GV’s Approach to Healthcare Investing: An Interview with Dr. Krishna Yeshwant

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Please note:  This article was originally published on TechCrunch.com.

Healthcare investments — in particular, investments in digital health — are booming, and don’t seem to be slowing down. According to CB Insights, digital health funding hit nearly $5.8 billion in venture funding last year, surpassing the previous record of $4.3 billion in 2014.

One of the top venture firms, GV (previously known as Google Ventures), recently came out with their year in review, revealing that more than one-third of their investments are in the life sciences and healthcare. (They currently have $2.4 billion under management.) “I can think of no more important mission than to improve human health and global quality of life,” CEO Bill Maris said in a recent announcement.

One of the strengths of the GV life science and health investment team is having a diverse mix of PhDs and MDs as investors, including general partner Dr. Krishna Yeshwant. Yeshwant continues to practice internal medicine part-time at Brigham and Women’s Hospital in Boston, and credits that with helping to keep him in touch with the challenges facing healthcare.

I recently sat down with Yeshwant to talk about GV’s investment strategy.

Yeshwant started his career, interestingly, studying computer science at Stanford. From there, he helped found two tech companies, which were eventually acquired by Hewlett-Packard and Symantec. He could have successfully continued on his path in tech, but decided instead to go to medical school after his father became ill and needed a cardiac bypass. “I remember just being in the hospital thinking this is just messed up. There are so many areas for improvement,” he said.

He went on to pursue an MD-MBA at Harvard. During this time, he became involved in a lot of medical-device work, and even started a diagnostics company. This work eventually led him to work with Bill Maris at Google Ventures.

Thus far, one of GV’s largest investments has been with Flatiron Health, an oncology-focused technology company based in New York City. According to Yeshwant, the concept was developed by two former Google employees who received support from GV. “Flatiron is basically integrating EMR’s (electronic medical records) in the outpatient and hospital setting,“ said Yeshwant, “and it provides data back to physicians as well as aggregating data to aid with discovery and help with regulatory processes.”

Others have also recognized Flatiron’s enormous potential. Flatiron recently announced they received $175 million in Series C funding from Roche Pharmaceuticals. In addition to the funding, Roche plans to be a subscriber to Flatiron’s software platform. Their hope is to use the platform to identify and bring innovative treatments to market faster.

Yeshwant strongly believes in the need for more tech solutions in healthcare like Flatiron Health. “There’s a fundamental need for infrastructure. A single disease type of lung cancer is actually lots of diseases. Other more complex diseases are going to need more data sets, multisite trials, and we need to create infrastructure for that,” he said.

It’s hard to argue with him on that point. Massive amounts of biometric data are being collected in healthcare right now, but there aren’t nearly enough tools for storage, communication and analysis of that data. There’s a great deal of opportunity for healthcare startups that can specialize in data management and analysis.

Three such companies in which GV has invested in this space are Metabiota, which provides risk analytics to prevent and reduce epidemics; Zephyr Health, which uses global health data and machine learning to provide treatment insights to pharma and medical device companies; and DNAnexus, a company that helps companies store their genetic information.

“Once you’re in a world where you can scale up and down your computational analysis, you can ask lots of simultaneous questions of your aggregated data sets and that’s well suited to the cloud environment,” said Yeshwant. “We invest heavily in those spaces.”

Besides software-based companies, GV is investing in a diverse range of other types of companies in healthcare and the life sciences. One such area is the genomics space. Thus far, GV has made major investments in Editas, a CRISPR gene-editing company; 23andMe, which offers chromosomal analysis to consumers; and Foundation Medicine, a company that offers genomic analysis of various cancers.

Yeshwant also feels one of the biggest challenges (and opportunities) in healthcare is helping healthcare organizations shift from fee-for-service to fee-for-value. “That’s the direction we’re going,” he said. “How do we migrate big systems in that direction? That’s the fundamental question.”

GV therefore has made some significant investments in companies that are shaking up the traditional provider model, including the telemedicine company Doctor on Demand and the innovative primary care provider, One Medical Group. “Anything you can do to move healthcare from a high cost setting to a low cost setting is generally going to be successful in that model,” said Yeshwant. “Telemedicine is a good example of that. We have a company called Spruce Health which is essentially asynchronous care. Value based care is a big area for us.” (Spruce Health is a platform for dermatologic care.)

Yeshwant hinted that future projects may be in the areas of population health and chronic disease management, investment in companies that engage consumers directly and possibly even some work in women’s health. One thing’s for sure: We can expect more exciting things to come in 2016 and beyond for GV.

 

 

Walgreens: Investing in the Power of the Patient

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Thanks in part to Affordable Care Act reforms and the rise of digital health, patients now have more skin in the game, more health care tools at their disposal, and more information than ever before to take charge of their own health.

Dr. Harry Leider, CMO and Group VP of Walgreens, speaking on a panel at last week’s Digital Healthcare Innovation Summit in Boston, said health care providers must find a way to adapt to the schedules and demands of patients, who have more say over how their health care dollars – and their time – are spent.

“Traditional providers are learning that they [patients] are not willing to take a half-day off from work, figure out what to do with their kids, to get routine care,” he told the panelists. “People are busier, the information technology has made it easier to get solutions without having to spend a half-day somewhere.”

It’s no surprise, then, that pharmacy retailers are placing big bets on consumer-facing health care opportunities.

In the past few years, the pharmacy-services giant CVS Health has made big investments in this area, dropping tobacco sales, expanding its MinuteClinics, and also establishing a drug ad-herence program. Now with Walgreens’ recent announcement of its $9.4 billion acquisition of Rite Aid Pharmacies, it has effectively overtaken CVS to become the leader with 46.5% of the market to CVS’ 30.9% share.

But Walgreens is looking to get bigger on the back end as well. Also, just this week it announced an upgrade to their mobile app which improves its functionality and also expands their telehealth services to 25 states (previously available in only 5 states). Walgreens’ other health care investments hint at its level of commitment, including its partnership with controversial laboratory services company Theranos and a recent announcement that it has partnered with health information tech giant Epic to install that firm’s electronic health record software across all of its health care clinics.

Walgreens is banking on its huge presence to provide easy and convenient access to the next generation of health care consumers. “Everybody knows Walgreens,” Leider said. “We have 8,300 stores, 25,000 pharmacies, and over 1,000 nurse practitioners in our clinics.” He also emphasized that half of Walgreens are located in ethnically diverse areas, with a large number of especially high-risk populations, which gives them a unique opportunity to influence health care outcomes. “Take the average diabetic patient. Diabetes is an epidemic in our country, but especially among diverse populations. First of all, a diabetic, if they’re lucky, sees a primary care doctor two to three times a year. The average diabetic comes to our pharmacy counter 20 times a year. So the opportunity to provide systems that can solve problems is greater because of this.”

Walgreens has started a digitally supported Healthy Choices Program, which rewards consum-ers for walking, weighing themselves, logging blood pressure and blood glucose levels, commit-ting to smoking cessation, and setting other health goals. In addition, it offers digital health coaching, pharmacy checks, and even virtual doctor visits.

Roughly 800,000 people have signed up, Leider said. About 500,000, of those patients are sharing their personal health data with Walgreens. What the company has found thus far from its collection of these data is that engaged users (who are actively tracking their weight) lost an average of 3.3 pounds more than non-engaged users and 1 out of 6 lost more than 10 lbs. In addition, Walgreens found that its engaged users have overall healthier behaviors and better drug adherence.

Still, he’s not a blind advocate of digital health: “I don’t think digital health alone can solve the problems you’re talking about.” Leider insists that Walgreens is not trying to usurp the tradition-al establishment but rather be a resource to providers. “We really see ourselves as supporting traditional providers and adding value to the ecosystem. We’re not gearing ourselves up to do primary care,” he said. “So our strategy really is to provide a low-cost option for care and to partner with health systems and providers.”

Going forward, Dr. Leider would like to see a greater transition to value-based care. “Despite what everybody’s saying, most providers are still trying to keep the beds full and have the most number of visits. So, for all this tech to be funded and sustainable, it’s got to be the right envi-ronment to really reward people for staying well.”

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This article was originally published at www.digitalhealthcaresummit.com.  

Don’t Count Out Theranos

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The past few weeks haven’t been easy for Theranos, the pioneer hoping to make blood diagnostics a whole lot easier.

A scathing account by The Wall Street Journal, followed by some troubling documents released by the FDA, armed critics of the upstart start-up. The company clearly needs to counter these charges and demonstrate efficacy of its tests and the soundness of its business model.

However, change isn’t easy even in an industry like blood testing, which must be disrupted. We are literally still drawing vials and vials of blood for laboratory tests. This procedure seems only a shade better than the days of medical bloodletting with leeches. Also, these tests are notoriously expensive and have slow turnaround times.

What if Theranos CEO Elizabeth Holmes is on to something here?

What if her vision of easier, faster and cheaper blood testing is really possible? Wouldn’t we all like to see that? Blood testing is a very fundamental aspect of medicine and improving the current antiquated process has the potential to truly transform health care in a big way. Imagine how many more people might be compliant with their blood tests with this type of testing. Imagine how much faster we’d get results in critical situations, and how many lives might be saved. Imagine how much we could save our very wasteful and expensive health care system by making this process cheaper.

Before you say it’s impossible, let’s remember that the FDA did approve one of Theranos’ tests via its nanotainer technology, a test for the herpes simplex virus (HSV). That is an impressive feat, and quite frankly, I’d really like to see what other tests Theranos has been able to do via its tiny nanotainers. According to Holmes, the firm has something on the order of 120 tests submitted for approval with the FDA. Squash them now and the world may never know.

The media frenzy circling Theranos is unfortunate, and we should all hope it won’t kill off something that could really transform health care for the better. We shouldn’t be trying to protect the status quo in our dysfunctional health care system. Instead, we should be less hasty to judge Theranos.

Let’s keep in mind when we read media reports that there are a lot of stakeholders embedded in the health care industry – from equipment makers to laboratories to walk-in clinics and pharmacies – that might like to see Elizabeth Holmes fail. Some of these players currently own the market. That means they dictate the availability, the turnaround times, and yes, the price of these tests. Sure, maybe they could innovate also, but there’s inherently less motivation when you’re already a market leader. How about we introduce some competition to drive prices down and introduce more motivation to innovate?

Theranos, admittedly, has a lot of work to do. It is trying to disrupt the entire laboratory industry, while currently having just one FDA-approved test. I’m hoping more of its technology will meet FDA approval. In the meantime, it makes business sense to offer venous blood draws. If the company wants to capture enough of the market, it needs to offer the full spectrum of services to customers, be it using its proprietary technology or the industry standard.

As for Holmes, I can’t blame her for being protective of her nascent company. Unfortunately, people tend to be suspicious of things they don’t know much about, so that approach is not going to work anymore. Her challenge in the coming months will be how to effectively share more information with the media and increase transparency, now that she and Theranos are much more in the public eye.

There’s reason for optimism, not paranoia, about Theranos. Let’s allow some room for its visionary leader to carry out her ambitions. Maybe, just maybe, she’s on to something that can change health care, and the world, for the better.

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Conflict-of-interest disclosure:

I have no financial or other ties to Theranos or Elizabeth Holmes. My biases include wanting to see positive health care change and more women leaders. The opinions I’ve expressed here are my own and not those of any of my employers or affiliates.

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This article was originally published at www.digitalhealthcaresummit.com.

Investing in Problem-Solving, Not Product: PureTech’s “Proactive” Approach

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Step into the sixth floor offices of PureTech Health in downtown Boston and you may feel that you’ve dropped into a rabbit hole and right into a lush wonderland of wall-to-wall greenery. It’s a surprising interior for the otherwise nondescript office building on the heavily trafficked Boylston Street.

But the unique décor might provide a clue about how this innovative company, run by CEO Daphne Zohar, operates. Referred to as an intellectual property (IP) commercialization company, one of a rare breed seen in the U.S., it licenses and develops health tech and life sciences patents from academic and independently-run labs. The model is common in the U.K.–PureTech Health went public on the London Stock Exchange this past May, raising nearly $200 million—but is radically different from how typical biopharma or venture capital firms operate.

“We start with the problem–take obesity or other disorders, like schizophrenia, ADHD–where we feel like there really isn’t a very good way to address it, and we bring together a network of 50 plus experts from around the globe, people who have really thought deeply about this problem and others who may be in slightly different disciplines,” explains Julie DiCarlo, PureTech’s SVP of Communciations and Investor Relations. “They look at the problem from different perspectives and start vetting potential technologies or science to address it. So it’s really different than a company that might say, ‘Here’s a really cool technology that we want to invest in.’”

After the think tank identifies potentially useful innovations, PureTech tests the concepts to see if previously reported results are reproducible. DiCarlo adds, “From there, we might find that there’s one that really stands out as a really potentially exciting and game-changing opportunity and if it passes all of our rigorous tests, we’ll start a company around it.”

This process of search and discovery has lead to the founding of some of the most innovative healthcare-focused companies, with diverse treatments ranging from drugs and biologics, to devices and digital health.

Akili Interactive Labs develops video game therapies for treating cognitive disorders, which have been found to improve cognitive ability and executive function among the elderly. In the future, Akili hopes to also develop treatments for those suffering from disorders like ADHD, autism and depression.

Vedanta Biosciences hopes to treat autoimmune and infectious diseases by modulating a patient’s microbiome. At this stage, Vedanta is isolating specific strains of organisms in order to learn which combinations result in particular, desired phenotypic expressions and outcomes.

Gelesis has developed an oral hydrogel capsule for the treatment of obesity (and related disorders, such as diabetes) which works mechanically, causing early satiety and decreased appetite, before dissolving and being eliminated by the body.

Tal Medical is working on a tabletop medical device (modeled like a much smaller MRI machine) that has been shown to rapidly reverse depression through neurostimulation. A single treatment with the device has been found to have an effect equal to four to six weeks of traditional pharmacologic treatment.

PureTech has 12 companies currently in their portfolio with a goal to add an additional one to two each year. Although each is independently-run, they are all majority-owned by PureTech, sometimes for the long-term. This approach allows for more flexibility than at a typical life sciences or VC firm. These companies have the potential to become completely independent, be sold to larger biopharmas, develop partnerships with other healthcare organizations, or may be retained by PureTech to continue growing the company’s product lines.

Executive Vice President of Science and Technology Erik Elenko calls PureTech’s approach “100 percent proactive.” “Think about a typical entrepreneur who has one technology and they [sic] get really excited about it but there could be 10 others out there. We’re reaching out to people, we’re not having companies come and pitch us…The key is that you start with a problem and come up with a solution, rather than investing in a technology which may or not be useful.”

The company also draws on a large, interdisciplinary panel of experts—including outside experts in addition to members of its own scientific advisory board—who look at complex healthcare problems from a multitude of angles. Among the most valuable and in-demand consultants are those working in digital health. According to Elenko, healthcare and IT have radically different cultures and “different ways of approaching the world,” so finding individuals that have connections in both worlds is invaluable in solving today’s complex healthcare challenges.

PureTech has ambitious plans for the future.

“If you look at our fundamental goal, it’s to solve the most difficult healthcare problems that exist through interdisciplinary and unexpected solutions,” shared Elenko. “Success is getting therapies to market for patients, reaching more patients through partners and helping patients by looking at their toughest problems.”

This article was originally published on MedTech Boston.


Cool Startup: RubiconMD

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Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.

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.

Cool Startup: twoXAR

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Andrew M. Radin (left) with friend and twoXAR business parter Andrew A. Radin.


It’s not every day that you meet someone with the same name as you. And it’s even less likely this person will have similar interests and be someone with whom you might want to start a business.

But that’s exactly the story of the two Andrew Radins, founders of twoXAR.

Chief Business Officer Andrew M. Radin met his co-founder and Chief Executive officer Andrew A. Radin battling over a domain name–you guessed it–andrewradin.com.  About six or seven years ago, the former asked the latter, who owned the domain, if he could buy it from him and was told (in not so many words) to get lost.

Somehow, this exchange sparked a friendship, first on Facebook, then through commonalities such as travel to China, working in science and tech and their independent, entrepreneurial pursuits.  A little over a year ago, as Andrew A. Radin completed work on a computational method to enhance drug and treatment discovery, he naturally thought of joining forces with his namesake and friend, Andrew M. Radin.

For Andrew M. who was just completing his MBA from MIT Sloan, the timing was right and the discovery compelling enough to turn down other appealing job offers and join Andrew A. in forming the aptly named twoXAR (pronounced TWO-czar). Based in Silicon Valley, the company predicts efficacy of drug candidates by applying statistical algorithms to various data sets.We caught up with Andrew M. Radin recently to hear about their exciting new venture and their progress.

Tell us about what you do at twoXAR.

We take large diverse, independent data sets including biological, chemical, clinical etc.–some subsets include gene expression assays, RNA-seq, protein binding profiles, chemical structure, drug libraries (tens  of thousands of drugs), whatever we can get our hands on–and use statistical algorithms to predict efficacy of drug candidates in a human across therapeutic areas. The raw output from our technology (DUMA Drug Discovery Platform) is the probability of a given drug to treat a given disease. It all takes only a matter of minutes.

Where do you get your data sets?  Are they from clinical trials?

Some of our data comes from clinical trials, but we pride ourselves on using data sets that are largely independent from each other and come from a variety of sources along the biomedical R&D chain–as early as basic research and as late as clinical data from drugs that have been on the market for 30 years.  All of these data sets are extremely noisy, but we specialize in identifying signal in this noise then seeking overlapping evidence from radically different data sets to strengthen that signal.

These data come from proprietary and public sources. The more data we have, the better results DUMA delivers.

Could you give an example of how you could use this tool in pharmacologic research?

Our technology allows us to better characterize the attributes of a disease beyond just gene expression. We can examine how a drug might be related to a myriad of informational evidence streams allowing a researcher to build more confidence on a prediction for drug efficacy.

Let’s take Parkinson’s Disease as an example. Existing treatments focus on managing the symptoms. The real societal win would be to stop, and possibly reverse, the progression of the disease altogether. This is what we are focusing on.

In Parkinson’s disease, we’ve acquired gene expression data on over 200 Parkinson’s patients sourced from the NIH and examined over 25,000 drug candidates and have found a handful of promising candidates across a variety of mechanisms of action.

So you can “test out” a drug before actually running a clinical trial?

That’s the idea. Using proprietary data mining techniques coupled with machine learning, we’ve developed DUMA, an in silico drug discovery platform that takes a drug library and predicts the probability of each of those drugs to treat the disease in question in a human body. We can plug in different drug libraries (small molecules, biologics, etc.) and different disease data sets as desired.

At this stage we are taking our in silico predictions to in vivo preclinical studies before moving to the clinic. Over time we aim to demonstrate that computational models can be more predictive of efficacy in humans than animal models are.

It seems, intuitively, that this would be really valuable, but I would imagine that your clients would want to see proof that this model works.  How do you prove that you have something worthwhile here?

Validation is critical and we are working on a number of programs to demonstrate the effectiveness of our platform. First, we are internally validating the model by putting known treatments for the disease into DUMA, but blinding the system to their current use. If in the results the known treatments are concentrated at the top of our list we know it’s working. Second, we take the drug candidates near the top of the list that are not yet known treatments and conduct preclinical studies with clear endpoints to demonstrate efficacy in the physical world. We are currently conducting studies with labs who have experience with these animal models to publish methods for peer-reviewed journals.

You have a really advanced tool to come up with potentially great treatments, but what’s to say that’s better than what’s going on out there now?  How do you prove it’s better or faster? 

If you look at drug industry trends, the top drug companies have moved out of R&D and become marketing houses–shifting the R&D risk to startups and small and medium drug companies. Drug prospecting is recognized to be extremely risky and established methods have produced exciting results in the past but have, over time, become less effective in striking the motherlode. Meanwhile, the drug industry suffers from the same big data woes as many industries–they can produce and collect petabytes and petabytes of data, but that goldmine is near-worthless if you don’t have the tools to interpret it and extract the gold. Advances in data science enable twoXAR to analyze, interpret, and produce actionable results with this data orders of magnitude faster than the industry has in the past.

It seems that this could be scaled up to have many different applications.  How do you see twoXAR transforming the industry? 

In regards to scale, not only can computational platforms look at more data faster than humans without bias, much smaller teams can accomplish more. At twoXAR, we have a handful of people in a garage and we can essentially do the work of many wet lab teams spanning multiple disease states. Investors, researchers, and patient advocacy groups are very interested in what we are doing because they see the disruptive potential of our technology and how it will augment the discovery of new life-saving treatments for our families and will completely recast the drug R&D space. One of the things I learned at MIT from professors Brynjolfsson and Little is that the increasingly exponential growth of technological progress often takes us by surprise. I predict that tectonic shifts in the drug industry will be coming much quicker than many folks expect.

To learn more about twoXAR, visit their website and blog.

This article was originally published on MedTech Boston.

A Peek Inside the Harvard Forum on Health Care Innovation

Prof. John Quelch discussing the Bloodbuy case study.

The Harvard Forum on Health Care Innovation, a joint collaboration between Harvard Business School and Harvard Medical School, was recently held in Cambridge, Mass, on April 15-16, 2015. This private, invitation-only event assembled an elite group that included HBS and HMS alumni and faculty, as well as other key opinion leaders in healthcare. Cara Sterling, Director of HBS’s Health Care Initiative, who organized the event, shared that the goal for the event was to provide an opportunity for “people from different sectors to come together and talk freely” in order to “spur innovation in healthcare.”

One key aspect of the event was the introduction of the finalists of the HBS-HMS Health Acceleration Challenge, a contest that was launched to seek innovative, early-stage healthcare ventures that have great potential for transforming healthcare.

Out of a total of 478 applicants, 18 were selected as semi-finalists; from those, four of the brightest were chosen as finalists to share a $150,000 Cox Prize. They’ve also had an HBS case study written about them, and each team presented and received feedback at this year’s Forum. The final winner will be decided in a year’s time, by identifying the startup venture that is most successful in disseminating and scaling their healthcare solution.

Look out for the great work of these four finalists in the coming year:

  • Bloodbuy is a startup that aims to improve the efficiency and price transparency of the blood supply market by matching blood centers and hospitals through an online, cloud-based platform. In a pilot program, this system was found to decrease hospital costs by 23% while also decreasing the risk of blood shortages and the waste of blood products.
  • The I-Pass Patient Handoff Program is a training curriculum developed by six clinicians to improve the exchange of patient information between providers that occurs at the change of a shift. A research study of this intervention, published in the New England Journal of Medicine, found that use of I-Pass led to an impressive 30% reduction in medical errors.
  • Medalogix is a predictive analytics company that has created a product to that can assist those in the post-acute care sector to better identify hospice-eligible patients. Through working with Medalogix, clients have been able to successfully increase transfers to hospice from home health care and decrease the number of live discharges from hospice.
  • Twine Health is a startup that has created a cloud-based, collaborative care platform of the same name that enables providers to partner with their patients through coaches to provide seamless care and support for the management of chronic disease. In a recent clinical trial, Twine more efficiently helped patients achieve blood pressure control, which resulted in cost-savings (versus the traditional model of care).

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In addition to the Health Acceleration Challenge finalists, there was also an impressive line-up of healthcare experts that shared their thoughts throughout the two days in keynotes and panel discussions. Below are some of the highlights:

Value in Healthcare

Speaker Peter Orszag, Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup, discussed three major structural forces that he feels will have a major affect on healthcare quality and spending, including the shift to value based payments, digitization of healthcare, and the increased role of the consumer in healthcare spending. He also discussed three big unknowns and their future impact on the heathcare cost curve, namely: future policy changes, increasing consolidation of the healthcare market, and emerging healthcare innovation.

A Blueprint for the Future

Mark Bertolini, Chairman and CEO of Aetna, gave a keynote speech entitled “A Blueprint for a 21st Century Health Care System” in which he highlighted five key measures that hold promise to improve healthcare:

  • System re-design that enables lower cost, higher quality care with increased access
  • Sophisticated health IT systems
  • Care optimization, especially to coordinate care for the 5 percent for whom most healthcare dollars are spent
  • Aligning economic incentives with healthcare goals
  • Increasing patient engagement.

Employers as Innovators

In an engaging panel discussion, moderator Bryan Roberts, Partner at Venrock, discussed the growing role of “employers as innovators” with expert panel members Ellen Exum, Director of Benefits/Global Design and Strategy at IBM; Adam Jackson, CEO and Cofounder of Doctor on Demand; Brian Marcotte, CEO and President of the National Business Group on Health; and Derek Newell, CEO of Jiff.

There was a robust discussion regarding the use of wearables and other tools as part of wellness programs to increase engagement and compliance, and to hopefully improve outcomes. One example was Adam Jackson’s Doctor on Demand which, for $40 per telehealth visit, has been found to decrease costs, decrease absenteeism, and increase productivity and morale.

Focus on Neurologic Disease

In a discussion with William Sahlman, Professor of Business Administration at HBS, Deborah Dunsire, MD, President and CEO of FORUM Pharmaceuticals shared her company’s mission of tackling neurological disease. Costs to society due to neurologic disease are great, she argued, not just in terms of direct costs, but also indirect costs – and there should be increased focus in developing treatments for these disorders. One significant challenge is the lack of mental health advocacy, which is an obstacle to obtaining funding for research.

The “Retail-ization” of Healthcare

Speaker Helena Foulkes, President of CVS/Pharmacy and Executive VP of CVS Health, shared the key factors that she feels are driving the “retail-ization” of healthcare:

  • Excessive spending on chronic disease
  • Increasing number of baby boomers on Medicare
  • Rising use of the internet to research health information online
  • Growing numbers of employers with high deductible plans.

She also shared the initiatives that CVS has begun to help tackle these problems, which include drug adherence programs, a focus on patients with the greatest needs, and integrating digital tools.

Dr. Watson Will See You Now

Speaker Mark Megerian, Senior Tech Staff Member at IBM Watson Solutions, shared the exciting (and for some, frightening) prospect of using machine learning and predictive analytics to make clinical recommendations via IBM’s Watson program.

Trained at Memorial Sloan Kettering (MSK), Watson has been shown to be capable of making recommendations similar to MSK oncologists, with 97 percent accuracy, for breast, colon, rectal, and lung cancers. They are now scaling to include other types of cancers and also to involve other organizations.

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Closing remarks were given by Dr. Jeffrey Flier, Dean of HMS, who shared that he feels healthcare delivery innovation has been sorely lacking, and that HMS and HBS are now deeply committed to medicine and entrepreneurship. Harvard hopes to lead healthcare innovation in the future. From the look of this year’s very promising Health Acceleration Challenge finalists, it seems his wish is likely to come true.

This article was originally published on MedTechBoston.com.

What’s Hot in Boston Biotech

Xconomy

Popular business and technology news site Xconomy held its eighth annual life sciences forum on April 8, 2015 at the Broad Institute in Cambridge, Mass. This year’s theme was “What’s Hot in Boston Biotech” and drew a who’s who of industry leaders, scientists, and entrepreneurs. The sold-out event packed the 250-seat auditorium of the Broad Institute and drew a dynamic crowd from all segments of the life sciences industry.

So, the burning question… what is hot in Boston biotech?

New Treatments for Neurodegenerative Diseases

Adam Koppel, Senior VP and Chief Strategy Officer at Biogen, discussed exciting new treatments that are in the pipeline for some of the most challenging neurodegenerative disorders. Highly anticipated medications include aducanumab for Alzheimer’s disease, anti-LINGO for multiple sclerosis, and ISIS-SMN for spinal muscular atrophy. Aducanumab has gotten a lot of attention in the news recently as a result of the positive results of a clinical trial showing a dose and time-dependent reduction in amyloid plaque.

Another company working on therapies for Alzheimer’s (and other neurodegenerative diseases such as Parkinson’s and ALS) is Yumanity. Tony Coles, CEO, and Susan Lindquist, Scientific Founder, discussed Yumanity’s use of yeast as a neuronal model that could tackle the protein folding problems at the root of many neurodegenerative diseases.

Exciting Frontiers in Synthetic Biology

James Collins, Professor of Medical Engineering and Science at MIT, and Amir Nashat, Managing Partner at Polaris Partners, discussed new opportunities in synthetic biology. Notable innovations include the development of therapeutics and diagnostics that can be affordably embedded in paper, cloth, or made into pellet form, as well as the synthetic engineering of microbes to fight diseases. The speakers also discussed the importance of ethical considerations and the need for safeguards as this area of science advances.

Immuno-Based Cancer Therapies

Chuck Wilson, CEO and President of Unum Therapeutics, and Ben Auspitz, Partner at Fidelity Biosciences, discussed a bold new avenue for cancer treatment that involves re-engineering a patient’s own T-cells with antibodies that respond specifically to their cancers. Currently, the therapy has been successfully used in the treatment of acute lymphoblastic leukemia, but it holds great potential in treating other cancers – and also for possibly developing a cancer vaccine.

Harnessing the Microbiome 

Another exciting area of research in biotech is in the development of therapies that aim to modulate the microbiome to treat disease. Bernat Olle, Principal of PureTech Ventures, and Marian Nakada, VP of Venture Investments at JNJ Innovation, spoke about a joint venture – Vedanta Biosciences – focusing on microbiome treatments for autoimmune and inflammatory diseases.

The Future of Genetic Therapy

In a fantastic panel on the potential and pitfalls of gene therapy, led by moderator Michelle Dipp, Co-founder and CEO of Ovascience, panel members discussed the fact that gene therapy is still in its nascency. Many underestimate the time that it will take to develop effective therapies. Panel members included: Steven Paul, President and CEO of Voyager Therapeutics; Olivier Danos, SVP of Gene Therapy at Biogen; and Peter Kolchinsky, Managing Member and Portfolio Manager at RA Capital Management. Other challenges are in developing better gene vectors and anticipating how the broad adoption of genetic carrier testing in the future may affect the development of gene therapies.

The Potential of Precision Medicine

Samantha Singer, COO of the Broad Institute, moderated an interesting panel on precision medicine, with speakers David Altschuler, Executive VP of Global Research and CSO of Vertex Pharmaceuticals, and Alexis Borisy, Chairman of Foundation Medicine and Partner at Third Rock Ventures. Altschuler said that the advantage of precision medicine is that it will enable companies to target therapies more specifically and to “fail less often.” Efficiency, pace, and the success of drug development are likely to be enhanced as a result of better knowledge of the genetic basis of disease.

Scalability Challenges

Noubar Afeyan, Managing Partner and CEO of Flagship Venture, gave an entertaining talk about the challenges and opportunities of the biotech industry in Boston and Cambridge. He shared that he felt this was an unprecedented environment for biotech, in large part due to the co-existence and collaboration of large biotechs and pharmas along with smaller, entrepreneurial companies that engaged in more radical innovation.

He went on to discuss that he felt that scalability was the biggest challenge for Boston biotechs, in terms of resources, people, the process, and other externalities (such as space, the regulatory environment, and the development of partnerships). This is where much of the focus should be in the industry in order to encourage further growth.

This story was originally published at MedTechBoston.com.