are leading them, because if they do, there goes the access and the sponsorships, as well as your job. While the former doesn’t apply to your Editors, many of us who write also hope that we uncover a technology that benefits people, or is even revolutionary. We like a bracing story.

However, Mr Bilton, perhaps mindful of the cart he rode in on, doesn’t scoop an equal share of blame onto the ‘mainstream’ press. To this Editor’s mind, the Ken Auletta profile in the New Yorker should have been stopped by the New Yorker’s EIC and sent back to Mr Auletta with a blue-penciled “DIG DEEPER”. This excerpt is from the VF article:

Auletta acerbically noted that the technology behind Theranos was “treated as a state secret, and Holmes’s description of the process was comically vague.” She told him, for instance, that one process occurred when “a chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.”

Say wot? Sheer gobbledygook. For the WSJ investigative reporter John Carreyrou, who read this and eventually blew the lid off Theranos, this was caviar on toast too delicious to pass up. (Vanity Fair, on the other hand, was too busy making Ms Holmes one of its New Establishment, but investigative reporting has never been one of their strong points. Another reason why this article is an interesting read.)

A side note: Ms Holmes kept on refusing to disclose, even to VCs, the blood analysis process as a technology too secret to share, even with fellow researchers to get verification and validation. And that led to very few truly major VCs investing in the formerly $9 bn valued company, a point Mr Bilton relishes.

The final revelations in the article–truly the lead–should scare anyone who values a free press. They are the bullying tactics taken by Theranos’ legal team led by that new governing board member, David Boies, to intimidate both Mr Carreyrou and the WSJ from their investigative reporting. Mr Bilton’s source describes the team marching into the WSJ office in June, threatening legal action on the proprietary information Mr Carreyrou supposedly had (he did have internal documents). After repeatedly denying all requests for an interview with Ms Holmes, the WSJ went with the story in October, and the rest is history. Mr Boies now has his hands full elsewhere with other types of letters: CMS, SEC, DOJ and FDA. And Ms Holmes is no longer making herself available to the media, even to her former friends in the tech press. The Secret Culprit in the Theranos Mess

Theranos flunks CMS review. Is there a there, there?

There is no kinder way to put it. The impression that Theranos is equivalent to what writer Gertrude Stein said of her vanished home in Oakland, California–‘there is no there there’–is building. The US Center for Medicare and Medicaid Services (CMS) after multiple inspections in 2014 and 2015, found that the company failed its own standards on its proprietary Edison blood-testing and analysis system. Cited by the Wall Street Journal, which had access to the full 121-page report, is that “erratic quality-control results for Edison-run tests were frequent in July 2014 and from February 2015 to June 2015.” Overall, Edison devices produced test results that differed widely from traditional lab machines for the same blood samples. Additional problems were unqualified staff, blood samples at the wrong temperature and delays in notifying patients of flawed tests.

Theranos has promised to make further corrections at its Newark, California testing site but it may be too late. “CMS has deemed the company’s plan inadequate and plans to impose sanctions against Theranos, according to people familiar with the matter. In January, the agency said the punishment could range from fines to suspending or revoking the lab’s certification to legally test human samples.” (WSJ)

No stronger case has been made for an early-stage company under-promising and over-delivering than this, especially in health. There is no joy in hearing the grand slam of its $9 billion valuation cratering, but on the other hand, there are a lot of other worthy startups and early-stage companies which could have used the funding. A high profile fail such as this scares off investors from angels to VCs worldwide and tarnishes the entire health tech sector as well as young entrepreneurs. Also many of us looked forward to inexpensive, retail driven, minimally sampled blood testing.

In this Editor’s view, the wide-eyed CEO Elizabeth Holmes should attend more to the integrity of her company’s operations and less to working political connections such as Hillary Clinton fundraisers (last month) and putting everyone from Henry Kissinger, George Shultz and retired Marine Gen. James Mattis on the company’s board of governors (BioSpace). In Marine-speak, knock it off.

Ed. note: If the WSJ is paywalled (search on the headline “Theranos Devices Often Failed Accuracy Requirements” to get around it), see BioSpace. Previous coverage in TTA here.

Update 7 Apr: Some effort in the operations integrity area was made with another Theranos announcement of eight Scientific and Advisory Board members appointed (only two with any previous connection to the company) and three scientific review sessions at their Palo Alto HQ. MedCityNews

Blood is drawn: Theranos responds vigorously to TTA re WSJ

From his very first interactions with Theranos, the reporter made abundantly clear that he considered Theranos to be a target to be taken down, and not simply the subject of an objective news story. The articles that appeared last week are the inevitable product of that approach.–Theranos Facts, 22 Oct

Breaking news. Blood is drawn. A spokesperson for Theranos (from FTI Consulting), Ms Shea Maney, has responded directly to this Editor regarding the content of the Wall Street Journal article, previously covered here (The $9 billion question mark) along with followup in primarily Fortune but also commentary in the Health Care Blog. Her note to me (which undoubtedly has gone to other press) is reprinted below in its entirety, save the standard closing line:

We read your coverage of Theranos with interest, and noticed you were particularly interested in accuracy and our finger-stick tests, among other themes. There have been a lot of inaccuracies in the coverage of these topics, which is why we have posted detailed information on our technology, accuracy, and conversations with The Wall Street Journal on our website: https://www.theranos.com/news/posts/custom/theranos-facts

On accuracy: Theranos’ technology is reviewed by regulators, proven in the field, and praised by leaders in the industry and doctors and individuals that we serve. We are confident in the reliability of our tests, because we have validated their accuracy. (more…)

The Theranos Kerfuffle: a setback, but is it for the best? (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/10/question_mark.jpg” thumb_width=”120″ /]Some clarity emerges from the controversy around Theranos and last week’s Wall Street Journal exposé [TTA 16 Oct]. Last week’s rebuttal/denial released by the company said remarkably little, which disturbed Roger Parloff, the Fortune writer who profiled the company in June 2014’s high-profile cover story. He failed to reach CEO Elizabeth Holmes, who on her break from an all-day with the Harvard Medical School Board of Fellows, taped a segment with CNBC stock tout Jim Cramer (a questionable priority indeed–Ed.) Fortunately he received more specific answers via email from General Counsel Heather King. It clarifies among other things that venipuncture, not finger stick, is used in the majority of their tests in practice, and that dilution of samples is within industry practice for use in third-party analyzing machines. There also seem to be two sides to the proficiency-testing story. (Oddly, no mention of the sensational claims around British biochemist Ian Gibbons who was key to Theranos’ patent development and the alleged legal threats to his widow.)

For those who have difficulty getting through the WSJ paywall, Mr Parloff’s summary of the WSJ article’s main points is helpful. His conclusion: Theranos is wisely ‘dialing back’ its USP on drawing blood through finger stick to “Smaller samples. Smaller needles. Better experience.” (A neat pivot from what Theranos ‘made their bones’ on and still features–tiny finger-sticks.) His open-ended question (for, presumably, the next article): can it profitably run its low-cost testing business when it’s using the same analyzing machines as the big testing labs; and while cheaper, can doctors and patients trust the Theranos tests (which are a matter of health, and perhaps life and death) if they’ve flunked their first test at transparency?

Another view from Health 2.0 supremo Matthew Holt over at his Health Care Blog is that for Theranos, this blow is eminently recoverable if they play their cards right. Witness the recovery made by 23andMe, now in the good graces of FDA after having blown it badly to near-shutdown. (more…)

Weekend Must Read: WSJ’s experts sketch out future healthcare

Fortunately not paywalled on the Wall Street Journal‘s site is The Future of Health Care: Hacking, Hospitals, Technology and More, a view of Healthcare and Us out to about 2030. Most of these ten short essays give cause for optimism, except for that first one–hacking. If you thought PHI breaches were bad, DNA hacking will make that look benign. ‘The Experts’ include Robert Wachter, MD [TTA 16 April, author of ‘The Overdose’], Dr John Sotos who was medical adviser on ‘House’, David Blumenthal of the Commonwealth Fund, Marc Agronin of Miami Jewish Health System and Dr Drew Harris of Thomas Jefferson University’s School of Population Health.

Here’s the topic list:

* How Future Hackers Will Target Your DNA
“In the future, DNA hackers won’t sneak viruses into your laptop and crash websites. Instead, they’ll sneak viruses into your body and crash you, and maybe billions of other people, too.”
* What Health Care Will Look Like in 2030. Maybe.
” Computerized algorithms will empower individuals to make rapid, sound decisions about their own health and health care.”
* The Nursing Home of the Future Will Be in Our Homes
“The future solution, however, will be wholly home-based, with regular visits from a variety of different professional and volunteer caregivers providing assistance in every shape and form…Ultimately, much of the care provided by nursing-home or assisted-living staff today will be condensed into a mobile robot (or screen presence)…” (more…)

“Who do I call?” when the cyberalarm goes off

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/02/Hackermania.jpg” thumb_width=”175″ /]A top read for the weekend is this short article by Gillian Tett in the FT on the lack of coordination in the US in not only protecting systems from cyberattack, but also the lack of coordination between public and private sectors in protection–and when something does go wrong. As Henry Kissinger famously said about Europe when various crises loomed, ‘who do I call?’

Indicators of a gathering storm are everywhere:

* Wednesday’s hours-long, still unexplained outages at the NYSE and United Airlines. (The Wall Street Journal website going down for a bit was the topping on the jitters)

* A joint report from Cambridge University and Lloyds insurance group, also released Wednesday, estimated that a hack shutting down the US electrical grid would create $1 trillion in damage. (more…)

A ‘Game of Thrones’ analogy to potential health insurer mergers

The Wall Street Journal has likened the merger action pending among America’s largest insurers to the series ‘Game of Thrones’, said thrones occupied by Aetna, Cigna, Humana, UnitedHealthcare and Anthem. These more aptly remind this Editor of the final stages of airline deregulation, except that none are in a non-medieval bankruptcy court. Their actions reflects the payers’ urgent concerns that now is the time to reinforce a national presence, that revenues in a Obamacare environment (well, we’ll see the effect of that US Supreme Court subsidy decision due imminently) can do nothing but go down and that Medicare Advantage, commercial accounts, health system relationships (ACOs) and health IT systems are the place to be. What is missing: the fate of those independent, state and regional Blue Cross-Blue Shield (collectively, the ‘Blues’) which are not part of Anthem, many of which are ‘non-profit’ (note the quotes); the positive effect of competition on pricing and a fair consideration of the negative effects of monopoly. Ah, but there are no flung axes, regicide or poisonings to be found here. The real theme of ‘Game of Thrones’ is the effect of the powerful on the powerless (we the insured), which the WSJ writer doesn’t address…..Insurers Playing a Game of Thrones (if you hit a paywall, search on the title)