public health – Sociology Eso Science http://www.sociologyesoscience.com/ Sun, 13 Mar 2022 13:00:20 +0000 en-US hourly 1 https://wordpress.org/?v=5.9.3 https://www.sociologyesoscience.com/wp-content/uploads/2021/06/favicon-6-150x150.png public health – Sociology Eso Science http://www.sociologyesoscience.com/ 32 32 Is the AAP ready to replace the Congress as India’s national opposition? https://www.sociologyesoscience.com/is-the-aap-ready-to-replace-the-congress-as-indias-national-opposition/ Sun, 13 Mar 2022 13:00:20 +0000 https://www.sociologyesoscience.com/is-the-aap-ready-to-replace-the-congress-as-indias-national-opposition/ A landslide victory in Punjab propelled the Aam Aadmi Party (AAP) from ruling a “glorified municipality” to becoming the fifth Indian party to successfully expand beyond its home state and gain another state. The AAP now governs two states, as many as Congress. As Congress grapples with an existential crisis after the dismal electoral record […]]]>

A landslide victory in Punjab propelled the Aam Aadmi Party (AAP) from ruling a “glorified municipality” to becoming the fifth Indian party to successfully expand beyond its home state and gain another state. The AAP now governs two states, as many as Congress.

As Congress grapples with an existential crisis after the dismal electoral record of winning just five of 50 state assemblies up for grabs since 2014 and being routed in two consecutive national elections, the success of the AAP to sweep another state has raised whispers that the AAP is the possible “national and natural replacement for Congress”.

As the AAP takes the heels of Congress in Gujarat, Himachal Pradesh, Karnataka and beyond, here are five reasons why the party could well replace Congress as India’s national opposition.

‘Alternative governance’ agenda captures voters’ hopes

The Indian state, despite its stability, has lagged behind in creating economic growth and jobs, reducing hunger, malnutrition and poverty and has seemingly given up on providing health care and food. education, ensuring urban governance, gender parity and reduced social stratification, etc.

Such failures provide extraordinary leeway for reforms that address these critical issues and thereby create new electoral bases for a party.

Yet existing parties, particularly Congress, have failed to offer an alternative paradigm. As such, we the people have been content with the familiar trope of being “too populous to be well governed”. A sense of hopeless status quo and a lack of imagination have permeated our approach to most public policy issues.

A Bharatiya Janata Party (BJP) government is barely distinguishable from a Congress government, especially in the states, as the famous Arun Shourie so aptly put it. “The BJP is Congress plus the cow,” he said.

Congress has become a prisoner of its own heritage, upholding archaic structures and laws, unable to free itself from outdated approaches to governance. He remains convinced of his sense of right and seems content to wait his turn as an opposition, to be elected to power because of a possible anti-incumbent. This right and convenience is why Congress does not have a marketable governance model for states, unlike the AAP model in Delhi and the BJP model in Gujarat.

In such a vacuum, the PAA offers an alternative form of governance that lowers the cost of living and increases the disposable incomes of ordinary people through innovations in welfarism; improves opportunities for the upliftment and dignified existence of the poor through reformed public health and education systems; improves service delivery through the use of technology and updated delivery structures, such as door-to-door service delivery and provisions for universal water supply and sewerage access.

Through these steps, the party has thoughtfully identified unmet voter needs, challenged itself to meet them, and thereby created a sustainable voter base that transcends former voting blocs. It is this enduring base that explains why the AAP, after gaining a foothold in one state, sweeps it and thus can defeat Congress in other states as well.

Solves the riddle of the BJP’s ‘Hindu’ and nationalist appeal

The BJP’s success under Modi against the Congress was underscored by the party’s success in defining the Congress as “anti-Hindu” and “anti-national”, thus making the Congress a pariah for a significant portion of voters. The BJP keeps these voters consolidated by constantly stirring the cultural and social pot and appropriating the mantle of “protector of the national and Hindu interest”. Due to the emotive appeal of Hindutva and nationalism, the BJP has created a bond with voters that has grown immune to governance failures.

The AAP has managed to navigate this minefield with innocuous symbolism, such as temple visits, one-crore fees for martyrs, tiranga yatras, and the Teerth Yatra yojana. He has also carefully avoided becoming entangled in cultural and religious debates that keep the body politic’s focus on cultural differences rather than governance issues.

While the AAP has received much criticism for pandering to the emotional needs of the people through the type of religious and nationalist symbolism that the BJP also uses, such criticism overlooks how a fractured political regime, where society is polarized on such conflicting issues, is not able to settle such debates. On the contrary, such challenges only distract us from focusing on the things that unite us and alienate the Liberals from a significant portion of voters.

Thus, the AAP has struck a balance where Hindus who feel alienated are brought back into the liberal fold by having their feelings publicly acknowledged and respected, neutralizing the sense of victimization that the BJP has carefully nurtured among Hindus and thus allowing elections to be fought over issues of governance.

A charismatic and competent leader

The AAP gains another point against Congress by comparing the attractiveness of its leaders; Arvind Kejriwal versus Rahul Gandhi.

Gandhi has held no governance post and is unable to inspire voters’ confidence in his ability to govern, while Kejriwal served as chief minister three times and was re-elected based on his governance record.

Kejriwal is also a much more powerful organization builder and a more persuasive public speaker. Moreover, Gandhi was systematically demonized and as a result is widely seen as the incompetent representative of a corrupt dynasty in decline responsible for the corruption and nepotism that frustrated the aspirations of the common man, creating sentiment among the voters of a lack of alternatives to Modi.

By contrast, Kejriwal is seen as a self-made man who passed both the IIT and civil service entrance exams; won a Magsaysay Award for Social Services; and is a renowned anti-corruption crusader. This makes him better placed to emerge as a face of opposition behind whom the public can unite and credibly challenge Modi.

Mastery of the “new-age electoral campaign”

In the competition for national opposition space, the AAP has another ace up its sleeve: its mastery of new-age election campaigning.

The AAP has a dominating presence on various social media platforms; ostensibly has a better understanding of search algorithms; has more passionate online volunteers; and has innovative multimedia messaging that allows it to disproportionately define the narrative online – and subsequently, offline; a task with which Congress often finds itself confronted.

In fact, Congress, the original “godfather” of welfare policy and the party behind India’s 1991 reforms, is unable to claim ownership of either over the BJP due to the construction superior narrative of the latter.

A combat-ready group with a mission

The Congress is run by leaders and volunteers who are demoralized, uninspired and out of step with the expectations of the people. The party has become impoverished despite the enrichment of its leaders. It has failed to attract new talent as its own leaders abandon it to launch their own parties or join its rivals.

In contrast, the AAP has an army of loyal and dedicated young volunteers, with unwavering faith in the party’s mission. It helps her create a buzz and win the perception battle.

The rise of the AAP has not been without its share of failures. He was left for dead after the Lok Sabha debacle in 2014, then again after the disappointing results of the 2017 Assembly elections in Punjab and finally, after the Lok Sabha washout in 2019 where he won only only one seat. Yet, due to an indomitable fighting spirit, the AAP has risen like a Phoenix from the ashes after each defeat.

Pushed against the wall, she reinvents herself, appeals to a new electoral base, launches with all her might and outflanks her better-off rivals in battles of perception, without being intimidated or shouting.

This fighting spirit is ultimately what can help the AAP unseat the bickering, exhausted, worn-out, decaying Congress that often dies in states where it is pushed into third place. And it is this fighting spirit that may make the BJP wary of the AAP’s emergence as its main rival, ending its dream streak of easy victories over Congress.

With the strong AAP at the forefront, the opposition could finally find its voice, a proposition that should only appeal to the AAP even more with opposition voters.

Praneet Pathak studied marketing at IMT and is a keen observer of Indian democracy.

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CASTLE BIOSCIENCES INC Management report and analysis of the financial situation and operating results. (Form 10-K) https://www.sociologyesoscience.com/castle-biosciences-inc-management-report-and-analysis-of-the-financial-situation-and-operating-results-form-10-k/ Mon, 28 Feb 2022 23:39:10 +0000 https://www.sociologyesoscience.com/castle-biosciences-inc-management-report-and-analysis-of-the-financial-situation-and-operating-results-form-10-k/ You should read the following discussion and analysis of financial condition and results of operations together with our consolidated financial statements and related notes included elsewhere in this Annual Report on Form 10-K. This discussion and other parts of this Annual Report on Form 10-K contain forward-looking statements that involve risk and uncertainties, such as […]]]>
You should read the following discussion and analysis of financial condition and
results of operations together with our consolidated financial statements and
related notes included elsewhere in this Annual Report on Form 10-K. This
discussion and other parts of this Annual Report on Form 10-K contain
forward-looking statements that involve risk and uncertainties, such as
statements of our plans, objectives, expectations and intentions. Our actual
results, performance or achievements could differ materially from any future
results, performance or achievements discussed in these forward-looking
statements. Factors

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that could cause or contribute to such differences include, but are not limited to, those discussed in the section entitled “Risk Factors”.

Overview


Castle Biosciences is improving health through innovative tests that guide
patient care. For the diseases that our portfolio of tests cover, we believe the
traditional approach to developing a treatment plan for cancers and other
diseases using clinical and pathology factors alone is inadequate and can be
improved by incorporating the personalized information our diagnostic and
prognostic tests provide.

We currently market five proprietary MAAAs, designed to answer clinical
questions in dermatologic cancers, UM and BE. Our revenue is primarily generated
by our DecisionDx®-Melanoma risk stratification test for cutaneous melanoma and
our DecisionDx®-UM risk stratification test for UM.

The foundation of our business is our dermatologic cancer franchise, and our
lead product is DecisionDx-Melanoma, a proprietary risk stratification GEP test
that predicts the risk of metastasis, or recurrence for patients diagnosed with
invasive cutaneous melanoma, a deadly skin cancer. In the management of
melanoma, as with nearly all diseases, treatment plans are directed by patient
risk-stratification. This test has two distinct, complementary clinically
actionable uses. The first revolves around predicting the likelihood of having a
SLN negative biopsy result so that physicians and patients can discuss the risk
and benefit of undergoing the SLNB surgical procedure. The second use is to
inform the appropriate treatment plan during the initial five years
post-diagnosis, regardless of the decision to undergo or avoid invasive SLNB
surgery. In a typical year, we estimate approximately 130,000 patients are
diagnosed with invasive cutaneous melanoma in the United States. We launched
DecisionDx-Melanoma in May 2013. Based on the substantial clinical evidence that
we have developed, we have received Medicare coverage for DecisionDx-Melanoma,
which represents approximately 50% of the addressable patient population for
this test.

On August 31, 2020, we commercially launched our SCC proprietary GEP test,
DecisionDx®­SCC, for use in patients with one or more risk factors (also
referred to as "high-risk" SCC). On November 2, 2020, we commercially launched
our proprietary GEP test for difficult-to-diagnose melanocytic lesions,
DecisionDx® DiffDx™-Melanoma for use in patients with a melanocytic lesion and
uncertainty related to the malignancy of the lesion. We believe that these two
additional skin cancer tests address areas of high clinical need in
dermatological cancer and, together, represent an estimated addressable
population of approximately 500,000 patients in the United States.

We further expanded our commercially available dermatologic portfolio in May
2021 when we acquired the myPath Laboratory from Myriad Genetics, Inc. for a
cash purchase price of $32.5 million. myPath Melanoma is a clinically validated
GEP test that addresses the same unmet clinical need as our DecisionDx
DiffDx-Melanoma test. Today, we offer both our myPath Melanoma test and our
DecisionDx DiffDx-Melanoma test under an offering that we refer to as our CDO of
molecular testing solutions. By offering both of these tests in a single
offering, we believe we have demonstrated the ability to improve the test result
performance for patients with difficult-to-diagnose melanocytic lesions.

In 2021, we announced the launch of our innovative pipeline initiative to
develop a genomic test aimed at predicting response to systemic therapy in
patients with moderate to severe psoriasis, atopic dermatitis and related
inflammatory skin conditions. In the U.S. alone, there are approximately 18
million patients diagnosed with psoriasis and atopic dermatitis. Approximately
450,000 of these patients annually are eligible for systemic therapies. If
successful, this inflammatory skin disease pipeline test has the potential to
add approximately $1.9 billion to our current estimated U.S. TAM. In 2021, we
initiated a 4,800 patient, prospective, multi-center clinical study to develop
and validate this pipeline test and have 50 committed centers, out of the
initial target of 50. Based upon our current development and validation
timelines, we expect to commercialize this pipeline test by the end of 2025.

In addition to our dermatologic franchise, we also market a test for patients
diagnosed with UM, a rare cancer of the eye. DecisionDx®-UM is a proprietary,
risk stratification GEP test that predicts the risk of metastasis for patients
with UM. We believe DecisionDx-UM is the standard of care in the management of
newly diagnosed UM in the majority of ocular oncology practices in the United
States. We launched DecisionDx-UM in January 2010. Based on the substantial
clinical evidence that we have developed, we received Medicare coverage for
DecisionDx-UM, which represents approximately 50% of the addressable patient
population.

In December 2021, we extended our commercial portfolio of proprietary tests into
the gastroenterology market through our acquisition of Cernostics and the
TissueCypher® platform. The TissueCypher platform focuses on unlocking, in the
case of the initial test for use in patients with BE, the importance of the
location of the expression of proteins or lack thereof within the morphology of
the disease (also known as spatialomics). This "spatialomic" information is then
interpreted using artificial intelligence approaches to predict the likelihood
of progression to high-grade dysplasia and/or esophageal cancer in patients with
non-dysplastic, indefinite or low-grade dysplasia BE. We believe the addition of
expertise in the spatialomics area

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positions us for continued growth and success in diagnostics, complementing our first-to-market dermatology franchise and our proprietary test for MU.


The number of test reports we generate is a key indicator that we use to assess
our business. A test report is generated when we receive a sample in our
laboratory, and then the relevant test information is entered into our
Laboratory Information Management System, the expression of the biomarkers is
measured, then a proprietary algorithmic analysis of the combined biomarkers is
performed to generate a report providing the results of that analysis, which is
sent to the clinician who ordered the test. The numbers of GEP test reports
delivered by us during the years ended December 31, 2021 and 2020 are presented
in the table below:

                                                                 

Proprietary dermatological GEP tests

                                DecisionDx-
                                  Melanoma                 DecisionDx-SCC(1)                 CDO(2)                Dermatologic Total            DecisionDx-UM              Grand Total
Q1 2021                             4,060                           527                          218                      4,805                         337                     5,142
Q2 2021                             5,128                           784                          627                      6,539                         468                     7,007
Q3 2021                             5,505                           934                          913                      7,352                         375                     7,727
Q4 2021                             5,635                         1,265                          904                      7,804                         438                     8,242
For the year ended December
31, 2021                           20,328                         3,510                        2,662                     26,500                       1,618                    28,118

Q1 2020                             4,574                             -                            -                      4,574                         361                     4,935
Q2 2020                             3,008                             -                            -                      3,008                         306                     3,314
Q3 2020                             4,404                            57                            -                      4,461                         318                     4,779
Q4 2020                             4,246                           428                           73                      4,747                         410                     5,157
For the year ended December
31, 2020                           16,232                           485                           73                     16,790                      
1,395                    18,185



(1) We commercially launched DecisionDx-SCC on August 31, 2020.

(2)Includes DecisionDx DiffDx-Melanoma, which we marketed on
November 2, 2020and myPath Melanoma, which we began offering following our acquisition of Myriad myPath Laboratory on May 28, 2021. We offer both myPath Melanoma and DecisionDx DiffDx-Melanoma as part of our CDO.


For the year ended December 31, 2021, our dermatologic test report volume
increased by 57.8%, reflecting growth in DecisionDx-Melanoma as well as the full
year availability of DecisionDx-SCC and DecisionDx DiffDx-Melanoma (now offered
as part of CDO). For a discussion of how we recognize revenue derived from our
GEP tests, refer to "Net Revenues" under "Components of Results of Operations"
below.

The principal focus of our current commercial efforts is to educate clinicians
and pathologists on the value of our molecular diagnostic testing products
through our direct sales force in the U.S. In dermatology, we began 2020 with 32
outside sales territories. In the third quarter of 2020, we expanded our
dermatologic commercial team to create a dedicated sales force of ten
territories to support the launch of our DecisionDx Diff-Dx Melanoma test to
dermatopathologists. During the first half of 2021, we folded this dedicated
team into our existing sales team and completed a further expansion, bringing
our dermatologic sales force to the mid-60s. In connection with our acquisition
of Cernostics in December 2021, we hired an initial commercial team of
approximately 14 outside sales territories, along with commensurate internal
sales associates and medical science liaisons, to support our launch of the
TissueCypher Barrett's Esophagus Assay. This dedicated team focuses on
gastroenterology specialists that diagnose and manage patients with BE. However,
we will continue to evaluate our mix of outside sales territories, inside sales
support, marketing and medical affairs in the context of our dermatologic tests
and gastroenterology tests and adjust our investments based upon these
evaluations.

We continue to see new clinicians order our dermatologic tests for the first
time. For the year ended December 31, 2021, we saw approximately 1,938 new
ordering clinicians for our dermatologic tests compared to 1,396 during the same
period of 2020. Total ordering clinicians for our dermatologic tests were
approximately 5,900 for the year ended December 31, 2021.

For more information about the metrics we disclose, see “Information About Certain Metrics” below.


In developing our DecisionDx-SCC and DecisionDx DiffDx-Melanoma tests, we
believed that in addition to addressing significant unmet clinical needs, we
would see strategic opportunities for leverage, as many of the clinicians
currently ordering DecisionDx-Melanoma would likely be the same clinicians who
would find value in these other skin cancer tests. For example,

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we found that for the year ended December 31, 2021, approximately 78% of all
clinicians ordering DecisionDx-SCC had also ordered our DecisionDx-Melanoma test
during that same period.

We bill third-party payors and patients for the tests we perform. The majority
of our revenue collections is paid by third-party insurers, including Medicare.
We have received LCDs, which provide coverage for our DecisionDx-Melanoma,
myPath Melanoma and DecisionDx-UM tests that meet certain criteria for Medicare
and Medicare Advantage beneficiaries, representing approximately 60 million
covered lives. In 2022, DecisionDx-UM has received coverage from United
Healthcare that will represent approximately 43 million covered lives. A
''covered life'' means a subscriber, or a dependent of a subscriber, who is
insured under an insurance carrier's policy.

Palmetto, the MAC responsible for administering MolDX, the program that assesses
molecular diagnostic technologies, issued a final expanded LCD for
DecisionDx-Melanoma, effective November 22, 2020. With this expanded LCD and the
accompanying billing and coding articles, we estimate that a significant
majority of the DecisionDx-Melanoma tests performed for Medicare patients will
meet the coverage criteria. Noridian, the MAC responsible for administering
claims for laboratory services performed in Arizona, has adopted the same
coverage policy as Palmetto and also issued an expanded final LCD for
DecisionDx-Melanoma, effective December 6, 2020.

Separately, Palmetto issued a final LCD for DecisionDx-UM, which became
effective in July 2017, and Noridian issued a similar LCD that became effective
in September 2017. The Noridian LCD provides for coverage to determine
metastatic risk in connection with the management of a patient's newly diagnosed
uveal melanoma and to guide surveillance and referral to medical oncology for
those patients. Similar to cutaneous melanoma, the median age at diagnosis for
uveal melanoma is estimated at 58-62 years old, therefore the Medicare eligible
population represents close to 45% of the addressable market.

On May 17, 2019, CMS determined that DecisionDx-UM meets the criteria for
"existing advanced diagnostic laboratory test" status, also referred to as
"existing ADLT" status. For 2020, our rate was set by Noridian, our local MAC,
but effective in 2021 our rate is set annually based upon the median private
payor rate for the first half of the second preceding calendar year. Our rate
for 2021 was $7,776 and will remain at $7,776 for 2022, in each case based on
the calculation of the median private payor rate.

Also, on May 17, 2019, CMS determined that DecisionDx-Melanoma meets the
criteria for "new ADLT" status. Accordingly, from July 1, 2019 through March 31,
2020, the Medicare reimbursement rate was equal to the initial list price of
$7,193. From April 1, 2020 through December 31, 2021, the rate was also $7,193,
which was calculated based upon the median private payor rate for
DecisionDx-Melanoma from July 1, 2019 to November 30, 2019. CMS has informed us
that the rate for 2022 will continue to be $7,193, based on the median private
payor rate.

myPath Melanoma is currently covered under a MolDX LCD policy through Noridian
that oversees laboratories in both Utah and Arizona. Noridian issued an LCD that
became effective in June 2019. On September 6, 2019, myPath Melanoma was
approved as a new ADLT. The rate for 2022 will be $1,950.

TissueCypher is performed in our Pittsburgh, Pennsylvania laboratory and falls
under the Medicare jurisdiction that is managed by Novitas. Novitas previously
reviewed TissueCypher and we are receiving payments for claims according to the
CLFS. For 2022, CMS published in its CLFS a payment amount of $2,513 for the
test.

Beginning in 2023, the rates for DecisionDx-Melanoma, DecisionDx-UM, and myPath
Melanoma tests will be set annually based upon the median private payor rate for
the first half of the second preceding calendar year. For example, the rate for
2023 will be set using median private payor rate data from January 1, 2021 to
June 30, 2021.

In the second quarter of 2020, we submitted our technical assessment dossier for
DecisionDx-SCC to Palmetto and Noridian. The dossier was accepted as complete in
the third quarter of 2020. In early 2021, we submitted our technical assessment
dossier for DecisionDx DiffDx-Melanoma. The dossier was accepted as complete in
the first quarter of 2021. We expect that draft LCDs for DecisionDx-SCC and
DecisionDx DiffDx-Melanoma could potentially be posted by the end of the second
quarter of 2022 resulting in potentially final LCDs effective in 2023. However,
there is no assurance that the timing of any draft or final LCD will match our
expectations or our historical experience with LCDs for our other tests.

In the second quarter of 2021, Palmetto and the other MACs that participate in
the MolDX program posted a revised draft LCD for DecisionDx-Melanoma. The draft
LCD includes commentary about two publications regarding the clinical utility of
GEP tests and was posted to give providers an opportunity to comment. Each of
the draft LCDs include an assessment stating that the MAC does not believe that
the new data is sufficient to change the coverage criteria. We have submitted
comments on the draft LCD. The comment period on the last of these draft LCDs
closed on August 8, 2021. We are unable to predict when the final draft LCD will
be posted.

Since becoming a public company, we have financed our operations with the
revenue generated from the sale of our products, proceeds from our July 2019
IPO, follow-on public offerings of common stock in June 2020 and December 2020
and bank debt, which has since been repaid in full. We believe that our existing
cash and cash equivalents and anticipated cash generated

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from sales of our products will be sufficient to fund our operations for the
next 12 months and into the foreseeable future. However, we have based these
estimates on assumptions, including those related to the impact of COVID-19 on
our financial condition, that may prove to be wrong, and could result in us
depleting our capital resources sooner than expected.

Our net (loss) income may fluctuate significantly from period to period,
depending on the timing of our planned development activities, the growth of our
sales and marketing activities and the timing of revenue recognition under ASC
606. We expect our expenses will increase substantially over time as we:

•conducting clinical studies to generate evidence in support of our current and future product candidates;

•execute our marketing strategy for our current and future commercial products;

•pursue our ongoing and planned development of new products in our pipeline;

•seek to discover and develop additional product candidates;

•hire additional scientific and research and development personnel; and

• add additional operational, financial and management information systems and personnel.


Furthermore, we expect to continue to incur additional costs associated with
operating as a public company, including significant legal, accounting, investor
relations and other expenses.

Impact of the COVID-19 pandemic


We are continuing to closely monitor the impact of the COVID-19 pandemic on our
business and taking proactive efforts designed to protect the health and safety
of our workforce, continue our business operations and advance our corporate
objectives. We are providing the following update with respect to the impact of
COVID-19 on our business:

•We have maintained, and expect to continue to maintain, uninterrupted business
operations with adequate access to reagents and consumables needed for testing
patient samples and normal turnaround times for our delivery of test reports. We
have continued to maintain our previously implemented adjustments to our
operations designed to keep employees safe and comply with federal, state and
local guidelines, including those regarding social distancing.

•Following the onset of the COVID-19 pandemic, we experienced declines in orders
and test report volume. For example, in the second quarter of 2020, test reports
delivered for our lead product, DecisionDx-Melanoma, decreased 18.5% compared to
the second quarter of 2019. For the year ended December 31, 2020, our growth in
DecisionDx-Melanoma test report volume was 4.5%, compared to year-over-year
growth of 29.1% for the year ended December 31, 2019. Our analysis of
third-party data indicates that cutaneous melanoma diagnoses for the year ended
December 31, 2020 were down approximately 20% compared to the year ended
December 31, 2019. In the first quarter of 2021, test reports delivered for
DecisionDx-Melanoma decreased by 11.2% compared to the first quarter of 2020. We
believe these decreases in our test report volume were linked to delays and/or
cancellations in patient visits, resulting in fewer diagnostic biopsies and thus
a reduction in the number of diagnoses of cutaneous melanoma in response, as
well as the cumulative impact on promotional responsiveness as a result of
reduced sales calls per day and in-person sales call during the COVID-19
pandemic.

•We saw positive trends in orders and test report volumes in the second, third,
and fourth quarters of 2021. In the second, third and fourth quarters of 2021,
test reports delivered for DecisionDx-Melanoma increased by 70.5%, 25.0% and
32.7%, respectively, compared to the same quarters in 2020.

•Our commercial team uses a combination of in-person, virtual, and non-personal
promotional and educational efforts. Since the beginning of 2021, we have seen
improvements in the number of promotional calls per day, as well as a continued
shift from virtual to in-person sales calls. During the three-months ended
December 31, 2021, in-person sales calls accounting for over 90% of all calls
during such period. However, we have not yet achieved pre-COVID-19 levels of
calls per day per sales representative.

•Our future results will be dependent upon the extent and duration of the
COVID-19 crisis, including the emergence and spread of variants of the virus,
such as the Omicron variant, and government restrictions, which are beyond our
control. Although state and local government restrictions put in place to slow
the spread of the virus have been eased in certain locations, restrictions may
be reinstated from time to time in various regions depending on the
circumstances, potentially impacting the flow of future patient visits as well
as access to our sales targets. Even with the easing of state and local
restrictions and the availability of vaccinations, patient visits and diagnoses
of cutaneous melanoma may be impacted by continued apprehension regarding
possible exposure to the virus. For example, our

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analysis of third-party data indicates that cutaneous melanoma diagnoses during
the year ended December 31, 2021 remain approximately 11% below the pre-COVID,
2019 levels.

•We continue to believe our cash, cash equivalents and anticipated cash to be
generated from sales of our products, will be sufficient to fund our operations
for the next 12 months and into the foreseeable future.

As conditions are continuously evolving, we are unable to predict how our future
test report volume will be impacted, or the extent to which our results of
operations, financial condition or cash flows will be impacted, by the COVID-19
pandemic, or other future public health crises. Accordingly, the test report
data presented above is not necessarily indicative of our results of operations
that can be expected for future periods. For more information on the potential
impact of the COVID-19 pandemic on our business, see the risk factors included
under "Risks Related to Our Business" and the other risk factors included in
Part I, Item 1A., "Risk Factors," of this Annual Report on Form 10-K.

Factors affecting our performance

We believe that several important factors have had and which we believe will continue to have an impact on our operating performance and results of operations, including:


•Report volume. We believe that the number of reports we deliver to physicians
is an important indicator of the growth of adoption among the healthcare
provider community. Our revenue and costs are affected by the volume of testing
and mix of customers. Our performance depends on our ability to retain and
broaden adoption with existing prescribing physicians, as well as attract new
physicians. In the near term, our report volume may be negatively impacted by
ongoing developments of the COVID-19 pandemic as discussed above.

•Reimbursement. We believe that expanding reimbursement is an important
indicator of the value of our products. Payors require extensive evidence of
clinical utility, clinical validity, patient outcomes and health economic
benefits in order to provide reimbursement for diagnostic products. Our revenue
depends on our ability to demonstrate the value of our products to these payors.

•Gross margin. We believe that our gross margin is an important indicator of the
operating performance of our business. Higher gross margins reflect the average
selling price of our tests, as well as the operating efficiency of our
laboratory operations.

•New product development. A significant aspect of our business is our investment
in research and development activities, including activities related to the
development of new products. In addition to the development of new product
candidates, we believe these studies are critical to gaining physician adoption
of new products and driving favorable coverage decisions by payors for such
products.

Information about some metrics

The following provides additional information about certain measures we have disclosed in this MD&A and Analysis of Financial Condition and Results of Operations.


Test reports delivered for DecisionDx-Melanoma, DecisionDx-SCC, myPath
Melanoma/DecisionDx DiffDx-Melanoma, DecisionDx-UM and TissueCypher Barret's
Esophagus Assay represents the number of completed test reports delivered by us
during the reporting period indicated. The period in which a test report is
delivered does not necessarily correspond with the period the related revenue,
if any, is recognized, due to the timing and amount of adjustments for variable
consideration under ASC 606. We use this metric to evaluate the growth in
adoption of our tests and to measure against our internal performance
objectives. We believe this metric is useful to investors in evaluating the
volume of our business activity from period-to-period that may not be
discernible from our reported revenues under ASC 606. We also sometimes present,
on a limited basis, data on the number of orders received. We believe order data
can provide additional insight on current demand trends, particularly during the
COVID-19 pandemic and with respect to new product launches, when considered in
conjunction with test report volume. However, orders received in a particular
period do not necessarily correspond with actual delivered test reports or
reported revenues for the same period or subsequent periods.

New ordering clinicians for our dermatologic tests represents the number of
clinicians who ordered a dermatologic test from us for the first time during the
reporting period specified. Our dermatologic tests consist of
DecisionDx-Melanoma, DecisionDx-SCC and our CDO. We believe this metric is
useful in evaluating the effectiveness of our sales and marketing efforts in
establishing new relationships with clinicians and increasing the adoption of
our suite of dermatologic tests. We also believe this metric provides useful
information to investors in assessing our ability to expand the use of our
dermatologic tests. Since this metric is based upon the reporting period in
which an order is placed, it does not necessarily correspond to the reporting
period in which a test report was delivered or revenue was recognized.

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Components of operating results

Net income


We generate revenues from the sale of our products. Currently, our revenues are
primarily derived from the sale of DecisionDx-Melanoma and DecisionDx-UM. We
bill third-party payors and patients for the tests we perform.

Under ASC 606, we recognize revenue at the amount we expect to be entitled,
subject to a constraint for variable consideration, in the period in which our
tests are delivered to the treating physicians. We have determined that our
contracts contain variable consideration under ASC 606 because the amounts paid
by third-party payors may be paid at less than our standard rates or not paid at
all, with such differences considered implicit price concessions. Variable
consideration is recognized only to the extent it is probable that a significant
reversal of revenue will not occur in future periods when the uncertainties are
resolved. Variable consideration is evaluated each reporting period and
adjustments are recorded as increases or decreases in revenues. Variable
consideration for Medicare claims that are not covered by an LCD, including
those claims subject to approval by an ALJ at an appeal hearing, is deemed to be
fully constrained due to factors outside our influence (i.e., judgment or
actions of third parties) and the uncertainty of the amount to be received is
not expected to be resolved for a long period of time. For these fully
constrained claims, we generally recognize revenue in the period the uncertainty
is favorably resolved, if at all. Due to potential future changes in Medicare
coverage policies and appeal cycles, insurance coverage policies, contractual
rates and other trends in the reimbursement of our tests, our revenues may
fluctuate significantly from period-to-period. Additionally, our ability to
recognize revenue for our recently launched tests, DecisionDx-SCC and DecisionDx
DiffDx-Melanoma, is dependent on the development of reimbursement experience and
coverage decisions for these tests. Due to limited reimbursement experience, we
are currently recognizing revenues for these two tests on the basis of actual
cash collections.

Our ability to increase our revenues will depend on our ability to further
penetrate our target markets, and, in particular, generate sales through our
direct sales force, develop and commercialize additional tests, obtain
reimbursement from additional third-party payors and increase our reimbursement
rate for tests performed.

Cost of sales (excluding amortization of acquired intangible assets)


The components of our cost of sales are material and service costs associated
with testing samples, personnel costs (including salaries, bonuses, benefits and
stock-based compensation expense), electronic medical record set up costs, order
and delivery systems, shipping charges to transport samples, third-party test
fees, and allocated overhead including rent, information technology costs,
equipment and facilities depreciation and utilities. Costs associated with
testing samples are recorded when the test is processed, regardless of whether
and when revenues are recognized with respect to that test. As a result, our
cost of sales as a percentage of revenues may vary significantly from
period-to-period because we do not recognize all revenues in the period in which
the associated costs are incurred. We expect cost of sales in absolute dollars
to increase as the number of tests we perform increases. Additionally, we expect
cost of sales to increase with the expansion of laboratory capacity and staffing
in advance of the anticipated growth of our recently launched tests.

Gross margin and gross margin percentage are key indicators we use to assess our
business. See the table in "Results of Operations-Comparison of the years ended
December 31, 2021 and 2020" for details.

Research and development


Research and development expenses include costs incurred to develop our genomic
tests, collect clinical samples and conduct clinical studies to develop and
support our products. These costs consist of personnel costs (including
salaries, bonuses, benefits and stock-based compensation expense), prototype
materials, laboratory supplies, consulting costs, regulatory costs, electronic
medical records set up costs, costs associated with setting up and conducting
clinical studies and allocated overhead, including rent, information technology,
equipment depreciation and utilities. We expense all research and development
costs in the periods in which they are incurred. We expect our research and
development expenses to increase in absolute dollars as we continue to invest in
research and development activities related to developing enhanced and new
products.

We expect to use a portion of our cash and cash equivalents to further support
and accelerate our research and development activities, including three
important studies that are underway to support our DecisionDx-Melanoma test. The
first is the PERSONALize study, in which we are evaluating DecisionDx-Melanoma
for interactions with adjuvant therapies. The second is the CONNECTION study,
which is collecting long-term outcomes for up to 10,000 patients who have been
tested with DecisionDx-Melanoma. The third is the DECIDE study, which is
designed to determine the association of GEP test results with SLNB surgical
decisions in patients eligible for SLNB as well as to track outcomes for
patients who did and did not undergo SLNB. Also, as noted above, we recently
initiated a 4,800 patient, prospective, multi-center clinical study to develop,
validate and bring to market a pipeline test aimed at predicting response to
systemic therapy in patients with moderate to severe psoriasis, atopic
dermatitis and related inflammatory skin conditions. We have also initiated two
additional disease studies for pipeline tests for new indications.

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Selling, general and administrative expenses


Selling, general and administrative ("SG&A") expenses include executive, selling
and marketing, legal, finance and accounting, human resources, billing and
client services. These expenses consist of personnel costs (including salaries,
bonuses, benefits and stock-based compensation expense), direct marketing
expenses, audit and legal expenses, consulting costs, training and medical
education activities, payor outreach programs and allocated overhead, including
rent, information technology, equipment depreciation, and utilities. We expect
continued increases in SG&A expenses related to compliance with the rules and
regulations of the SEC and Nasdaq (in particular as we no longer qualify as an
emerging growth company and a smaller reporting company, and have become a large
accelerated filer), investor relations activities and additional insurance
expenses. Other administrative and professional services expenses within SG&A
are expected to increase with the scale of our business, but selling and
marketing-related expenses are expected to increase significantly, consistent
with our growth strategy.

Amortization of acquired intangible assets

The amortization of acquired intangible assets is mainly associated with the technology developed.

Other exploitation products

Other operating revenue consists of automatic payment received from HHS for provider relief funds pursuant to the CARES Act.

interest income

Interest income consists primarily of income on cash and cash equivalents, primarily money market funds.

Interest charges

Interest expense is primarily attributable to borrowings under our term debt, which was fully repaid in December 2020and also includes the related amortization of debt discounting and issuance costs.

Loss on extinguishment of debt

The loss on extinguishment of debt relates to the prepayment of our term loan facility in December 2020.

Income tax expense (benefits)


In connection with our acquisition of Cernostics in December 2021, and taking
into consideration the additional deferred tax liabilities resulting from such
acquisition, we determined that a portion of our valuation allowance should be
reduced, which was reflected in our income tax benefit for the year ended
December 31, 2021. Our consolidated financial statements do not reflect any
federal or state income tax benefits attributable to the net losses we have
incurred, due to the uncertainty of realizing a benefit from those items. As of
December 31, 2021, we had federal NOL carryforwards of $99.4 million, of which
$43.5 million will begin to expire in 2030 if not utilized to offset federal
taxable income, and $55.9 million may be carried forward indefinitely. Also, as
of December 31, 2021, we had state NOL carryforwards of $67.5 million, which
begin to expire in 2028 if not utilized to offset state taxable income.

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Operating results


Certain prior year amounts in the tables below have been reclassified to conform
to the current year presentation. Specifically, we no longer present gross
margin on the face of our financial statements and therefore the cost of sales
line is now presented within the operating expenses section. This
reclassification had no impact on operating loss, loss before income taxes or
net loss.

Comparison of the years ended December 31, 2021 and 2020

The following table summarizes our results of operations for the periods indicated (in thousands, except percentages):

                                                          Years Ended December 31,
                                                          2021                    2020                         Change
Net revenues                                      $      94,085               $  62,649          $  31,436                  50.2  %
Operating expenses and other operating income:
Cost of sales (exclusive of amortization of
acquired intangible assets)                              15,822                   9,685              6,137                  63.4  %
Research and development                                 29,646                  13,256             16,390                 123.6  %
Selling, general and administrative                      86,738                  48,132             38,606                  80.2  %
Amortization of acquired intangible assets                1,958                       -              1,958                    NA(1)
Other operating income                                        -                  (1,882)             1,882                 100.0  %
Total operating expenses, net                           134,164                  69,191             64,973                  93.9  %
Operating loss                                          (40,079)                 (6,542)           (33,537)               (512.6) %
Interest income                                              68                     373               (305)                (81.8) %
Interest expense                                             (1)                 (2,634)             2,633                 100.0  %
Loss on extinguishment of debt                                -                  (1,397)             1,397                 100.0  %

Loss before income taxes                                (40,012)                (10,200)           (29,812)               (292.3) %
Income tax (benefit) expense                             (8,720)                     84             (8,804)                   NM(2)
Net loss                                          $     (31,292)              $ (10,284)         $ (21,008)               (204.3) %




(1) NA = Not applicable
(2) NM = Not meaningful

The following table shows the amount of stock-based compensation expense reflected in the above line items (in thousands):


                                                               Years Ended 

the 31st of December,

                                                              2021                   2020               Change

Cost of sales (excluding amortization of acquired intangible assets)

                                      $        2,058          $     1,049          $    1,009
Research and development                                         4,522                1,492               3,030
Selling, general and administrative                             15,160                5,768               9,392
Total stock-based compensation expense                  $       21,740      

$8,309 $13,431




The following table provides a disaggregation of net revenues by type (in
thousands):

                           Years Ended December 31,
                              2021                 2020         Change
Dermatologic(1)      $      85,753              $ 57,646      $ 28,107
Other(2)                     8,332                 5,003         3,329
Total net revenues   $      94,085              $ 62,649      $ 31,436



(1) Dermatologic includes DecisionDx-Melanoma, DecisionDx-SCC and CDO. (2)Other mainly consists of DecisionDx-UM.

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The following table presents the calculation of gross margin (in thousands,
except percentages):

                                                               Years Ended December 31,
                                                            2021                       2020               Change
Net revenues                                          $     94,085                $    62,649          $   31,436
Less: Cost of sales (exclusive of amortization of
acquired intangible assets)                                 15,822                      9,685               6,137
Less: Amortization of acquired intangible assets             1,958                          -               1,958
Gross margin                                          $     76,305                $    52,964          $   23,341
Gross margin percentage                                       81.1   %                   84.5  %             (3.4) %


Net Revenues

Net revenues increased by $31.4 million, or 50.2%, to $94.1 million for the year
ended December 31, 2021, primarily due to higher revenues from our dermatologic
tests, which increased by $28.1 million. The higher dermatologic test revenue
was primarily attributable to higher volume from DecisionDx-Melanoma, which
increased 25.2%, higher per-unit revenues for DecisionDx-Melanoma, which reflect
the expanded LCD for the test that became effective in the fourth quarter of
2020, and increased revenues from DecisionDx-SCC and our CDO. We believe the
higher test report volume for DecisionDx-Melanoma during the year ended
December 31, 2021 reflects the relaxing of COVID-19 restrictions, and the
related positive impacts on the flow of patient visits, as well as the effects
of our sales force expansions discussed above. Revenues from other tests
(non-dermatologic) contributed $3.3 million to the overall increase in net
revenues for the year ended December 31, 2021. This increase was principally due
to the significantly higher Medicare rate for DecisionDx-UM that became
effective January 1, 2021 and, to a lesser extent, the effect of a 16.0%
increase in DecisionDx-UM test report volume. We believe the higher test report
volume for DecisionDx-UM during the year ended December 31, 2021 is due in part
to patients making up for missed eye exams from 2020 due to COVID-19 impacts.
Net revenues include positive revenue adjustments related to tests delivered in
previous periods, associated with changes in estimated variable consideration,
of $3.3 million for the year ended December 31, 2021 compared to $0.2 million
for the year ended December 31, 2020. The year-over-year increase is primarily
attributable to favorable adjustments related to the settlement and collection
during the year ended December 31, 2021 of certain groups of receivables from
prior years.

Cost of sales (excluding amortization of intangible assets acquired)


Cost of sales (exclusive of amortization of acquired intangible assets) for the
year ended December 31, 2021 increased by $6.1 million, or 63.4%, compared to
the year ended December 31, 2020, primarily due to higher personnel costs due to
additional headcount in our laboratory testing operations, and increased costs
of supplies and services, attributable to the higher activity levels. The
additional personnel costs included a year-over-year increase in stock-based
compensation expense of $1.0 million. Due to the nature of our business, a
significant portion of our cost of sales expenses represent fixed costs
associated with our testing operations. Accordingly, our cost of sales expense
will not necessarily increase or decrease commensurately with the change in net
revenues from period to period. We expect our cost of sales (exclusive of
amortization of acquired intangible assets) to continue to increase in future
periods as we hire additional laboratory personnel and related resources to
support our expected growth in volume for our dermatologic, GI and pipeline
tests

Gross margin


Our gross margin percentage was 81.1% for the year ended December 31, 2021,
compared to 84.5% for the same period in 2020. The decrease was largely due to
amortization expense associated with our acquired intangible assets. In the near
term, we expect that our gross margin percentage will decline as we invest in
additional laboratory personnel and related resources to support the anticipated
growth in our report volumes for tests in advance of obtaining reimbursement
coverage. Additionally, our gross margin percentage will be negatively impacted
by amortization of intangible assets associated with recent acquisitions.

Research and development


Research and development expenses increased by $16.4 million, or 123.6%, for the
year ended December 31, 2021, compared to the year ended December 31, 2020,
primarily due to increases in personnel costs and costs incurred in our clinical
studies. Approximately 55% of the increase is attributable to higher personnel
costs, due to expansions in headcount in support of our growth, including higher
stock-based compensation expense of $3.0 million compared to 2020. Approximately
27% of the increase was attributable to higher costs for clinical studies,
including costs related to the PERSONALize, CONNECTION and DECIDE studies as
well as our recently initiated a 4,800 patient, prospective, multi-center
clinical study to develop, validate and bring to market a pipeline test for
inflammatory skin diseases. Also, during the year ended December 31, 2021, we
expanded evidence supporting our portfolio of tests with 15 peer-reviewed
publications and initiated our collaboration with

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NCI/SEER. We plan to continue to increase our research and development expenditures as we fund ongoing evidence development for our existing products as well as additional pipeline programs.

Selling, general and administrative expenses


SG&A expense increased by $38.6 million, or 80.2%, for the year ended
December 31, 2021 compared to the year ended December 31, 2020. Approximately
67% of the increase is attributable to higher personnel costs, particularly due
to increased headcount, which includes salaries, stock-based compensation and
bonuses. We expanded our sales organization headcount in the third quarter of
2020 in preparation for the commercial launch of our DecisionDx DiffDx-Melanoma
test and further expanded our sales team during the first and second quarters of
2021, bringing our dermatology-facing commercial team to the mid-60s. The higher
personnel costs also reflect expanded headcount in our administrative support
functions. Stock-based compensation expense included in SG&A expense was $15.2
million for the year ended December 31, 2021 compared to $5.8 million for the
year ended December 31, 2020. The remainder of the increase in SG&A expense was
primarily associated with training events, travel, professional fees and other
general increases. The higher expenses for training events and travel reflect
both a higher headcount as well a return to more in-person activities in 2021 as
result of easing of COVID-19 restrictions.

Amortization of acquired intangible assets


Amortization of acquired intangible assets was $2.0 million for the year ended
December 31, 2021 and was entirely associated with amortization of developed
technology attributable to the acquisitions of Myriad myPath, LLC and Cernostics
in May 2021 and December 2021, respectively. There was no such amortization
during the year ended December 31, 2020. Amortization of acquired intangible
assets is projected to be approximately $6.7 million for the year ending
December 31, 2022, but may increase in the future to the extent we complete
additional acquisitions.

Other exploitation products


Other operating income of $1.9 million for the year ended December 31, 2020
consisted entirely of the automatic payment received from HHS pursuant to the
CARES Act for provider relief funds. We initially recognized income attributable
to the payment in the second quarter of 2020 based on our expectation of meeting
the requirements to retain the funds. However, due a change in requirements of
the program in the third quarter of 2020, we reversed this income. However, in
the fourth quarter of 2020, a legislative change was enacted affecting the
program, under which we concluded it is reasonably assured we will qualify to
retain the funds. Accordingly, we recognized the income again in the fourth
quarter of 2020. There were no similar transactions during the year ended
December 31, 2021. See Note 2 to the consolidated financial statements for
additional information.

interest income

Interest income decreased by $0.3 million for the year ended December 31, 2021compared to the year ended December 31, 2020due to lower interest rates, despite our higher average cash and cash equivalent balances.

Interest charges


Interest expense was essentially zero for the year ended December 31, 2021
compared to $2.6 million for the year ended December 31, 2020. The decrease is a
result of the early termination and repayment of all amounts due on our term
loan facility in December 2020.

Loss on extinguishment of debt


We recorded an extinguishment loss of $1.4 million during the year ended
December 31, 2020 related to the early repayment and termination of our term
loan facility. The extinguishment loss was attributable to the write-off of the
unamortized discount and issuance costs as well as early termination and
prepayment fees. There were no similar transactions during the year ended
December 31, 2021.

Income tax expense (benefits)


Income tax (benefit) expense was $(8.7) million for the year ended December 31,
2021 compared to $0.1 million for the year ended December 31, 2020.
Substantially all of the income tax (benefit) in the year ended December 31,
2021 was attributable to a reduction in our valuation allowance on net deferred
tax assets resulting from our acquisition of Cernostics in December 2021.
Specifically, we took into consideration the additional deferred tax liabilities
resulting from the acquisition and determined that a portion of our existing
valuation allowance should be reduced to offset this liability. Other than this
item, the recorded income tax (benefit) expense includes minimal amounts because
in both the years ended December 31, 2021 and 2020, the income tax benefit of
the net loss was largely offset by corresponding changes in the valuation
allowance on net deferred tax assets, as we have determined that it is more
likely than not that these benefits will not be realized.

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Stock-based compensation expense


Stock-based compensation expense, which is allocated among cost of sales,
research and development expense and SG&A expense, totaled $21.7 million for the
year ended December 31, 2021 compared to $8.3 million for the year ended
December 31, 2020, which we attribute in part to the addition of 144 employees
in 2021, a 71.6% increase from 2020. We expect material increases in stock-based
compensation expense in future periods, reflecting additional awards outstanding
due to expected growth in our headcount. As of December 31, 2021, the total
unrecognized stock-based compensation cost related to outstanding awards was
$99.3 million, which is expected to be recognized on a straight-line basis over
a weighted-average period of 3.3 years.

Cash and capital resources

Sources of liquidity


Our principal sources of liquidity are our cash and cash equivalents and cash
generated from the sale of our products. As of December 31, 2021 and 2020, we
had cash and cash equivalents of $329.6 million and $409.9 million,
respectively. In addition to the revenue generated from the sale of our
commercial products, we have financed our operations through our IPO in July
2019, two follow-on public offerings of common stock in June 2020 and December
2020, and a $25.0 million secured term loan credit facility, which we repaid in
full in December 2020.

On December 14, 2020, we filed an automatically effective shelf registration
statement on Form S-3 (File No. 333-251331) with the SEC as a "well-known
seasoned issuer." The registration statement allows us to issue an indeterminate
number or amount of common stock, preferred stock, debt securities and warrants
from time-to-time in one or more offerings. However, there can be no assurance
that we will complete any such offerings of securities. Any future offerings
under this registration statement will be dependent upon, among other factors,
market conditions, available pricing, our financial condition, investor
perception of our prospects, our capital needs and our ability to maintain
status as a well-known seasoned issuer.

Public offerings of ordinary shares


On June 29, 2020 and July 2, 2020, we issued and sold 2,000,000 and 300,000
shares of our common stock, respectively, of our common stock in a follow-on
public offering at a price of $37.00 per share. We received $79.5 million in
aggregate net proceeds, after deducting underwriting discounts and commissions
and offering costs. The shares issued and sold on July 2, 2020 reflect the
underwriters' exercise in full of their 30-day option to purchase additional
shares at the public offering price, less underwriting discounts and
commissions.

On December 18, 2020, we issued and sold 4,600,000 shares of our common stock
(including the exercise in full by the underwriters of their option to purchase
an additional 600,000 shares) in a follow-on public offering at a price of
$58.00 per share. We received $250.5 million in aggregate net proceeds, after
deducting underwriting discounts and commissions and offering costs (excluding
$0.4 million in offering costs that were incurred but not paid as of December
31, 2020). The shares issued and sold includes the underwriters' exercise in
full of their 30-day option to purchase additional shares at the public offering
price, less underwriting discounts and commissions. On December 21, 2020, we
used a portion of these proceeds to repay, in full, our outstanding term loan
credit facility. See "Long-Term Debt" below for additional information.

As mentioned above, we plan to use some of these products, as well as the few $65.9 million of the net proceeds of our IPO in July 2019to further support and accelerate our research and development activities, including the aforementioned clinical studies.

Prepayment of health insurance


On April 16, 2020, we received an advance payment of $8.3 million ("the Advance
Payment") from CMS under its Accelerated and Advance Payment Program, which was
expanded to provide increased cash flow to service providers during the COVID-19
pandemic. CMS began recoupment of the Advance Payment in April 2021 by applying
25% of the Medicare payments otherwise owed to us against the balance of the
Advance Payment. Recoupment of the full amount of the Advance Payment was
complete by December 31, 2021.

Material cash needs


Our primary uses of capital are, and we expect will continue to be, compensation
and related expenses, clinical research and development services, laboratory
operations, equipment and related supplies, legal and other regulatory expenses,
general administrative costs and, from time to time, expansion of our laboratory
and office facilities in support of our growth. We anticipate that a substantial
portion of our cash requirements in the foreseeable future will relate to the
further commercialization of our currently marketed products, the development of
our future product candidates in our pipeline and the potential
commercialization of these pipeline products, should their development be
successful.

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In the past 12 months we completed two strategic opportunities, which we funded
using our available cash on hand, and in the longer-term may evaluate and
consummate other strategic acquisitions of businesses, assets, products or
technologies, which we expect to be able to fund from our available cash and
cash equivalents. In May 2021 and December 2021, we completed the acquisitions
of the Myriad myPath Laboratory for $32.5 million and Cernostics, Inc. for $30.7
million, respectively. In both cases, the source of funding was from our
existing cash and cash equivalents. Under the definitive agreement with
Cernostics, we have also agreed to pay up to an additional $50 million in cash
or our common stock, at our sole discretion, based on the achievement of certain
commercial milestones relating to the year ending December 31, 2022. Our
liability with respect to the commercial milestone payments will depend on our
ability to successfully integrate Cernostics into our suite of commercial
product offerings, while future cash requirements arising from any additional
strategic acquisitions will depend on, among other things, our identification of
a target company with a product offering that we view as complementary to our
product offerings. See Note 5 to the consolidated financial statements for
additional information on recent acquisitions.

Since our inception, we have generally incurred significant losses and negative
cash flows. For the year ended December 31, 2021 we had a net loss of $31.3
million and an accumulated deficit of $93.8 million as of December 31, 2021. Our
ability to generate revenue sufficient to achieve profitability will depend
heavily on the successful commercialization of our currently marketed products
and the products we plan to launch in the future as well as our spending on
research and development activities. We expect to incur additional expenses and
losses in the future as we invest in the commercialization of our existing
products, the development of our future product candidates and the
commercialization of our product candidates. Further, we expect that any
acquisitions of businesses, products, assets or technologies will also increase
our expenses. We believe that our existing cash and cash equivalents and
anticipated cash generated from the sale of our commercial products will be
sufficient to fund our operations for the next twelve months. We believe we will
meet longer-term expected cash requirements and obligations through a
combination of existing cash and cash equivalents, anticipated cash generated
from sales of our products and issuances of equity securities or debt offerings,
including through our shelf registration statement on Form S-3 that became
automatically effective in December 2020. However, we have based these estimates
on assumptions that may prove to be wrong, and we could utilize our available
capital resources sooner than we expect. There are numerous risks and
uncertainties associated with developing genomic tests, including, among others,
the uncertainty of:

• successful initiation and completion of clinical study protocols;

•successful identification and acquisition of tissue samples;

•the development and validation of genomic classifiers; and

•the acceptance of new genomic tests by doctors, patients and third-party payers.


Because of the numerous risks and uncertainties associated with research,
development and commercialization of product candidates, we are unable to
estimate our exact working capital requirements. Our future funding requirements
will depend on, and could increase significantly as a result of, many factors,
including those listed above as well as those listed in the section titled "Risk
Factors."

We do not currently have any committed external source of funds. In the event
additional funding is required, we expect that we would use a combination of
equity and debt financings, which may not be available to us when needed, on
terms that we deem to be favorable or at all. To the extent that we raise
additional capital through the sale of equity or convertible debt securities,
the ownership interest of our stockholders will be diluted, and the terms of
these securities may include liquidation or other preferences that adversely
affect the rights of common stockholders. Debt financing and preferred equity
financing, if available, may involve agreements that include covenants limiting
or restricting our ability to take specific actions, such as incurring
additional debt, making acquisitions or capital expenditures or declaring
dividends. Any disruptions to, or volatility in, the credit and financial
markets or any deterioration in overall economic conditions may make any
necessary debt or equity financing more difficult to obtain, more costly and/or
more dilutive. If we are unable to raise additional funds through debt, or
equity financings or other arrangements when needed, we may be required to
delay, limit, reduce or terminate our product discovery and development
activities or future commercialization efforts.

Leases


We have entered into various operating and finance leases, which are primarily
associated with our laboratory facilities and office space. Total undiscounted
future minimum payment obligations under our operating leases and finance leases
as of December 31, 2021 totaled approximately $10.6 million, of which $1.4
million is payable in 2022 and $9.2 million is payable through the end of 2033.
The leases expire on various dates through 2033 and provide certain options to
renew for additional periods. We expect our lease obligations will increase in
the near term as we expand our facilities, operations and headcount in support
of the anticipated growth in our portfolio of commercial products and pipeline
tests. Refer to Note 9 to the consolidated financial statements for additional
information on our leasing arrangements.

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Cash flow

The following table summarizes our sources and uses of cash and cash equivalents for each of the periods presented (in thousands):

                                                                          Years Ended December
                                                                                   31,
                                                                                       2021               2020
Net cash (used in) provided by operating activities                                $ (18,983)         $   9,865
Net cash used in investing activities                                                (66,657)            (4,748)
Net cash provided by financing activities                                              5,421            305,890
Net change in cash and cash equivalents                                              (80,219)           311,007
Cash and cash equivalents, beginning of year                                         409,852             98,845
Cash and cash equivalents, end of year                                             $ 329,633          $ 409,852


Operating Activities

Net cash used in operating activities of $19.0 million for the year ended
December 31, 2021 was primarily attributable to the net loss of $31.3 million,
deferred income taxes of $8.7 million, recoupment of the Advance Payment of $8.3
million and increases in accounts receivable of $4.6 million, partially offset
by stock compensation expense of $21.7 million, increases in accrued
compensation of $6.2 million, depreciation and amortization of $3.4 million and
increases in other accrued liabilities of $2.3 million.

Net cash provided by operating activities was $9.9 million for the year ended
December 31, 2020 and was primarily attributable to net non-cash charges of
$10.5 million (consisting of $8.3 million in stock-based compensation expense,
$1.4 million of loss on extinguishment of debt, and $0.8 million in amortization
of debt discount and issuance costs), the receipt of the Advance Payment of $8.3
million, increases in accrued compensation of $3.3 million and decreases in
accounts receivable of $1.7 million, partially offset by the net loss of $10.3
million and increases in prepaid expenses and other current assets of $2.8
million, other assets of $1.4 million and inventory of $1.0 million.

Investing activities


Net cash used in investing activities for the year ended December 31, 2021 was
primarily attributable to our asset acquisitions of Myriad myPath LLC and
Cernostics (which collectively totaled $63.2 million) and purchases of property
and equipment of $3.5 million.

Net cash used in investing activities for the year ended December 31, 2020
entirely made up of purchases of property, plant and equipment.

Fundraising activities


Net cash provided by financing activities for the year ended December 31, 2021
consisted primarily of $4.2 million of proceeds from exercise of common stock
options and $2.3 million of proceeds from contributions to the employee stock
purchase plan, partially offset by payment of employees' taxes on vested
restricted stock units of $0.8 million and payment of common stock offering
costs of $0.3 million. We did not complete any public offerings of common stock
during the year ended December 31, 2021.

Net cash provided by financing activities for the year ended December 31, 2020
consisted primarily of $330.0 million of proceeds from two public offerings of
our common stock (net of underwriting discounts, commissions and issuance
costs), $1.6 million of proceeds from contributions to the employee stock
purchase plan and $1.6 million of proceeds from exercise of common stock
options, partially offset by repayments of term debt, including extinguishment
costs, of $27.4 million.

Inflation

We do not believe that inflation has had a material impact on our results of
operations during the periods presented. However, recently, the rate of
inflation in the U.S. has risen to levels not experienced in decades. We have
begun to see some inflationary pressures, primarily in personnel and related
costs. The extent of any future impacts from inflation on our business and our
results of operations will be dependent upon how long the elevated inflation
levels persist and if the rate of inflation were to further increase, neither of
which we are able to predict.

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Critical accounting estimates


Our consolidated financial statements are prepared in accordance with accounting
principles generally accepted in the United States of America. The preparation
of our consolidated financial statements and related disclosures requires us to
make estimates and judgments that affect the reported amounts of assets,
liabilities, costs and expenses, and the disclosure of contingent assets and
liabilities in our consolidated financial statements. We base our estimates on
historical experience, known trends and events and various other factors that we
believe are reasonable under the circumstances, the results of which form the
basis for making judgments about the carrying values of assets and liabilities
that are not readily apparent from other sources. We evaluate our estimates and
assumptions on an ongoing basis. Our actual results may differ from these
estimates under different assumptions or conditions.

While our significant accounting policies are described in more detail in Note 2
to our audited consolidated financial statements, we believe that the following
accounting policies are those most critical to the judgments and estimates used
in the preparation of our consolidated financial statements.

Revenue recognition


We recognize revenue is recognized in accordance with ASC 606. In accordance
with ASC 606, we follow a five-step process to recognize revenues: (1) identify
the contract with the customer, (2) identify the performance obligations, (3)
determine the transaction price, (4) allocate the transaction price to the
performance obligations and (5) recognize revenues when the performance
obligations are satisfied. We have determined that we have a contract with the
patient when the treating clinician orders the test. Our contracts generally
contain a single performance obligation, which is the delivery of the test
report, and we satisfy our performance obligation at a point-in-time upon the
delivery of the test report to the treating physician, at which point we can
bill for the report. The amount of revenue recognized reflects the amount of
consideration to which we expect to be entitled, or the transaction price, and
considers the effects of variable consideration.

All of our revenues from contracts with customers are associated with the
provision of diagnostic and prognostic testing services. Most of our revenues
are attributable to DecisionDx-Melanoma for cutaneous melanoma. We also provide
a test for UM, DecisionDx-UM. We launched a test for patients with cutaneous
SCC, DecisionDx-SCC in August 2020 and launched a test for use in patients with
suspicious pigmented lesions, DecisionDx DiffDx-Melanoma in November 2020. We
began offering a test for difficult-to-diagnose melanocytic lesions, myPath
Melanoma, following an asset acquisition completed in May 2021 and began
offering the TissueCypher® Barrett's Esophagus Assay for patients with BE
following an asset acquisition completed in December 2021. Information on the
disaggregation of revenues is included below.

Once we satisfy our performance obligations and bill for the service, the timing
of the collection of payments may vary based on the payment practices of the
third-party payor and the existence of contractually established reimbursement
rates. Most of the payments for our services are made by third-party payors,
including Medicare and commercial health insurance carriers. Certain contracts
contain a contractual commitment of a reimbursement rate that differs from our
list prices. However, absent a contractually committed reimbursement rate with a
commercial carrier or governmental program, our diagnostic tests may or may not
be covered by these entities' existing reimbursement policies. In addition,
patients do not enter into direct agreements with us that commit them to pay any
portion of the cost of the tests in the event that their insurance provider
declines to reimburse us. We may pursue, on a case-by-case basis, reimbursement
from such patients in the form of co-payments and co-insurance, in accordance
with the contractual obligations that we have with the insurance carrier or
health plan. These situations may result in a delay in the collection of
payments.

The Medicare claims that are covered by policy under an LCD are generally paid
at the established rate by our Medicare contractor within 30 days from receipt.
Medicare claims that were either submitted to Medicare prior to the LCD's
effective date or are not covered by the terms of the LCD, but meet the
definition of being medically reasonable and necessary pursuant to the
controlling Section 1862(a)(1)(A) of the Social Security Act are generally
appealed and may ultimately be paid at the first (termed "redetermination"),
second (termed "reconsideration") or third level of appeal (de novo hearing with
an ALJ). A successful appeal at any of these levels results in payment.

In the absence of LCD coverage or contractually established reimbursement rates,
we have concluded that our contracts include variable consideration because the
amounts paid by Medicare or commercial health insurance carriers may be paid at
less than our standard rates or not paid at all, with such differences
considered implicit price concessions. Variable consideration attributable to
these price concessions is measured at the expected value using the "most likely
amount" method under ASC 606. The amounts are determined by historical average
collection rates by test type and payor category taking into consideration the
range of possible outcomes, the predictive value of our past experiences, the
time period of when uncertainties expect to be resolved and the amount of
consideration that is susceptible to factors outside of our influence, such as
the judgment and actions of third parties. Such variable consideration is
included in the transaction price only to the extent it is probable that a
significant reversal in the amount of cumulative revenue recognized will not
occur when the uncertainties with respect to the amount are resolved. Variable
consideration may be constrained and excluded from the transaction price in
situations where

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there is no contractually agreed upon reimbursement coverage or in the absence
of a predictable pattern and history of collectability with a payor. Variable
consideration for Medicare claims that are not covered by an LCD, including
those claims subject to approval by an ALJ at an appeal hearing, is deemed to be
fully constrained due to factors outside our influence (i.e., judgment or
actions of third parties) and the uncertainty of the amount to be received is
not expected to be resolved for a long period of time. Variable consideration is
evaluated each reporting period and adjustments are recorded as increases or
decreases in revenues. Included in revenues for the years ended December 31,
2021 and 2020 were $3,324,000 and $176,000, respectively, of revenue increases
associated with changes in estimated variable consideration related to
performance obligations satisfied in previous periods. These amounts include (i)
adjustments for actual collections versus estimated amounts and (ii) cash
collections and the related recognition of revenue in current period for tests
delivered in prior periods due to the release of the constraint on variable
consideration.

Consolidation of DecisionDx-Melanoma Claims


In June 2017, we submitted to OMHA a formal request to participate in a program
that OMHA developed with the intent of providing appellants a means to have
large volumes of claim disputes adjudicated at an accelerated rate. The program
consolidates outstanding claims at the ALJ level and uses a statistical-sampling
approach where five ALJs will determine reimbursement results for a sample of
claims which are then extrapolated to the universe of claims. Our consolidation
includes 2,698 DecisionDx-Melanoma claims dating from 2013 through spring 2017.
Hearings were held in April 2019 with a supplemental hearing in May 2019. On
March 12, 2020, OMHA issued a decision denying payment on all claims in the
consolidation. We have filed an appeal to the decision, although no ruling on
such appeal has been issued to date. In accordance with ASC 606 and consistent
with prior periods, we have not recognized (fully constrained the variable
consideration) any revenues attributable to these claims in our consolidated
financial statements pending the outcome of this matter.

Stock-based compensation


Stock-based compensation expense for equity instruments issued to employees and
non-employees, including stock options, restricted stock units ("RSUs") and
purchase rights issued under our 2019 Employee Stock Purchase Plan ("ESPP") is
measured based on the grant date fair value of the awards. For stock options and
purchase rights granted under the ESPP, we estimate the grant date fair value
using the Black-Scholes option-pricing valuation model. For RSUs, we use the
closing price of our common stock on the date of grant to determine the fair
value. We recognize compensation costs on a straight-line basis for all
stock-based compensation awards over the requisite service period of the awards,
which is generally the awards' vesting period, typically four years for options
and RSUs and the two-year offering period for the ESPP. Forfeitures are
accounted for as they occur.

Below is a description of the key assumptions used in the option pricing model:


•Expected term. The expected term is the period of time that granted options are
expected to be outstanding. For stock options, we have set the expected term
using the simplified method based on the weighted average of both the period to
vesting and the period to maturity for each option, as we have concluded that
our stock option exercise history does not provide a reasonable basis upon which
to estimate the expected term. For the ESPP, the expected term is the period of
time from the offering date to the purchase date.

•Expected volatility. Previously, because of the limited period of time our
stock had been traded in an active market, we calculated expected volatility by
using the historical stock prices of a group of similar companies looking back
over the estimated life of the option or the purchase rights under our ESPP and
averaging the volatilities of these companies. In the third quarter of 2021, we
adjusted this calculation to include our own stock price on a relative basis to
the peer group in the calculation of expected volatility, as our common stock
has now been traded in an active market for more than two years.

•Risk-free interest rate. We base the risk-free interest rate used in the Black-Scholes pricing model on the prevailing market yield at the time the option is granted and on the offer date for the ESPP provided by the Federal Reserve Board Statistical releases and historical publications of the Treasury
constant maturity rates for equivalent residual terms.


•Dividend yield. We have not paid, and do not have plans to pay, cash dividends.
Therefore, we use an expected dividend yield of zero in the Black-Scholes option
valuation model.

The fair value of our common stock is also an assumption used to determine the
fair value of stock options. Prior to our IPO, the estimated fair value of our
common stock had been determined by our board of directors as of the date of
each award, with input from management, considering our most recently available
third-party valuations of common stock and our board of directors' assessment of
additional objective and subjective factors that it believed were relevant and
which may have changed from the date of the most recent valuation through the
date of the grant, which intended all options granted to be exercisable at price
per share not less than the per share fair value of our common stock underlying
those options on the grant date.

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Subsequent to our IPO, the fair value of our common stock is the closing selling
price per share of our common stock as reported on the Nasdaq Global Market on
the date of grant or other relevant determination date.

The following table sets forth the assumptions used to determine the fair value
of stock options:

                                                     Years Ended December 31,
                                                2021                          2020
     Average expected term (years)               6.1                           6
     Expected stock price volatility       66.50% - 68.83%              
59.57%- 67.02%
     Risk-free interest rate                0.51% - 1.48%                0.28% - 1.76%
     Dividend yield                              -%                            -%

The following table presents the assumptions used to determine the fair value of the call rights issued under the ESPP:


                                                     Years Ended December 

31,

                                               2021                           2020
    Average expected term (years)               1.2                           1.2
    Expected stock price volatility       61.13% - 86.50%              
56.80% - 100.49%
    Risk-free interest rate                0.06% - 0.20%                 0.12% - 0.95%
    Dividend yield                              -%                             -%


Intangible Assets

Our intangible assets, which are comprised primarily of acquired developed
technology, are considered to be finite-lived and are amortized on a
straight-line basis over their estimated useful lives. Estimating the useful
lives of our intangible assets requires considerable judgment. In determining
the estimated useful lives, management considers factors such as historical
experience, industry and regulatory factors, competition, patent expirations and
commercial plans. If new information becomes available in future periods, we may
be required to revise our estimated useful lives. If the revised useful lives
are shorter than originally estimated, our future amortization expense will
increase.

Conditional consideration


Under the terms of business combinations or asset acquisitions, we may be
required to pay additional consideration if specified future events occur or if
certain conditions are met. With respect to the additional consideration that
may be payable in connection with our acquisition of Cernostics, which was
treated as an asset acquisition for accounting purposes, we account for the
contingent consideration as liability in accordance with ASC 480, Distinguishing
Liabilities from Equity ("ASC 480"), under the guidance for obligations that
must or may be settled by issuance of a variable number of shares. In accordance
with ASC 480, we record the contingent consideration initially and subsequently
at fair value with changes in fair value recorded in the statements of
operations and comprehensive loss each period. This liability is classified as a
"Level 3" fair value measurement (as defined in Note 11 to our consolidated
financial statements) due to the use of significant unobservable inputs and a
Monte Carlo simulation to determine its fair value. The Monte Carlo simulation
uses projections of the commercial milestones for the applicable period as well
as the corresponding targets and approximate timing of payment based on the
terms of the arrangement. The analysis also uses assumptions for expected
volatility of the financial metrics and a risk-adjusted discount rate. The
assumptions and estimates we use in the Monte Carlo simulation require
considerable judgment and may change in future periods as a result of new
information.

Recent accounting pronouncements

See Note 2, “Summary of Significant Accounting Policies,” in the Notes to our Consolidated Financial Statements included with this Annual Report on Form 10-K for a discussion of recent accounting pronouncements.

Accounting election of the JOBS law


Previously, we were an emerging growth company within the meaning of the JOBS
Act. Section 107(b) of the JOBS Act provides that an emerging growth company can
leverage the extended transition period, provided in Section 102(b) of the JOBS
Act, for complying with new or revised accounting standards. However, because
the market value of our common stock held by non-affiliates exceeded $700.0
million as of June 30, 2021, we are no longer an emerging growth company
effective December 31, 2021. As a result, we now apply public company adoption
dates for new or revised accounting standards. Further, we were required to
comply with the auditor attestation requirements of Section 404(b) of
Sarbanes-Oxley regarding our internal control over financial reporting as of
December 31, 2021.

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Ministry of Health releases “Maldives Health Statistics 2020” https://www.sociologyesoscience.com/ministry-of-health-releases-maldives-health-statistics-2020/ Sun, 27 Feb 2022 09:23:02 +0000 https://www.sociologyesoscience.com/ministry-of-health-releases-maldives-health-statistics-2020/ The Department of Health has released “Maldives Health Statistics 2020”. The book was released at a special ceremony held at the Ministry of Health on Sunday. Special Adviser on Social Policy, Dr. Mustafa Luthfy was the chief guest at the function. This book includes important data such as births and deaths, disease burden, public health […]]]>

The Department of Health has released “Maldives Health Statistics 2020”.

The book was released at a special ceremony held at the Ministry of Health on Sunday.

Special Adviser on Social Policy, Dr. Mustafa Luthfy was the chief guest at the function.

This book includes important data such as births and deaths, disease burden, public health and human resources in the health sector. Some of the statistics included in the book show that 40% of medical professionals working in the Maldives are specialists.

According to statistics made public, 59% of the nurses working in the Maldives are locals.

Statistics show that more than half of the births in the Maldives have taken place by caesarean section.

Ministry statistics show that 35% of admissions were due to non-communicable diseases.

The book also includes a chapter on the COVID-19 situation in the Maldives. It is reported that more than 13,000 cases of COVID-19 have been reported in the Maldives in 2020.

The Ministry of Health says the findings of the Maldives Health Statistics 2020 will help in making evidence-based decisions and in formulating and strengthening policies for improving the health sector. In addition, the results will also help in results-based planning of health programs and health interventions.

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Remembering Paul Farmer, a healer and guide https://www.sociologyesoscience.com/remembering-paul-farmer-a-healer-and-guide/ Fri, 25 Feb 2022 22:04:49 +0000 https://www.sociologyesoscience.com/remembering-paul-farmer-a-healer-and-guide/ My mother says those who die in their sleep are divine. Dr. Paul Edward Farmer died Monday in his sleep. He was only 62 years old. He had devoted his life to improving the health of the poorest. A physician by profession, he was also a trained anthropologist, prolific writer and professor at Kolokotrones University […]]]>

My mother says those who die in their sleep are divine. Dr. Paul Edward Farmer died Monday in his sleep. He was only 62 years old. He had devoted his life to improving the health of the poorest. A physician by profession, he was also a trained anthropologist, prolific writer and professor at Kolokotrones University and chair of the Department of Global Health and Social Medicine at Harvard Medical School. He was co-founder of the non-profit organization Partners in Health (PIH).

I have never met Farmer but have followed his work, writings, interviews and other material that emerged from his years of work in Haiti, Rwanda and impoverished areas of West Africa . His death is devastating news for the small global tribe of doctors and healthcare workers who defied capitalist greed and dedicated their lives to the poor and disadvantaged. Farmer was the beacon of this dying tribe.

As a trained anthropologist, Farmer had a knack for asking simple but important questions that peeled back the layers of social stratification. Many of his books have revealed how poverty works in the modern world. It amazed him how ordinary people in countries like Nicaragua, El Salvador and Haiti were able to put their lives on the line for dignity and social justice. His latest book Fever, Feuds and Diamonds: Ebola and the Ravages of History (2020), discusses the Ebola epidemic in West Africa and traces the origins of this region’s neglected health care to centuries of domination. colonial. This ability to logically trace the epidemic to an end point in the region’s colonial history shows a teacher mastering his talent and capable of revealing the “visibly invisible” to his students.

That said, the massive but significant web of Paul Farmer, the author, is extremely difficult to keep up with. His books deal not only with the sociopolitics of health care, but also with spirituality, liberation theology, hope, political economy, and even culture and society. His book Infections and Inequalities not only examined the link between poverty and disease, but also revealed how developed countries like the United States treat poor “invisible countries” like Haiti. His articles on tuberculosis and HIV are an important medical resource for physicians. Mountains Beyond Mountains, her biography by Tracy Kidder, is an inspiring book that all aspiring doctors should read. In Pathologies of Power, Farmer addressed disparities in access to existing medical technologies.

With the Covid-19 outbreak tearing the world’s health systems apart and opening gaping holes in our interpretation of public health care, Farmer’s work becomes a beacon, especially for resource-limited settings like India. . He believed that the social construction of epidemics and the lived experience of illness are very different and that poverty is not an accident of nature but the result of historically determined and economically driven forces. In India, many of us work in facilities that have been called “clinical deserts” by Farmer. These are hospitals without the tools of the trade. Farmer asked if such clinical deserts could be irrigated and concluded that they could. He believed that if a MASH hospital can be built next to a battlefield, then one can certainly be built after the battle is over – for example, in Sierra Leone, Liberia, Peru or Guatemala after the civil war. He believed in pragmatic solidarity with health partners.

Kidder writes in Mountains Beyond Mountains that during a trip to Cuba, Farmer revealed that he did not believe in Marxism but that he loved the then Cuban President Fidel Castro, mainly for the protection of the sick and the people. vulnerable. He writes that when they finally arrived at their hotel in Havana, Farmer said, “I can sleep here. Here, everyone has a doctor.

As Farmer sleeps eternally, it is the responsibility of each of us to ensure his legacy is maintained. Let’s promise him that everyone on this planet will have a doctor.

The author is Professor, Department of Orthopaedics, AIIMS, New Delhi

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The two-week celebration of medical pioneer Elsie Inglis will be held in Edinburgh for the statue appeal https://www.sociologyesoscience.com/the-two-week-celebration-of-medical-pioneer-elsie-inglis-will-be-held-in-edinburgh-for-the-statue-appeal/ Fri, 18 Feb 2022 04:58:48 +0000 https://www.sociologyesoscience.com/the-two-week-celebration-of-medical-pioneer-elsie-inglis-will-be-held-in-edinburgh-for-the-statue-appeal/ Srailblazing doctor and surgeon Elsie Inglis will be honored with a new statue in Edinburgh if an ongoing campaign is successful. But it’s only now that pioneering physician and surgeon Elsie Inglis is on the verge of full recognition in her hometown. Plans for a two-week Edinburgh celebration of his life and legacy in Edinburgh […]]]>
Srailblazing doctor and surgeon Elsie Inglis will be honored with a new statue in Edinburgh if an ongoing campaign is successful.

But it’s only now that pioneering physician and surgeon Elsie Inglis is on the verge of full recognition in her hometown.

Plans for a two-week Edinburgh celebration of his life and legacy in Edinburgh have been unveiled as part of a fundraising campaign for a long-awaited statue.

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A campaign to honor the founder of the Scottish Women’s Hospitals service, who was rejected by the British War Office over her suggestion of female medical units, was launched five years ago to coincide with the centenary of his death.

Mothers and children demonstrate outside the Elsie Inglis Memorial Hospital in Edinburgh on the last day before it closed in October 1988. Photo: Denis Straughan

Led by the Edinburgh branch of the Girlguiding movement, the statue campaign won the crucial backing of the city’s Lord Provost, Frank Ross, and cross-party support in the City Council, in November.

It is hoped £50,000 will be raised from the next fundraising scheme to pay for a statue of Dr Inglis – whose organization was responsible for sending 14 medical teams to war zones across Europe – to be designed and erected on the Royal Mile.

Among those appearing will be BBC health editor Hugh Pym, historian Alastair Bruce, Governor of Edinburgh Castle and a councilor from Downtown Abbey, Sara Sheridan, author of the book Where Are The Women? which highlights the stories of ‘sidelined’ women in Scottish history, award-winning film and television producer Iram Qureshi and Linda Bauld, Professor of Public Health at the University of Edinburgh, who received much praise for his guidance during the pandemic.

Broadcaster Kirsty Wark, tennis coach Judy Murray, actress Gerda Stevenson and kilt maker Deirdre Kinloch Anderson are also backing a £50,000 appeal, which is backed by firms Mercat Tours and Edinburgh Gin.

Linda Bauld is Professor of Public Health at the University of Edinburgh and Senior Social Policy Advisor to the Scottish Government. Photo: Andrew Milligan

Highlights of the program of fundraising events, which will run from February 27 to March 13, include an exhibition of memorabilia from Scottish Women’s Hospitals at St Giles Cathedral, where Dr Inglis’ funeral was held in 1917 , a mass Girlguiding gathering on the meadows and a series of afternoon tea lectures in the City Chambers.

A walking tour of the city will highlight the achievements of Dr Inglis and the ‘Edinburgh Seven’ activists, the first female students to go to university in the UK.

A fundraising gala dinner at the downtown restaurant Dine and an International Women’s Day event at the French Institute in the city, hosted by Consul Laurence Pais are also being held.

Thea Laurie, co-founder of the Statue for Elsie campaign, said: “It captured the imagination, not just of women in Edinburgh, but of people in Edinburgh as well.

Sara Sheridan PIC: Aleksandra Modrzejewska

“We are delighted that the legendary and inspiring suffragist doctor, philanthropist and founder of Scottish Women’s Hospitals will be remembered forever.

“Young people all over Edinburgh hear her name and learn her story for the first time and ask for a statue for a woman.”

Girlguiding Edinburgh spokeswoman Susan Brown said: “The statue will provide a focal point for young women in Edinburgh to motivate them to find out more about this wonderful lady.

“We empower girls to learn about the world, form their own perspectives, speak out for the change they want to see, and fight for the key issues that matter to them, just like Elsie l ‘already done.”

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Poor pre-pregnancy cardiometabolic health observed in the United States https://www.sociologyesoscience.com/poor-pre-pregnancy-cardiometabolic-health-observed-in-the-united-states/ Mon, 14 Feb 2022 19:15:00 +0000 https://www.sociologyesoscience.com/poor-pre-pregnancy-cardiometabolic-health-observed-in-the-united-states/ Geography serves as a marker for broader socioeconomic and racial gaps, which public health policies and efforts can curb. More than half of women who gave birth in the United States in 2019 had poor cardiometabolic health, and time trends suggest the situation is getting worse, according to research published Monday in a special issue […]]]>

Geography serves as a marker for broader socioeconomic and racial gaps, which public health policies and efforts can curb.

More than half of women who gave birth in the United States in 2019 had poor cardiometabolic health, and time trends suggest the situation is getting worse, according to research published Monday in a special issue of Go Red for Women. Traffic.

With many studies linking pregnancy complications like preeclampsia and gestational diabetes to worse long-term cardiovascular outcomesthe researchers say improving the overall health of women before they become pregnant should be a priority for policy makers and primary care clinicians.

The researchers say that while this is a significant problem across the United States, it may be particularly important to target states where a low percentage of women enter pregnancy in ideal cardiometabolic health. Hopefully, future efforts can “identify factors that may contribute to this, such as access to health care, access to healthy food and green spaces, and neighborhood safety,” lead author Natalie A. Cameron, MD (Northwestern University Feinberg School of Medicine, Chicago, IL), told TCTMD.

Geography as a surrogate marker

Using maternal birth records from the U.S. Centers for Disease Control and Prevention, researchers identified more than 14 million women ages 20 to 44 who gave birth in the U.S. between 2016 and 2019. Good health cardiac (defined as a body mass index of 18.0 to 24.9 kg/m2 without hypertension or diabetes) averaged lowest in the Southern (38.1%) and Midwestern (38.8%) states and highest in the West (42.2%) and Northeast (43.6%).

Commenting on the study, Vesna Garovic, MD, PhD (Mayo Clinic, Rochester, MN), told TCTMD that “geography really serves as a surrogate marker for socioeconomic status, education, and racial disparities in delivery of maternal health care, which differs from state to state. The same states that have these unfavorable profiles for pregnancy in the United States have unfavorable cardiometabolic profiles for the general population, which kind of has implications again important for overall health. But for pregnant women in particular, who are stressed by weight, lipid changes and fluid retention, the implications are more pronounced, she added.

Cameron was surprised to see such a low percentage of women entering pregnancy with good cardiometabolic health, which overall declined from 43.5% in 2016 to 40.2% in 2019. “I thought that number was pretty low. given that these are women of childbearing age,” she said. “We looked at women ages 20 to 44, but that’s still young enough to only have 40% of them entering pregnancy with favorable cardiometabolic health.”

Notably, 81.4% of the population was between 20 and 34 years old. Overall, 22.7% were Hispanic/Latin, 14% were non-Hispanic black, and 52.7% were non-Hispanic white. Although the database used for the study did not include any post-pregnancy data, the researchers observed an inverse correlation between favorable cardiometabolic health and a high school diploma or less, as well as with Medicaid (P < 0.01 for both).

“There are certainly a lot more social and economic factors that we need to look at to help design policies,” Cameron said.

“At the individual patient level, we would like more women to see their primary care physician before pregnancy for regular check-ups to ensure they have normal blood pressure, do not have diabetes or prediabetes, that they’re not a smoker, and that they’re of normal weight so that their doctors can help them manage those conditions if they have any,” she added. “And that way they can help maximize the health of their pregnancy and their baby too.”

For patients who experience cardiometabolic complications during pregnancy, Cameron advised doctors to look for risk factors as early as possible “to try to optimize them for the future pregnancy.” For those already entering pregnancy with poor cardiometabolic health, it’s never too late to make improvements, she said.

Garovic said healthy diet and exercise are important, but doctors need to work with women who want to start a family in a timely manner so they are healthy when they become pregnant.

Unfortunately, the data suggests “that what was bad is getting worse,” she added, noting, however, that “it may be the population that is particularly motivated to pursue these lifestyle changes in order to ‘achieve their reproductive goals’.

Going forward, Garovic would like research to focus on identifying markers of preclinical abnormalities associated with increased risk of cardiovascular disease beyond what is currently included in typical risk factor stratification. “Pre-pregnancy and pregnancy outcomes may play a role in how we assess overall risk, but unfortunately at this stage, even though we are aware that pregnancy complications may increase their risk of heart disease and stroke, these are not factored in and calculated into traditional risk scores,” she said.

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HBKU Launches New Masters in Social Policy and Program Evaluation https://www.sociologyesoscience.com/hbku-launches-new-masters-in-social-policy-and-program-evaluation/ Sun, 30 Jan 2022 17:17:44 +0000 https://www.sociologyesoscience.com/hbku-launches-new-masters-in-social-policy-and-program-evaluation/ The College of Public Policy (CPP) at Hamad Bin Khalifa University (HBKU) has launched its new program, the Masters in Social Policy and Program Evaluation (MSPPE). The two-year, full-time MSPPE offers students a unique opportunity to develop the skills needed to shape the strategic direction of social policy and program evaluation in Qatar and beyond. […]]]>

The College of Public Policy (CPP) at Hamad Bin Khalifa University (HBKU) has launched its new program, the Masters in Social Policy and Program Evaluation (MSPPE). The two-year, full-time MSPPE offers students a unique opportunity to develop the skills needed to shape the strategic direction of social policy and program evaluation in Qatar and beyond. From September 2022, the program is open to students from all fields, especially those with work experience in social policy and/or policy evaluation.

The combination of evaluation and social policy, and the intensive training students receive in program evaluation, makes the MSPPE unique in the region. The program will provide advanced analytical and substantive knowledge of social policy and program evaluation. Students will learn evaluation skills that are integral to building trusted evidence to inform programs and policies, support communities, as well as drive organizational change in the public, private, and nonprofit sectors on issues of local and global importance.
The interdisciplinary degree will draw on several areas of study, including economics, political science, sociology, psychology, education, law, applied ethics, and public health. Classroom teaching will be complemented by applied research through CPP’s Public Policy Lab as well as internship opportunities that provide hands-on, real-world experience. All students will be required to write a master’s thesis on a research topic relevant to Qatar, the Middle East or the world.
“The goal of social policy is ultimately human and societal well-being. With this intent, our new MA program will challenge students to assess the ethical underpinnings of social policy interventions. With the knowledge they will acquire, they will become professionals ready to lead the evaluation of social policy programs, both to improve outcomes and provide solutions to social problems,” said Dr. Anis Ben Brik, Associate Professor and MSPPE program coordinator at RPC.
Dr. Leslie A Pal, Founding Dean of the CPP, said: “The degree program will build vital national capacities in social policy programming and support Qatar’s national development through evidence-based social policies and ethically informed.
The MSPPE will be supported by CPP’s Social Policy Research and Evaluation Program, whose research agenda aims to benefit social policy research and evaluation at local, regional and international levels through education programs, research activities and ministry support. international organizations, civil society and private sector bodies.

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Thumbs up for the proposed smoking restrictions https://www.sociologyesoscience.com/thumbs-up-for-the-proposed-smoking-restrictions/ Mon, 24 Jan 2022 00:00:00 +0000 https://www.sociologyesoscience.com/thumbs-up-for-the-proposed-smoking-restrictions/ PETALING JAYA: As expected, the smoking cessation proposal received broad support from health professionals. However, as one pointed out, it is still in its infancy and issues such as enforcement will need to be given due consideration before any legislation is introduced. Malaysian Medical Association (MMA) President Dr. Koh Kar Chai said the move could […]]]>

PETALING JAYA: As expected, the smoking cessation proposal received broad support from health professionals.

However, as one pointed out, it is still in its infancy and issues such as enforcement will need to be given due consideration before any legislation is introduced.

Malaysian Medical Association (MMA) President Dr. Koh Kar Chai said the move could significantly reduce the many health problems and co-morbidity problems caused by smoking in future generations.

Last week, Health Minister Khairy Jamaluddin announced that the government plans to table tobacco and tobacco control legislation during the next Dewan Rakyat session.

Currently, tobacco products are covered by the Food Act 1983.

The proposal follows a recent decision by the New Zealand government to ban the sale of tobacco to anyone born after 2008.

Under Kiwi law, anyone 14 and under today will never be able to legally purchase tobacco products during their lifetime.

Singapore is also considering a similar proposal.

Applauding the decision, Koh pointed out that there is overwhelming evidence to show that smoking is detrimental to health.

“It’s a step in the right direction. At MMA, we have been advocating for a smoke-free Malaysia and we have run many anti-smoking campaigns. It’s good to see progress now,” he said. the sun.

Koh said there should be support from both sides of the aisle when the bill is tabled for debate in Dewan Rakyat.

Tobacco use is a major health problem in Malaysia, according to the World Health Organization (WHO).

According to the 2020 report of the WHO Framework Convention on Tobacco Control, Malaysians start smoking at an early age. One in five Malaysians is a smoker and 21.3% of smokers start smoking at the age of 15.

The cost of health care is also staggering. Malaysia is expected to spend RM7.4 billion to cover the cost of treating smoking-related diseases, such as lung cancer and heart disease, by 2025, according to WHO estimates.

Koh stressed that point-of-sale enforcement must be strict to ensure cigarettes are not sold to minors.

He noted that anti-smuggling measures should also be in place to ensure that tobacco products and other similar addictive substances do not slip into Malaysia.

Besides criminalizing the sale of cigarettes to an entire generation, Koh said, education can also serve as a powerful way to discourage young people from taking up the habit.

“With greater awareness of smoking-caused diseases, the danger of second-hand smoke, and the high cost of treating smoking-related diseases, I think young people might be discouraged from lighting up,” he said. declared.

He also urged the government to continue raising taxes on cigarettes in a bid to price these items beyond the reach of the younger generation.

“The tax collected can then be used to cover the cost of public health care,” he added.

Azrul Mohd Khalib, director of the Galen Center for Health and Social Policy, said such a move would pay dividends not only for the future generation, but also for those approaching the age of maturity today.

Like Koh, he sees a challenge in enforcing such legislation.

“How do you know if a person is legally authorized to buy cigarettes without presenting their identity card? Maybe we can ask customers to show an individualized QR code to prove their legitimacy,” Azrul said. the sun.

He said there should also be easier access to nicotine replacement therapy (NRT), such as patches and gum, which have been successful in helping smokers kick the habit.

“It is essential that the government provides adequate support to those who want to quit smoking using evidence-based approaches such as NRT. Electronic cigarettes do not have the same track record in treating nicotine addiction,” he added.

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Library, Historical Society presents ‘Country Doctors of Arkansas’ https://www.sociologyesoscience.com/library-historical-society-presents-country-doctors-of-arkansas/ Sun, 16 Jan 2022 10:17:23 +0000 https://www.sociologyesoscience.com/library-historical-society-presents-country-doctors-of-arkansas/ The Garland County Historical Society, in association with the Garland County Library, will present the virtual “Country Doctors of Arkansas” program with the book’s author, Dr. Sam Taggart, at noon Tuesday. The public is invited to participate by visiting the library’s Facebook page, http://facebook.com/garlandcountylibrary, or its YouTube channel, http://www.youtube.com/garlandcolibrary. “From the 1830s to the present, […]]]>

The Garland County Historical Society, in association with the Garland County Library, will present the virtual “Country Doctors of Arkansas” program with the book’s author, Dr. Sam Taggart, at noon Tuesday.

The public is invited to participate by visiting the library’s Facebook page, http://facebook.com/garlandcountylibrary, or its YouTube channel, http://www.youtube.com/garlandcolibrary.

“From the 1830s to the present, Dr. Taggart explores the evolution of country physicians and profiles physicians serving small communities in Arkansas,” the Historical Society said in a press release.

Taggart’s 2021 book, “Country Doctors of Arkansas,” began with a series of interviews that examined the lives and practices of rural doctors in Arkansas over the past 70 years, according to the release, and is the first project of the Arkansas Physicians Oral History Project.

“He begins his book by examining the practice of medicine in rural Arkansas from 1804 to 1945. His 40 interviews focus on physicians in small towns or slightly larger towns in rural areas. The oldest physician interviewed is born in the 1920s and the youngest in the 1980s,” he said.

“He emphasizes that ‘every small town has its own story with various characters and dramas’ and his book conveys a ‘tapestry of the history of health and disease in rural America told one doctor at a time'” , the statement said.

Taggart, a family physician, grew up in the White River Delta in Augusta. He received his college education at Arkansas State University at Jonesboro and then attended medical school at the University of Arkansas Medical School at Little Rock. After earning a medical degree, he completed a residency in family medicine, then spent two years in the military. He then returned to Arkansas to practice medicine and has lived in Benton and Hot Springs for the past 40 years. He retired in 2013 as a senior partner and founder of Family Practice Associates of Benton.

His first novel, “We All Hear Voices”, was published in 2007 and won the Independent Book Publishers Association National Popular Fiction Bronze Award in 2010. In 2010, he published a second novel, “With a Heavy Heart”, which tells the story of a German spy in Bauxite and Hot Springs during World War II.

In 2012 he was commissioned by the Arkansas Times to write a history of health care in Arkansas over the past 200 years. “The Public’s Health” was published in January 2013. “Country Doctors of Arkansas”, published in June 2021, was also published by the Arkansas Times. He lectures on the history of health care in Arkansas and writes for the journal of the Arkansas Academy of Family Physicians, according to the release.

Author Dr. Sam Taggart. Photo courtesy of the Garland County Historical Society. – Photo submitted
Photo Dr TE Rhine, who practiced medicine in Thornton from 1899 to 1964. He visited patients on horseback, buggy and Model-T and often operated on his kitchen table early in his career. Photo courtesy of the Garland County Historical Society. – Photo submitted
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Joe Biden should depoliticize COVID-19 vaccine, says Arthur Brooks https://www.sociologyesoscience.com/joe-biden-should-depoliticize-covid-19-vaccine-says-arthur-brooks/ Sat, 08 Jan 2022 00:32:44 +0000 https://www.sociologyesoscience.com/joe-biden-should-depoliticize-covid-19-vaccine-says-arthur-brooks/ Author and social scientist Arthur Brooks says it’s time to depoliticize the COVID-19 vaccine and for the Biden administration to start over with its public health advisory team. “It’s political. It’s sociological. It’s psychological right now, ”he said. “We have to depoliticize. We have to move away from force and coercion and we have to […]]]>


Author and social scientist Arthur Brooks says it’s time to depoliticize the COVID-19 vaccine and for the Biden administration to start over with its public health advisory team.

“It’s political. It’s sociological. It’s psychological right now, ”he said.

“We have to depoliticize. We have to move away from force and coercion and we have to really start working on trust and fear. These are the key elements, and we have gone in the wrong direction.

Brooks addressed a variety of topical issues on Friday in an hour-long discussion at the Kem C. Gardner Policy Institute at the University of Utah. Utah House President Brad Wilson, R-Kaysville, facilitated the conversation for a small audience of local politicians and community and business leaders.

The author of several books, including “Love Your Enemies,” “The Conservative Heart,” and a new book to help people find success and their goal as they age called “From Strength to Strength,” Brooks spoke to several times to the Utah public over the years.

Utah, he said, has garnered a lot of national attention.

“There is a possibility that Utah and Salt Lake City could help bring this country together again,” Brooks said.

Developing the COVID-19 vaccine is a moon-like achievement, but it’s an empty victory because so many people don’t trust public health officials, and “I understand why,” Brooks said. “It’s very politicized.”

National level public health leaders will not stand up and say schools should be open, said Brooks, a professor of management at Harvard Business School where he teaches a course on happiness. Public health data, he said, unequivocally indicates that schools should be open.

Utah House President Brad Wilson, R-Kaysville, left, listens to Arthur Brooks, Professor William Henry Bloomberg of Public Leadership Practice at Harvard Kennedy School and Professor of Management Practice at Harvard Business School, speaks at the Kem C. Gardner Policy Institute Symposium at the Thomas S. Monson Center in Salt Lake City on Friday, January 7, 2022.
Laura Seitz, Deseret News

“We need the President of the United States to stand up and say, ‘Open schools’. It would be a non-partisan thing to do, ”he said. “Non-partisan words are always more powerful when you stand by your side. “

Additionally, Brooks said President Joe Biden needs a new coronavirus team to “wipe out” what has really happened over the past two years, “a whole new team of people who haven’t fear”.

“I don’t want to slander anyone, but I think it’s very important to see new faces that are relentlessly apolitical,” Brooks said.

Public health officials must recognize that there is evidence that the virus originated in Wuhan, China, and that natural immunity is real, he said, noting that some studies show it is 27 times more potent than immunity vaccinated.

“We are not stupid. It is very important that we have confidence in public health officials. And when we trust the public health officials and they say ‘Yes, these things are true and you have to go and get vaccinated for the sake of our community and for your sake,’ then people will, ‘ Brooks said.

“When you force people to do it, they don’t want to. Americans are funny like that, aren’t they?

Brooks, the former president of the right-wing American Enterprise Institute, also discussed how to overcome people’s lack of trust in government institutions.

He called it a “national crisis” that lasted long before the COVID-19 pandemic. The US military is the only government entity that has gained confidence over the years, although it has also declined a bit in recent times, he said.

Even though the loss of trust in institutions is a problem, Brooks said he does not see it as a threat to American democracy.

“I think it’s a threat to American unity and the trust we can actually have in each other, which makes it impossible or really, really hard for us to do things. This trust issue is something we need to address, ”he said.

Arthur Brooks, Professor William Henry Bloomberg of Public Leadership Practice at Harvard Kennedy School and Professor of Management Practice at Harvard Business School, left, chats with Catherine Kanter, center, and the Mayor of Salt Lake City Erin Mendenhall at a Gardner Policy Institute Kem C Symposium at the Thomas S. Monson Center in Salt Lake City on Friday January 7, 2022.

Arthur Brooks, Professor William Henry Bloomberg of Public Leadership Practice at Harvard Kennedy School and Professor of Management Practice at Harvard Business School, left, chats with Catherine Kanter, center, and the Mayor of Salt Lake City Erin Mendenhall at a Gardner Policy Institute Kem C Symposium at the Thomas S. Monson Center in Salt Lake City on Friday January 7, 2022.
Laura Seitz, Deseret News

Political, community and business leaders must publicly fight against excesses on their side.

In a speech Thursday on the anniversary of the Jan.6 attack on the U.S. Capitol, Biden said, “You can’t love your country only when you win.” Brooks applauded the statement as a wise and correct message, but for the wrong audience.

“He has to say this to the people of the cultural left who only believe in elections when Democrats win, who love America only when progressive things happen and who hate America and slander this whole country. and think we’re all a bunch of right-wing stooges when the Supreme Court has the wrong makeup or the wrong party gains control of Congress, ”Brooks said.

“And the right has to do exactly the same.”

In addition, he said politicians on both sides must “be caught showing love”.

Brooks also touched on ways for leaders to depoliticize society at large, saying they shouldn’t use hot issues to gain partisan advantage by politicizing things that shouldn’t be political. It’s easy to make race or COVID-19 something that sets people on fire, he said.

“You make it worse under the circumstances,” he said.

Brooks said he believes the partisanship that exists in the country will wane over the next five years.

“We cannot keep this level of partisan energy around absolutely every issue,” he said. “It would be historically abnormal for the United States.”


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