Healthcare: The Business We’re In

While standing in line to board a cross-country bus, a middle-aged man crumples to the floor. Stunned momentarily, bystanders gasp then began trying to help. Someone calls 9-1-1. A woman kneels to see if he’s OK. No response. A nearby man begins pushing on the chest, hoping he is doing it right.

An approaching siren announces the arrival of the EMS ambulance. Paramedics come through the door and take over. Many things happen at once, each of the medics playing their role. They work on the patient until a decision is made to transport.

At the nearest hospital the EMS control phone in the Emergency Department rings with the particular ding that everyone knows. If you’ve worked in that emergency department, for the rest of your life if you hear that sound, no matter where you are, your head will snap around.

DING! The charge nurse sweeps up the handset, listens briefly, and then scribbles on the small whiteboard, “M47 CPR-8.” An ambulance is inbound under lights and siren racing through traffic with a male patient, 47 years old, CPR in progress, ETA 8 minutes.

The code team gathers quickly in the trauma room, covers the table with sheets, and, because only a small percentage of CPRs survive, hidden underneath the sheets is a white body bag. Machines are switched on; IV bags, angiocatheters, drugs and the rest of the Code Blue paraphernalia are hung, pulled, opened and made ready.

The medics arrive, quickly transferring the patient to the table and the code team gets busy doing all those things you’ve seen on TV. After a half hour of work, several electric shocks from sophisticated machines, rounds of drugs, hundreds of manual ventilations and thousands of chest compressions, the attending physician, after polling the team, calls the time of death, and orders chest compressions to stop.

The person on the chest has the most personal contact. You feel the warmth of the flesh. You watch the color of the skin because you must keep it pink and warm with effective CPR. You smell the breath; the late-night beer, the morning coffee. Everyone in clinical medicine has been part of these teams and has seen the same thing and has been on the chest at some time.

When you stop, the pink skin quickly turns bluish on the ears and lips. Cyanotic. The blue color spreads then all of the skin turns gray and cold. No one wants to watch death take over, but you can’t avoid seeing that begin, especially if you’re the one on the chest. Death wins.

After a minute, you go back to treating of all those other people who need help. In a busy ED, it can happen a few times a day. It is ordinary. Routine.

You and I are in healthcare, and this is the business we’re in—part of it anyway. In one way or another it’s the business we are all in.

Drama happens at times, but most of the healthcare industry is quiet and calm, whether it’s in a clinic or a research laboratory. It’s not just about saving the dying; it’s about everything from toenail fungus to heart disease and cancer. It’s fixing the small ouch to repairing body-wreckage of major trauma. It’s also about preventing disease by treating the healthy to keep them that way.

My D Healthcare Daily blog posts will be mostly about the quiet part of the industry and occasionally about the not-so-quiet. This will be about the people, processes, and products of healthcare, about forming companies and doing what must be done. And sometimes it will about other things in healthcare too. It’s all fair game.

Initially, every healthcare advance in molecules and technologies begins as an idea that occurs to someone in a laboratory, or office, or sometimes at lunch. A major Texas biopharmaceutical company can trace its start to a sketch on the backside of a placemat that was made in a lunch diner with the jukebox playing and airplanes hanging from the ceiling.

Every link in that Code Blue event—every device, drug, or treatment—was created by people who translated ideas into goods and services that were refined and commercialized by companies. It’s a long and complex process for every medical thing that touches a patient, and for many that don’t.

Sometimes the companies are big pharma, or big medtech. Often in North Texas the companies are small “NewCos,” and because they are small, they can only take the ideas part way along the journey. OK, then what?

If you’re in a NewCo and you’re on the technical side, you focus on getting that molecule or device to succeed in clinical trials. If you’re the CEO you focus on building a compelling value proposition so the next round of capital will be available and you focus on spending every dollar so that the company becomes worth more than the dollar you spent. If you’re an investor you want to produce a return on investment so you focus on helping it all work.

All of the interests must be aligned; building companies, turning technologies into products, hiring savvy people to make it happen, and getting capital to move it forward. Everyone must be focused on creating products that will make a difference to healthcare.

In Dallas and North Texas, this encompasses everything from providers with clinics and hospitals, researchers inventing new technologies, and companies that create, manufacture, market, and sell health-related products.

My day job is to help start new pharmaceutical and medical device companies based on university technologies that come out of the research laboratories and from the creative inventiveness of clinicians in our hospitals. We’ve done a few.

This industry comprises you and me and all those who are or want to be part of it. It’s big business in North Texas, and it’s fascinating to me. I hope it will be interesting to you, too.

 

— Lawrence E. “Joe” Allred is assistant vice president for venture development at the University of Texas Southwestern Medical Center in the Office for Technology Development.