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.

The Billionaire Doctor Who Plans to Cure Cancer

Dr_Patrick_Soon-Shiong_(14212355607)
Dr. Patrick Soon-Shiong (courtesy Wikimedia Commons)

Recently, I had the opportunity to speak to billionaire surgeon-inventor Dr. Patrick Soon-Shiong about his plans, both private and through the Cancer Moonshot 2020, to cure cancer.

Soon-Shiong, who made his fortune by founding and selling two pharmaceutical companies, has gathered a group of pharmaceutical companies, academic institutions, and insurers to spur cancer research and to attempt to make breakthrough gains by the year 2020. This effort dovetails with the Obama administration’s $1B plan to fund cancer research led by Vice President Joe Biden, whose son, Beau, recently died after a long struggle with brain cancer.

Soon-Shiong’s path to cancer research began while doing research for NASA that involved harnessing stem cells to make insulin. He stumbled upon a paper that reported that the binding of zinc to the blood protein albumin is what transposes it into pancreatic islet cells, enabling the production of insulin.  This discovery led to an “aha” moment.   “A light bulb went on. In fact you should feed the tumor, not stop the tumor.  And if you could take a nanoparticle of albumin and attach Taxol [a common cancer drug] at the core, then it [the tumor] would take up the albumin and kill itself, like rat poison.”  This revelation led to his creation of the cancer drug Abraxane, or albumin-bound paclitaxel (Taxol).  Abraxane is used currently in a wide variety of cancers, including breast, lung and pancreatic cancer. “To this day, oncologists don’t understand the mechanism of action of Abraxane,” he said,  “They think of it as another form of Taxol.”  According to Soon-Shiong, Abraxane works so well is because the binding to the blood protein albumin allows it to penetrate cancer tissues better.

Abraxane has had huge clinical and commercial success, but he says the path to getting there wasn’t easy.  Initially, after developing Abraxane, he approached large pharmaceutical companies but was unable to gain support despite showing that it had remarkable results in animal models.  He was forced to make the painful decision to leave a secure academic career to risk launching his own company.  His risk paid off.  He ultimately founded both APP Pharma and Abraxis BioScience to support his work.  In the end, APP Pharma was sold to Fresenius SE for $4.6B and Abraxis BioScience was sold to Celgene for $4.5B.  Then, in 2011, he founded NantWorks, a holding company with a portfolio of firms to pursue his diverse entrepreneurial interests.  One of these is NantHealth, a company that has developed a fully integrated digital health platform to collect and analyze genomics and proteomics data on cancer research patients.

Soon-Shiong, a bit of an heretic in the world of oncology, has ideas that veer from the traditional approach to cancer treatment.  One example is how he wants to harness patients’ natural immune abilities to treat their cancers.  “As we sit here speaking, we are creating 10,000 cancer cells a day.  And the natural killer cells in your body are monitoring it and killing it,” he said, “Cancer is a normal evolutionary process.  And guess how we’re trained as oncologists?  To give you the maximal tolerated dose of drugs to kill those natural killer cells that are protecting you, which makes no sense.  This is the dogma in oncology and even in drug development.”

He’d like to see drugs given at lower doses to cause what he calls “cytostress” instead of “cytotoxicity”.  The natural killer cells of our bodies look for cells that are under stress (by detecting distinct proteins and enzymes that are released) and then destroy those cells.  He suggests that chemotherapy should be administered at what he calls the “lowest effective dose” instead of the much higher “maximal therapeutic dose” typically given in clinical trials for cancer.  The lowest effective dose, he argues, won’t completely wipe out patients’ immune systems, and thereby allow patients’ natural killer cells to target “cytostressed” cancer cells.  He argues that this approach will revolutionize cancer treatment and lead to more cures and cites numerous personal anecdotes when this approach has worked for his patients.

Unfortunately, for the time being, he’s had a difficult time convincing oncologists and drug companies to move away from what he calls the “schizophrenic dichotomy” of treating with the maximal therapeutic dose that destroys natural immune function.

Another challenge to finding a cure for cancer, according to Soon-Shiong, is developing health IT systems to support cancer research.  “Cancer is really a rare disease,” he said, “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer.  So you actually need to create a collaborative overarching global connected system.”  He continued, “The problem is now you have the other obstacle to the advance of medicine and the cure of cancer…it is going to be bombastic, dogmatic IT.”  In order to solve this problem, Soon-Shiong is collaborating with other health IT experts in the Commonwell Alliance to facilitate the development of the digital architecture needed to support the interoperability of electronic medical records.

His critics question the sheer breadth of the projects he’s begun under his NantWorks empire, but Soon-Shiong seems too consumed with making his ideas a reality to worry about critics.  At a time when one might expect him to retire, he seems to be only just beginning. “At this point in my career, it’s just:  let’s show that there are patients that are alive.  Let’s show we’ve created less suffering in cancer patients and then expand it globally.”

Featured Startup: Blondin Bioscience

blondinCancer treatment is a frustrating waiting game at the present time.  Patients with solid tumors often undergo brutal chemotherapy cycles for weeks to months before they can get an idea (through radiologic examination) of whether their therapy has been working to shrink their tumor.  At times, the studies show the therapy is working , but at other times, the studies may show that in fact, treatment may be failing, allowing the cancer to grow.  This delay in diagnosis in cancer treatment is what the life sciences startup Blondin Bioscience hopes to correct.

Blondin Bioscience is a company that is currently developing a point-of-care molecular diagnostic assay which they hope will disrupt the traditional current model of care for cancer patients.  Their test, which is called FACT (fluorescent analysis of cell-free telomeres), has the ability to detect a nucleic acid biomarker (telomeres) in the blood that is released from dying cancer cells.  Blondin Bioscience proposes that this test can be used as an adjunct to cancer treatment, allowing oncologists to monitor the effectiveness of chemotherapy treatment in real-time–days, not weeks or months–and thereby, be able to quickly direct treatments and improve outcomes for patients.  Additional benefits are the cheaper cost versus radiologic studies and cost savings from potentially avoiding ineffective treatments, as well as easier access, as this test could be made available in doctors’ offices versus having to make patients travel to centralized, larger hospitals and centers in order to have radiologic studies.  Patients would also know sooner whether their treatment is working, thereby decreasing the emotional toll of cancer treatment.

Blondin Bioscience is based in Birmingham, Alabama, and is lead by Chief Executive Officer Brad Spencer, and founders Dr. Katri Selander and Dr. Kevin Harris, who are both Assistant Professors of Medicine at the University of Alabama at Birmingham (UAB) and are members of the UAB Comprehensive Cancer Center.  Their leadership team also includes Director of Research Dr. Kate Hayden and Director of Operations Kathleen Hamrick.

Thus far, Blondin Bio has raised $750,000 from an NIH SBIR grant and has been studying their testing method in a clinical trial for prostate cancer, but hopes to scale in order to test other cancer types.

For more information, please visit their website here:  Blondin Bioscience.

 

It’s Time For ‘Gender Lens Investing’ in Healthcare

gender

Today I had the opportunity to speak very briefly at a White House-sponsored roundtable called the “Impact of Gender/Sex on Innovation and Novel Technologies (iGIANT)” in Cambridge, MA.  Other partners for this event were the American Medical Women’s Association, Boston Scientific, and Medstro.  This is what I shared.

What I’ve found while working in the digital health space is that there is a significant lack of women in the healthcare investment industry. Though women make 80% of healthcare decisions in families, and despite women making up 78% of the healthcare workforce, we are sorely underrepresented among investment and corporate leadership. In the digital health space, only 6% of CEOs of startups are women. That, I believe, reflects the fact that only 6% of venture capitalists are women. While we don’t like to admit it, money is power. And if women don’t have access to the purse strings that fund innovations, then of course, innovations that concern women and that can impact women’s health are going to be underfunded and underrepresented.

What I’d like to see is more healthcare and academic institutions, in the public and private sectors, committing to what’s called “gender lens investing”, making it a criteria to invest with gender equity in mind. This may mean making an effort to engage with only those investment and venture capital firms that commit to diversity, have adequate female representation, and make a commitment to try to invest in projects that interest and can benefit women.

I believe that more diverse teams will translate to improved health innovations that can benefit more diverse groups of people. Diverse investors lead to diverse founders and companies; diverse companies lead to diverse innovations; diverse innovations are what serve diverse stakeholders.  And that is what will ultimately lead to equity, not just in terms of gender equity, but also racial/ethnic equity.

This cultural change could be facilitated through a policy recommendation, perhaps through a white paper study or policy brief on the matter, and also by all of us here urging individuals and organizations at every level to invest their funds more conscientiously and in a mission-driven manner with gender equity in mind.  Thank you.

Ref:

  1. “The State of Women in Healthcare”, Rock Health, March 2015
  2. “Venture Capital’s Next Venture? Women”, Tech Crunch, June 2015
  3. “Investing for Positive Impact on Women”, Croatan Institute, Nov 2015

 

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

google-ventures-story

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.

 

 

Cool Startup: RubiconMD

RubiconMD team sitting 2

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: twoXAR

Andrew Radin x 2
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).

***

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.

***

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.

Cool Startup: Bloom Technologies

bloom tech sensor
checking for contractions with the Bloom sensor

It’s hard to read Peter Thiel’s Zero to One book and not start thinking in an entrepreneurial way.  Afterwards, I thought about where we have gaps in healthcare.  There is a lot of technology out there (apps, wearables) right now that has empowered patients to take charge of their own health.  One area that seems to be lacking is in women’s health.

There are a number of critical challenges in women’s health right now that could benefit from innovation.

First is the growing problem of access to women’s health providers, particularly Ob/Gyn’s, which will only increase in the years to come.  Demand remains constant, while supply is dwindling, because of factors such as an aging workforce and its low appeal to medical students related to demanding work hours and professional liability.  The Association of American Medical Colleges anticipates a shortage of 159,300 Ob/Gyn’s by the year 2025.

Second is the persistent scourge of preterm birth.  According to the CDC, preterm birth affects 1 in 9 of pregnancies and is the number one cause of infant death and long-term neurologic disability in the U.S.  It has been estimated that preterm birth costs our healthcare system more than $26 billion a year, though the societal costs are likely much greater.

Thinking about these two major problems made me wonder if anyone out there is working on technology that could positively impact either of these problems.  That’s how I stumbled across and connected with Bloom Technologies, a healthcare tech startup based out of San Francisco.  Bloom is currently developing a wearable contraction monitor that could help pregnant women determine first, if they are having contractions, and second, if those contractions are of the true, labor-inducing variety, or the false, Braxton-Hicks, variety.

Obviously, this product could have a great deal of potential.  It’s almost a right-of-passage in pregnancy for women to make frequent visits to the hospital only to be sent home, after being told that it’s not “real labor” yet.  Might this wearable device be able to tell patients when it’s the real deal?  And are there patients that would be interested in such a thing?  Molly Dickens, the head of Content and Consumer Experience at Bloom, feels that women are often confused and overwhelmed by all the rapid changes of pregnancy and anything that could help them to better understand what’s going may be welcome.

I think the Bloom sensor has even greater potential beyond just the obvious.  In light of our impending Ob/Gyn shortage, might we be able to use this device to remotely monitor patients in the future?  Could this be integrated into a telehealth approach for obstetrical care in the future?  Remote visits could obviously help to decrease over-utilization and costs of healthcare.  Also, in light of our epidemic of preterm birth, might this help us to detect preterm labor earlier, and therefore intervene in a more timely manner?  I would love to see this device studied in clinical trials.

The other thing that I find exciting about this product is that Bloom is developing this device to be of clinical-grade quality, one that could potentially rival current inpatient systems for contraction monitoring.  Currently, in Ob/Gyn, we use tocodynamometers, which measure pressure changes in the abdomen to get information about contractions.  Toco’s (as they’re called) are accurate as far as determining the timing of contractions, but pretty dismal at telling the strength of uterine contractions.  Bloom CEO, Eric Dy, shares that he and his colleagues are working at the circuit level on the signal, size, quality, and power of these devices to assure an exceptional product that–unlike traditional tocodynamometers–will measure electrical signals much like cardiac monitoring (the uterus, after all, is a muscle, too).  If these devices are better than the traditional toco’s used at every hospital across the country, we might see a real transformation of inpatient obstetrics as well.

I, for one, would also love the convenience of being able to just check my phone to see what’s going on with my patient & her baby, instead of having to solely rely on a single, static inpatient site to evaluate them.

In addition to contraction monitoring, Bloom is also working on other technologies that will help women to gain valuable information about their health from conception to the postpartum period, which they hope will ultimately help to drive better outcomes.

If you’d like to learn more about Bloom, check out their links below:

Website 

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