A blog covering the health/care ecosystem and people.

A “rebel” is both a noun and a verb. As a noun, Merriam-Webster tells us that a rebel is a person who opposes or takes up arms against a government or a ruler. As a verb, “to rebel” is to oppose or disobey one in authority or control, or otherwise renounce and resist by force the authority of one’s government.” An additional definition of the verb is, “to feel or exhibit anger or revulsion.” If you’ve been a patient facing a diagnosis of an illness, whether rare or common, you may well have felt these various feelings stirring inside your self.

If it’s January, it’s Davos-time — that is the annual meeting of the World Economic Forum convening global experts and passionistas focused on big ideas and challenges facing us mere humans living on Planet Earth. Parallel with the WEF is the annual publication of the 2024 Edelman Trust Barometer, now in its 24th year, focusing on global citizens’ concerns that unite people around the world. For the 2024 study, Edelman’s team fielded the survey in November 2023, collecting input from over 32,000 people living in 28 countries. About 1,150 interviews (plus or minus) were done in each nation which included

“I’m in Berlin, and we don’t like walls,” Bart De Witte responded in a concluding Q&A session yesterday at the 2nd Symposium on the Future of Health Systems, convened by the World Health Organization (WHO) in Porto on 5th September.               Over two days, this meeting convened stakeholders focused on WHO’s European Region to support the Organization’s digital health action plan for 2023-2030 – which fosters cross-nation health planning covering the EU space. AI’s promise in health care to automate and streamline administration, and augment diagnosis and treatment, comes with accompanying risks that can

Nearly all patients are concerned about their medical records getting leaked or breached, which is The State of Patient Privacy, the title of a consumer study from Health Gorilla with a headline finding that “Patients don’t trust Big Tech with their health data.”             With trust the “backbone” of health information exchange, Health Gorilla calls out, we have to face a big challenge here as health care enters its own sort of industrial revolution embedded AI and data analytics across the health/care ecosystem. How to re-build trust with the very technology that can help health care,

“The security of online data is the top consideration for consumers across many forms of online activities including email, search, social media, banking, shopping and dating”….and using health apps. A new poll from Morning Consult, explained on their website, explains that For Consumers, Data Privacy Has a Fluid Definition.               Those privacy nuances and concerns vary by activity, shown in the first chart here from the study. For online banking, the most important consideration among most consumers (55%) is the privacy and security of their online data. Privacy and security of personal data was

“Tom Lawry reminds us that the health care industry can shift from glacial to warp speed when it needs to. Given the right tools, we can evolve from health systems to systems of health, baked with Responsible Intelligence to do good while embedded with respect, inclusion, and transparency. Health citizens deserve Tom’s vision to emerge,” I wrote in a quote on the back of Tom’s new book, Hacking Health Care: How AI and the Intelligence Revolution Will Reboot an Ailing System.                 Tom knows whereof he speaks and writes and opines: he has

He had me at the statement, “I believe health data is medicine.” Those were the words of Ardy Arianpour, CEO and Co-Founder of Seqster, when sharing with me how his company was founded. We met up last week at the DIA Europe 2022 meeting (Drug Information Association) in the cool SQUARE Conference Center in Brussels, Belgium (my current home base for work and life). It was a rare opportunity to sit still with this on-the-go guy with whom an hour spent is the equivalent of three hours with most other folks. Ardy and the team call Seqster “the operating system

I cannot recall a season when so many health consumer studies have been launched into my email inbox. While I have believed consumers’ health engagement has been The New Black for the bulk of my career span, the current Zeitgeist for health care consumerism reflects that futurist mantra: “”We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run,” coined by Roy Amara, past president of Institute for the Future. That well-used and timely observation is known as Amara’s Law. This feels especially apt right “now” as we enter 2022,

A new look into Americans’ views on health privacy from Morning Consult provides a current snapshot on citizens’ concerned embrace of technology — worried pragmatism, let’s call it. This ambivalence will flavor how health citizens will adopt and adapt to the growing digitization of health care, and challenge the healthcare ecosystem’s assumption that patients and caregivers will universally, uniformly engage with medical tools and apps and technologies. More Boomers are concerned with health data app privacy than Gen Z consumers, as the chart illustrates. 46% of U.S. adults said that health monitoring apps were not an invasion of privacy; 32%

The COVID-19 pandemic sparked a reappraisal of value-based care, a shift to remote and virtual care, and acceleration of healthcare stakeholders’ investments in Artificial Intelligence-based solutions, Philips discovered in the 2021 Future Health Index, the company’s latest survey conducted among 2,800 health care leaders working in 14 countries. This week at the 2021 annual HIMSS conference, Philips is “making the case for moving to the cloud,” discussing the Philips HealthSuite, a cloud-based platform for connecting providers and patients, devices (and the data they generate), and care across the health care continuum. That’s a big promise and vision, so to kick

The pandemic ushered in millions of peoples’ first digital health experiences, many of which will persist according to the 23rd Annual U.S. Consumer Technology Ownership & Market Potential Study, published by the Consumer Technology Association. CTA conducted an online survey among 2,409 U.S. adult 18 and over in April 2021 to gather data for this annual report. To ensure a fair sample, CTA drew three datasets for the general population along with an Hispanic oversample and an oversample for people 65 years of age and older. The study looked at 83 consumer technology products and sub-categories, including many directly related

Trust in the technology industry has crashed to an all-time low based on the 2021 Edelman Trust Barometer. As Richard Edelman, CEO, concisely asserted, “Tech loses its halo.” The first chart shows the one-year trend on trust across industries through U.S. consumers’ eyes. Most industries lost citizens’ trust between 2020 and 2021, most notably, Technology, dropping the greatest margin at 9 points Retail, falling 7 points, Entertainment. falling 5 points, and, Fashion and automotive declining by 4 points. Several sectors’ trust equity rose in the year, especially healthcare growing by 8 points and food and beverage rose slightly by 2

Expanding omni-channel, data-driven, cost-effective health care in the community, tailoring that care, and attending to mental health paint the picture of health through the lens of CVS Health. The company published the Health Trends Report 2021 today, calling out ten forces shaping health care this year. Those themes are, The Year of the Pharmacist The Next Step Forward in Cardiac Care Cancer Needs a Better Roadmap The EHR Hits Its Stride The Mental Health Shadow of COVID-19 Tailor Care to the Older Patient More Agents that Predict Disease Paying for the New Medical Miracle Virtual Care Goes Mainstream, and Diabetes

The growing use of APIs in health information technology innovation for patient care has been a boon to speeding development placed in the hands of providers and patients. Using APIs can help drive interoperability and make data “liquid” and useable. APIs can enable “Data liberación,” a concept proposed by Todd Park when he worked in the Obama administration. Without securing patients’ personal health data leveraging APIs, those intimate details are highly hackable explained in All That we Let In, a report from Knight Ink and Appr0ov. It is likely that behind growing health data hacks is the marginally greater financial

The coronavirus pandemic disrupted and re-shaped the annual CES across so many respects — the meeting of thousands making up the global consumer tech community “met” virtually, both keynote and education sessions were pre-recorded, and the lovely serendipity of learning and meeting new concepts and contacts wasn’t so straightforward. But for those of us working with and innovating solutions for health and health care, #CES2021 was baked with health goodness, in and beyond “digital health” categories. In my consumer-facing health care work, I’ve adopted the mantra that our homes are our health hubs. Reflecting on my many conversations during CES

explained in a new report from EY co-sponsored by the American Hospital Association (AHA) and the AHA Center for Health Innovation. Digital Transformation – Anywhere Care envisions “health care with no address, or bringing care to the consumer or patient rather than expecting the patient to go to the hospital” as a “vital sign” of health care’s changes going into the new year of 2021. COVID-19 accelerated a movement in which I’ve been involved for over a decade, known as “participatory health.” In its early phase in the U.S., Dr. Tom Ferguson identified the emerging role of the internet in

In the COVID-19 era, most U.S. consumers believe they have an obligation to share personal health information to stop the spread of the coronavirus. However, only 44% would be willing to share their personal data with a national database, a MITRE study learned. Only one-third of Americans would be willing to share their temperature, 29% their location, and one-fourth information about their chronic conditions. The Harris Poll conducted the study among 2,065 U.S. adults 18 and over in mid-June 2020 to gauge peoples’ perspectives on health data and privacy. Three-quarters of people in the U.S. believe that data privacy “is a

The Consumer Technology Association (CTA), collaborating with industry stakeholders, has ushered in a standard for artificial intelligence in health care.   CTA is the membership organization for companies that innovate, manufacture and market consumer-facing tech like big-screen TVs, slick new autos, video games and voice assistants. So what’s an organization like CTA doing with AI and health care? Let me connect the dots. Check out this graphic taken from my book, HealthConsuming: From Health Consumer to Health Citizen. This shows the ten categories of tech I revisit each year at CES, CTA’s annual mega-conference of new-new things in consumer electronics

Physicians are evolving as digital doctors, embracing the growing role of data generated in electronic health records as well as through their patients using wearable technologies and mobile health apps downloaded in ubiquitous smartphones, described in The Rise of the Data-Driven Physician, a 2020 Health Trends Report from Stanford Medicine Stanford Medicine interviewed 523 physicians and 210 medical students and residents in September and October 2019 to assess clinicians’ perspectives on digital health topics for this study. The study title citing the “data-driven physician” is based on the key survey finding that doctors are preparing to embrace data, from both traditional

In CTA’s 2020 Consumer Tech Forecast launched yesterday at Media Day 1 at CES, Steve Koenig VP of Research, said that, “digital health is an ecosystem of ecosystems.” Health, medical and wellness trends featured large in the forecast, which brought together key trends for 5G, robotics, voice tech, AR/VR/XR, and the next iteration of IoT — which Steve said will still be called “IoT,” but in this phase will morph into the “Intelligence of Things.” That speaks to Steve’s phrase, “ecosystem of ecosystems,” because that’s not just “digital” health — that’s now the true nature of health/care, and what is

As technology continues to re-shape consumers’ experiences and expectations with health/care, retail, travel and work, peoples’ concerns about data privacy are also growing as observed by a 2020 consumer trends forecast from GlobalWebIndex, Connecting the dots. First, some overall context to the study. GlobalWebIndex “connects the dots” of consumers trends in 2020 including the topics shown in the first graphic including commerce and retail, gaming, travel, human touch, nostalgia, privacy and digital health — the first of these trends discussed in the report. Note that the data discussed in this post include responses from consumers residing in both the U.S.

“Bold thinking is great. Bold doing is better,” Dr. Eric Topol introduced his talk yesterday at Medecision’s Liberation 2019 conference. I have the opportunity, for which I’m so grateful, of not only attending this meeting but playing a role as a speaker, a sometimes stage “emcee,” and a keynote speaker. And as an attendee, I learn so much from other speakers, fellow attendees, and Medecision staff all sharing perspectives during breakouts and networking breaks. In mode of attendee (and self-confessed collegial-groupie of Dr. Topol’s), I took in his remarks taking notes as fast as I could thanks to Mom teaching

There are about 55 million patient records held by the United Kingdom’s National Health Service (NHS). Their monetary value to private sector companies would be £5 billion and nearly that much in patient benefits. Add in value for patient outcomes, and the total approaches £10 billion. In today’s UK:US currency exchange rate, 10 billion British pound sterling is worth roughly $12 billion. Realising the Value of Healthcare Data from EY explores how patient data can, in the words of the report, “unlock significant operational savings, enhanced patient outcomes, and wider economic benefits” for the NHS and patients through using artificial

The health/care ecosystem continues to morph as the stakeholder groups themselves are blurring across and outside of their core businesses. Today’s example of this is Clover Health, which launched Clover Therapeutics this week. This research organization will develop medicines targeting older adults — which makes sense because Clover Health’s target consumer market is Medicare Advantage beneficiaries. “Clover Therapeutics was created to address the significant unmet needs in chronic progressive diseases in the Medicare population,” Cheng Zhang, Head of Clover Therapeutics, is quoted in the press release. The company will first collaborate with Genentech (Roche) to research and develop therapies based

Social, mobile, analytics and the cloud now underpin the health care industry. We’ve been SMAC’ed, and Accenture’s Digital Health Tech Vision 2019 believes we’re in a post-digital era ripe with opportunity. Five trends comprise the Vision: DARQ Power, the acronym for Distributed ledger technology, Artificial intelligence (AI), extended Reality, and Quantum computing. Adopting these applications can help health care reduce costs, drive labor efficiency and support people-centered design and experience. Get to Know Me is the use of technology to develop and deepen relationships with people. As an example of this trend, Accenture points to Mindstrong which leverages AI and

The 2019 Edelman Trust Barometer measured the biggest gap in trust for the healthcare industry between the U.S. “informed public” and the mass population. Fewer American women, too, trust the healthcare industry than men do. “This inequality of trust may be reflective of the mass population continuing to feel left behind as compared to others, even as they recognize the advances that are being made that could benefit them. Given tone and tenor of the day, and particularly among mass population, healthcare may continue to see increasing demands for change and regulation,” Susan Isenberg, Edelman’s head of healthcare, notes in

“The Fourth Industrial Age,” Dr. Abraham Verghese writes, “has great potential to help, but also to harm, to exaggerate the profound gap that already exists between those who have much and those who have less each passing year.” Dr. Verghese asserts this in his forward to Deep Medicine, Dr. Eric Topol’s latest work which explores the promise of artificial intelligence (AI), Big Data, and robotics — three legs of the Fourth Industrial Age stool. [If you don’t know the work of Dr. Verghese, and since you’re reading the Health Populi blog, you must get to know Dr. V now. Your

“The promise of AI is undeniable…could AI help clinicians deliver better and more humanistic care?” This question is asked and answered in a JAMA viewpoint published January 1/8 2019 titled, Humanizing Artificial Intelligence. This theme motivated a conversation held over a dinner convened by Philips hosted by Frans Van Houten this week at HIMSS19. To provide context Geoff Colvin, Fortune‘s Senior Editor, first talked about taking friction out of industries, as Lyft and Uber have done in the transport sector. “Taking friction out of industries challenges and changes business models,” Geoff noted. With Uber’s IPO valuation approaching $100 billion, I’d say that’s

Eat food, not too much, mostly plants, Michael Pollan advised us on the cover of his breakthrough book on nutrition in America, In Defense of Food.  In Las Vegas, it’s not too easy to live and eat  according to Pollan’s Food Rules. We’re at a fork in the road when it comes to food, retail grocery shopping, and health, which is an intersection I’m increasingly working in these days. The Groceryshop conference is further informing my understanding of the landscape of the technology that’s enabling the consumer’s ability to curate, purchase, and receive the food they want to satisfy hunger and

Information is power in the hands of people. When it’s open in the sunshine, it empowers people — whether doctors, patients, researchers, Presidents, teachers, students, Everyday People. Welcome to the era of Open Source Healthcare, not only the “about time” for patients to own their health, but for the launch of a new publication that will support and continue to evolve the concept. It’s really a movement that’s already in process.     Let’s go back to some definitions and healthcare basics to understand just why Open Source Healthcare is already a thing. When information access is uneven, it’s considered

With the vast majority of patients’ medical records now digitized in electronic health records systems, the opportunities to mine, learn from, and act on the findings are promising for U.S. healthcare. More data is moving into internet clouds every day, from healthcare encounters with clinicians and inpatient hospital stays to prescribed medicines, retail receipts for over-the-counter remedies, wearable technologies, credit card swipes for products and services, and GPS check-ins. That’s a treasure trove of digital footprints that can tell a lot about us as patients, either in real-time or via prediction. But can we nudge stakeholders in health and healthcare

Most Americans say that pharmaceutical manufacturers, banks, advertisers, energy firms, and tech companies have too much power and influence in today’s American economy, according to Public Attitudes Toward Technology Companies, a research report from the Pew Research Center. A plurality of Americans says labor unions and farming and agriculture have too little power, along with a majority of people who believe that small business lacks sufficient power in the current U.S. economy. This data point is part of a larger consumer survey on Americans’ attitudes about the growing role of technology in society, particularly with respect to political and social impacts.

When it comes to healthcare costs, lines that decline over time are generally seen as good news. That’s how media outlets will cover the top-line of PwC’s report Medical cost trend: Behind the numbers 2019. However, there are other forces underneath the stable-looking 6.0% medical trend growth projected for 2019 that will impact healthcare providers, insurers, and suppliers to the industry. There’s this macro-health economic story, and then there’s the micro-economics of healthcare for the household. Simply put: the impact of growing financial risk for healthcare costs will be felt by patients/consumers themselves. I’ve curated the four charts from the

Two in 3 Americans haven’t heard the phrases “personalized medicine” or “precision medicine.” When the concept of therapies tailored to individual patients is explained, most people like the idea of diagnostic tools that can identify biological markers and marry to personal medical records data to help determine medical treatments that best fit them. This picture of U.S. consumers’ views on personalized medicine comes from a survey conducted for PMC, the Personalized Medicine Coalition, and GenomeWeb, published in May 2018. The poll results are published in Public Perspectives on Personalized Medicine, with the top-line finding that life science industry innovators must

When you’re on the battlefield and you can’t see what lies ahead, go high, recommended General Von Clausewitz in his book, On War. I paraphrase this prescription from the good General-strategist’s book, On War — “War is the realm of uncertainty; three-quarters of the factors on which action in war is based are wrapped in a fog of greater or lesser uncertainty. A sensitive and discriminating judgment is called for; a skilled intelligence to scent out the truth.” Governor Mark Leavitt, who held the post of Secretary of Health and Human Services under President Bush, offered this advice at the recent Liberation

On July 18, 2017, Neil Gomes, Chief Digital Officer at Thomas Jefferson University and Jefferson Health in Philadelphia, tweeted this: When I saw this tweet, I was especially struck by Gomes’s phrase, “Designed & developed with heart/love by my @DICEGRP.” That’s Jefferson’s health solutions group that focuses on digital innovation and consumer experience. Here’s a health system that’s focused on that customer experience, which has become a critical success factor for healthcare to thrive. That’s because, as Steve Laughlin, VP and General Manager of IBM’s Global Consumer Group recently explained to me, a consumer’s last great customer experience becomes the

Health permeates a plethora of TIME magazine’s 25 Best Inventions of 2017. From head to foot, health is the mother of invention, based on TIME’s curation of “the best” things launched to market in the past year. Starting with “the head,” the Oculus Go virtual reality (VR) headset from Facebook. While the first function with which VR is associated is fun and games, Dr. Brennan Spiegel at UCLA Geffen School of Medicine has been proving out VR‘s value in helping patients deal with pain and medical management. Keep your eye on his and others’ research into VR’s use in healthcare. The

Artificial Intelligence, AI, can help drive the Triple Aim in healthcare, reducing cost, improving quality, and expanding access, according to Artificial Intelligence: Healthcare’s New Nervous System from Accenture. Acquisitions of AI developers in health will be fast-paced, growing at a compound annual growth rate of 40% – “explosive” in the word of Accenture – moving from $600 mm in 2014 to $6.6 billion in 2021. What these AI startups will do is to enable machines to sense, comprehend, act and learn, Accenture foresees, to augment administrative and clinical tasks which could free up healthcare labor (say, doctors, other clinicians, and accountants)

Healthcare is at a digital inflection point, asserts   Internet Trends 2017 – Code Conference, by the iconic Mary Meeker of Kleiner Perkins. Published May 31, 2017, few tech-focused reports have the gravitas or generate the readership that this report does. I’m one of Meeker’s perennial readers, covering this report through my health/care lens here on Health Populi for several years (links to previous posts below). Of the report’s 355 pages, 22 are devoted to healthcare (pages 288-319), a section curated by Noah Kaufman of KP. This section of the report assembles data from a range of publicly available sources,

The future of wellness combines: Connected (you) Social IRL (in-real-life) Banishing bad (de-tabooing what’s traditionally seen as “bad”) Humanizing data, and The end of experts. These insights come from adidas, whose team developed a forecast of the future of fit, announced at the 2017 South-by-Southwest Festival in Austin this weekend. I had the honor of participating in this forecast and shepherding the SXSW panel on The End of Experts: Crowdsourcing Your Wellness at the adidas meet-up held over the weekend. The future of fit and wellness is Connected, because we are growing to understand that balancing many elements in our daily

A special report on patient engagement and digital technology was published this month in the New England Journal of Medicine (NEJM). Based on a survey of doctors and healthcare executives, the research found that clinicians and managers welcome the opportunity to use digital tech — when it makes financial sense. That conclusion inspired the title of the article, Patient Engagement Survey: Technology Tools Gain Support – But Cost Is a Hurdle. NEJM polled 595 members of the NEJM Catalyst Insights Council, which included healthcare executives and clinicians who deliver healthcare. Here is NEJM’s scenario on patient-engaging health IT, a Holy Grail of sorts:

Health citizens in America will need to be even more mindful, critical, and engaged healthcare consumers in 2017 based on several factors shaping the market; among these driving forces, the election of Donald Trump for U.S. president, the uncertain future of the Affordable Care Act and health insurance, emerging technologies, and peoples’ growing demand for convenience and self-service in daily life. The patient is increasingly the payor in healthcare. Bearing more first-dollar costs through high-deductible health plans and growing out-of-pocket spending for prescription drugs and other patient-facing goods and services, we’re seeking greater transparency regarding availability, cost and quality of

“Because health is personal” is the tagline at the 2016 Connected Health Conference being held at the Gaylord Resort in National Harbor in metro Washington, DC. “Personal,” “Connected,” and “Health” are the three words that comprise the adjectives in the Personal Connected Health Alliance, the host of this conference. PCHA was formed through the merger of HIMSS, the health IT association, and Continua, the organization advocating for health technology “interoperability” — the ability for digital and communications technologies to communicate with each other, to remove friction from health data exchange. This week, PCHA announced that it will bring the Wireless-Life Sciences Alliance into

Consumers are open to technology-enabled healthcare, but look to providers to ensure quality and privacy of patients’ personal health information, according to Will Patients and Caregivers Embrace Tech-Enabled Healthcare?, based on the Deloitte 2016 Survey of US Health Care Consumers. Seven in 10 consumers would use at least one of the technologies Deloitte served up in its study, with telemedicine at the top of the list: 49% of people favor telemedicine for post-surgical care, 48% for chronic disease management, 36% for care while traveling, and 32% for minor health issues. While Millennials are generally keener across-the-board for tech-enabled health care,

Investing information technology dollars in telehealth and mobile platforms, patient engagement, and cybersecurity are major focuses for leading IT-savvy hospitals in America, according to the 2016 Most Wired survey of healthcare organizations, released in July 2016 sponsored by Hospitals and Health Networks and Health Forum, a division of the American Hospitals Association. This survey, in its 18th year, has become an important benchmark measuring the adoption of information technology tools and services among American hospitals and health systems. The complete list of Most Wired hospitals for 2016 can be found here. The most popular telehealth services offered by the Most Wired hospitals are

Nearly 1 in 2 people own at least one wearable device, up from 21% in 2014; one-third of people own more than one such device that tracks some aspect of everyday life, according to PwC’s latest research on the topic, The Wearable Life 2.0 – Connected living in a wearable world, from PwC. Wearable technology in this report is defined as accessories and clothing incorporating computer and advanced electronic technologies, such as fitness trackers, smart glasses (e.g., Google Glass), smartwatches, and smart clothing. Specifically, 45% of people own a fitness band, such as a Fitbit, the most popular device in this

Pressures on the pharmaceutical industry are coming from every stakeholder touchpoint, driving companies to merge, set prices high for short-term gains, and (finally) put more resources toward providing patients services. Let’s call out just a few of the events from the past couple of weeks which, together, paint the current rocky landscape for pharma and life science companies: Last week on April 28th, termed “healthcare’s $45 billion day,” three big M&A deals hit the financial markets: Abbott sought to acquire St. Jude Medical (worth $30 bn alone), AbbVie looked to buy Stemcentrx for just under $6 bn, and Sanofi tagged

Who better than a financial services institution based in Silicon Valley to assess the state of digital health? Few organizations are better situated, geographically and sector-wise, than SVB Analytics, a division of Silicon Valley Bank based in, yes, Silicon Valley (Santa Clara, to pinpoint). The group’s report, Digital Health: Opportunities for Advancing Healthcare, provides an up-to-date landscape on the convergence of healthcare and technology. SVB Analytics defines digital health as “solutions that use digital technology to improve patients’ health outcomes and/or reduce the cost of healthcare.” The report provides context for the digital health market in terms of health care costs,

Retailers in the U.S. are morphing into health destinations in 2016. Members of Target’s management team attended the 2016 Consumer Electronics Show (CES) and shared their perspectives in the company blog. Among the Target teams observations came from the Chief Marketing Officer, Jeff Jones, who observed, “A tidal wave of newness is coming to fitness technology and many companies are on the cusp of changing the game. From nutrition and sleep to how you exercise, it’s all going to be measured, linked and tracked. Wearables are here to stay and getting smarter every year.” The Senior Vice President for Hardlines,