E-health Day – Internet of Me: Vision and Challenges

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I had the opportunity to attend the e-health day in Sierre (TechnoArk) on June 3rd 2016. The event was well organized around big players (Boston Scientific, Roche), showing their vision of the technology and its implementation in their own business model, and startups (L.I.F.E. Corporation, Karmagenes) unveiling their innovations in the field. Moreover, other stakeholders like the health insurance Groupe Mutuel and government-financed agency CIPRET presented their real-world experiences. The event was closed by a panel discussion on the relationships between eDoctors and ePatients.

Globally, the vision of health is: health care providers will be able to improve health outcomes by working with digital patients (the data collected by sensors will be integrated and analyze to provide personalized treatments and consequently better outcomes). Several projects are developed: prosthesis control, diabetes management, vital signs monitoring for elderly people…

Below I summarize the key takeaways from the most interesting talks (not all of them).

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BOSTON SCIENTIFIC – MEDTECH : WHICH BUSINESS MODEL FOR THE E-PATIENT ?
By Frédéric Briguet, EU Digital Health Engagement

  • The goal of the presentation was to provide clues on which business model is the most appropriate for digital health companies.
  • Medical technology companies create and develop products for patients but they really have to be aware of their ecosystem and the influences that will drive patients’ behavior.
    Body sensors brought revolutionary tools to life. They are wireless, responsive, use mobile devices and allow data analysis to be performed. However, what is the real impact on health and disease management? Many companies have sensors supported by solid hardware, cloud data collection and a dashboard for mobile phone.
  • Despite the evolution of technology, we are still lacking clinical studies and proofs. In addition, the user dropout rate is pretty high (after 6 to 8 months, users abandon the sensor(s) and the app). Needless to say that, on top of all the previous disadvantages, the amount of data generated is extremely heavy and it is difficult to extract the most relevant indicators to analyze them.
    However, the first digital health products helped open new perspectives and the potential of connections between all the stakeholders. Empowering and engaging healthcare providers is also one of the key benefits of the first digital health initiatives. Beyond those elements, what’s crucial to ensure adoption and reimbursement is to demonstrate the cost savings the technology could bring to the current health care settings. Doctors also have to support it and be convinced of the use and utility for their own patients.
  • All in all, the future of healthcare is expected to improve outcomes, reduce hospital readmission rate and control costs while maintaining care access.
  • The experience of the speaker allowed him to say which business models where the most appropriate to survive and thrive in that new field. He established 4 directions (that can be combined):
    1. The patient is not a consumer. Generally speaking, he is not really willing to know that he’s ill. His main focus is to live. Family and friends are the most concerned about the patient’s health and wellbeing. Creating and developing tools that could ease the burden for the supportive people around the patient is generally well received and adopted.
    2. Understand the business ecosystem. Knowing where to position the company is fundamental to avoid being stuck in a no man’s land. Focusing on lifestyle, coaching or care pathways is different and requirements increase massively for the care pathway segment.
    3. The population is ageing and increasing. The health care system will have to support an additional financial burden with the passing of the years because we know that the majority of the costs is generated toward the end of life. Hospitals are paid today according to their own efficiency (shorter hospital stays as well as improved outcomes will generate higher payments from heath insurances). It is the OPM principle (Other People Money) meaning that the patient (who consumes) is not the payer. It is then crucial to find new solutions to reduce the costs.
    4. Understanding the disease is more than fundamental. Compliance and adherence management and control in order to avoid hospital readmissions is one of the main issues of the whole healthcare system. Beyond that point, enhancing and improving the patient’s experience as well as the quality of care could well trigger new motivations for the patient to be compliant to his treatment.
  • Go beyond sensors-mobile-cloud-dashbord to include blockchain technology, augmented reality, internet of things… + any relevant technology or innovation that can bring value to the system. This value has to be demonstrated and proved as viable for the whole system.
  • The technology has to be integrated in the patient’s experience, nearly invisible, but not less complex.

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PATIENTS LIKE ME – THE POWER OF WE
By Chris Fidyk, Business Development Director Europe

  • Accelerating research and development of new treatment but also allowing patients to support each other and exchange life experience with a disease is the main goal of PatientsLikeMe. That network is maybe the smallest social network but the larger medical registry with more than 500’000 patients. Patientslikeme provides tools for patients to put their disease into context.
  • Today, there is a lot of momentum about patient centricity. It becomes more mainstream. Patients owe other patients their own experience (drugs, symptoms,…). Empowering people to express themselves about their journey in the disease. Then, when all the stories are aggregated, meanings and trends can be extracted.
  • It is also possible to see all people taking the same drug, its perceived effectiveness as well as some conversation analytics allowing to understand which symptoms are the most talked about, the treatment awareness, the barriers to access in addition to the reasons behind their treatment failure or cessation or continuation.
  • Data (experience and discussions) stay online and available even when the patient dies to enrich other patients’ lives. Regular video postings on Patientslikeme Youtube channel show patients sharing their own experience with the website and how it helps them cope with their disease.

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ROCHE DIABETES CARE – EHEALTH: THE FUTURE WE CREATE TODAY
By Horst Merkle, Diabetes Management Solutions Director

  • You can only do something with data when you can access to it.
  • Infrastructure is the foundation for innovation and creativity” – as quoted by a speaker at the Connected Health Conference.
  • How to meet the future? The lack of healthcare staff, the increase in chronic diseases and the rising healthcare costs are the challenges. How to manage them: accountability and empowerment for the patient and the consumer. Mastering your own health with less health and care services.
  • Today, technology-driven health is messy. The solutions have to be easy to use and secure for the patient.
  • The Personal Connected Health Alliance (PCHA) is at the forefront of health and wellness in today’s society, driving advancements in mobile and communications technologies, and the growing use of new devices, health trackers and apps by consumers and healthcare providers.
  • PCHA brings together the critical elements needed to ensure that these technologies are user-friendly, secure and can easily collect, display and relay personal health data. In PCHA’s vision for healthcare, consumers can use readily available technologies to access their personal health data, receive targeted health and wellness education, consult with healthcare providers and gain support from friends and family to improve their health.
  • PCHA focused on engaging consumers with their health via personalized health solutions designed for user-friendly connectivity (interoperability) that meet their lifestyle needs.
  • Business models are the main obstacles for interoperability to work.
  • Accu-Check Connect System from Roche provides an integrated meter, an app, and online tools for better diabetes management. The glucometer can share data in the cloud with the healthcare provider.

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WITHINGS – FROM QUANTIFIED SELF TO PREVENTIVE MEDICINE
By Alexis Normand, Health Development Director

  • The main goal of Withings is to sell connected products to the general public. Those products can be bought in supermarkets and will help the consumer monitor vital signs such as weight, blood pressure,… Without being a doctor, the consumer can create a dashboard for his health. Changes in health are driven by him and, due to the fact that he generates data, he will be at the center of the data collection and analysis.
  • Those tools could also be used to enhance corporate wellness and engage employees through gamification. Employers will offer a connected bracelet and will organize a competition. Employers are however inherently screening employees for health issues and can analyze aggregated data to discover trends. Data around workout and physical activity are enriched by environmental and lifestyle inputs but also by stress management and absenteeism information.
  • In the e-health field, we are in the prevention area and also on new territories like personal health dashboard and employer focus on employees’ health.
  • E-health could be widely applied together with EHRs (Electronic Health Records). Linking EHRs to outcomes allow hospitals to monitor their performance to get more money from payers as they will limit the expenses for the system as a whole.
  • Withings also builds an open health data platform with the implementation of national observatories aggregating data from all the users. Those platforms will support research on connected devices with scientific publication and could stimulate partnerships and collaborations with other data sources.

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GROUPE MUTUEL – IGNILIFE – DAILY HEALTH COACH
By Stéphane Andematten, Marketing Leader

  • Real world business case from concept to realization in partnership with the startup Ignilife.
  • Today more than 165’000 health apps are available with 40% dedicated to medical uses and 60% to wellness.
    Regarding Switzerland, few initiatives have been developed to date. Groupe Mutuel would like to be the forerunner and not a follower in the field.
  • Ignilife is a French startup with a subsidiary in Switzerland. It is the perfect combination of entrepreneurship, medical skills and user experience. Ignilife has a previous experience with Malakoff Médéric, the leader for private health insurance in France.
  • Ignilife is a e-coaching platform based on people. It covers physical and emotional wellbeing. A first auto-evaluation is performed by the user in order to have a broad overview. An assessment is then released by the system with risk factors and advices to manage and lower their impact. Support and follow-up is provided as a selection of programs the user can choose from. He can also connect his devices.
    Close to 300 video and audio plays are available. Each time a contest or challenge is won, it is input in the platform to show the progress and evolution.
  • It is essential to develop a rich, engaging and fun platform to keep the user motivated. The goals set are reasonable and not out of reach. There is a social media component where users can exchange experience and tips. More functionalities will be developed in the next future (health at work, back health, burnout prevention,…)
    Data protection is well managed, as all the data are stored in Switzerland on independent servers.
  • Groupe Mutuel pretends it does not use data collected by user but only on an aggregated basis. The rationale behind the implementation of such a project is the focus on prevention. It will help to keep health expenses at an acceptable level in the longer term.
  • Some stats:
    25’000 Ignilife users (out of more than 1’100’000 insured people)
    Mobile users connect much more than desktop users (2x)
    91% did their auto-evaluation
    61% engaged in a coaching program
    47% changed their habits

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MANAGE MY DATA OR BE MANAGED BY MY DATA
By Stéphane Koch, Expert in Digital Experience

  • People like to measure their own weight, the calories they burnt, their heart rate,…
    There is a real value added in using quantified self.
    However, coherence is not always part of the measures and can distort statistics extracted out of the data. Sensors sometimes lose connection with the app leaving gaps or errors in measures. Improving apps with coherence system would be a big step further or even allowing the user to correct the data himself.
  • Quantified self generally has a positive impact on the user’s wellbeing but it can also generate stress if the progress takes time to emerge or if it stops. Knowing the scope of the technology as well as his body are fundamental.
  • The website DMD (in French) allows the evaluation of digital tools and the sharing of everyone’s user experience.

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CIPRET – 7000 SWISS PEOPLE STOPPED SMOKING THANK TO A FACEBOOK PROGRAM
By Alexandre Dubuis, PhD, CIPRET Valais leader

  • CIPRET is a center for the prevention of tobacco use, recognized of public interest by authorities.
    It launched early 2016 a program to help people stop smoking via Facebook.
  • A real human adventure started and succeeded. The initiative was in 2 phases: recruitment and program on the same platform. It was completely free for the users. They just had to like the page, say they are interested and accept that all the posts written by CIPRET were the first they saw when they opened their Facebook app.
  • 3 pillars of the program:
    – Daily advices (personalized and not always linked to tobacco consumption)
    – Group support (tips and experience sharing)
    – Physical desire to smoke (will only last between 3 and 5 minutes => tips given to avoid relapse).
  • Professional support has been organized at 3 levels : the first one, community managers answer simple questions ; the second one, prevention experts take specific questions ; the third level, medical practioners take care of medical questions.
  • Some stats:
    1’500 posts created
    Support was on call during the whole week from 6am to 11pm
    13’000 messages have been answered in the first weeks
  • Key strengths: no moral scolding, always up-to-date, focus on workouts, nutrition, Sunday evening chats, real meeting groups.

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L.I.F.E – EXPRESS YOUR TRUTH THROUGH YOUR ACCURATE DATA
By Dario Ossola, PhD, Algorithm R&D Coordinator

  • L.I.F.E stands for Live – Inspire – Free – Entertain
  • The project started at the core of The Ark and focused on predictive models for tiredness, exhaustion and strain with the development of a garment.
    That garment is equipped with sensors to monitor vital signs (it is medically accurate and there is no need of a smartphone). It allows total freedom.
    It can be the third platform of communication (with the first 2 being computers and smartphones).
  • The medical accuracy is fundamental and it can be used in medical practice but also in sports. That garment has the same results as the invasive methods to analyze vital signs. It allows real life measurements and expansive communication (data omnipresence, diverse data analysis levels).
  • Two web sites: http://x10x.com/ (for women) and http://x10y.com/ (for men)

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ISYPEM2 – PERSONALIZATION OF TREATMENT DOAGE THANK TO MEDICAL DATABASES
By Séverine Petitprez, Scientific associate, Clinical pharmacology CHUV and Alevtina Dubovitskaya, Research assistant, HES-SO Valais

  • Software for personalized treatment dosage.
    Unique treatment dosage works very well for simple drugs like paracetamol. Unfortunately, for oncology or chronic diseases drugs, which are much more complex molecules, it doesn’t work as well. It can lead to toxicity, side effects or no effect at all.
  • Therapeutic follow-up normally starts with a blood sample, pharmacology experts interact and guide the doctor in order to personalize the treatment.
  • A new software (EzeCHieL) do exactly the same but in a much faster and more practical way. The software can create the patient’s drug metabolism curve based on the EHR (Electronic Health Record) and medical databases. Some genetic characteristics or co-morbidities can lead to changes in drug blood concentration.
  • Interoperability (web interface) as well as confidentiality and data security are guaranteed (pseudonymisation, anonymisation).

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KARMAGENES – BE A GAME CHANGER MEET YOURSELF
By Kyriakos Kokkoris, CEO

  • Karmagenes is a game combining gene profiling and psychological analysis. Integrating genetics with psychology for improved personal development.
  • What defines who you are: what you are (DNA) and where you live (environment & perception).
  • Genetics meet psychology.
  • Human centric approach
  • Could be a network of personalities and connect locally.
  • Personal guide for career development, personal motivation, and physical as well as emotional well-being.

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PANEL DISCUSSION – E-DOCTORS AND E-PATIENTS, AN EMERGING RELATIONSHIP
Moderated by Sébastien Mabillard, Swiss Digital Health coordinator with 5 paticipants: Dr. Jean-Gabriel Jeannot; Dr. Pietro Scalfaro; Pierre-Mikael Legris; Christine Bienvenu; David-Zacharie Issom.

  • The market is not yet mature, a lot of opportunities are waiting to be seized.
    The patient is at the center of all motivations.
  • Despite new technologies, there is a lot to do to reach the patient. Few success stories (the CIPRET is however an excellent example).
  • What about doctors’ digital education? Patients are really driving the trend today; they stimulate doctors to be up to date and they push technology adoption.
    Patients are very often looking for information online. Doctors should be prepared and help patients to use the right web sites in order to find appropriate and correct information. Doctors should also contribute and provide content on website to populate them with correct information.
  • All that information help to start interesting conversations. Information exchange should also be facilitated. The patient could be educated to provide the appropriate amount of information to avoid overload.
  • Patient should take part and be part of medical research. The patient is the least used resource in health care. With patients’ associations, precious information is stored and exchanged. That data can be analyzed.
  • The social component is extremely important for patients. Several of them like to share their experience and find support online. They also feel useful to provide information for other that have been diagnosed recently.
  • By giving access to medical and health information, communication and interactions with doctors will be easier and improved.

The potential for disruption in healthcare by Apple

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A lot has been said about the role of Apple in healthcare, the disruption it could bring and the need for it. If Steve Jobs was alive today, he would surely help the healthcare industry improve.

There is a lot of work and some progress are currently being made but they are slow to implement because evolution is not always seen as such (we all know about the learning curve…).

Apple is not the only company that could bring change and improvements, even disruption, in healthcare. All the technology companies are interested in this field and they will inevitably contribute to change the landscape.

What could Apple bring?

Analyze and integrate health data

The introduction of HealthKit in June 2014 was the start of a big wave of healthcare initiatives launched by Apple. Data collected via the HealthKit through wearables like the Apple Watch can be shared with the user’s doctor in order to improve the doctor-patient relationship. Data can then be integrated in the EHRs (Electronic Health Records) of the patient in order to enlarge the data collection.

Beyond data collection stands data analysis and it’s done with the help of the partnership with IBM Watson to support this effort.

Improve EHRs and real-time medical data to broaden prevention initiatives

Merging EHR and real-time data could enable the use of predictive analytics to anticipate health issues and diseases spread.

The implementation of EHRs could simplify and quicken the collection, use and consultation of medical data, especially in the case of emergencies. This could dramatically help to avoid medical errors due to the lack of specific retrospective information.

Partnerships

Apple has been and is still extremely smart in building strategic partnerships. 3 main partners worth keeping in mind:

  • IBM Watson: storage and analysis of raw data on IBM Watson Health Cloud for the data collected on HealthKit and ResearchKit.
  • Mayo Clinic: access to over 1 million patients in several countries around the world using dedicated proprietary EHR and communication tools for doctor-patient interactions.
  • Epic Systems: expertise in EHR covering over 100m people in USA.

HealthKit & ResearchKit

The main goal of the HealthKit is to collect data from wearables and other connected devices to better monitor individual health. HealthKit also allows the integration of 3rd party apps and devices.

ResearchKit is an add-on to the HealthKit as it helps create apps to improve clinical trials and medical studies.

Apple Watch v. 2.0 and new wearables

The new versions of the Apple Watch could potentially be developed into more sophisticated health-tracking devices with improved heart rate monitor. Moreover, thank to non-invasive technologies, new vital signs could to be captured and analyzed more accurately.

 

Related sources:

Why healthcare needs a Steve Jobs-like disruptor, STAT, February 2016.

Three More Industries Apple Could Disrupt, re/code, July 2015.

Steve Jobs didn’t disrupt, he adapted. So should healthcare, Becker’s Hospital Review, July 2014.

The Industries Apple Could Disrupt Next, Harvard Business Review, June 2014.

 

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The opioid pain drug misuse problem solved?

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Today using opioids to treat chronic pain seems quite obvious for a lot of clinicians. This trivialization, beyond the responsibility of both the clinician and the patient, is responsible for the dramatic increase of opioid misuses and overdoses.

An excellent article written by Dr. Daniel Alford in the last issue of NEJM proposed smart solutions. Prescriber education is one of them. It would allow a more specific approach to addressing the opioid-misuse epidemic: benefit-risk assessment of patient’s needs and care individualization. It should be completed with patient close follow-up and monitoring as well as the careful evaluation at each encounter of whether to start, continue, decrease, increase or stop the treatment.

Training should start early in the medical education and students have to be aware of the best practices for that type of prescription. All the options for chronic pain management have to be taught and not only to doctors but to all healthcare providers in order to tackle the lack of awareness and education in the field.

Beyond drugs, other alternatives should be tested and proposed, especially when an opioid-based treatment is stopped. Explanations have to be provided in order to reassure the patient that his/her pain is manageable without this type of drugs.

The whole discussion, and a whole lot of other healthcare themes, are closely linked to the doctor-patient relationship. Trust, collaboration and open discussion are all key in order to have the best outcomes for the patient.

As a conclusion, I would like to invite you to watch the fantastic talk given by Elliot Krane, an expert in chronic pain about how this disease invades the body, what are the treatment options and what’s next.

 

Additional information:

Overdose Death Rates – US National Institute on Drug Abuse

Understanding the Epidemic – US Centers for Disease Control and Prevention

How drug use changes the brain — and makes relapse all too common – STAT – April 2017

The Painkillers That Could End the Opioid Crisis – MIT Technology Review – August 2016

Opioid Prescribing for Chronic Pain — Achieving the Right Balance through Education – NEJM – February 2016

Mortality Trends Among Working-Age Whites: The Untold Story – The Commonwealth Fund – January 2016

Trends in Opioid Analgesic Abuse and Mortality in the United States – NEJM – January 2015

When Pain Kills – AARP – September 2015

Opioid Addiction Facts and Figures – ASAM

Assessment & Management of Chronic Pain – Healthcare Guideline – ICSI – November 2013

 

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Gender-specific medicine is necessary

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What’s gender-specific medicine?

As stated in a well-known article, “Gender-specific medicine is the study of how diseases differ between men and women in terms of prevention, clinical signs, therapeutic approach, prognosis, psychological and social impact. It is a neglected dimension of medicine.” Medical research conducted over the past 40 years has focused almost exclusively on male patients.

How men and women are different?

Differences could lead to wrong diagnosis, symptoms underestimation, and even premature death. Differences appear in a variety of domains such as:

  • PKPD (pharmacokinetics & pharmacodynamics): efficacy and side effects profiles as well as drug-drug interactions.
  • cardiovascular diseases: risk factors for these diseases; clinical manifestations; influence of drugs (see below for more).
  • cancer: incidence; aggressiveness and prognosis.
  • liver diseases: epidemiology and progression.

The main goal

The main goal of gender medicine is focused on understanding the differences of patho-physiology, clinical signs, prevention and treatment of diseases equally represented in men and women.

Advocacy

Advocacy in this field is emerging with amazing women like Marianne Legato, Alyson McGregor and Noel Bairey Merz, whose conference and TED Talks below really show the decisive importance of this discipline.

Conclusion

Traditionally, research has been done almost entirely on men and those conclusions were then applied to both men and women. Even though the law requires that women be included in studies, the gender-different results are almost never analyzed. Instead, they are blended. This is detrimental to both men and women. Perhaps now is the time for everything in research and medicine to be reviewed in the light of potentially significant gender differences.

Additional resources:

The Foundation for Gender-specific Medicine

Why Sex Matters

Women’s Heart Attacks Look Nothing Like Men’s – TIME – 2016

Gender-Specific Medicine in the Genomic Era – Clinical Science – 2015

Sexism In The Doctor’s Office Starts Here – Even actual lab rats are subjected to science’s male bias – HuffPost – 2015

Why Gender-Specific Medicine Matters in the Emergency Department – Emergency Physicians Monthly – 2015

Gender medicine: a task for the third millennium – Clinical Chemistry and Laboratory Medicine – 2013

Men and women get sick in different ways: Developing gender-specific medicine is a major challenge of the future – Science Daily – 2013

Incorporating and evaluating an integrated gender-specific medicine curriculum: a survey study in Dutch GP training – BMC Medical Education – 2009

 

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US drug pricing is on the verge of change

MoneyPills

Drug pricing is always a topic for discussion regardless of the country where you live.

The USA have long been considered as the most expensive country when it comes to drugs. Today, several initiatives are trying to contain their price and limit the explosion of healthcare expenditures. It is not easy and several political leaders failed in front of the powerful lobby supporting the pharmaceutical industry.

Maybe, instead of price cuts, we should think of more nuanced version of price control like value-based pricing or risk-sharing agreements.

An extremely interesting article explore the future opportunity of risk-sharing agreements in the USA. It is widely used in Europe as well as in other countries but shows a slow uptake in the USA. The conclusion of the article is positive as there is room for improvement. “Most manufacturers and payers expressed interest in RSAs and see potential value in their use. Due to numerous barriers associated with outcomes-based agreements, stakeholders were more optimistic about financial-based RSAs. In the US private sector, however, there remains considerable interest—improved data systems and shifting incentives (via health reform and accountable care organizations) may generate more action.”

However, despite hot debate launched by Hillary Clinton recently about drug pricing, the US Congress is still dominated by Republicans, who is completely supporting the pharmaceutical industry. Drug pricing and healthcare coverage will be one of the hottest debate question of the US Presidential Elections this fall.

Some articles are much less optimistic as they show that the bargaining power of private payers is far from sufficient to be able to negotiate discounts.

Drug pricing has to change in the USA because affordability and healthcare coverage will define the sales potential of the product. If the drug is so expensive that no one can afford it and no insurance will pay for it, it has no future sales opportunity. It is key to find a good balance between rewarding innovation and R&D efforts AND allowing patients to access the medicine and care they need.

 

Additional resources:

Private Sector Risk-Sharing Agreements in the United States: Trends, Barriers, and Prospects – American Journal of Managed Care – September 2015

It’s Time to Rein in Exorbitant Pharmaceutical Prices – HBR – September 2015

Why we can’t stop US drug companies from charging astronomical prices – Quartz – September 2015

Drug prices: Which companies may be the next targets? – CNBC – September 2015

Rational Drug Pricing – Huffpost Business – September 2015

Why Are Drug Costs So High in the United States? – Medscape – November 2014

High Cancer Drug Prices in the United States: Reasons and Proposed Solutions – ASCO – July 2014

Higher US Branded Drug Prices And Spending Compared To Other Countries May Stem Partly From Quick Uptake Of New Drugs – Health Affairs – April 2013

Pricing and Reimbursement in U.S. Pharmaceutical Markets – NBER – August 2010

 

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Alphabet (ex-Google) is the next big thing in Life sciences

A lot is currently written about the initiatives launched by Alphabet (Google) in the life sciences field.

I had the wonderful opportunity to have a look at the report written by the internet analyst, John Blackledge, from Cowen and I must say that he’s very smart at showing the huge potential of the life sciences at the core of Alphabet (Google).

This report is amazing as it allows you to have a better understanding of what’s happening now inside Alphabet (Google). I summarized the key points/quotes from the report below and I added other articles at the end of this blog post. Moreover, I will update it frequently as the news come in. This is a fascinating topic, I really hope Alphabet (Google) would be able to replicate the same success it has built with its search engine.

Key quotes & comments from the report:

  • Expansion into health care and related segments allows Google to leverage its core competencies in Internet communications technology, data structuring and analysis, and fundamental process reinvention.

 

  • Specific areas of focus in healthcare include:
    (1) the sequencing the human genome and the rise of precision medicine: despite the monumental significance of mapping the human genome and the implications for drug discovery, this was but one step in a long journey that continues to this day. Moreover, genes are but one factor in disease, and little is known about what role environment and lifestyle play.
    (2) the digitization of health data is exploding, with a virtually endless list of sources that can offer insight into clinical data, drug studies and more. As more data is digitized, there will be a profound impact on how patient care is administered, how therapies are researched, and how drugs are tested. EHRs (Electronic Health Records) are crucial but implementation is very challenging. Harmonization and data aggregation need to find their way. Wearables are another interesting topic in the digitization of health data. Social media and discussion boards as well as patients website are essential parts of the system that must be closely monitored as more and more patients use those communication channels in order to provide feedback and comments on treatments and daily struggles with healthcare providers.
    (3) the shift to value-based care, where payments are based on the value of care, is driving a change in how services are delivered and how much consumers engage in the process. From a provider perspective, doctors are incentivized to manage patients to the best possible health outcome at the lowest cost. From a patient perspective,
    consumers are being empowered to take a more active role in their own health care.
    These health care trends are being accommodated by technology advances in areas such as social, mobile, analytics and cloud computing, all areas of Google expertise.

 

  • Alphabet invests in health in five different ways:
    (1) Google Life Sciences originated in Google[x], a research lab within Google that was funded by the company’s board of directors in January 2010 to pursue “moonshots”—audacious new projects that have a low probability of succeeding, but could be truly revolutionary if they do. The company views moonshots as critical in driving the true innovation required to affect revolutionary change and avoid the “incrementalism” or evolutionary change that tends to lead to corporate irrelevance over time. The Life Sciences team is responsible for such innovations as glucose monitoring smart contact lenses. With an expanding list of intellectual property, Life Sciences has begun to accelerate its collaborative efforts with third parties. The company is aggressively partnering with leading players in the health care space on a growing number of programs.
    (2) Calico’s mission is to harness advanced technologies to increase understanding of the biology that controls lifespan. Calico was originally conceived by Google Ventures President and General Partner, Bill Maris, who observed that most companies seek to find treatments for disease and associated symptoms, but that none address the root cause of disease and death. He wondered if studying the impact of aging on genetic material could lead to the discovery of drugs that could address many age-related diseases and significantly extend the human life span.
    (3) Google Ventures has provided seed, venture and growth stage funding to a host of companies in diverse fields, but its stated focus is machine learning and life science investing.
    (4) Google Capital was formed to invest in later-stage technology companies with a focus on emerging technology leaders and potential disruptors. Unlike the earlier stage companies in Google’s other investment vehicles, the later stage companies in Google Capital tend to be fairly common household names. Although the stated focus of Google Capital is on technology companies, the collision of technology and health care is blurring the lines of what a traditional “technology” company looks like.
    (5) Google Core: Over time, Google has invested in numerous health-related initiatives within its main corporate division. These have tended to be very closely linked to the company’s core businesses, such as Search. Earlier this year, the company announced that it will add health information that has been fact-checked by physicians directly to search results. The company is also talking to the FDA about using search query data to identify adverse drug reactions.

 

  • Google’s Health-Related Focus Areas: regardless of where they are housed within Google’s corporate structure, most of Google’s health-related endeavors share common characteristics.
    (1) Longevity
    (2) Genetics and Chronic Care
    (3) Diagnostics
    (4) Diabetes/Digital Health
    (5) Medical Devices
    (6) Telehealth/Digital Health
    (7) Wearables/Fitness

 

  • Google’s health endeavors fit with the company’s goals of “making the world’s information useful” and helping millions of people. Indeed, Google believes that many of the same principles, techniques and problem solving capabilities employed by its software developers can be applied to the massive inefficiencies that exist in health care to create transformational solutions and medical breakthroughs that help people live longer, healthier lives. Health care ambitions can be summarized as:
    (1) Analyze: Analytics to inform decision-making and provide business insight
    (2) Attract: Attract health care constituents to platforms and solutions that drive engagement
    (3) Aggregate: Aggregate data from disparate sources onto the Internet or GCP

 

Additional resources:

Alphabet to help researchers predict disease – Financial Times – April 2017

Google Life Sciences Exodus – STAT – March 2016

Verily, Google’s Health Gambit, Is Stacked With Scientists. Now It Needs to Build a Business – ReCode – December 2015

Google hires mental health expert to lead new life sciences unit – Financial Times – September 2015 (Subscription required)

Head of Mental Health Institute Leaving for Google Life Sciences – The New York Times – September 2015

Google Bets on Insurance Startup Oscar Health – WSJ – September 2015

Is Health Care Google’s Next Big Business After Search? This Investment Bank Thinks So – Re/Code – September 2015

Why Google Is Going All In On Diabetes – NPR – September 2015

Google’s health startup, AbbVie team up on drug research – Chicago-Sun Times – September 2015

Google Life Sciences Company Has New Deal, Official Nemesis in Diabetes – Re/Code – August 2015

Alphabet Breathes New Life, Resources Into Google’s Health Care Projects – iHealthBeat – August 2015

Google Health – Easy as ABC. Alphabet, Calico and the Aging of Humanity – What on Earth are they doing? – Digital Intervention – August 2015

 

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Using “Tumour-Traps” to Monitor The Spread of Breast Cancer

Excellent & insightful article on how it is now possible to track cancer progression.

Snackable Science

Breast cancer is the most common form of cancer in the UK, with approximately 50,000 British women diagnosed with the disease every year. Despite this high occurrence, breast cancer patients have relatively good prospects and almost 80% of sufferers are still alive 10 years after their initial diagnosis. One factor that influences a patient’s chances of survival is the presence or absence of secondary tumours, which occur when cancer cells spread from the breast and establish themselves in other parts of the body.

In research published this month in the journal Nature Communications, a team of scientists led by the University of Michigan’s Dr Lonnie Shea describe an exciting new material, which can be implanted under the skin to capture invasive cancer cells as they move throughout the body. “Tumour traps” like this could be used in the future as part of an early warning system to alert doctors to the…

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Health illiteracy – A major concern in today’s medicine

Health literacy – the ability to obtain, understand and use health information

Making sure that patients understand the information provided to them is critical for health outcomes but also to avoid side effects and disease complications.

The lack of understanding leads to several issues, not only medical like drugs confusion, over- or under-dosage, mismanagement and worsening of treatable conditions, but also financial (it is estimated, for the USA, that health illiteracy costs between USD 100 and 250 billion each year).

Moreover, it is alarming to see that, in a developed country like the USA, only 12% of the population has “proficient health literacy”.

Beyond the communication, language and cultural barriers could be very difficult to get over.

How to empower patients?

Several tools are available today to empower the patients: simplified literature & visual guides to attract attention, patient group meetings led by nurses or dedicated healthcare providers, patient associations, health-related websites, websites for patients… Apart from those interactions, mobile health together with specific apps can provide access to resources regarding one’s health.

Open communication (in both ways), patience as well as avoiding the stigmatization of weak people can really help improve health literacy and simply serve as a form of emotional support during challenging times.

It is fundamental to teach not only young doctors but also senior staff in the healthcare industry in order to tackle that issue. Without proper education and information, even the best medicine is useless.

 

Additional Resources:

Health Literacy Definition – National Network of Libraries of Medicine

Health Literacy Training and Activities – Centers for Disease Control and Prevention

Health illiteracy could be the death of us – The Guardian – 2015

Understanding the true impact of health illiteracy – ArtcraftHealth – 2015

Want to Fix Healthcare? Fix Health Literacy First – Citylimits – 2015

Racial/ethnic disparities in knowledge about one’s breast cancer characteristics – Cancer – 2015

Making health literacy a priority in EU policy – EU – 2013

Consequences of Health Illiteracy – University of Texas – 2012

Many Americans have poor health literacy – The Washington Post – 2011

The Silent Epidemic — The Health Effects of Illiteracy – NEJM – 2006 – Not only health illiteracy but illiteracy stricto sensu (unability to read)

Visual Learning Tools Overcome Health Illiteracy – Patient Safety & Quality Healthcare – 2006

Health Literacy – A prescription to end confusion – NAP – 2004 (free, just register)

Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century – Health Promotion International – 2000

 

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Google Willingness to Help Life Sciences – Wired

Google, or Alphabet, wants biomedical research and life sciences to be more than just side projects.

Several years ago, its efforts under way in that field were probably not considered seriously by the industrial stakeholders like Big Pharma and biotech companies.

Today it is different after several investments commited lately.

Discover more in the Wired article

 

Additional Resources

4 of the biggest healthcare challenges Google is tackling – HealthcareDIVE – August 2015

Here’s why Google Ventures invests so much money in life-science companies – Business Insider – May 2015

Andrew Conrad – Google Life Sciences – The 25 most influential people in biopharma in 2015 – FierceBiotech – May 2015

Google Continues To Build Upon Its Life Sciences Ecosystem – Forbes – September 2014

Meet the Google X Life Sciences Team – WSJ – July 2014

 

 

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The difficult implementation of value-based healthcare – The Commonwealth Fund

ValueBasedCare

“A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment.

Providers’ views are generally positive regarding the impact of health information technology on quality of care, but they are more divided on the increased use of medical homes and accountable care organizations.

Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties. Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments. An earlier brief focused on providers’ experiences under the ACA’s coverage expansions and their opinions about the law.”

Probably each start of a new system is painful and requires people to adapt to it. However, it will have to be carefully monitored as adoption by healthcare providers is crucial for the success of the new system. It will validate the concept of value-based healthcare.

Read more

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MicroHealth Helps Patients Manage Chronic Illnesses

We know that chronic diseases account for the majority of health expenditures. Helping patients with digital tools improving the management of their condition is a great step forward!

10 thoughts from 5 great healthcare minds – Becker’s Hospital Review

5 important people gave their thoughts about our current healthcare system in this Becker’s Hospital Review article:

– Jonathan Bush, founder and CEO of athenahealth (Watertown, Mass.)

– Malcolm Gladwell, journalist and best-selling author

– Chuck Lauer, former publisher of Modern Healthcare, and author, public speaker and career coach

– Nancy Schlichting, CEO of Henry Ford Health System (Detroit)

– John Halamka, MD, CIO of Beth Israel Deaconess Medical Center (Boston)

My favorite thoughts in a nutshell:

– On healthcare’s sustainability: new infrastructure is essential. Obsolete systems are a burden and a brake when it comes to innovation and efficiency.

– On changing the practice of medicine: doctors will have to consider the patient as a whole and spend time taking care of all the aspects of his/her health.

– On high-price medicine: prices should be linked with the innovation the product brings to the patient and the other stakeholders including the health system.

– On sharing healthcare data: data sharing with the goal of improving the life of each patient by learning and analytics could be a game-changer in the next future.

All these quotes could inspire leadership styles and help us create, implement and deliver better care for the patients in need.

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Scientists are developing an x-ray pill you can swallow for colonoscopy

Less invasive technology is clearly the future. It will allow more cases to be diagnosed and treated early leading to better care and cure.

Failure to publish the results of all clinical trials is skewing medical science – The Economist

Truth

A recent article published in The Economist highlights the fact that more than half of all the clinical trials are never published.

In any situation, if we only know half of the truth, distorsions ocurr and could lead to inappropriate and harmful decisions. A US law was passed in 2007 to encourage pharmaceutical companies to register them on a website and give follow-up on the results.

But this is not always precisely executed. After the legal maximum of a year was up, the percentage of clinical trials which had had their results published:

– 17% of those paid for by industry;

– 8% of those sponsored by the National Institutes of Health;

– 6% of those paid for by other government agencies/academic institutions.

The quantity of missing trials is huge and hiding poor results is not what we expect from scientists.

It has to change as hidden or missing data could lead to the use of inappropriate drugs in some patients. There is hope: the website Alltrials (launched by Ben Goldacre) and the charity behind this initiative are leading the movement toward more transparency. The charity “Sense About Science is working on an index, to be published later this year, that will rate pharma firms according to the extent of their commitment to publish all trials”.

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Pager is an “Uber/Amazon for Healthcare” – Forbes

Several new innovative and internet-linked services are emerging every day.

Several years ago, Amazon was selling books online, then it became a one-stop shop for many other things; Google expanded its traditional search engine business into a variety of other activities; Apple as well as other mobile phone producers launched smartphones only few years ago.., we can go on forever with examples.

Healthcare is one of the last area reached by digitalization. But the trend is now more than settled.

Recently a new startup named Pager raised USD 14 million for making your medical appointments instant and for a flat fee during extended hours (from 8:00am to 10:00pm).

A Forbes article drew some parallel with Uber for taxi ordering:  “The service finds and verifies doctors for its network and bills you automatically over a linked credit card”. However the CEO, Gaspard de Dreuzy, compared the company with Amazon instead: “Pager is focused on delivering a broader range of care options on demand than exist today. It could be a tele-consult via phone or messaging, or an in-person visit in the home, or a referral to the right specialist. We like to think of ourselves as the Amazon for healthcare.”

The service is only currently available in New York, but the company will soon expand its operations with the funds raised.

Other companies like ZocDoc or Doctors on Demand are also facilitating life for patients or people looking for health services quickly.

Below an pic from WSJ (see the related article in the Additional material section):

OnDemandDoctors-WSJ2015

Additional material:

Startups Vie to Build an Uber for Health Care – WSJ – August 2015

The Best Digital Business Models Put Evolution Before Revolution – Harvard Business Review – January 2015

There’s Now A Seamless For When You’re Feeling Sick – Huffington Post – December 2014

9 Healthcare Tech Startups To Watch – InformationWeek Healthcare – December 2014

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Why Are We Failing To Fund Mental Health Research?

Insightful post on the reasons of mental health underfunding.

Snackable Science

Everyone is affected by mental illness in some capacity, either directly or through those that we know. Around a quarter of the population experience a mental health condition each year and this high prevalence has considerable repercussions, both socially and economically. Indeed, many would be surprised to hear that on top of obvious human suffering, mental illness is estimated to cost the UK an eye-watering £105 billion a year once healthcare expenses and lost productivity have been taken into account.

With mental illness disrupting the lives of so many and harming the economy to such an extent, I was genuinely surprised to hear of the funding gap that exists in mental health research. Compared to other diseases that place a similar burden on society, publicly funded research into mental health is disproportionately low. Cancer research provides some of the strongest evidence of this effect, receiving around 20% of total UK research expenditure, almost four times more than the amount invested…

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With Big Data & Digital Health – New Collaborations are Emerging in the Pharma Industry – PWC

TeamWork

A newly published report by PWC reveals novel collaboration models for improved value of medicines

“Driven by empowered consumers and connected technology, the New Health Economy is shifting business incentives from volume to value with a focus on health outcomes beyond the clinic.”

Big data together with EHR (electronic health records) and wearables drive patient empowerment. Today, more and more, people have their say in treatment choices. Actually, health benefits and prices are crucial criteria for decision, especially as patients face today higher out-of-pocket expenses than ever before. We all well know that expensive treatments are financially disastrous for patients as mentioned in one of my previous posts.

Currently, increased focus is put on drug cost effectiveness as we switch progressively from a fee-for-service to an outcome-based world. Every treatment should be precisely calculated in order to be sure that it is optimized for all stakeholders from all points of view. In this context, already last year, PWC highlighted the beginning of a new system: the New Health Economy, where outcomes and quality are rewarded (instead of volume). It is the continuum of what has been started by Michael E. Porter several years ago.

All these changes have essential meanings. Therefore business models need to adapt to current trends: digital is unavoidable; purchaser perspective is necessary; patients need to become partners; regulatory changes have to be anticipated.

Adapting business models is fantastic but not sufficient. Novel collaborations are needed to optimize them for long-term success. All the stakeholders have to be integrated and blended by the biopharma companies: government agencies, insurers (payers as a whole), new entrants, consumers. Beyond collaborations, a consensus on the value of new medicines should be agreed on. Additionally, consumer and patient health information should be leveraged to improved personalization and precision of treatments.

In one word, several changes will flow the industry and challenges will pave the way to success. But it will become much more exciting to develop drugs in this context than ever before!

Report: PWC-21st-century-pharmaceutical-collaboration-July2015

 

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Digital Health Expected to Save US Healthcare System > $100 Billion Over Next 4 Years – Accenture

A new survey done by Accenture showed that Digital Health could have a huge impact on healthcare costs, especially in the US

A wonderful infographic has been designed to show the key points from the study (see below). There is no need to say more about it.

The link to the article.

 

Additional material:

2015 Global health care Outlook – 2015 – Deloitte

The future of healthcare—there’s an app for that – 2012 – Bain & Company

The digital dimension of healthcare – 2012 – Global Health Policy Summit Working Group

 

Accenture-Colossal-Clash-Infographic