Innovation Ecosystem/Opinion

Will hope or hype reign in Rhode Island?

Breathing in the stink of polycyclic aromatic hydrocarbons from asphalt products, breathing out the vapor ware of yet another startup networking event

Photo by Ridhard Asinof

Maria Tocco, the founding entrepreneur behind Providence Flea, with the soon to be completed Wexford Innovation Complex in the background.

By Richard Asinof
Posted 5/27/19
The narratives around health care, the fossil fuel industry, and the innovation ecosystem often seem captive of hardened silos of industrial smokestacks scraping the sky. What is the best way to clear the air and do an intervention around the perverse relationships to which we have become captive?
What is the connection between the perverse relationships we have with the fossil fuel industry and the health care service delivery industry? Do the organizers of the Venture Café Providence need to rethink their approach to startups in Rhode Island? When will economic development advocates of the innovation ecosystem in Rhode Island find the time to visit the Institute of Applied Life Sciences at UMass in Amherst? How will the attempts by the FDA to hide glitches in medical devices lead to increased scrutiny of the future pipeline for firms seeking approval for their products? How can patients and consumers change the outcomes when health care is treated as a commodity? Will the increase in the number of women physicians alter the learning curve in medicine? When will the new pedestrian bridge, now completed, open for use?
The recent front-page article in The Providence Journal, talking about primary care, was insipid at best and misleading at worst. The reporter failed to talk about any of the ongoing work of the Care Transformation Collaborative or PCMH-Kids. The reporter also failed to talk to anyone from the community health center network, the backbone of primary care for managed Medicaid patients, serving nearly one-third of all Rhode Islanders. Further, the reporter failed to talk with anyone associated with Integra, the top-rated accountable care organization in the state. Was that because the ACO is associated with Care New England?
Worse, the reporter failed to mention the ongoing initiatives around Neighborhood Health Centers in Central Falls and Scituate. Even more perplexing, the reporter failed to mention the increasingly important role that nurses play in delivering care as an integral part of the primary care infrastructure.
Finally, the reporter’s narrow focus seemed to be only on primary care physicians affiliated with Lifespan. And, despite a brief mention of health inequities, there was no reporting about the innovative approach being developed in Rhode Island around health equity zones.
Ignorance is no excuse under the law, and ignorance should not be used as an excuse for bad, inaccurate, slanted reporting.

PROVIDENCE – For a number of weeks, I have wrestled with the best way to write about what has kept emerging as a common thread in my reporting on the innovation ecosystem in Rhode Island: the connection between the perverse relationships we have with the fossil fuel industry, and its partner in crime, the electric utility industry, and, in turn, how that traumatic relationship was intimately connected with an equally perverse relationship we have with the health care service delivery industry. Not a small or insignificant leap.

How to write about it became the challenge: in an era when most people no longer read, and polling has become our daily weathervane to take the pulse of our political destiny, finding an entry point was proving difficult.

My first attempt was heavy-handed and repetitive:

In the recent story, “In the Shadow of No Towers,” I wrote about the enduring perverse relationship we have with the fossil fuel industry, reporting on the history of the Brayton Point coal-burning plant in the aftermath of the implosion of the twin cooling towers at the now defunct power station, 56 years after it first began operation in 1963, the year that President John Kennedy was assassinated.

The story included a compilation of excellent reporting by Tim Faulkner at ecoRI News and Mike Jarbeau, the baykeeper at Save The Bay. The headline was a nod to cartoonist, Art Spiegelman, the author of the 2004 book by the same name. [See link below to ConvergenceRI story, “In the shadow of no towers.”]

The story began: Many people watched and cheered the implosion of the twin cooling towers at the Brayton Point power plant in Somerset, Mass. on Saturday morning, April 27, reveling in the thrilling industrial porn of destruction. Reporters swarmed the event. Videos of the implosion were posted everywhere and replayed again and again on the local news.

Naming the experience of watching the towers implode as the “thrilling industrial porn of destruction” was an attempt to illuminate the sense of bearing witness to, and being a participant in, a much larger canvas, a made-for-TV cartoon of doom.

The story continued: On the ground, following the implosion, most reporters soon departed; some local residents put on breathing masks to protect them from airborne cement dust particles spewed into the air from the implosion, yet one more health hazard to be endured, two years after the decades-old polluting coal-burning plant had been shuttered, a grim reminder of the constant patina of black coal dust that had settled on their lives ever since the plant began operating in 1963.

Yes, the skyline had changed, as one local TV news anchor observed in a Sunday evening broadcast, in a Captain Obvious moment. But, a more probing question to ask would be: How has the political landscape shifted as a result of the implosion? What lessons have been learned about our perverse relationship to the fossil fuel industry? How do we report on the significance of such an implosion, now that time is running out on our ability to sustain life on Earth as we have known it, with the planet under siege from man-made climate change?

In that news story, I attempted to use the history of Brayton Point to portray how we had become captive of a false narrative – the value proposition put forth by the fossil fuel industry and their partners in crime and deception, the electric utility industry: how everyone profits from the business of producing cheap, low-cost energy, by burning coal [and fracked natural gas] to boil water to turn turbines, in order to keep the electricity flowing and the lights on.

The problem was: the true costs of burning coal were never factored into the cost benefit analysis. Consumers were kept in the dark. Big industries prospered; Wall Street investors cheered. We were caught in the devil’s bargain.

I wrote: “The externalities of public health costs – the deaths and diseases directly attributed to the operation of the coal-burning plant – had never been included as part of the cost equation. Nor had the problems of coal-burning power plants – accelerated climate change and ocean warming and nitrification and the destruction of fisheries – ever been factored into the cost equation.”

We are now living on the precipice of the end of life on Earth as we have known it, as a result of man-made climate change, from which there will be no superheroes, no guardians of the galaxy, to come screaming across the sky to rescue us. Only ourselves.

I then attempted to document the perverse connections between health care service delivery industry and the fossil fuel industry, an even deeper dive into the weeds.

What the data tells us

Listening in on the gathering held on May 14 discussing the preliminary analysis of the ongoing efforts to deconstruct cost trends in medical costs now underway in Rhode Island, I was struck by the parallel nature of the perverse relationships we have with the fossil fuel industry and with the health care industry: with fossil fuels, we don’t include the “externalities” related to the true costs of the resulting damage being done to our health and our climate; with health care, the escalating medical costs are never linked to the problems of how we define diseases and disorders, and the connection to the contaminants we eat in our food, drink in our water, and the air we breathe.

A recent news story, I wrote, had helped to crystallize the connection:

Aaron Reuben’s story in Wired, which originally appeared in Mother Jones, “The Evidence is Strong: Air Pollution Seems To Cause Dementia,” lays out the evidence in compelling fashion, documenting the striking findings of recent studies.

“I have no hesitation whatsoever to say that air pollution causes dementia,” says Caleb Finch, gerontologist sand leader of USC’s Air Pollution and Brain Disease research network, who has completed a number a new studies that revealed that air pollution is much worse for human health than previously imagined, as reported by Reuben. According to Finch, “Air pollution is just as bad as cigarette smoke.”

As detailed by Reuben, one study, published in 2018, in which researchers followed 130,000 older adults living in London for several years, found that those Londoners exposed to the highest levels of air pollutants were one and a half times more likely to develop Alzheimer’s.

A 2017 study published in The Lancet followed all adults living in Ontario, roughly 6.5 million people for a decade, and found that those who lived closer to major high-traffic roads were significantly more likely to develop Alzheimer’s disease, regardless of their health at baseline of socioeconomic status.

Both studies estimated that some 6 to 7 percent of all dementia cases in their samples could be attributed to air pollution exposures.

A third study, undertaken by three economists at Arizona State University – Kelly Bishop, Nicolai Kuminoff and Jonathan Ketcham – decided to link EPA air quality data to 15 years of Medicare records for 6.9 million Americans over the age of 65. As Reuben recounted, the researchers, rather than simply ask if Americans exposed to more air pollution developed dementia at higher rates, arbitrarily separated Americans into higher and lower air pollution exposure groups.

As the three economists reported in the National Bureau of Economic Research in 2018, their research determined that air pollution could indeed cause dementia, specifically Alzheimer’s dementia. Further, in U.S. counties that had to comply quickly with new air quality standards, older people developed Alzheimer’s at lower rates than their peers in counties where the new rules didn’t apply.

What the three researchers determined, as reported by Reuben, was granular and damning: Annual exposure to an average of one more microgram of fine particle pollution per cubic meter of air [an amount well within the range of difference you could see if you moved from a clean neighborhood to a more polluted neighborhood] raised the typical U.S. elder’s risk of dementia as if they had aged 2.7 additional years. The authors estimated that the size of this elevated risk approached that of other well-known dementia drivers, including hypertension and heart disease.

Children at risk
None of the findings of these research studies, of course, should be seen as particularly startling. The evidence had already been laid out in compelling fashion. In his video, “Little Things Matter: The Impact of Toxins on the Developing Brain,” Bruce Lanphear, professor of Health Sciences at Simon Fraser University in British Columbia, spelled out the dilemma in clear, succinct terms.

By allowing children to be exposed to toxins or chemicals of unknown toxicity, we are unwittingly using our children as part of a massive experiment,” Lanphear said.

In the video, Lanphear presented the evidence in easy-to-understand graphic images, demonstrating how the impact of toxins on the developing brain is often permanent.

“Children who are more heavily exposed to toxins do not have the same peak cognitive ability as those who have lower exposures,” Lanphear explained, showing how decreases in IQ can be attributed to the result of the effects from a stew of toxins on the developing brain, including lead, mercury, PCBs, organic and phosphate pesticides, among others.

But it doesn’t have to be this way, Lanphear continued. “Like the European Union, we could require industry to prove that the chemicals they use aren’t toxic before they enter the market.”

The video is part of a series Lanphear has produced, entitled: “Unleashing the Power of Prevention: Creating Video To Re-Imagine Our Approach to Disease.” The other videos include: “The Deadly Impact of Airborne Particles”; and “Prevention Paradox: Why We are Failing to Prevent Disease.”

“We have lived out a narrative that we would find cures for cancer, heart disease and other chronic diseases,” according to Lanphear. Technology and drugs are apolitical and profitable, he continued. “But we won’t solve our health problems through technology alone; we need social reforms and regulations and to build healthy cities and curb pollutants and hazardous consumer products.”

Evidence-based news
The connections seemed clear and straightforward to me, and I thought about including similar news stories emphasizing the connections – the efforts by the Trump administration to erase the number of deaths caused by coal-burning pollution in a twist on new math; the warning signs in Canada of how the financial infrastructure of the fossil fuel industry was crumbling; a study by International Monetary Fund researchers that identified how the true cost of fossil fuel industry subsidies exceeded actual spending by the U.S. Pentagon; and the recent jury verdicts in California, rendered against the manufacturers of glyphosate, the active ingredient in the herbicide, Roundup, for causing cancer.

However, I recognized the limits of using facts and figures to make the case. Odds were that I had already lost most of my readers by now.

So, I began to envision a third entry point to the story: to talk about hope and the way that ordinary citizens can change the outcomes in their communities. It was, in fact, a central theme in almost every story that appeared in the May 20 edition of ConvergenceRI.

I wrote:

Last week’s issue of ConvergenceRI had covered a wealth of stories: new recovery housing for mothers and their children, the first of its kind in Rhode Island; the R.I. DEM finally taking action against the alleged corporate source of the ever-present stink on Allens Avenue, some three years after ConvergenceRI first reported on complaints by residents and identified the potential cause of the strong odors; the ongoing work of a cost compact seeking to deconstruct health costs looking at the state’s All Payer Claims Database; the 2019 annual meeting of the Rhode Island Foundation, where the community foundation with $1 billion in assets laid out its future efforts to develop long-term plans for health care and education; the first-person story from someone donning the costume of a “handmaiden” at the State House; and an interview with the proselytizer-in-chief for Innovate Newport, a new church of innovation being built in a former elementary school in Newport. [See link below to May 20 newsletter of ConvergenceRI.]

The inherent message in almost all of these stories was about the importance of listening to citizens. As I wrote in the story about the stink on the Providence waterfront: The lesson history often teaches us, if we are willing to listen, whether it is in Love Canal in the 1970s or in Flint, Mich., 40 years later, is a fundamental truth: it is ordinary citizens speaking up as a community – and demanding that reticent and reluctant government officials take action to protect the public health of the community – that will force the issues out into the open.

Ordinary citizens are the ones living on the front lines, who much like the character of Miss Clavell in Madeline, sense that “something is not right.”

The approach, I can acknowledge, was a bit too self-serving.

When everything became illuminated
Then I attended the pre-launch event organized by the Venture Café Providence, and everything was illuminated.

First, there was the setting: The brick walls of the three-story atrium of South Street Landing, the rehabbed powerhouse for the electricity-producing generating station for what was once known as Narragansett Electric, is a terrible place to hold a speaking program. The sound is quickly swallowed up by the cavernous space, while the hum of background conversations is magnified. You have to raise your voices to be heard, even in face-to-face conversations.

The event was one of those we-talk, you-listen sessions, which began rather inauspiciously when a representative of the Cambridge Innovation Center, interrupting a conversation I was having with the CEO of a company that had recently relocated to Rhode Island, put his hand on my shoulder and attempted to forcibly push me away from my place in line, as if we were all a bunch of sheep to be herded. The entrance line had become backed up because of the inefficient check-in system to print out nametags.

When I resisted, and told him to take his hands off of me, he was a bit shocked by the forcefulness of my response. It was symbolic of the overarching problem with the evening: the organizer had no idea who I was, whom I was talking to, and why we were there, and he didn’t care. The line wasn’t flowing, even if it was the Venture Café’s own fault for creating a convoluted sign-in process, and the organizer was going to solve the problem by literally pushing me. Maybe it was OK to try to physically push people out of the way standing on line in Boston.

It was supposed to be a networking event, but most of the participants, particularly those on stage in front of the microphone, appeared to be more interested in promoting themselves, not listening to others.

For sure, many of the usual suspects were there, people who were seeking to find new sources of money to carry their startup firms over the chasm and into a commercial stage venture.

When Tim Rowe, the founder of the Cambridge Innovation Center and the Venture Café initiative, had spoken at a Slater Technology Fund event a month earlier in April, a similar kind of “glib” tone of voice was evident during an interview with ConvergenceRI, when Rowe talked about the potential for a new industry cluster built around computational biology, but said he was unfamiliar with EpiVax, one of the pioneering biotech firms in Rhode Island, with its own proprietary immuno-informatics system.

There was a slide presented during one of the talks by a successful entrepreneur, which said: “Out of 6,000 data scientists in the U.S., only 180 work in health care.” The information seemed to be inaccurate and out-of-date, depending on how you defined “data scientists.” Given the ongoing work on biostatistics in Rhode Island, along with the research being underwritten by A-TCR in translational research in biostatistics, the number seemed to be wrong.

The most compelling, passionate conversation of the evening concerned the story that ConvergenceRI had written that week, “The stench that was eating the Providence waterfront.” One of the attendees at the event had shared the story on her Facebook page, and complimented ConvergenceRI on the reporting. Two other participants joined the conversation, saying that they had also read the story.

Innovation at work; watch out for collisions
For all the manipulative energy put into managing the networking event by Venture Café Providence, there was another, far better example of innovation at work in Providence – Providence Flea, with its open air market on Sunday, May 26, attracting hundreds of visitors. Providence Flea was the brainchild of Maria Tocco, who created the juried vintage and artisan/maker market in June of 2013.

In the summer and fall, Providence Flea has carved out a place next to the Providence River, across from the Providence Innovation and Design District, to host its open air market, replete with food trucks. The future of that space is now being threatened by Boston developers, who want to erect a building that critics say will reduce access to the river and create a canyon of dark shadows.

Perhaps the organizers of Venture Café Providence should plan a visit the Providence Flea to better understand the innovative forces of collision and serendipity in the innovation ecosystem in Rhode Island.


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