A Personal Post: Living the Scientific Method

I took a break from clinical practice as of May of this year.  I have been in practice for over 20 years (counting my 4 years in residency training) so it still feels very strange.  I am so used to living with the doctor’s paranoid mantra of “I must be missing something” that it’s really hard to shake.  There are a lot of other emotions too:  guilt, relief, excitement, loss, and (dare I admit?) joy.

I’m having weird dreams, too. Disturbed sleep has been a normal work hazard and my constant companion over the years, so in a way that’s not surprising.  Yesterday, though, I actually dreamt that I was flying for the first time in my life.  It was a lucid dream and I was even able to choose which directions to travel.  It was probably the best dream I’ve ever had.  It’s also worth noting that I haven’t had a “falling” dream in a while (which I used to have commonly). That is really something.  It doesn’t take a Freud to figure out that maybe I’m feeling freer and lighter than before.

Taking a break from clinical work has been something I’ve been thinking about and struggled with for a few years now.  I’m glad that I finally had the courage to just do it.  As often seems to be the case, things tend to be scarier in my imagination than when they actually come to pass.  (I hope that this is some type of corollary that always holds true because this revelation has encouraged me to be braver lately.)  To my surprise, the world around me did not in fact self-destruct as I worried it might, and all seems fine. In fact, maybe things are even better.  Funny.

Most people don’t understand, after working so hard to become a doctor and working at it so long to finally become a half-way decent doctor, why I’d then just want to stop. Maybe I should explain.

Like many Indian kids who grew up in households that revere learning and science and believe in karmic goodness, I decided early that I wanted to be a doctor.  I think I first started telling people when I was around 10.  It was a no brainer: I was fascinated by science and was good at it (my favorite subjects were biology and genetics); doctors are venerated in my culture (second only to priests); my dad in fact had wanted to be a doctor but didn’t get into med school so there was also some inherited, aspirational, existential yearning there; and last but not least, taking care of people matched my soft-hearted personality.

My teenage self–an embarrassing but impressive nerd–took on this mission with zeal.  I applied to a science magnet program for high school, I obsessed about getting A’s, I entered science fairs, I was a candy striper, I volunteered to be a lab assistant, and in so doing, got into a competitive undergrad and med school degree program.  I tell you all this only to show just how very badly I wanted to be a doctor and how grateful I was when I finally became the very first doctor in my family.  It made me proud to make my family proud.

As is my way, I followed my gut when I made the decision to be an ob/gyn. The most moving experience I had had in med school was witnessing a childbirth for the first time, born to a single, too thin, very alone, young black woman.  No family member was with her at the birth, until of course, her baby was born, and then they two had each other.  I’m a crier, so of course I cried.  I don’t know, but in the desolate atmosphere of Newark, NJ at that time, which had too many drugs, HIV, and crime, I was touched by the beauty and hope of that moment.  I took it as a sign that this was what I was supposed to do.

The analytical side of me also thought ob/gyn to be an ideal field.  It offered the best of all worlds of medicine: a primary care aspect that could grant me the satisfaction of having long-term relationships with patients, a surgical side that could grant me the instant gratification of solving certain problems immediately for patients, and even an emergency medicine aspect to satisfy the adrenaline junkie in me that enjoyed the natural endorphin rush of sometimes having to save the day with quick decision making and action.

I also just admired the women role models I saw in that field.  They all seemed like firebrands and lady bosses–kick-ass, bold, honest. (Yes, some would call them bitchy. And that, they would say is a compliment. 🙂 )  They were leaders among women and leaders among doctors.  I wanted that to rub off on me.  I don’t think I’m at the level yet of my favorites, but I did have a patient tell me last year that she thought I was “tiny but mighty” and that is now how I like to think of myself.  It’s motivating to try and live up to that high compliment.

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Me & baby Grace, May 2017

But, I’m not gonna lie: this career has been hard. Really hard. It’s been physically, mentally, emotionally, and spiritually hard.  I know I’m not unique among other doctors in my specialty, or even other specialties, or for that matter, even compared to other people working in high stress fields, but I guess I’m just sharing my own personal journey and saying that I’ve struggled a lot with how to cope with the exhaustion, sleep deprivation, mental stress, heartbreak, and yes, even depression, that comes with this work.  I could write a book on it, but I try to be a little Buddha about it and live with the knowledge that these are temporary states of pain and move on instead of dwell on it, so I think that this post is all I will say for now, and maybe ever.

I probably sound like a whiner.  I know many other people have it much worse.  Doctors in general are not a group of people that other people feel too sorry for.  That is appropriate.  I do know how extremely privileged I’ve been to have this amazing career, which in net has given me much, much more than it has taken from me. And even though many of my lowest lows have been at the hospital, so have many of my highest highs.  In all the ways that my medical career has bruised me–physically, mentally, emotionally, and spiritually–it has also burnished me and I feel deep gratitude for that.  I’m better as a result.

Medicine has helped to grow my love for humanity.  I thought I had a good amount of empathy when I started as an idealistic, young med student, but I really didn’t know the depths I could achieve personally until having heard and felt some of the struggles of my patients over the years. Now, sometimes I even think I can viscerally feel people’s pain, as if it’s my own.

It’s hard to keep being a witness to everyone’s hardship and suffering and feel powerless to do very much, especially in a system that allows you only 15 minutes per patient.  I’ve burnt out on that.  I’ve always cried easily, but now it’s a little bit ridiculous.  I’ll cry during a dumb movie, for example, not so much because I believe the fiction in the movie but because I know these types of things happen to actual people everyday, some of whom I’ve met and I’ll then remember them, and the fiction ends up feeling very real to me.  I’ve learned to put myself in little escapist bubbles for short periods of time to re-charge my batteries.  Maybe that’s what I’m doing now.

There’s the struggle of the individual patient but also the systemic dysfunctions that bother me, maybe now more than ever in this toxic political climate: how we practice medicine, the design of our healthcare system, and how we as doctors have little influence on socioeconomic problems that are so much at the root of public health. I don’t think it’s right that doctors spend more time with the medical record than with patients, that they are paid on incentives based on quantity of care rather than quality, that we have a structure that encourages quick fixes and overprescribing rather than the time-consuming process of actual care and healing, that patients can’t afford healthcare, that they go into debt over it, that they can’t afford healthy food, that they work too much to have time to take care of themselves, that mental health and prevention are so undervalued and underutilized, and that women seem to be the most screwed-over members in society on multiple, mind-blowing levels and hardly anyone seems to give a shit.  I’m tired of all of this and more and I’m also tired of having to be a silent part of it and I guess I needed a break from my participation in it to think about what I can do with myself that will inspire me, make me feel more productive and like I’m making a bigger difference in the world, be able to be more myself and share my opinions freely about what I see without need to censor myself, and also that at the end of the day, will just feel right to me.  I need to get back to following my most trusted resource: my gut.

I’m also an intellectually curious person.  I’m a learner.  I’ve been restless the last few years while in practice.  I think it’s hard to do any one single thing for more than a decade, let alone two decades. I think it’s a kind of intellectual death to expect a person to keep being and doing only one thing for their entire lives, especially if they have a personality like this.  We accept that kids keep growing and changing.  Can we also expect and accept that adults do the same?

Realizing this about myself, I went back to school a few years ago to enroll in a master’s degree program in a thing called “healthcare leadership”.  Honestly, I’m embarrassed by the pomposity of the name and I wasn’t even sure what I’d do with such a degree, but I liked the coursework, which was a hybrid of public health and business management courses and I thought it would help build on my background in medicine and that maybe that it would lead me down interesting, gratifying avenues.  That has turned out to be true.  My mind has bloomed with new ideas, and I’ve discovered a new passion for medical innovation and healthcare technology.  It’s lead to some interesting new opportunities that seem to keep growing the more open I am and the more I put myself out there.

I’m excited about the future and where this will lead.  It feels like an experiment.  I know this could end up being a disaster. But still, I’m excited.  It reminds me of what I love about science in the first place: making hypotheses, trying new experiments, discovering something previously unknown before…whether good or bad.  Once in a rare while, there is even some magnificent discovery.  I wonder what I’ll discover while living life using the scientific method?  An experiment, even when the hypothesis is proved wrong, is a success in terms of learning and discovery.  I try to remember that these are core things that I live for.  (That’s why, for example, I love to travel.)

I’m now trying to think of creative ways to stay clinically engaged but in a more flexible way.  I might moonlight, work part-time, in the clinic, or as a hospitalist.  I’m not sure yet.

This month I’ll be back to seeing patients in a short-term position as a clinical researcher testing a women’s health device in a trial for a medtech company that is hoping to develop a better treatment for incontinence.  I’m excited about that.  What if it turns out to be better than surgery? What if it’s a revolution in terms of treatment of this problem?  How nice if I can say I helped.  Again, if it fails, it was still a worthy experiment.

I am also looking forward to continuing to work with and support startups trying to improve medicine and healthcare and I also hope to get more involved with charitable work, especially in support of women and girls.  (Besides these issues, I also deeply care about animals, the environment, and the food system. It probably sounds nuts that I have so many causes!)

Once in a while I think,”What the hell am I doing? What is even my purpose here on Earth?”  Am I here for others or for myself?  To be the consummate doctor, to serve others?  To learn and grow?  To just enjoy life & have fun?

These questions used to torture me, but I’ve finally realized that it’s probably a little bit of all of these things, and maybe I should stop analyzing so much and yes…just follow my gut.

This should be an interesting experiment.  There is, of course, no clear or guaranteed outcome, but I am taking joy in conducting it.

 

Digital Health Investments Hitting All-Time High

This article was originally published on Healthegy.

Digital health investments are on track to hit an all-time record in 2016, according to Katya Hancock, director of strategic partnerships at StartUp Health, who spoke at the Digital Healthcare Innovation Summit.

Year-to-date for 2016, digital health companies have raised over $6.5 billion in investments, already surpassing the $6.1 billion that was invested in the space last year.

The sector set a record in the third quarter when companies raised $2.37 billion, the most raised in a single quarter.

Total investments in digital health since 2010 have amounted to $20 billion. According to Hancock, the general consensus at StartUp Health is that digital health is still only in its early stages, and that we are far from a market bubble.

Currently, StartUp Health has 170 companies, across 26 countries, in its portfolio. The firm has an ambitious mission, “to improve the health and well being of everyone in the world,” and aims to do this by supporting and investing in entrepreneurs who hope to reinvent and transform health care.

StartUp has recently outlined 10 major moonshots that it feels will have the greatest impact on health: improving access to health care, decreasing health care costs, curing diseases, cancer, women’s health, children’s health, nutrition, brain health, mental health, and longevity. In addition, StartUp Health actively tracks 7,500 companies outside its portfolio to gain market insights into the digital health space.

Market Trends

Through its market research, the company has identified a number of interesting trends in the digital health market that are worth noting:

US and Global Growth: As mentioned previously, digital health investments are growing with year-over-year increases. In addition, international investments are increasing rapidly. Some of the largest deals are in fact happening abroad, in particular in China. Two of the largest investments, in fact, have been in China, with a seed-stage investment of $500 million in start-up Ping An Good Doctor and $448 million in Baby Tree, both based in China.

Digital Health’s “First Wave”: Digital health is still in its “first wave,” with early investments in sensors and wearables still in early stages and not yet realizing returns. A second wave is expected that may include more sophisticated sensors, which are likely to offer deeper insights and improved solutions.

An Active Investor Ecosystem: The digital health investor ecosystem is extremely diverse, with over 500 unique investors in the space, with over 140 making multiple deals in 2016.

Unique Collaborations: Stakeholders with specialized expertise are coming together for unique partner collaborations. One example is the large $500 million investment by Google and Sanofi into diabetes start-up Onduo. We can expect more of these unique partnerships going forward, aiming to bring together parties with different skillsets to tackle difficult health care challenges.

The Rise of the Rest: Finally, there is a rise of new innovation centers and hubs away from the prominent East and West Coasts to include other sites in the US and internationally. New ecosystems are attracting investors to locales previously underserved by digital health.

Most Active Subsectors

Patient/consumer experience remains the top category for funding in the digital health market, attracting $2.53 billion in investments. The next largest categories were wellness at $918 million, personalized health and quantified-self at $634 million, big data and analytics at $564 million, and medical devices at $478 million. Other categories with less funding included workflow, clinical decision support, and population health.

Most Active Therapeutic Areas

Not surprisingly, the top three therapeutic areas that receive the greatest digital health investment are cancer, mental health, and chronic disease, including diabetes. Other significant areas of funding include: cardiology, dermatology, autism, pulmonology, ophthalmology, immunology, and rare disease.

While the investments are not in drug development per se, according to Hancock, “The lines are getting blurry between digital health and the life sciences. Some companies that we thought we wouldn’t be working with, we now are.”

Top Deals

The largest investment deals were both in the patient/consumer experience category, with a $500 million investment in Ping An Good Doctor (in China) with an undisclosed investor, and $500 million in Onduo, led by Google Ventures. The next largest deals were $448 million in Baby Tree (in China), led by Matrix Partners, and $400 million in Oscar Health, led by Khosla Ventures. Other notable investments include Human Longevity, Inc., which received $220 million, led by StartUp Health; Flatiron Health, which received $175 million, led by Roche Pharma; and Clover, which received $160 million, led by Green Oaks Capital Management.

Top Investors

The most active investors in the space were Khosla Ventures and StartUp Health, both of which made 10 deals in 2016. They were followed by GE Ventures, which made nine deals, and Safeguard Scientifics, which had six deals.

Digital health has high potential for improving health outcomes, and it is expected that investments will continue to grow in the US and internationally going forward. As it is still a young market, only time will tell if returns are realized on this potential.

Improving Gender Diversity in Health Tech

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Image courtesy Healthegy

This article was originally published on Healthegy.com.

Last month, the seventh annual Rock Health Women’s Summit was held in San Francisco to promote gender diversity and support more women leaders in Digital Health. According to research from Rock Health, women are the predominant players in the health care marketplace. Women represent 78% of the health care workforce, make 80% of health care decisions in families, and represent 75% of all caregivers in the home. Their influence on health care is profound.

It’s strange, then, that women don’t have equal representation in industry, especially in terms of leadership positions. Women run only 6% of the companies in Digital Health. As it so happens, women also represent only 6% of the venture capital industry. (According to angel investor John Landry, who spoke last month at Capital W’s Boston Women’s Venture Summit, this number is even worse in Boston, with only 3% of VCs being women.)

The gender disparity in venture capital creates a barrier to achieving gender balance in the companies they fund, as VC teams with mostly men are more likely to invest in companies with mostly men. It’s been found that VC teams with women are two times more likely to invest in management teams with women and three times more likely to invest in companies with women CEOs.

Besides being equitable, from a business perspective, it’s also profitable to invest in companies with women on the executive team. According to Rock Health, start-up teams with women on the executive team raise more money than all-male teams during first rounds. Also, companies that have women in board-level leadership positions have been found to produce a greater return on investment.

Gender diverse companies also tend to have greater diversity in general, in terms of race, sexual identity, and sexual orientation. This is important to consider because employees these days – Millennials especially (now the largest generation in the workforce) – prioritize diversity at work. Millennials have a “remarkable lack of allegiance,” according to Lynne Sterrett of Deloitte Consulting, adding, “It’s a serious challenge to us as business leaders.” What has been shown to attract and retain Millennials is having shared personal values and a deep sense of purpose. According to Ali Diab, CEO of Collective Health, a company with a health care benefits platform, “There is a certain meaning, a certain sociological tapestry that Millennials want to feel when they come into the workplace. They want to feel like what they do has that social impact broadly speaking.” Diversity has been cited in numerous studies to be integral to creating a more inclusive work culture and has also been found to result in teams that make better decisions, perform better, and are more successful.

Events like the ones sponsored by Rock Health and Capital W last month help to spotlight success stories that can hopefully inspire others. One Massachusetts firm, Zaffre Investments, the investment arm of Blue Cross and Blue Shield of Massachusetts, and its managing director, Leah O’Donnell, were recognized at the Capital W Summit for being the investment firm with the highest ratio of women-led companies in 2014 and 2015. Six of the firm’s 10 companies are women-led, including Boston-based Ovuline, which has a fertility-tracking app.

Although progress is being made, change has been very slow. Terra Terwilliger from the Clayman Institute, who spoke at the Rock Health meeting, discussed the problem (in both men and women) of unintended bias, sharing an eye-opening study that demonstrated how removing gender from resumes can improve the chances of hiring more women. She challenged the audience to consider before hiring or not hiring an applicant to ask themselves if they, too, may have an unintended bias.

Ali Diab has solved this problem at Collective Health by instituting a 1:1 men to women hiring ratio. He shared that his inspiration for this was his personal experience, having been raised by a mother who worked. “I grew up in a household where my mom was a surgeon but my dad went to grad school, a PhD program, so I got to observe the power of having that sort of a professional female force in the house.” He went on to say, “I also got to observe all of the gender issues she had from her home country, which is in the Middle East … but also here in the US where she dealt with a lot of sexism. So for me it was a very personal thing, I just wanted to make sure we had women well represented because I just feel very passionate about it because of my mom’s experience.” Collective Health has been very successful with this strategy and has even managed to create an engineering team that includes 25% women, which is unheard of – “astronomical” according to Diab – in typical tech companies. Diab also shared that he feels Collective Health has seen the fruits of this hiring policy in the market as well.

Former VC partner Karen Boezi, now an investor with Broadway Angels, urged women to be more confident, speak up, and take more risks. She also encouraged greater investments in women, sharing her thoughts about how successful they can be. “Women, I think, can be very focused on ‘getting it done.’ They have their eye on the ball and they are very good executors, very good managers.” The panel was especially bullish about women with children, calling them “ruthlessly efficient.” In speaking about the positive experience of a small investment firm called Mission Bay Capital, which invested in her biotech company (among others), she said, “They’ve had nine exits so far, all led by women.”

Hopefully, as more people in Digital Health recognize the business advantages of having gender diverse teams in their firms, opportunities for women will continue to increase.

 

Cool Startup: GenoSpace

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Healthcare is drowning in a deluge of data. Decision-makers must somehow make sense of a heterogeneous array of information — demographic, clinical, patient-generated, treatment and outcomes data. The latest waves of information also include data from mHealth and genomic sources. It’s not hard to imagine that many in the healthcare industry suffer from information overload and struggle with a bit of ‘analysis paralysis.’ How can organizations make sense of all this big data and actually harness it to improve healthcare and outcomes?

One company helping answer this question is GenoSpace, an ambitious genomic and health data management startup based in Cambridge, Mass. Its current chairman, John Quackenbush, and CEO, Mick Correll worked together in the Center for Cancer Computational Biology at Dana Farber before co-founding the company in 2012. Contracts with notable customers like the Multiple Myeloma Research Foundation (MMRF) and PathGroup funded GenoSpace before the first round of outside funding in 2014.

It was around that time that GenoSpace hired Daniel Meyer, an entrepreneur with a background in venture capital, as Chief Operating Officer. According to him, it was GenoSpace’s ability to attract high-quality customers early on (a rarity for most early-stage companies in life sciences) that convinced him to join. Recently, we sat down with Meyer to learn more about how GenoSpace helps healthcare organizations make sense of all the big data.

Tell us about what you do at GenoSpace.

When you’re dealing with genomics and other biomedical data, there are a variety of different users and reasons for their use. So you could have an institution that has users engaged in research, clinical development, lab medicine and clinical care. They have different software application needs that cut across the same or similar data sets. One of the things we try to do is develop the tools, the interfaces and the experience that will enable all of those different people to get the most from the data.

Could you go over your major offerings?  

We have three primary categories of offerings: analysis and interpretation of a single assay result together with phenotypic and other clinical data, interactive analysis of data from many individuals as a group, such as from a large observational study (where we really excel is when a customer has integrated demographic, clinical, genomic, treatment, outcomes and other data) and enabling patients to directly report and interact with their data. We’ve created software applications and web-based sites for patients to upload their data, track their results and better understand their condition. Although we have a core competency in genomic data, we do not only deal with genomic data.  Research and clinical care rarely rely solely on a single data type.

Now that Obama has announced the Precision Medicine Initiative expanding genomic study, do you also expect your work to expand?

We think it’s a fascinating announcement and those are the types of initiatives we support. One of the interesting things is that we have customers right now solving many of the problems that the initiative will face. For example, we have been working with Inova, a healthcare system based in Northern Virginia that serves more than two million people per year in the metro DC area. They have been collecting a rich set of whole-genome sequencing data together with structured clinical data on thousands of people. Their data management and analysis needs map directly to those of precision medicine initiatives like the one announced by the White House.

I’d imagine that you’d have greater demand on the private side.  

We have spent most of our time there. Our first clinical lab customer, PathGroup, is delivering industry-leading molecular profiling across a wide geographic footprint, including to some big cities in their coverage area and also smaller cities and towns.  Our ability to help them bring academic-quality medicine to community oncology is a huge impact. Roughly 85% of oncology patients are treated in a community setting. If you’re only deploying in major cities with academic medical centers, you’re missing out.

What are your next plans? Any new projects or goals?

We are  looking to expand to different customer use cases. That can be in terms of the therapeutic indication, such as rare diseases, neurologic or cardiac disease. But it can also be integrating different kinds of data. We have a lot of experience working with demographic, diagnostic, treatment and outcomes data together with genomic results, and there are more opportunities to expand.

Are you also working on using machine learning to do predictive analytics?

We think about that a little differently. There’s supervised analysis, the user asking questions and getting answers about the data, and there’s unsupervised analysis. For many of our customers, they’re not looking for a black box. Our goal is not to replace molecular pathologists, but to work hand in hand with them to make sure their work is better, more operationally efficient and more sustainable, particularly if it’s a commercial entity.

That last piece is underappreciated by a lot of folks. We do a lot of work in genomics and in precision medicine and there’s a lot of science and advanced technology. All that work is lost in most settings if you don’t deliver it properly. You have to understand the science and the innovation, but also how to get it in the hands of people who can impact patients. That’s a big part of what we do.

Any final thoughts?

One of the fun things about being here is we have folks with a lot of different capabilities—in software engineering, interactive design, data science, etc. For a lot of the interesting problems that people are trying to solve in medicine, it takes that interdisciplinary team approach as opposed to a whole bunch of people with the same type of experience.

To learn more about GenoSpace, visit their website at genospace.com or follow them on Twitter at @GENOSPACE.

This article was originally published on MedTech Boston.