Amazon Enters

Amazon is now so dominant as a corporate force that even the announcement of a plan to someday enter a new industry is enough to crush stocks.

This happened to Blue Apron last summer after Amazon bought Whole Foods and filed a trademark for a possible meal-kit service a week after Blue Apron’s IPO, whose new stock proceeded to immediately tank.

Now it’s happening to healthcare, as Amazon, Berkshire, JPMorgan partner to cut U.S. healthcare costs:

Shares of UnitedHealth Group Inc (UNH.N), Cigna Corp and health insurer Anthem Inc (ANTM.N) were 4 percent to 7.2 percent lower at the close. Drugstore operators CVS and Walgreen Boots Alliance (WBA.O), as well as Express Scripts, closed between 3 percent and 5.2 percent lower. Drug distributors Cardinal Health (CAH.N), AmerisourceBergen Corp (ABC.N) and McKesson Corp (MCK.N) were off 1 percent to 3 percent. Amazon closed up 1.4 percent.

To be sure, the $69 billion loss in healthcare stock value should rapidly self-correct (unlike for Blue Apron, which does not enjoy a stranglehold on an entire segment of the economy).

But in the announcement, the new venture has zero stated plans outside of using “technology” to reduce costs for their own employees, but they do plan to “share the strategies and technology they ultimately develop to reduce costs for the economy and the government.” It doesn’t matter what Amazon does, just that they plan on doing something.

The fact that Bezos is joined by the biggest bank (JPMorgan) and the biggest non-healthcare insurer (Berkshire) just nicely rounds out the trifecta.

Who knows, maybe they could deign to start by developing a good EMR that also uses standards to make healthcare data completely portable in order to empower patients and reduce confusion, overuse, and duplication. If it’s just Amazon Prime Rx with cheaper mail order prescriptions, I’ll be a bit underwhelmed.

“The ballooning costs of healthcare act as a hungry tapeworm on the American economy,” said Berkshire Hathaway Chairman and CEO Buffett. “Our group does not come to this problem with answers. But we also do not accept it as inevitable.”

Buffet’s still got it.

The big industry of big pharma ads

From Harper’s January 2018 index:

Amount the US pharmaceutical industry spent in 2016 on ads for prescription drugs: $6,400,000,000

Number of countries in which direct-to-consumer pharmaceutical ads are legal: 2

$6.4 billion? Holy moly, what a depressing figure. Think about how much healthcare that would buy.

In case you’re curious, our partner in crime is New Zealand.

In case you’re still curious, permitting DTC advertising is a terrible idea that can only be satisfactorily explained by the power of lobbying.


Longtime readers know that I don’t do ads, guest posts, or push products. I do however share a coupon or referral code or two for something people might actually want if it results in someone saving money (and not just me making a few bucks).

Which brings us to SmashUSMLE. The bottom line is that if you’re interested, the coupon code BW10 saves you 10%.

I don’t think most people need to be interested at this point.

While SmashUSMLE has Step 1 and Step 2 CK qbanks, it’s essentially billed as a curriculum-replacement tool with hundreds of hours of video lectures. It’s got all the trappings: It has the FRED qbank software. It has accelerated video playback options. It has a phone app.

It’s competing with pricey options like DIT and Kaplan. And while it’s cheaper than both of those, it still costs a fortune ($395 for 1 month, $795 for 3 months). There is a 15-day free trial, however, so if you were planning on doing an expensive course, you wouldn’t lose anything by trying. 15 days is actually a really generous trial; you could get a lot of value for free if you remember to cancel it if you don’t think it’s worth the dough. The solo qbank product option is cheap ($59.99 for a month), but the competition on that front is really stiff.

From my brief review sampling, the qbank lacks polish. Questions use the clinical vignette format but do not ape the USMLE house-style particularly well. A UWorld replacement it’s not.

As for the videos, I would never ever personally be interested in buying a video course, so my intrinsic bias probably precludes a fair assessment. Like DIT, they follow First Aid. The style is pure casual whiteboard—like a friend trying to teach you in a room in the back of the library—which I imagine is nice and approachable for students feeling overwhelmed. But, again, these felt a bit on the unpolished side of the spectrum. I’m not sure I could imagine spending the 100+ hours it would take to watch them all even at 2x speed. The free sample online is representative, so you can make your own decisions.



Renewed ExamGuru Code

ExamGuru, the original qbank dedicated to the shelf exams, has just released a new emergency medicine product (currently clocking in at 302 questions). So EG now covers all the core shelf exams + EM (but not, say, neurology), and you can still buy the same total package organized for Step 2 CK (2600+ questions) for dedicated prep. While there have always been plenty of resources for most shelf exams, family medicine and non-core rotations can sometimes be a bit harder to approach. Peds, for example, was also little thin on UW (at least back in my day).

Everyone still needs UW as far as I’m concerned. But for those who enjoy question-based learning and need more review, EG remains a viable adjunct. Code BW15 takes 15% off your purchase, as well as earns me a few bucks.