text:
Aantares Aantares BB Your News, Money, Sports News Andrew Gillum hit with federal grand jury subpoena, report says
Andrew Gillum hit with federal grand jury subpoena, report says
TALLAHASSEE – A federal grand jury has issued a subpoena to Andrew Gillum, the former Democratic gubernatorial candidate, and his campaign, according to a report from the Tampa Bay Times.
The Times obtained a copy of the subpoena issued to Gillum, which asked for information on: John Jackson, president and CEO of the Massachusetts-based Schott Foundation for Public Education, where Gillum was a board member until 2017; Opportunity to Learn Action Fund, where Gillum was president until at least 2017; Donald Sussman, who donated $1.5 million to Gillum's campaign; and Sharon Lettman-Hicks, CEO of the National Black Justice Commission, a black LGBTQ advocacy group.
"We stand ready to assist any future review of our work because I am confident we always did the right thing and complied fully with the law," Gillum said.
Grand jury investigations are secret, so the Times was not provided any details about what the grand jury might be investigating. The FBI would not comment.
Lynn Dee
Aallegiant
Will he comply, I wonder? Or will he have some glam shots taken, sink into the malaise of an existential dilemma, and be interviewed by Maggie Haberman of the New York Times?
Oh, wait. That's just for Trumpers. Never mind.
Zach Floyd: "I want Trump to start claiming things like he's eaten 1,000 bees in his life so we can see Scott Walker try to eat a bunch of bees." Plus: And Jeb! take the bold stand of announcing he will not be eating any bees.
Posts: 41634 | Location: SoCal by the Mall | Mbr Since: 10-06-2003 IP
Ignored post by Lynn Dee posted
Gus Rodgers
Originally posted by Lynn Dee:
C'mon he has to comply. He can't assert white Republican privilege.
Due process of law was never intended to apply to his kind. Jusy ask Chief Justice Taney.
"It may be true that a man will, in time, be able to travel beyond a certain distance in space beyond the narrow confines of the solar system, but whatever that distance is, bacteria could go further."
Francis Crick, Life Itself
Posts: 31053 | Location: Dacron, Ohio | Mbr Since: 05-19-2004 IP
Ignored post by Gus Rodgers posted
Holy Bhagworm
Zealot...
All law has been suspended because of trump.
Posts: 23479 | Location: 1 | Mbr Since: 08-11-2004 IP
Ignored post by Holy Bhagworm posted
Originally posted by Holy Bhagworm:
Old friends, and a grand jury inquiry, follow Andrew Gillum into private business
Andrew Gillum started a business earlier this year with the same political adviser now embroiled with the former Democratic nominee for governor in an expansive federal investigation.
Sharon Lettman-Hicks is part of CJD Group, LLC., a consultant company Gillum registered Jan. 25. Two months later, federal authorities demanded records on Gillum and Lettman-Hicks in a grand jury subpoena that included several other entities related to the two long-time friends.
Gillum's business launched after 15 years as an elected official in Tallahassee, the last few clouded by an FBI probe into city hall and capped by an agonizing defeat in November to Republican Ron DeSantis.
Yet rather than a fresh start with a new business, the subpoena is another example of how Gillum has been unable to escape the tentacles of a federal probe that dogged his gubernatorial campaign and now threatens his future political aspirations.
Rick Scott Oversaw The Largest Medicare Fraud In The Nation's History
"Mostly True"... Politifact
Do as I say, Not as I do!
And this is what Rick Scott's Company did:
• Columbia billed Medicare, Medicaid, and other federal programs for tests that were not necessary or had not been ordered by physicians;
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals;
• The company illegally claimed non-reimbursable marketing and advertising costs as community education;
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of similar claims with Columbia/HCA in 2002 for an additional $881 million. The total for the two fines was $1.7 billion.
On Scott's 2010 campaign website, he admitted to the $1.7 billion fine, though the link is no longer on the site.
I'm just happy as hell that Ron DeSantis is Governor of Florida!
Me too. You deserve him.
And I was very pleased with the Conservatives that DeSantis appointed to the Florida Supreme Court.
Appointed what? Learn to write a sentence, cretin. Now, stop annoying us.
I was extremely pleased.
I am extremely pleased I don't live in Florida.
Found an article that says Florida is in top 5 of where millennials are moving! Gerrymandering should be interesting.
We already have enough Liberals here.
Shining star: Despite being the focal point of a federal grand jury subpoena, Andrew Gillum is still the leading man for Florida Democrats.
My impression of Florida is that most people are stupid racists like you and Dewey.
Quick Reply to: Andrew Gillum hit with federal grand jury subpoena, report says


The nine-pin lanes at the Blanco Bowling Club.
She was telling the truth. This old-school bowling alley and restaurant first opened in 1948 on the main strip of tiny Blanco (pop. 1,956), the Hill Country town smack dab between Austin and San Antonio. For decades the club's been known for its home-cooked meals and nine-pin bowling, a German style of the sport that first originated in medieval Europe and, in America, survives only among the German communities of central Texas, who settled there in the mid-1800s. Blanco is one of just 11 such bowling clubs left in the state.
Local kids still serve as pin-setters, ducking hurtling balls and hustling for cash tips. Every man here wears a hat, cowboy or baseball. Photos of longtime league members dot the wood-paneled walls, and signs prohibit foul language.
There are literal vats of sweet tea, and the friendly staff will swiftly help you reach a lifetime quota of being called "ma'am," all while serving up great Southern eats. Nearly everything is battered and deep-fried—just order the basket of stuff: cheese, okra, and "Texas toothpicks," fried strips of jalapeños and onions.
Another server promised us that the $9.95 all-you-can-eat catfish was super-fresh, and she too was telling the truth. "It tastes the way it feels to sink into a feather pillow," said my dining companion. I dove Guy Fieri–style into a hearty cheeseburger topped with a layer of pickled jalapeños. We downed cold Texas beers, watched the regulars play dominoes, and, finally, placed our order for it, the thing we'd trekked all the way across the Hill Country for, passing at least three deer, one billboard advertising handgun permits, and something called the Blanco Cowboy Church: the homemade pie.
At once creamy and chunky with shredded pulp, braced in a strong crust imbued with a pleasant hint of saltiness, the coconut meringue pie was everything I'd hoped it would be, and my companion's gooey slice of decadent pecan was, somehow, not overly saccharine. We couldn't finish either, though that turned out to be a blessing: The next day, paired with coffee, it made for a perfect breakfast.


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Justice for Janitors movement wins big in Toronto
By Ritch Whyman
In the last week of March thousands of workers in the janitorial industry made a historic breakthrough by winning a pension plan in their recent round of collective bargaining.
For the last decade members of SEIU (Service Employees International Union) Local 2's Justice for Janitors movement have been fighting against an industry rife with abuse and sub-contracting schemes. Over the past 10 years nearly 4,000 workers have joined the union in Toronto. Thousands more workers have joined in other cities such as Ottawa, Halifax and Vancouver. They have been able to win health, dental, and vision care benefits, above inflation wage increases, and personal emergency days.
This past year the fight was focused on two things:
1. Beating back the employers and their clients, including many of the wealthiest property management firms and owners in the world
2. Winning retirement security – a pension plan
Also on the agenda was recouping the wages lost when the Ford government cancelled the minimum wage hike to $15/hr from $14/hr.
Toronto cleaners voted in favour of an agreement that won them wage increases above the industrial norm. Cleaners wages go above the $15.00/hr mark and by the end of the agreement get cleaners close to and above $16.45/hr, depending on the job classifications.
Most importantly they broke new ground by winning a pension plan slated to start in the 3rd year of the contract. With only 10% of private sector workers covered by defined benefit pension plans this victory opens the door for other workers to reverse the trend of employers, banks, and governments eroding pensions.
This breakthrough further opens the door for several thousand cleaners in other unions to demand and win pensions in Toronto. It also puts cleaning companies in Ottawa on notice that close to 3,000 unionized cleaners will also be demanding pensions. By 2022 over 10,000 contracted-out cleaners in Ontario could be enrolled in pension plans.
By standing strong and pushing back, Toronto cleaners have shown that it is still possible to beat back the bosses attacks and win retirement security for all workers.
This article was first published by socialist.ca
By RF
Categories // Justice for janitors, SEIU
Tags // featured

redpajama_set_name: RedPajamaCommonCrawl


text:
package me.excelsiorvfx.ExcelsiorBase.world;

import me.excelsiorvfx.ExcelsiorBase.API.ExcelsiorAPI;

import org.bukkit.Bukkit;
import org.bukkit.Location;
import org.bukkit.entity.Player;
import org.bukkit.plugin.java.JavaPlugin;

import com.sk89q.worldedit.LocalSession;
import com.sk89q.worldedit.LocalWorld;
import com.sk89q.worldedit.bukkit.BukkitUtil;
import com.sk89q.worldedit.bukkit.WorldEditPlugin;
import com.sk89q.worldedit.regions.Region;

public class WorldEditHandle implements ExcelsiorAPI {

	@Override
	public void enable(JavaPlugin p) {
		p.getLogger().info("WorldEditHandler enabled!");
	}

	public WorldEditHandle() {}

	public Location GetSelectionMax(Player pl){
		WorldEditPlugin we = (WorldEditPlugin) Bukkit.getServer().getPluginManager().getPlugin("WorldEdit");
		double x = 0;
		double y = 0;
		double z = 0;
        LocalWorld lw=BukkitUtil.getLocalWorld(pl.getWorld());
        LocalSession ls=we.getSession(pl);
        Region rs;
        try {
            rs = ls.getSelection(lw);
            x = rs.getMaximumPoint().getX();
            y = rs.getMaximumPoint().getY();
            z = rs.getMaximumPoint().getZ();
        } catch (Exception e) {
        }
        Location rst=new Location(pl.getWorld(), x, y, z);
        return rst;
    }
	public Location GetSelectionMin(Player pl){
		WorldEditPlugin we = (WorldEditPlugin) Bukkit.getServer().getPluginManager().getPlugin("WorldEdit");
		double x = 0;
		double y = 0;
		double z = 0;
        LocalWorld lw=BukkitUtil.getLocalWorld(pl.getWorld());
        LocalSession ls=we.getSession(pl);
        Region rs;
        try {
            rs = ls.getSelection(lw);
            x = rs.getMinimumPoint().getX();
            y = rs.getMinimumPoint().getY();
            z = rs.getMinimumPoint().getZ();
        } catch (Exception e) {
        }
        Location rst=new Location(pl.getWorld(), x, y, z);
        return rst;
    }

	public void saveLocation(Location loc) {

	}

}

redpajama_set_name: RedPajamaGithub


The Department of Veterans Affairs mission is to serve America's veterans and their families with dignity and compassion and to be their principal advocate in ensuring that they receive the care, support, and recognition earned in service to this Nation. KeyLogic is proud to help the VA support this important mission.
KeyLogic personnel helped increase patient safety and improved decision-making with the development of the Electronic Incident Reporting system.
KeyLogic developed web-based Microsoft SQL Server Reporting Services (SSRS) reports for the VA's Office of Information & Technology that provided information sharing and transparency across the office.


text:
Home > Terms and Conditions > Virtual Milestone Challenge Prizes
Great Eastern Women's Run Virtual Milestone Challenge (the "Challenge") Terms and Conditions
1. This Challenge is open to all participants who have registered for the Great Eastern Women's Run and who have:
(a) downloaded the 42Race mobile application ("42Race app");
(b) liked the Facebook or Instagram page of Great Eastern Women's Run;
(c) completed the relevant Milestone in the Challenge on the 42Race App and taken a screenshot of the completion e-badge; and
(d) left a comment on the relevant Milestone (as defined in paragraph 2) post on Facebook or Instagram with the screenshot of the relevant Milestone's completion e-badge by the end of the respective timeframes set out at paragraph 2. There will be a Facebook or Instagram post published for each Milestone in the Challenge. The Facebook or Instagram post will be published and pinned at 0900hrs on the specified date and for the duration of the dates and timings stated below.
(each a "Participant", collectively "Participants").
2. There are five (5) Milestones in the Virtual Milestone Challenge. Each Milestone will have five (5) winners. To qualify as one of the five winners for each Milestone, Participants have to complete the following distances whether in one or in multiple sessions, tracked by the 42Race App during the respective challenge periods set out below:
Milestone 1: Complete a total of 3km by 2 October 2022 (Facebook or Instagram post will be published and pinned from 0900 hours on 26 September to 2359 hours on 2 October 2022).
Milestone 2: Complete a total of 5km by 9 October 2022 (Facebook or Instagram post will be published and pinned from 0900 hours on 3 October to 2359 hours on 9 October 2022).
Milestone 3: Complete a total of 10km by 16 October 2022 (Facebook or Instagram post will be published and pinned from 0900 hours on 10 October to 2359 hours on 16 October 2022).
(each a "Milestone")
Each Participant must leave their comment containing the completion e-badge of that relevant Milestone on the Facebook or Instagram post for that Milestone before 2359 hours of the end date for that Milestone.
3. The winners for the respective Milestone will receive the prizes as set out below:
Milestone 1: 5 winners will each win a set of 4 Golden Village Movie Tickets worth S$48.
Milestone 2: 5 winners will each win Resorts World Sentosa Gift Vouchers worth S$100.
Milestone 3: 5 winners will each win a Manduka Begin Mat 5mm 68" worth S$119.
Milestone 4: 5 winners will each win a SUUNTO 5 Peak Multisport Watch worth S$399.
Milestone 5: 5 winners will each win a Le Creuset Round Signature Skillet (26cm) worth S$499.
4. Winners will be randomly selected from all qualified Participants by The Great Eastern Life Assurance Company Limited ("Great Eastern") in its sole and absolute discretion. Only Participants who meet all criteria of the Challenge mechanics will be considered for the prizes.
5. This Challenge is not valid with other offers or promotions held by Great Eastern unless otherwise stated.
6. Great Eastern shall be entitled at its sole and absolute discretion to replace or substitute any of the prizes stated at paragraph 3 with another item of equal or similar value selected by Great Eastern. Otherwise, each prize is not exchangeable for cash or for any other items.
7. By participating in the Challenge, each Participant agrees and consent to Great Eastern and its related corporations (collectively, the "Companies"), as well as their respective representatives, the Companies' authorised service providers and relevant third parties (the Companies and all the other foregoing parties, collectively, "Great Eastern Persons"), collecting, using, disclosing, and/or sharing amongst themselves such personal data, for purposes reasonably required by the Companies to conduct the Challenge which the participant is signing up for and such other purposes as described in Great Eastern's Privacy Statement (collectively, the "Purposes") which is accessible from Great Eastern Singapore's website, which each participant confirms they have read and understood.
Each Participant's consent herein supplements but does not supersede nor replace any other consents that Participant may have previously provided to Great Eastern Persons, and each Participant's consents herein are cumulative and additional to any rights which any of the Great Eastern Persons may have to collect, use, and/or disclose of a Participant's Personal Data, with or without that Participant's consent, to the extent permitted under applicable law.
In addition, where personal data of any person is disclosed by a Participant, that Participant further confirms and represents that the Participant has obtained the consent of the person concerned for the Purposes, unless such consent is not required under applicable laws: (i) to collect such personal data; (ii) for the disclosure of such personal data to the Great Eastern Persons; and (iii) for the Great Eastern Persons' collection, use and/or disclosure of such personal data.
8. Winners of each Milestone will be contacted within ten (10) days after the end of the relevant Milestone via a private message on Facebook or Instagram (the "Notification Message "). If the winner cannot be contacted or does not respond by the date as indicated in the Notification Message, their prize will be forfeited, withdrawn or given to a reserve winner at the sole and absolute discretion of Great Eastern. Should a Participant be deemed ineligible after the announcement of all winners has been made, Great Eastern reserves the right to disqualify such Participant.
9. The Notification Message will set out the procedure for prize redemption.
10. A winner who does not respond to the Notification Message within one (1) month from the date of the Notification Message may have their prize forfeited, withdrawn or given to a reserve winner at the sole and absolute discretion of Great Eastern.
11. Great Eastern shall not be liable for or be responsible in respect of any expenses, losses, costs, damages, liabilities or other consequences of whatsoever nature (collectively "Losses") suffered or incurred directly or indirectly by Participants of the Challenge howsoever caused or arising and without limiting the generality of the foregoing, whether by reason of or on account of any act or omission whether negligent or otherwise on the part of Great Eastern or its employees or agents.
12. Participants acknowledge and accept that the Prizes are provided on an "as is" and "as available" basis. Great Eastern does not warrant, represent or guarantee the usability or quality of the Prizes as they are provided by a third party. To the fullest extent permitted by the law, Great Eastern disclaims all warranties (whether express or implied) including but not limited to warranties that the Prizes will meet the Prize winners' requirements, warranties of satisfactory quality, warranties of merchantability or fitness for a particular purpose. All issues with regard to using the Prize shall be directed to the applicable merchant and not to Great Eastern. Upon the issuance of a Prize to a winner, neither Great Eastern nor its employees, directors, officers, agents or assignee shall be responsible or liable in any way to any person for any prizes that are tampered, damaged or not working properly. Participants acknowledge and accept that all Prizes may also be subject to additional terms and conditions imposed by the third party merchant providing the relevant Prize.
13. Great Eastern reserves the right to vary the terms and conditions or withdraw this Challenge at any time without prior notice.
14. The decision of Great Eastern on all matters relating to the Challenge shall be final and binding on all customers.
15. Participants grant Great Eastern the rights necessary for distribution and public display of any content submitted as part of this Challenge, and hereby grants Great Eastern on a royalty-free basis the perpetual right to exclusively and without limitation freely use, modify, edit, copy, reproduce, distribute, broadcast, translate, create derivative works from, alter and publicly display or publish any such intellectual property rights, for whatever purpose, in any form or medium, either on the Instagram/ Facebook page or elsewhere, whether promotional or in other activities or events arranged in relation to Great Eastern Women's Run, whether locally or worldwide.
16. The terms and conditions of the Challenge shall be governed by and interpreted in accordance with Singapore law. The courts of Singapore shall have exclusive jurisdiction over any disputes arising from the terms and conditions, including the validity and enforceability thereto.
17. By participating in the Challenge, the Participants shall be deemed to have agreed to abide by all terms and conditions of participating in the Challenge as set out here, including any amendments, additions, replacements and modifications hereto as may from time to time be made by Great Eastern.
18. Participants acknowledge and accept that they will be required to use third party programmes, software, websites and applications and will be subject to the terms and conditions, including privacy policies, governing a Participant's use of such third party programmes, websites and applications. Great Eastern has no control over the rights and obligations governing a Participant's use of any third party's programmes, software, websites and applications.


Due to Loy Clark's diverse work duties and customer list, we have a division known as Ancillary Services that provides the necessary support to the primary activities and operation of our organization and to our customers.
Loy Clark prides itself as a solution provider, offering ancillary services to support all our inter-divisional and our customers' project needs, which include the following.
Loy Clark Construction owns a large fleet of excavation machines and employs a large, experienced group of equipment operators ready to deploy to your project. Our fleet is comprised of Caterpillar 420F rubber-tired backhoes and Caterpillar 305CR rubber-tracked mini-excavators. Both types of machines are capable of large and small construction projects. Most importantly, Loy Clark employs only highly trained union journeymen equipment operators who all have years of experience in the underground utility construction industry. When you call Loy Clark Construction for operated construction equipment, you will get the best, most experienced and most highly qualified operators available in the market.
Loy Clark is capable of dispatching crews from a web-based dispatched order system for our larger customers. If your organization has the need for this type of web-based order system, please contact us to find out what we can do for you.
Loy Clark Construction owns and operates several vacuum excavation units that perform a wide range of duties, including bore mud removal, small and large pit excavation, and utility potholing. This technology provides the means to safely excavate around existing utilities to ensure they are not damaged during the excavation process.
Some clients use our vacuum excavation services to expose and locate existing utilities so they can be positively identified by type of utility, quantity of conduits/cables, size and depth. This information can be used to design new utility paths or even verify the condition of existing utilities. Vacuum excavation is a useful and safe way to excavate and will only increase in use to current and future legislation.
Our fleet of vacuum excavation units includes several trailer-mounted units and two mobile truck-mounted units that all have the capability of core drilling hard surfaces, backfilling potholes with granular material and reinstalling the core plug.
Loy Clark Construction has a new hydro-vac unit with even more powerful vacuum suction and a larger hose, which increases the overall hole depth and production capabilities of our vacuum excavation fleet.
Loy Clark Construction has several restoration crews that support our other divisions as well as our customers by providing asphalt concrete and concrete restoration services. This work includes restoring everyday potholes up to full trench-wide asphalt concrete patches in city streets and roadways.
Our concrete restoration services includes sidewalks, driveway approaches, curb and gutter, and concrete roadway panel replacement.
Loy Clark employs fully trained union craftsmen who are trained and capable of hard surface restoration.
Call us today for any of our support services for your home, business or upcoming project.


text:
� Obama's Other Recent Victories | Main | Liberal Terrorist: Peter Beinart, Obama Supporter, Calls Nobel Prize a Farce �
Mash-Up: Edsall vs. Halperin
I thought I'd mash-up two articles getting a lot of attention in the blogosphere.
The first is Thomas Edsall's good (mostly) article on liberal media bias. And how liberals in the media should stop pretending they're not liberal, stop lying, take ownership of the problem, and correct it.
The other is Mark Halperin's absurd grading of the Obama Administration. Halperin must be thanking God right now that the Nobel committee made him only the second biggest joke of the day (and, in fairness, a fairly distant second). But I'm not done with him yet.
I trust you'll be able to tell which is which. I have made frequent cuts without notice (as it would be disruptive to the nature of this mash-up). In one case (the discussion of the media's belief conservatives are stupid), I've moved Edsall's order of topics in order to make a better comparison at the end.
I recommend a reading of Edsall's critique in full -- we can deal with his claim that conservatives can't be real journalists later -- and Halperin's risible autoerotic beclowning too, just for the lulz.
Correction/Note: Halperin's piece is not, as I thought, new. It is in fact a grading from Obama's first 100 days. Not sure why the Seinfeld Presidency deserved such high marks then, either -- seems ludicrous to grade him after such a short period of time, and give him "A-'s" to boot.
But this was an error of assumption on my part, and I'm sorry about that.
Still: I like the mash-up.
�Many readers were not buying [the] contention that liberal bias had nothing to do with the slow response to ACORN and, before that, to the resignation of Van Jones, a White House aide,� Hoyt wrote this past Sunday.
[NYT "Public Editor Clark] Hoyt quoted correspondence from angry Times readers: ��So, beside Jill Abramson, Bill Keller and Barack Obama, were you able to find anyone, not resident in a cemetery, who was so tuned out?� asked Charles Harkins of Spartanburg, S.C. Jerry Komar of Collingswood, N.J., charged that Times editors �hoped the story would blow over. They were caught in their own web of bias.��
Barack Obama, President Grade: A-
Instantly comfortable and highly skilled at the hardest job in the world � proving his supporters' contention that all the traits that made him a great candidate would serve him well in the White House: even temper, cool demeanor, boldness under pressure, shrewd facility for managing personnel, unfailing instincts about when to delegate and when to engage. A handful of public missteps (particularly on his international trips and on torture issues) and a failure to ameliorate the partisan divide are the only true blemishes so far.
The actions at both the Post and the Times are ad hoc reactions to the latest blow up, and do little or nothing to address the underlying reality at most papers.
The mainstream press is liberal. Once, before 1965, reporters were a mix of the working stiffs leavened by ne�er-do-well college grads unfit for corporate headquarters or divinity school. Since the civil rights and women�s movements, the culture wars and Watergate, the press corps at such institutions as The Washington Post, ABC-NBC-CBS News, the NYT, The Wall Street Journal, Time, Newsweek, the Los Angeles Times, The Boston Globe, etc. is composed in large part of �new� or �creative� class members of the liberal elite�well-educated men and women who tend to favor abortion rights, women�s rights, civil rights, and gay rights. In the main, they find such figures as Bill O�Reilly, Glenn Beck, Sean Hannity, Pat Robertson, or Jerry Falwell beneath contempt.
Joe Biden, Vice President Grade: A-
Involved in major decisions, carrying water on Capitol Hill, fulfilling difficult foreign policy tasks, reaching out to constituencies for which he has great instincts and offering rigorous private advice when he believes he knows better. (And admirably staying on message � and on the reservation � when he doesn't get his way.) For many observers, part of a White House tableau of family values, purposeful diligence and middle-class championing.
In a UCLA study of media bias, reporters were found to be substantially more liberal and more Democratic than the public at large. Hoyt, in a column last year, acknowledged this finding: �Being human, journalists do have personal biases, and a long line of studies has shown that they tend to be more socially and politically liberal than the population at large. There is no reason to believe Times journalists are any different.�
If reporters were the only ones allowed to vote, Walter Mondale, Michael Dukakis, Al Gore, and John Kerry would have won the White House by landslide margins. More specifically, reporters and editors tend to be social liberals...
Michelle Obama, First Lady Grade: A+
Setting style trends that honor her personal taste, her position and her awareness of the economic crisis is just one of the ways she has stayed true to herself � brilliantly achieving her most important goal of raising her two daughters with as much grace and thoughtfulness as she brings to the public sphere.
Along the same lines, reporters might consider carefully the question of why the party of the left in this country, the party that claims to represent Jane and Joe Sixpack, has such trouble winning the votes of the white working class. The answer may lie more in the issue of redistributed benefits than in a right-wing conspiracy.
Rahm Emanuel, Chief of Staff
Exhibiting an uncharacteristic ability to delegate actions to others while thinking strategically. Has already moved or launched several major initiatives, with still more under-the-radar programs in the pipeline. Deserves much of the credit for getting an Administration filled with White House first timers (including his boss) off to a fast start, with only a few minor errors of substance, tone and relations with Capitol Hill. Living up to the great potential Obama saw in him when he insisted that Emanuel take the job.
Reporters might also attempt to think outside the prism of their own experience. Why did so many fail to see the news value when they learned from Glenn Beck that Van Jones, Obama�s environmental czar, had signed a 2004 petition accusing the Bush administration of deliberately allowing the 9/11 attacks to occur, calling for an �immediate inquiry,� and noting that a survey of New Yorkers showed 41 percent believed �US leaders had foreknowledge of impending 9/11 attacks and �consciously failed� to act? Similarly, what form of ideological myopia prompted the mainstream press to miss for days the story of ACORN staffers advising a self-proclaimed pimp and prostitute on ways to illegally get federal grants and to falsely fill out loan applications?
Robert Gibbs, White House Press Secretary
A clever amalgamation, Gibbs is stitched together with the most useful parts of his predecessors: courtly Southern humor (Mike McCurry), stare-down-style toughness (Ari Fleischer) and an ability to keep reporters on his side even in difficult circumstances (Dana Perino). Transition practice paid off; had good podium skills and consistent preparedness right from the start, despite the rude awakening of the grand tug-of-war nature of the job. Knows what to say � and when not to engage. Occasionally too flip or repetitive when the going gets rough, but he remains comfortably in the loop, which boosts his credibility and the press corps' confidence in his answers.
The Van Jones and ACORN cases are the extremes, but the more pervasive and subtle form liberal �blindness� takes is in routine coverage. Stories, local and national, of virtually every culture-war issue commonly reflect reporters� allegiance to social insurgents against traditionalists�and readers, who include many with traditionalist leanings, sense this. The facts and quotes from the school board meeting or Congressional debate are accurate. But something is missing in the reporting on the parents who do not want explicit sex education taught in the third grade, or the pro-lifers who are convinced that abortion is murder. These people exist all too often as stick figures or caricatures whose views are delegitimized.
David Axelrod, Senior Adviser to the President Grade: A-
Reluctantly came to Washington but has thrown himself into his first White House gig for the best of reasons: he cares about the President, his agenda and the country � and it shows... [T]he message, energy and clarity of the Administration's daily focus is consistent with the campaign's, and for this he and his friend the President deserve credit.
Attempts by journalists to conceal deeply held political convictions can be dangerous. While no agreed-upon mechanism or forum exists, at present, for editors and reporters in the mainstream media to declare personal ideology and partisan leanings, the goal of improved objectivity is more likely to be achieved through individual self-scrutiny and institutional honesty among those in authority. A reporter fully aware of his or her own relevant political and moral beliefs, and conscious of how those views influence what and how he or she reports, is likely to produce better journalism, in which both left and right get their due, without resorting to the bland, forced neutrality found in many publications seeking to conceal the beliefs of their staffs.
Hillary Clinton, Secretary of State
Exactly what Obama was counting on when he asked her to join the team: a significant, powerful, worldly, respected figure who could hit the ground running. So far she's playing nicely with others, hired an all-star team, and is working hard at the job with a great sense of history and opportunity. Is hearkening back to her Senate days by running a tight ship and avoiding controversy.
An important first step is to abandon the notion, popularized by Thomas Frank in What�s the Matter with Kansas?, that white working class voters are suckers, willing to cast ballots against their economic interests because corporations and evangelical Christians have scared the bejesus out of them with phony issues like gay marriage, abortion, government takeover of the healthcare system, and distribution of condoms in the schools.
These voters are not stupid... The mindset that perceives these voters as dumb jerks is what permitted a reporter and a series of Washington Post editors to let a description of evangelical Christians as �largely poor, uneducated and easy to command� go unquestioned into a front-page story.
Republican Congressional Leaders
Expelled from the White House and from control of both chambers of Congress (through their own mistakes as well as external factors), the party's chief Representatives continue to flounder in terms of legislative wins and public popularity. Still employing a scattershot pattern of attack and exhibiting a failure to promote the consistent personalities and positive policy messages essential in order to have a fighting chance against the Obama megaphone.


text:
Operators on-demand
Medical advisory boards
Clinical user surveys
Health product feedback
Experts overview
Announcing the Digital Health Founder's Fellowship
by Ruby Gadelrab | Dec 6, 2022
Attention Digital Health Founders: We are now accepting applications to attend the Digital Health Founder's Fellowship.
The challenges of scaling healthcare startups are many. Digital Health founders encounter regulatory considerations, the challenge of navigating the industry's numerous stakeholders and thinking through the incentives, time, and costs of demonstrating clinical outcomes to prove ROI. It's discouraging to see founders develop potentially impactful technologies only to struggle with finding product market fit and scaling their business.
It's my passion–and my life's work–to help healthcare leaders avoid these potential pitfalls on the path to commercialization. And, it's the motivation behind launching the Digital Health Founder's Fellowship: To help the next generation of digital health founders and startups build sustainable businesses and create positive outcomes in health.
Through a partnership between MDisrupt and Menlo Ventures, we are launching the inaugural Digital Health Founder's Fellowship. We are now accepting applications from founders interested in joining us. We will pack meaningful learning, networking, and mentorship into a two-day event (May 4-5, 2023), followed by ongoing community interactions that will connect startup leaders with fellow founders, top investors, industry stakeholders, and potential collaborators.
My co-host and partner in putting this event together is my friend and collaborator Greg Yap, Partner at Menlo Ventures. Greg invests in early-stage teams trying to solve significant problems in life science and healthcare. As an executive, entrepreneur, and now as a VC, Greg has focused on improving health through technology. He is committed to helping founders improve health outcomes, reduce healthcare costs, and increase access to better care.
Together, we are gathering leaders from across the healthcare ecosystem to help early-stage founders accelerate their path to scalable, sustainable business.
Founders of Digital Health Startups grapple with many of the same common challenges that arise when building a company. They also have to manage the complexity of building within the healthcare ecosystem of payors, providers, regulators, employers, and health systems.
To support these early-stage founders as they build, MDisrupt and Menlo Ventures created the Digital Health Founder's Fellowship with the mission of helping digital health companies accelerate their path to market and scale their businesses through expertise, access, and mentorship.
Capacity is limited
We want to create an atmosphere conducive to connection and conversation. The event is invitation-only and limited to 30 Founders/CEOs. Please scroll down for information on how you, or someone you know, can apply for consideration.
Digital Health Founder's Fellowship
Conference Sessions
This intimate two-day conference, held in early May, will offer access to an unparalleled network of industry-leading experts and decision-makers. Selected participants will have the opportunity to attend conference sessions on topics that will touch on the following:
The journey from concept to company
Playbooks for success and how to scale
Business models and channel strategies
Engaging payors, employers, and health systems
Regulatory considerations
The importance of clinical outcomes
Fundraising in a challenging economy
For more details on the event and ongoing updates to the agenda and speaker list, visit the Digital Health Founder's Fellowship page.
The Digital Health Founder's Fellowship was designed to create meaningful and lasting connections. The immersive/interactive nature of the event will introduce attendees to top-tier investors, fellow founders, industry leaders, and critical collaborators who can help them on their journey.
As part of the program, each founder will be thoughtfully matched to a mentor who can provide support as they navigate building their business.
This invitation-only event is free to attend. The hosts will cover all conference costs, networking reception, and food/drink during the event.
Participating founders will only have to cover the cost of travel and lodging.
To apply for consideration
If you, or someone you know, would benefit from attending, please fill out an application here. We look forward to reviewing your application.
To be considered, applicants must be:
A founder/CEO of a Digital Health company
Representing an early-stage company (Seed-stage through Series B funded)
Preparing go-to-market and business models
Leading a company based in the US or planning their US go-to-market strategy
Available to attend in person May 4-5 in Redwood City, CA
Please keep in mind these key dates:
December 6, 2022: Application submissions open
February 16, 2023: Application submissions close
March 1, 2023: 30 Founder/CEOs selected to participate will be notified
May 4-5, 2023: Join us for a two-day immersive digital health experience that connects the most accomplished digital health founders, experts, and VCs who can help you accelerate your path to market.
We look forward to reviewing your application. Good luck!
About our hosts:
MDisrupt is an Austin-based tech-enabled, health expert on demand network for digital health and the life sciences. Our goal is to be the bridge between technology and healthcare to help the most impactful health products make it to market quickly and responsibly. We partner with leading companies including Travera, ixlayer, and Thermo Scientific.
Ruby Gadelrab
MDisrupt CEO + Founder
Ruby Gadelrab is the CEO and Co-Founder of MDisrupt. She is a seasoned digital health executive and expert on commercializing healthcare and healthtech products. She served on the executive team at 23andMe as VP of Commercial Marketing and has worked for many leading biotech and genetic companies. Her passion is in helping companies demonstrate clinical outcomes to accelerate their path to commercialization and scale. Before founding MDisrupt, Ruby consulted for, advised, and mentored more than 25 digital health companies.
Menlo Ventures is a venture capital firm with a long history of helping founders build iconic companies. We believe new technology, appropriately applied, can enable much better healthcare. Our life sciences and digital health portfolio includes more than 25 emerging leaders, including Benchling, Delfi, Genesis, H1, Recursion, Riva, and Ophelia.
Greg Yap
Partner at Menlo Ventures
Greg Yap is a partner at Menlo Ventures, where he invests in early-stage teams trying to solve significant problems in life science and healthcare. Throughout his career as an executive, entrepreneur, and now investor, he has focused on improving health through technology. He is committed to helping founders improve health outcomes, reduce healthcare costs, and increase access to better care. In addition to his role at Menlo, Greg is an Aspen Institute Health Innovators Fellow.
The Theranos Verdict: In Healthcare, Money Should Follow Science
by Ruby Gadelrab | Jan 5, 2022
MDisrupt CEO and founder Ruby Gadelrab on the best way for investors to avoid Theranos-style mistakes
"Move fast—responsibly."
Silicon Valley has become known for its' "go fast and break things" approach. But the core principle of healthcare is "do no harm." However, one cannot safely, ethically or legally "fake it until you make it" when patients' health and lives are at stake.
That's one clear takeaway from the verdict that found Elizabeth Holmes, founder and former CEO of the health technology company Theranos, guilty on four counts of defrauding her investors about the company's blood-testing technology.
From my perspective, it's extremely unfortunate that Holmes was acquitted of four other counts of fraud involving patients who said they were deceived by Theranos's claims. While investors were indeed deceived, they had the opportunity to look more closely at Theranos before investing. Patients who believed the company's claims did not have that option. In this verdict, investors were vindicated, patients were not.
But in the rush to draw meaning from the verdict, let's not assume that all digital health companies—or even most of them—are like Theranos. There are plenty of healthtech companies out there who are eager to go fast, responsibly—and plenty of investors willing to do the homework that Theranos's investors skipped.
While healthcare is complex, highly regulated, and probably the hardest area in which to invest, there is a clear formula that investors can follow to avoid making costly—in every sense of the word—Theranos-style mistakes.
Invest in medical diligence
Investors routinely do technical and financial diligence using experts. When investing in healthcare technology companies, investors must also do medical diligence using healthcare experts. It's a critical element of establishing whether a product is commercially and clinically viable.
The 5 elements of medical diligence
1) Does the technology actually work? This is often known as analytical validation or technology validation. Investors need to determine if there is evidence to back up the founders' claims. And the marketing must be truthful. It is both unethical and illegal to overstate claims.
2) Show me the data! (Ask for the clinical validation data.) Does the technology actually pick up a disease or biomarker when it's present—and not pick it up when it's not there? Not all data are created equal. Good data are generated externally with scientists and research labs, great data are published in peer-reviewed journals, and excellent data are published and replicated. In the case of Theranos, every time they were asked for the data they claimed that they didn't want to share their "trade secrets." In healthcare you have to publish your studies and also submit them to regulatory bodies.
3) Evaluate the clinical utility. Ok, the technology works, and successfully detects what it is supposed to. But is the product clinically useful? Does it actually solve a real problem in healthcare or is it just technology for sake of technology looking for an application in healthcare? Will it actually change or impact the medical management of a patient? Is there buy-in from both health systems and healthcare providers?
4) Review the health economic data. How much does the technology cost to implement, and how much does it save the healthcare system compared to the standard of care? Will there be, or is there, Medicare, Medicaid, or private insurance reimbursement for the treatment or product?
5) Confirm legal and regulatory compliance. Has the founder evaluated all the laws and regulations that apply? Can the founders prove that the company and the technology are compliant with those laws? What is the reporting structure of the general counsel, the chief compliance officer, and/or the privacy officer? Are there any conflicts of interest with the same? Healthcare is one of the most regulated industries in the US, making healthcare compliance a crucial and growing field within the industry.
Look closely at company structure & culture
Make sure the RIGHT healthcare experts have a seat at the table and a strong voice in the process (and are not just there for show and credentials). There are a few important signals that can help investors determine whether this is happening.
For instance, does the company have physicians, scientists, or clinical experts within the team, or as investors? On the board of directors? What about as part of the C-suite or in senior positions? The most successful healthcare startups have a balance of clinical, commercial and tech skill sets. And ideally, a digital health company would have a chief medical officer and chief compliance officer on the executive team even in fractional roles. At MDisrupt, one of our specialties is matching vetted healthcare industry experts with digital health startups so they can access all the essential skills they need, on demand.
Company culture is also important. Talk to the employees—do they see a culture of silence and secrecy, or one of transparency and collaboration? One red flag: When there is high turnover in scientific, clinical, or compliance positions, a company is in trouble. (I know this because many such individuals join our expert network at MDisrupt. In fact, often the culture is so bad that they leave the company before they have other jobs.)
Don't assume all healthtech startups are like Theranos
Every day I meet incredible truth-seeking founders and who are building life-changing health technology products. Unfortunately and unfairly, many are being greeted with skepticism in the shadow of Theranos—particularly women founders, lab testing companies, and companies focusing on point of care and blood collection devices. Yet all it takes is some medical diligence to be able to separate the truth-seekers from the rest.
Involve experts from the start
Engaging the right experts early and often in the development of a health product can be the key to adoption and scale within a healthcare setting. By building collaborative partnerships between digital health and health industry experts, we can get the best of both worlds.
If you want to dive into more interesting topics related to healthcare, check out our blog at MDisrupt.
At MDisrupt, we believe the health products with the most potential to do good in the world should make it to market quickly. We help make this happen by connecting ambitious digital health innovators to the healthcare experts who have the skills they need most.
Our experts span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.
How 23andMe's Acquisition of Lemonaid Health Changes Personalized Healthcare
by Ruby Gadelrab | Oct 25, 2021
MDisrupt CEO and founder Ruby Gadelrab on why the combination of the two companies is so promising.
Integrating genetics into primary care—for real
On Friday, 23andMe announced its acquisition of Lemonaid Health, the telehealth upstart and drug-delivery service, "in a bid to make its personalized genetics approach part of patients' primary care," stated Fortune.
Between 2014 and 2017, I worked at 23andMe as VP of commercial marketing. It was there that I learned the principles of consumerized healthcare. Everyone in the company had a maniacal focus on the consumer experience. Every decision we made as an executive team was through the lens of "How does this positively impact the consumer experience?"
The acquisition of Lemonaid Health is a bold move by 23andMe. I believe that it is rooted in adding value to the consumer experience and has the potential to change the way we approach primary care.
What makes the 23andMe and Lemonaid acquisition so interesting?
Mastering consumer engagement
23andMe has mastered consumer engagement. It was one of the first companies to make genetic information simple and accessible to consumers and to demonstrate that individuals were willing to pay for information on both health and ancestry, with over 11 million consumers buying the tests. 23andMe was the first company to get FDA authorization to sell genetic tests directly to consumers without clinicians being involved in the process. And the company did a fantastic job of communicating the information in reports in a simple and engaging way. Furthermore, they engaged consumers in research, with an over 85% consent rate.
Clinicians are a core part of consumer healthcare
During my time at 23andMe, as consumers became more interested in the health reports that 23andMe provided, they started to take them to their healthcare providers to discuss. The problem was, most healthcare providers had no idea what the report was or what its clinical utility might be. Further, healthcare providers had no time to try and make sense of it in a 20-minute visit. This broke the consumer experience and made it difficult for the valuable information in the 23andMe report to be actionable within our current healthcare system. One of my roles was to create a "23andMe for Medical Professionals" program in an effort to educate clinical early adopters on what the reports meant.
Consumers taking their reports to their healthcare providers created frustration everywhere. Consumers were frustrated that valuable genomic data in their 23andMe report was not taken seriously by their healthcare providers. Healthcare providers were frustrated that they were receiving data outside the standard of care that they did not know how to use or have the right infrastructure to integrate into their patients' care. The company was frustrated because the healthcare providers' reactions and underutilization of the 23andMe report ruined their consumers' experience.
This issue underscores the importance of involving healthcare providers early and often as digital health innovations are built and deployed—something that's an essential pillar of our work at MDisrupt.
Genetic information is useful both clinically and personally, and yet traditional healthcare is about ten years behind medical genomics research. This can be attributed to the perceived lack of clinical utility for many genetic tests on the market as well as the "two-year problem." This is a problem of economics and the ROI of genetic testing. Whoever pays for preventive genetic testing doesn't get the benefit of it, because people change employers and providers at least every two years.
Post-COVID-19 pandemic, health systems have even less incentive to take an interest in genomics. These days, they have bigger problems: making up the revenue they lost during the pandemic and taking care of the patients whose medical treatment got delayed in the pandemic.
23andMe has the right idea. The only way to create an incredible consumer experience, and to make genomics part of the decision-making process in healthcare, is to own the pipes that can deliver true healthcare—meaning bringing healthcare providers into the process.
This does two things. First, it gives consumers a place to go to discuss their healthcare, genomic data included. Second, it allows a genetic testing company to deliver additional health services to its consumers (i.e., their own telemedicine channel). Having clinicians as part of the genomics journey is the only way to improve the consumer/patient experience, and make genomics meaningful in healthcare.
Genomics + telemedicine + therapeutics = a new category of genomically powered healthcare
Interestingly, it is the combined efforts of two digital health companies and not a genomics company and a healthcare system that may be able to truly integrate genomics into healthcare.
And with 23andMe, it doesn't stop there. Remember that the company has made significant efforts and investments into therapeutics with a $300M investment and partnership with GSK in order to redefine the process of drug discovery and potentially get drugs to market faster.
This is why the acquisition of Lemonaid Health by 23andMe is so fascinating. 23andMe, with its genomics data, consumer engagement, therapeutics efforts, provider network, and telemedicine platform can potentially become the path to truly individualized clinical care. We'll be watching closely to see what happens next with this new category of genomically-powered healthcare.
At MDisrupt, we believe that the most impactful health products should make it market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.
Overly White Genetic Databases = Decades More Health Disparities
by Ruby Gadelrab | Sep 14, 2021
MDisrupt CEO and founder Ruby Gadelrab on how more inclusive genetic databases can reduce health disparities and bring precision medicine to everyone.
The precision medicine problem no one talks about
Precision medicine has long been a promise of the The Human Genome Project (HGP). Humans are 99.9% genetically similar, but it is the 0.1% difference that holds the key to the causes and potential cures of our diseases. The goal of the HGP was that by building genetic databases large enough to allow scientists to see the patterns and variations in the 0.1% difference in our genetics, we could give healthcare providers "immense new powers to treat, prevent, and cure disease" through precision medicine (pharmacogenetics, cancer screening and diagnostics, and much more). However, nearly 20 years later, this promise of better diagnostics and personalized therapeutics is only a reality for those of European descent. That's because most of the world's genetic databases consist primarily of genomes from people of European descent – and yet we know that individuals of other ancestries suffer from certain genetic diseases at a much higher prevalence.
So, how did we get here?
3 reasons genetic databases are biased
First, the genome studies conducted that led to building the first genetic databases, the genome-wide association studies (GWAS) were done in the United States and, to a lesser extent, in Europe. A 2009 analysis of the GWAS studies showed that 96% of participants were of European descent.
Second, recruitment of participants in scientific research is notoriously difficult. The faster researchers recruit, enroll, and consent participants, the faster they get the data and can publish. Participants in the GWAS studies were mostly volunteers who lived near well-funded academic institutions, and who had the motivation and the means to travel to those institutions. This resulted in the study populations not being representative of the diversity of the US population. Very few institutions tried or were able to build trust with underserved and underrepresented populations in order to successfully enroll them in the studies. The majority of the studies were conducted by scientists who identified as white. In fact, according to the National Institutes of Health (NIH), only 7% of all NIH R01 Grants were awarded to Black American and Latinx scientists.
During the GWAS era, I worked as the head of international marketing for Affymetrix (now Thermo Fisher Scientific). Affymetrix was a leading manufacturer of microarrays, the technology used to conduct GWAS research. Even back then, we were concerned about the European bias in genetic studies, so my team and I spent 2009 to 2012 traveling around the world meeting with ministers of health and major research institutions, encouraging them to fund and build genetic databases representative of their own populations. Some of these initiatives did eventually take off—notable examples include The Saudi Genome Program, H3Africa and the China Genome Project.
Third, over the last five years, new types of genetic databases emerged from the private sector. More than 26 million people purchased direct-to-consumer genetic tests. While these products have done wonders for accessibility of genetic information, they are also cost-prohibitive for underserved populations and sold by companies that are primarily US-based. This has resulted in new genetic mega-databases that, once again, are biased to people of European descent.
Private sector solutions
Individuals of African descent are highly underrepresented in genetic databases and yet genetic diversity in Africa is higher than any other region in the world. What's more, African populations have the highest burden of disease due to Africa's complex population history; large variations in diet; climate; and elevated exposure to infectious disease.
To their credit, some private sector genetic testing companies have tried to address this gaping disparity in genetic databases.
23andMe had the right idea and tried to address the problem through The African Genetics Project, which sought to recruit and provide detailed ancestry results to 23andMe customers of African descent.
The Nigeria-based company 54Gene is also seeking to equalize precision medicine by creating the world's largest biobank of African genomes, which will be used to build the next generation of diagnostics and therapeutics.
Even so, we have made only marginal improvements in the diversity of our genetic databases. In 2020, a study conducted under the H3Africa Consortium showed that sequencing 426 individuals from 13 African countries resulted in the discovery of over three million novel genetic variants. This implies that we haven't even scratched the surface of discovering the clinically important variants from those of African and other non-European descent.
5 ways to address health disparities in precision medicine
So what can be done to address the critical issue of underrepresentation in genetic databases? Here are the key areas that I believe will lead to change:
1. Proactive recruiting.
Genetic researchers should be proactively recruiting underrepresented populations for future studies. This will require some non-traditional methods of recruitment into the studies,including engaging key community stakeholders and building trust in historically mistreated and underrepresented minority populations. Initiatives must also include community outreach and education (e.g., the creation of multilingual recruitment materials). Without this, there is no way we can make precision medicine equitable.
2. Do the right studies.
A continued and concerted effort is needed to conduct studies that address specific underrepresented populations, similar to the methodology in the H3Africa study mentioned above. We must take a systematic approach to ensure that the entire global population's genetics are appropriately and proportionately represented in genetic databases.
3. Create incentives.
Government funding agencies must build incentives for those who are recruiting and researching diverse cohorts. This includes the rebalancing of research funding for minority scientists.
4. Increase private sector investment in minority founders.
Important efforts to build non-Eurocentric genetic databases may actually come from the private sector, similar to the approaches that 23andMe and 54Gene are taking. However, implementing this on a larger scale would require a significantly increased level of investment into Black American and Latinx company founders, who received only 2.6% of all VC investments in 2020.
5. Build diverse leadership.
Both academia and the private sector must actively recruit diverse leadership teams—not just as entry-level and mid-level managers, but also in leadership roles, in the C-suite, and on boards of directors. Diverse teams are better at decision making, better at brainstorming, and better at creating products that represent a bigger proportion of the population.
We must do better
In 2020 and 2021, the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and several other Black Americans, along with hate crimes against Black and Asian communities—and in conjunction with the ongoing COVID-19 pandemic—have shone a spotlight on systemic racial disparities and inequities, which are also inherent in our healthcare system. European bias in genetic databases has huge implications for the health of individuals of non-European descent. It has the potential to contribute to decades of health disparities if we continue down this path. Without the changes outlined above, the genetic data we use to create the next generation of diagnostics, disease risk assessments, and therapeutic interventions will continue to make precision medicine available only to those of European descent. If we don't address this now, history will hold us accountable.
At MDisrupt we believe that the most impactful health products should make it market quickly. We do this by uniting digital health companies with experts from the healthcare industry to help them accelerate their time to market responsibly.
Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.
The Pandemic Fast-forwarded Digital Health. What's Next?
by Ruby Gadelrab | Feb 25, 2021
The Motley Fool recently interviewed Ruby Gadelrab, MDisrupt's CEO and founder, about the most important 2021 trends in digital health.
Motley Fool: Why don't we start with a brief introduction about you and MDisrupt?
Ruby Gadelrab: I have been in the biotech, healthcare, and digital health industry for about 24 years on the commercial side in various marketing and executive roles. I have worked at some notable companies in the space, including Affymetrix (now part of Thermo Fisher Scientific) and Invitae, a genetic information company. My last employed role was VP of commercial marketing at 23andMe.
Before founding MDisrupt 18 months ago, I consulted for two years for about 25 digital health companies, and I started noticing a pattern. I realized that these companies were seeking experts that understood the healthcare ecosystem. And these experts are hard to find.
MDisrupt is a platform that connects the digital health industry to the scientists and healthcare industry experts that they need to build, commercialize, and scale a health product both quickly and responsibly.
We currently work with a variety of experts including physicians, health system leaders, scientists, health economists, behavioral scientists, and lab operations and commercialization specialists.
Rapid innovation
Motley Fool: Let's start broadly by looking at the digital health space. What were some of your most interesting observations in this space in 2020?
Ruby Gadelrab: Let's start by defining what digital health is. Digital health is defined as the use of digital technologies and genomics to solve key problems in healthcare. So think algorithms, AI, data analytics, wearables, apps, telemedicine and virtual care, genetic tests and personalized medicine solutions. Healthcare typically has been slow to adopt digital health. Many of these solutions existed before the pandemic but struggled to get adoption.
So the high-level observations in 2020 as the pandemic hit us are these: The pandemic revealed how unprepared our healthcare system is for an event of such magnitude. The pandemic also revealed many of the inequity and access issues around health and digital health.
BUT there are silver linings. There is a fast forward button pushed on digital health and there are three themes:
Investments – It was the highest-ever year in digital health: According to Rock Health there were $14B of investments in digital health in 2020—an increase of 72% over the previous landmark year of 2018.
Speed of innovation – The FDA has issued over 300 emergency use authorizations for tests and devices during this pandemic. Many digital health companies quickly pivoted to create solutions for COVID-19. One example that's particularly relevant at this stage of the pandemic is Clear Labs. They developed a fully automated platform that can screen and sequence the SARS-COVID virus in under 24 hours. Now, with the new mutant strains of the virus, this is particularly relevant for epidemiological applications in monitoring and surveillance.
Adoption of telehealth and virtual care – This is an example of a technology that had been around for years but there was a reluctance about adoption—because of privacy issues, and because the Centers for Medicare and Medicaid Services (CMS) was only reimbursing telehealth visits in certain circumstances, for example in rural areas. But the pandemic forced patients, providers, and payors to experience different ways of delivering healthcare. In March of 2020, CMS reported that telehealth visits jumped from 10,000 per week to over 300,000.
Beyond COVID
Motley Fool: How do you expect those trends to evolve in 2021?
Ruby Gadelrab: For telehealth and virtual care, this is just the beginning. Providers and physicians experienced the comfort and convenience of delivering care from their homes. That trend will continue, especially now that CMS has released a policy showing that over 60 new telehealth services will now be reimbursed by Medicare.
Often when we think about telehealth we think of primary care services, but actually I think it will extend into areas of specialized care. One of our clients innovating in this area is Genome Medical. This is a genetics-focused medical practice that's delivered by telehealth. They are democratizing access to the very limited number of genetics experts in the country.
For sure there will be more COVID solutions. 2020 was about getting tests and vaccines out quickly, but 2021 will be more about back-to-work solutions. For example, Mesa Biotech built a point-of-care system that does rapid PCR of COVID and provides results in about 30 minutes outside of a lab setting. This is important as we consider back-to-work solutions and ways to bring testing closer to the consumer in the workplace or in retail pharmacies, for example. They were actually acquired by ThermoFisher recently for $550M. Many of these companies are thinking about the world beyond COVID. What they can do for COVID they can potentially do for other infectious diseases, too.
There will also be increased demand for at-home testing and monitoring solutions. Throughout the pandemic, we have seen states struggle to deliver COVID-19 testing efficiently. They have faced challenges with test availability and distribution as well as long turnaround times. And as we see new surges in infection rates, these problems have worsened.
Everlywell is one of our clients at MDisrupt and is an interesting example in this category.
Their mission was to democratize and simplify the lab testing process and get high quality lab testing straight into the hands of consumers with applications such as A1c, hormone testing, etc. In May, the FDA issued an emergency use authorization, making Everlywell's test the first stand-alone at-home sample collection kit for COVID-19 and making them the first digital health company to receive an EUA.
Everlywell has now shipped more than a million COVID-19 test kits, validating both consumer demand for at-home testing and consumer willingness to self-pay for diagnostic testing, In November Everlywell raised $175M to expand its consumer lab testing and digital health offerings and now has a valuation of $1.3 billion.
Delivering better engagement
Motley Fool: You worked at 23andMe in the past and with Everlywell during the pandemic. What's your future vision for the genetic testing industry? Are we just now seeing the tip of the iceberg on what value can be unlocked with this kind of innovation?
Ruby Gadelrab: What companies like 23andMe and Everlywell have done is demonstrated a few things that are critically important to the future of healthcare as a service:
That consumers and patients can effectively collect a sample at home and ship it back to the lab.
That consumers can accurately report phenotype data.
That a segment of the population wants direct and easy access to its health information and is willing to pay for it.
That they can deliver engaging consumer experiences and engage consumers in conversations around their health before they get sick.
In essence, what they have built is a novel way of delivering healthcare information and patient engagement experiences. And, quite frankly, it's a much better experience than what we can get from our healthcare system.
So I think the future of this space largely depends on who is willing to pay for this type of access, experience, and convenience. For sure there are segments of consumers who are willing to pay. But if companies like these can generate data to showcase improved outcomes, then there are potentially new stakeholders willing to consider paying for solutions like this, including employers, payors, and some health systems.
An example of this is Renown Health in northern Nevada. They launched the Healthy Nevada project where they offered patients in their system free genetic testing at home. They have had over 50,000 patients from within their system sign up and get access to their genetic test results.
Addressing health disparities
Motley Fool: The pandemic has revealed inequity in every corner of the world and revealed many health disparities. What did the pandemic teach you about the US healthcare system and what solutions might be effective?
Ruby Gadelrab: The pandemic was like putting a magnifying glass over our health system and showcasing the biggest gaps and health disparities. Everything from the most vulnerable populations contracting COVID at a higher rate to vulnerable populations suffering more severe symptoms when they contracted COVID, to who had access to testing if at all.
We saw that Black and minority populations were particularly impacted. And this started the big and tough conversations about ALL the disparities in health.
A couple of examples—most of the largest genetics databases are based on Caucasian populations. These databases are now being used to create diagnostic tests and therapeutics. Some of these innovations just won't be as effective when you use them on minority populations. Second example—many wearables use a particular type of light to monitor heart rate. This type of light is not as accurate on people with darker skin tones. So when we think about wearables being used in a medical setting to monitor cardiac issues, these are the types of things we have to take into account.
One company innovating in this area is 54gene. They are building the world's first biobank based on African genomes. Their goal is to close some of these gaps in health disparities by ensuring that people of African descent, globally, will be represented in the next generation of diagnostics and therapeutics.
Of course the discussion about health equity extends beyond race and into many other minority areas. Are we doing enough for women's health? For eldercare? For the LGBTQ community? Clearly the one-size-fits-all model of healthcare isn't working. It has to get more personalized and it has to address underserved populations by understanding their needs and their unique challenges.
One positive thing that has come from the pandemic is that there is a renewed focus on this, from investors and digital health innovators alike. We are seeing a new class of investors emerge who want to invest in minority founders building health companies that can address some of these issues.
Key steps for digital health
Motley Fool: A lot of your work with MDisrupt is advising and consulting with digital health startups. What do you tell them about competing with the big tech giants getting involved in healthcare? What competitive edges do smaller health-specific startups have over the Amazons and Microsofts of the world?
Ruby Gadelrab: Building health products that scale is really hard. And it's hard, it's expensive and it takes time, for everyone, whether you are a big tech company or a smaller digital health company. This is for a few reasons:
The user, the influencer, the payor, and the consumer of health products are each different stakeholders with different incentives.
Healthcare is highly regulated and the regulations in each country and sometimes in each state are different.
You can't test and iterate quickly like you can in tech. You need to do the studies to generate evidence to prove that your product is safe, effective, clinically useful, and that the economics work. These studies can often take many years.
You have to find your earliest adopters in the healthcare world. That often involves building expensive specialized sales teams and deploying KOL programs.
You have to get your product reimbursed and engage the medical community and medical societies.
These considerations apply to everyone, whether you are Amazon or Microsoft or smaller companies. So my advice:
Since it's impossible for one company to solve all of healthcare, pick a specific niche area that you know really well. If you don't know it through experience, engage healthcare experts. Ideally, hire a chief medical officer (CMO) that really knows the space and the problem you are trying to solve, and engage your target audience early and often.
Figure out early who you expect to be using the product and who is paying for it—because the type of product and commercial strategy you may build if a consumer is paying for it may be vastly different than if you expect it to be used in a healthcare setting.
Do not skimp on regulatory or evidence generation. This is an area where there are no shortcuts. The studies are critically important at every stage of commercialization. You need them to work with regulators, to convince physicians to adopt your solution, to engage medical societies and to build the dossier you need to convince payers to pay for it.
Four ways to improve outcomes
Motley Fool: We've seen certain healthtech companies be successful by occupying a niche where there are inefficiencies, and using technology to create value by streamlining or simplifying. What areas in the health space are still ripe for disruption?
Ruby Gadelrab: The $3.5T healthcare industry is ripe for digital disruption. Healthcare is at an inflection point. It's changing from being transactional when you are sick, into an ongoing service designed to keep you healthy.
The health system of the past 100 years wasn't about health or care. It's effectively a sick care system. We need a health system that starts to take care of people before they get sick—outside the walls of a hospital and more in their daily lives, by continually engaging with consumers BEFORE they become patients.
The changes over the next few years will be driven not only by technology but also by how it's going to get paid for. We are moving from a fee-for service system (where more procedures makes more money) to a value-based care system where health systems and providers are reimbursed by better outcomes.
So for digital health companies to be successful they need to demonstrate that they can improve outcomes. And typically these fall into one of four categories:
Health outcomes—Can we predict and prevent disease or do a better job of managing it outside of the health system if it occurs? Medication compliance?
Patient and physician experience—Are there solutions that improve the experience for both?
Access—Can we simplify access to delivering healthcare for more people when they need it, either inside and outside of a healthcare system?
Reducing costs—Can we create efficiencies in the health system or a clinical workflow that can increase productivity or reduce costs?
At MDisrupt, when we work with digital health companies we encourage them to think about which of these four problems their solution addresses, and how to generate the evidence to showcase this.
The best way for companies to do this, in my opinion, is to ensure that they engage scientists and health industry experts early and often throughout their product development. Clinicians understand the healthcare system, they see the problems and they know what the effective solutions need to be—and they can add tremendous value to digital health companies.
Connecting truth-seekers to talent
Motley Fool: Let's talk about the medical diligence part of MDisrupt. Diligence is important for investors in any sector, but in healthcare, the stakes can be life and death. Of course, investors can only base their decisions on information the company makes available, and we've seen instances of management either withholding certain material info or even outright lying at what its technology is capable of. What have you learned about medical diligence and how can investors have more confidence in a company by harnessing this knowledge?
Ruby Gadelrab: This was a really interesting experience for us when we first founded MDisrupt. Investors weren't really our first customers.
What we found early on is a breed of digital health companies where the founders were truth seekers and determined to create impactful, responsible health products and get them to market quickly. Many of these founders had business or tech backgrounds. They understood that access to health industry expertise was critical to their success and yet that talent is relatively hard to find. They were asking us for chief medical officers, regulatory experts, health economists, lab scientists, product managers and behavioral scientists.
At the same time, we were inundated with hundreds of messages from scientists, clinicians and other health industry experts asking us how they could get involved in lending their expertise and knowledge to digital health companies. We quickly realized we needed to build a platform that could connect digital health companies to the experts.
I guess like other start-ups in this space, finding true product-market fit is when the market pulls you in a specific direction. So that's where we focus now, on helping the digital health companies connect to the experts so they can get to market quickly and responsibly.
Of course, if investors want access to our experts to help them diligence their investments for clinical and commercial viability, we are more than happy to help them too.
Ruby Gadelrab: Here are the top trends we see at MDisrupt:
Telemedicine and virtual care
New Covid solutions focused on getting back to work
At-home testing and monitoring solutions
Behavioral and mental health solutions
Teams which have a good balance of tech and healthcare folks.
At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.
Raising the Bar on Digital Health: Clinical Outcomes are the New Standard
Optimizing product/market fit through user research
Breast Cancer Awareness Month: How digital health is improving breast cancer screening and care
7 P's to evaluate healthcare companies: A framework for physicians
Science Entrepreneurs


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