07 Oct 2020

The Caves We Live in Today

Plato’s Allegory of the Cave and lessons for today

If I ask: Why are blackberries red? And I tell you: Because they are green. What would you think? My answer, for some, may be perfectly logic, depending on their background and occupation. For a blackberry farmer, my answer would not only be perfectly logic, but they would actually have the correct answer immediately. However, for most of us, the question and the answer would have been confusing. By simply changing my words, I would have limited this confusion. Why are blackberries red? Because they are not ripe (= green). Blackberries actually go from red to black as they ripen.

If I ask, today, whether humans are living in caves, most will answer: No, of course not.

However, in similar fashion, this might not be true, depending on how we interpret the question? During the COVID 19 pandemic and global lockdown, many people might answer: Yes! This lockdown is a cave I cannot escape from. However, there is a deeper, metaphorical cave we might in fact be living in without even knowing. In this article I turn to the masters from the past and stand on their shoulders to challenge us. Let’s turn to the philosophers, people like Socrates, Plato and Aristotle.

The word philosophy in essence means the love of truth. As scientists and researchers, we are therefore all philosophers as we search for truth. In Plato’s Allegory of the Cave, he challenges society that many people live in caves and in a belief that is not based on truth.

According to Wheeler in Literary Terms and Definitions (Carlson Carson-Newman University) allegories are typically used as “literary devices or as rhetorical devices that convey (semi-) hidden or complex meanings through symbolic figures, actions, imagery or events which together create a moral spiritual or political meaning the author wishes to convey”.

The Allegory of the Cave distinguishes between those who make observational knowledge their source of truth and those who see the real truth. Stated differently (and in line with the late Jack Welsch’s first rule of business): The first rule of success is to confront reality. That means seeing the world the way it really is, and not the way we want it to be.

With that said, let us paint the picture of the Cave as was portrayed by Plato. There are four scenes in this allegory: the cave and its inhabitants; the games the inhabitants play; the escape from the cave; and the return to the cave.

The Cave and its inhabitants: Three prisoners are locked in chains in a cave, all facing an empty cave wall. They have been there all their life. They cannot move at all. Not even turn their heads. Behind them, there is a fire burning and other, free people are walking silently going about their day between the fire and the prisoners. The only thing the prisoners can see are the moving shadows on the wall as the free people pass by. For them, the shadows represent truth, their truth.

The games they play: They invent a game to guess what shadow image will appear next. When someone guesses right, he is hailed as a genius, the other two in awe of his wisdom.

The escape: Then, one prisoner escapes. He exists the cave and sees a world he never anticipated. He sees the sun as the source of true light. While initially he cannot believe it, he experiences beauty and creation and understands that the shadows they saw were only images of the real truth. That the shadows were not truth. It was meaningless.

The return: The escapee then returns to the Cave to share with his fellow prisoners his new knowledge. They do not believe him and threatens to kill him if he sets them free.

The Cave challenges us to always confront reality; to always question, even empirical evidence; to distinguish between perceptions and beliefs and truth. As scientists we need to remain objective and curious. We need to never stop questioning. We need to treat current “truths” as the best possible version of the truth given the evidence at our disposal. We need to be aware that new evidence might be forthcoming that will challenge current wisdom (shadows on the wall?) and we need to open ourselves for those possibilities.

Some truths are most likely irrefutable. For example, that earth is in fact round. Some cause and effect truths are irrefutable, for example that sunset leads to darkness. However, most of today’s empirical evidence is not irrefutable. Drug safety and efficacy for example remains the best version based on existing evidence.

Furthermore, Plato’s Cave teaches us that it is seldom popular or well accepted when we challenge the current convention and beliefs. Think about the concept of glycaemic index. When Jenkins constructed the index in 1981, he was ridiculed by his peers.

Lastly, Plato’s Cave challenges us all to think like philosophers, those who are in love with truth and will continue searching for truth. It challenges us to seek truth outside the basic constructs we were taught. It challenges the belief that, just because someone has an opinion, she or he is a genius. It challenges us to exit the Cave and to let go of the straddling bands that keeps us in the Cave.

“Logic is immaturity weaving its nets of gossamer wherewith it aims to catch the behemoth of knowledge. Logic is a crutch for the cripple, but a burden for the swift of foot and a greater burden still for the wise.”
― Mikhail Naimy, The Book of Mirdad

By Dr Tienie Stander

27 Jun 2018

JOIN US AS WE UNFOLD HEALTHCARE REFORM IN SOUTH AFRICA.

Presented by

Dr Tienie Stander Elsebe Klinck Ruwaida Sheik
Ntuthuko Bhengu Christoff Raath Dr. Rajesh Patel

To understand what may come, we need to have a deeper upstanding of healthcare’s complexities.
Join us as we unfold healthcare reform in South Africa.
Journey with us as we unpack healthcare post 1994 to current!

In bridging the gap between yesterday, today and tomorrow, we also collaboratively bridge the gap for generations to come.

Who should attend?

CEO’s, MD’s, country managers, functional managers of pharmaceutical companies.

Young up and coming managers in pharma who have not been exposed to this regulatory reform over these 24 years.

Companies that want to create a core team of leaders with a strategic memory of the past history of South Africa’s journey up to 2018.

Companies that wish to position themselves towards participants in NHI.

27 Sep 2017

ATTEND OUR TRAINING SESSION – THE FUNDER MINDSET: INSIGHT INTO THE FUNDER’S WORLD.

Due to popular demand, we have decided to present a Training Session as a follow up to the Workshop we held in July. We are honoured to invite you to this full day Training Session.

The Funder Mindset: Insight into the funder’s world – Training Session.

Date: Thursday, 12 October 2017
Time: 09:00 – 16:00
Venue: Radisson Blu Gautrain Hotel, Rivonia Road, Sandton.

WORKSHOP TOPICS

    • The Legal Framework: Regulatory, Suppliers, Providers with a view of future Implications.
    • Strategic imperative for a sustainable business in SA: The Hunger Games & NHI
    • Risk Sharing Funding Principles, Alternate Reimbursement Practices & value Based Contracting: Strategies for the Future
    • The Actuarial Black Box: Understanding Mission Impossible (Risk Management, managing contributions/reserves)
    • Conceptual Framework: Integration of how our clients can utilize the knowledge.

Cost to attend: R2,150 per person (ex VAT) – Snacks and refreshments will be provided. Please RSVP by Thursday, 5 October 2017

The objective of this workshop is to create a forum where the pharma and devices industry can have an opportunity to understand the challenges faced by and decisions made by funders. We look forward to seeing you there.

13 Jul 2017

GETTING A MEDICAL SCHEME PERSPECTIVE: A LOOK AT OUR RECENT WORKSHOP, THE FUNDER MINDSET

The question is often raised, as to why medical schemes do not pay for certain benefits. Members pay their contributions, but where does this go? What is risk pooling or cross subsidisation?

We realised that indeed there is a gap in understanding this concept and so an idea was born – to identify and link the truths between administrator, funder and the paying member.

On Thursday, July 13th , we hosted of the first of several workshops aimed at creating awareness, identifying challenges and ultimately working together to find solutions that are patient centric.

Gaining insight from the Medical Scheme Perspective is not an easy task. Our speakers, Milton Streak, Johan Van Zyl and Tienie Stander assisted in providing an objective view of the different industry role players.

Johan discussed the role of the administrator. Oftentimes there lacks an understanding as to the role that the administrator plays. Having years of experience in the field of health management, managed healthcare, health analytics as well as clinical and procedural coding, Johan was able to provide information regarding awareness, challenges faced, as well as potential solutions.

Milton spoke of governance of medical schemes, business trends in health care and amongst others enablers for improving health care. Milton has over 20 years’ experience serving in senior leadership positions at leading South African Medical Scheme Administrators/Managed Care Organisations and Medical Schemes and is currently an independent Healthcare Strategy Adviser.

Linking both Milton and Johan’s discussions, Tienie provided valuable insight as to how to bridge this gap. It starts with a partnership and joint discussions. The solution is the SA Constitution (S27). Everyone has the right to have access to social security, even if they are unable to support themselves and their dependents, including appropriate social assistance. The state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights.

We hope that by hosting such workshops we open dialogue that is so urgently required. A dialogue that challenges our approach, and perhaps serves as a catalyst to what ultimately requires a partnership of all stakeholders within the industry.

The Funder Mindset: Insight into the Funder’s World was the first of a series of workshops that will be held over the next few months. 

SPEAKER BIOS:

Johann Van Zyl
Johann is a medical practitioner and founder and Managing Director of Clinical Governance Services (Pty) Ltd (CGS).

Relevant Experience/Specialisation:
Johann has 12 years’ experience as a general practitioner coupled with some 19 years’ experience in health management, managed healthcare, health analytics and clinical and procedure coding. He specialises in clinical and procedure coding and the clinical analysis of health claims data.

Johann’s current responsibilities include:

    • Advising medical schemes on benefit design and related clinical matters
    • Advising medical schemes on clinical risk management strategies
    • Healthcare account auditing
    • Measuring financial and clinical healthcare outcomes
    • Monitoring outcomes and compliance reporting for contracted health care provider networks
    • Development of provider profiling models across various disciplines
    • Development, maintenance and costing of procedural coding structures
    • Development and maintenance of clinical coding grouping methodologies
    • Development of predictive models that are applied to analyse past claims experience and forecast scenarios
    • Advising corporate clients on health and wellness strategies

Education and Credentials
Bachelor of Medicine and Bachelor of Surgery (Studies in Medicine – University of Stellenbosch)

Master’s in Business Administration (University of Stellenbosch)
Registered with the Health Professions Council of South Africa

Milton Streak
Milton Streak was born on 31 July 1966 in the Northern Cape Province of South Africa. He matriculated from Potchefstroom Gymnasium in 1984 and obtained a B.Pharm Degree from the Northwest University, Potchefstroom in 1989. His post graduate studies included a Master of Management Degree (with distinction) from the University of the Witwatersrand, specialising in Entrepreneurship and New Venture Creation. Following completion of his Master’s studies, he was awarded the Wits Business School’s MANEX Award in 2012. Further post graduate studies included four Executive Management Programs at Harvard Business School from 2008 to 2016, focused on healthcare innovation and delivery as well as competitive dynamics. He also obtained a post graduate Certificate in Corporate Governance (Cum Laude) at the University of Johannesburg in 2011. He is a member of the Institute of Directors Southern Africa and has completed the IOD’s Directors Program.

Milton’s healthcare career includes both international and South African health insurance and healthcare management experience. His career spans over 27 years, with 21 years’ experience in corporate South Africa, serving in senior leadership positions at leading South African Medical Scheme Administrators/Managed Care Organisations and Medical Schemes, including the largest medical Scheme in South Africa, Discovery Health Medical Scheme, as Principal Officer/CEO from 2009 to 31 December 2016.

He is currently an independent Healthcare Strategy Adviser and has spent the last three months in India working with India’s 3rd largest stand-alone private health insurer on strategic projects.

Tienie Stander
Tienie graduated from the University of Stellenbosch and obtained an M.B., Ch.B. in 1981.  He practised as a MD until 1997 after which he managed a hospital. He was appointed as Principal Officer of a medical scheme in 1998. In 2000 he obtained an MBA at the North West University, South Africa.

He is the founder heXor (Pty) Ltd, now rebranded as VI Research where he acts as managing director.

Tienie was an extraordinary professor at North West University, school of pharmacy and is an external moderator of the School of Pharmacy of North West University.  He was a founding member and the first President of ISPOR South Africa and is a member of ISPOR International, International Aids Society and Health Financial Management Association.

He collaborates extensively with international academic organisations such as Harvard Medical School and British Columbia University, as well as most South African universities.  International experience includes consulting work in the SADC, Mauritius, Ghana, Libya, Egypt, Sudan, India, Thailand, UAE, Oman and China related to policy, health systems and health economics and outcomes research.

23 Jun 2017

ATTEND OUR WORKSHOP- THE FUNDER MINDSET: INSIGHT INTO THE FUNDER’S WORLD.

We will be hosting a number of workshops over the next few months. The first in the series will be focused on the Medical Scheme Perspective. We are honoured to invite you to the first of this series of workshops, titled:

The Funder Mindset: Insight into the funder’s world.

Date: Thursday, 13 July 2017
Time: 09:00 – 13:00
Venue: Radisson Blu Gautrain Hotel, Rivonia Road, Sandton.

AGENDA:
9:00 – 9:15 Welcome & opening

9:15 – 10:15 Tebogo Phaleng – Presenting the medical scheme administrator’s role (1hour)

    • What services are provided by an administrator?
    • What are the roles of actuaries?
    • How do administrators manage risk?
    • What are health care vs. non-health care costs?
    • What are the key challenges facing administrators?
    • How should suppliers engage with administrators?
    • How can we improve access to new innovations to patients in need?

10:15 – 10:30 Bio break
10:30 – 11:30 Milton Streak – Presenting the medical scheme perspective (1 hour)

    • How do medical schemes budget?
    • How do medical schemes agree on benefit richness per option?
    • How do you manage risk?
    • How do you create formularies?
    • How do medical schemes make reimbursement decisions?
    • What is the relationship between a scheme and its administrator?
    • What is the role, responsibilities and authority of the Principal Officer?
    • What is the role, responsibilities and authority of the Board of Trustees?
    • How does medical industry engage with suppliers (example pharma)?
    • What models of engagement can you recommend for suppliers?
    • How can we improve access to new innovations to patients in need?

11:30 – 12:00 Tienie Stander – Presenting the role of health outcomes research in this environment (30 mins)

    • Moving away from price arguments to value arguments
    • Breaking down the silo-thinking inherent in the industry
    • From clinical evidence to real-world evidence to quantify value
    • A framework for value quantification

12:30 – 12:30 Panel discussion (30 mins)

    • Questions from the audience

12:30 – 12:35 Closure
12:35 – 13:00 Refreshments

SPEAKERS:
Milton StreakMilton has 21 years’ experience serving in senior leadership positions at leading South African Medical Scheme Administrators/Managed Care Organisations and Medical Schemes, including Discovery Health Medical Scheme, as Principal Officer/CEO from 2009 to 2016. He is currently an independent Healthcare Strategy Adviser and has spent the last three months in India working with India’s 3rd largest standalone private health insurer.

Dr. Tebogo Phaleng: Tebogo was Deputy General Manager of Strategy and Risk Management at Discovery Health and Managing Director of Coalesce, a Strategy and Risk Advisory consultancy. He is currently the Managing Director of EOH Health.

Dr. Tienie StanderTienie is the managing director of VI Research. He is a member of ISPOR International, International Aids Society and Health Financial Management Association. He collaborates extensively with international academic organisations such as Harvard Medical School and British Columbia University. International experience includes consulting work in the SADC, Mauritius, Ghana, Libya, Egypt, Sudan, India, Thailand, UAE, Oman and China related to policy, health systems and health economics and outcomes research. 

Cost to attend: R1100
Please RSVP by Friday 7 July 2017

The objective of this workshop is to create a forum where the pharma and devices industry can have an opportunity to understand the challenges faced by and decisions made by funders. We look forward to seeing you there.

05 Jun 2017

IMPROVING WOMEN’S HEALTH ACROSS THE KURDISTAN REGION THROUGH THE CENTRE FOR RESEARCH AND EDUCATION IN WOMEN’S HEALTH (CREWH)

The inauguration of the Center for Research and Education in Women’s Health (CREWH) took place in Erbil, Iraq Kurdistan on the 24th of May 2017 under the patronage of Hawler Medical University and the ministry of health (MoH). The CREWH is part of Hawler Medical University and works towards improving women’s health across the Kurdistan region.

Dr. Hamdia Ahmed, president of the CREWH, outlined the need for this centre during her speech: [The] CREWH will advocate women’s health and development through education, research, capacity building and community projects. [The] CREWH was established to be a leading center dedicated to advocate women’s health and development with the academic institution and across the community.

Several speakers representing academics, official and international organisations, as well as the chairman of the party, president and professors of the university, the ministry of health, and the CREWH’s staff outlined the importance of such a centre and its role to improve the health and well-being of women in the community.

Professor Ibrahim Labouta also attended the event. During his speech, Prof. Labouta, addressed the critical importance of the development of a 5-year strategy, building the capacity of the staff in outcomes research and introducing information technology such as registries into this strategy.

Speeches by the representatives of UN Women and WHO further appraised the opening of the centre and emphasised its future role in enhancing the health and status of women in Kurdistan.

This event highlighted the importance of bringing together researchers, clinicians, outcomes research experts, international organisations and communities to promote women’s health through research, training, advocacy and community research projects. It also covered the following topics/issues:

    • Identifying strategies for improving women’s health
    • Exploring future business opportunities
    • Exploiting the competitive pharmaceutical market
    • Getting an insight of the needs of Kurdistan region in terms of outcomes and clinical research and training
    • Getting to know the latest regulatory developments, key indicators and major corporate developments

To find out more about the CREWH, visit http://hmu.edu.krd/WomensHealth.aspx or contact crewh@hmu.edu.krd

12 May 2017

IN SOUTH AFRICA, ONE OUT OF FOUR PEOPLE SUFFER FROM MENTAL HEALTH ISSUES.

This is according to Dr Renata Schoeman, who spoke on the impact of mental illness on the workforce at the Corporate Wellness Day hosted by the University of Stellenbosch Business School on Friday 12 May 2017 in Port Elizabeth.

South Africa still has a culture of silence surrounding mental health problems in the workplace. Employers and employees are unwilling to talk openly about conditions such as anxiety and depression for fear of association with weakness and failure. However, healthy employees are productive employees. Investing in a mentally healthy workforce is good business. It can curb medical costs, increase productivity, decrease absenteeism, and prevent and decrease disability costs. Investing in mental health also improves employee motivation, staff retention and competitiveness. The following experts shared their insights at the seminar:

    • Prof Piet Naudé, Director, USB: The ethical responsibility of leadership to enable multi-dimensional staff wellness.
    • Dr Renata Schoeman, Private Psychiatrist; Part-time Senior Lecturer: Leadership, USB: Clinical aspects of common mental health problems such as burnout and the importance of self-care.
    • Dr Tienie Stander, CEO, VI Research: The value of technology in corporate wellness assessments, interventions and outcome measurements.
    • Prof Christoffel Grobler, Associate professor, Walter Sisulu University; Clinical Head, Elizabeth Donkin hospital: The prevention and assessment of disability.

The following article from heraldlive.co.za by Estelle Ellis, provides more insights into the seminar.

High cost of mental problems

11 May 2017

FIRST ISPOR SA CHAPTER WORKSHOP FOR 2017

Topic: What’s the evidence? A practical approach on the HTA process in the UK: From the NICE appraisal to reimbursement

Date: 16 May 2017
Time: 08:45 – 15:00
Venue: Protea Hotel Marriot Balalaika Maude Street, Sandown, Sandton
Faculty: Nan Oliver

Nan Oliver has worked as a health economist in the UK over the past eight years. While working for Novartis Oncology she was responsible for 13 health technology appraisals, including 6 submissions to NICE, 5 to the Scottish Medicines Consortium and 2 to the AWMSG in Wales. These submissions were for drugs used to treat various rare cancers and tumours in areas including chronic myeloid leukaemia, gastrointestinal stromal tumours, pancreatic neuroendocrine tumours, myelofibrosis and acromegaly. In her last year in the UK, she was Head of Outcomes Research for Novartis Oncology. She has a B Pharm degree from Rhodes, MBA from UCT and a post-graduate diploma in health economics (PGDip HE) from the University of York. Having always worked in the pharmaceutical industry, Nan gained extensive experience in marketing, new product development and general management in South Africa before spending the last 14 years in the UK. She initially worked in marketing In the UK but it soon became evident that market access was the key to achieving access for patients to appropriate treatments and so she retrained in health economics. In the workshop, Nan will draw on her personal experience to highlight the processes and issues involved in making a submission to NICE, from planning the HTA strategy to developing the submission and managing the process through to final decision. The workshop will be interactive with plenty of time for discussion and questions.
Program:
08:45 – 09:00 Registration
09:00 – 09:10 Welcome and background
09:10 – 09:40 Brief overview of NICE process
09:40 – 10:10 Submission strategy development and timelines for developing submission
10:10 – 10:30 TEA
10:30 – 10:45 Developing the submission: ICER
10:45 – 11:05 Developing the submission: Costs
11:05 – 11:30 Developing the submission: Effectiveness
11:30 – 12:15 Developing the submission: Results interpretation
13:00 – 13:45 Lunch
13:45 – 14:00 Preparing submission
14:00 – 14:45 Interactions with NICE
15:00 Close of meeting

Registration fee: R2500 (Member), R3250 (Non Member) RSVP to info@isporsa.co.za or events@medsoc.co.za

01 Apr 2017

1ST ARAB INTERNATIONAL PHARMACY CONFERENCE IN CAIRO EGYPT 30 MARCH – 1 APRIL 2017, CAIRO

The first Annual International Pharmacy Conference was held in Cairo, Egypt from the 30th of March to the 1st of April 2017 under the Patronage of Ain Shams University. The theme of this event was PHARMACY VISION 2030 – Education, Profession and Pharmaco-Regulations.

Dr Tienie Stander, CEO of VI Research South Africa and Prof. Ibrahim Labouta were both speakers at this prime event. Their discussions included Clinical vs. Outcomes Research: an integrated approach for Pharmaceutical Companies and National Overview on Pricing Modalities respectively.

The main topics of this event included: Challenges and Opportunities Facing the Pharmaceutical Industry, Pharmacovigilance and Bioethics, Clinical Pharmacy Standard of Practice, Roles and Rights of Pharmacists in Health Care, Current and Future Perspectives of Pharmacy Education, Empowering and Developing Pharmacy Profession, Bridging the Gap between Practice and Education and Supporting and Making use of Pharmaceutical Research.

This unique scientific event provided attendees with insight on innovations in implementing clinical pharmacy services as well as new technologies and innovations in pharmacy practice. The conference furthermore examined ideas, such as the pharmacists’ role of shared accountability in patient education and improving patient outcomes. It further aimed to identify strategies for improving prescribing medicines in hospitals and developing highly effective medication management strategies.

Visit http://aapharmacist.com/ for more information.