⏭️Chris' Newsletter: No. 4 | precision dosing; telehealth apps; Chinese hacking; fertility devices, & atrial fibrillation
What's happening and what's next in digital health & hardware
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Hi Everyone! Happy Monday!
The number of categories in my newsletter is starting to expand, which is problematic since it’s easier to make sense of news when it fits into a mental model of how the world works. I’ve got a few different ideas for what that framework should look like (honestly it’s been the most fun part of making this newsletter), but I think it’s best to let let that stew for a bit longer before making a commitment. Please be patient 🙏
Thanks,
Chris
👩⚖️ Regulatory
The FDA will vote Friday on whether to allow a precision dose of peanut protein as a therapy for peanut allergy . This desensitization therapy may not seem like “digital health” at first, but the result of the vote (positive or negative) will set some precedent for the application of precision dosing, something that’s seeing a lot of interest. Link
💸 Healthcare Economics
Telemedicine isn’t used for the elderly because payers don’t cover it. Many hospital admissions from nursing homes (only 10% of which keep a physician on site) could be replaced with telemedicine but aren’t because getting paid is very difficult, partly because of the cautious adoption of Medicare and Medicaid and the timid embrace of value-based care as opposed to fee-for-service. Link
The steps needed to take to go from idea to reimbursement. Intended Use >> Analytical Validity >> Clinical Validity >> Health Economics >> Outcomes Data >> Reimbursement. Link
👩⚕️ Care Delivery
Epic integrates with app from leading telehealth provider. Epic’s partnership with American Well (the app maker) is in addition to Epic’s partnership with Zoom. These sorts of virtual “visits” are going to become increasingly common. Link
The American Medical Association issued a “Digital Health Implementation Playbook”. The audience is doctors, administrators, etc. and the main focus is to guide them to a successful implementation of Remote Patient Monitoring. As I’ve mentioned before, adoption by care providers is one of the biggest hurdles to success that digital health firms face. This is a welcome development. Link
⌚ Wearables and Apps
Withings launches the ECG version of their. ECG-at-the-wrist is new to consumers but the tech isn’t very fancy and has been well-understood by many for some years, so it isn’t surprising that we’re seeing more devices add it on. The precise value of such spot-checking though is still unclear. Link
Kegg, a fertility tracking device, met their $20k IndieGoGo funding goal. It’s a small amount, but they’re part of the HAX accelerator and surely have raised more than that in seed. This is a booming space (as the Economist wrote), and will likely continue to boom as women increasingly push child-bearing to later in life. Link
Some hearing aid devices can now stream music on Android. This feels fairly trivial (though surely not for those with hearing loss), but it’s more broadly interesting because it reflects the convergence of consumer audio and hearing aids. The OTC Hearing Aid Act was passed in 2017 and so we should expect to start seeing hearing aid manufacturers and headphone manufacturers start to step on each others toes. Link
Speculation continues about AR glasses from apple. This is relevant because AR glasses would likely have a camera looking at the wearer’s eye… a sensing mechanism many firms are betting will have diagnostic value… and because it would push such diagnostic opportunities out of the realm of spot-check diagnostics (possible with VR) and into the real-world. Link
🛠️Hardware
Google is moving production of the pixel to Vietnam. As I mentioned last week, increased tariffs and the spectre of uncertainty is pushing supply chains away from China, though still well within it’s sphere. Link
Nordic’s Thingy91 is a super-friendly prototype tool for exploring low-power cellular. The module itself can communicate over LTE-M and NB-IoT and was launched late last year, but this makes prototyping applications (especially those of the digital health sort 😉) much more accessible. Link
Google open-sources datasets for AI-assistants. I like this, but the only way it makes sense for google is to dilute market share from Amazon and Apple by making devices manufacturers more reliant on Google-created low-level tech. Link
Apple is doing free replacement for some Apple Watch screens. Only on some Aluminum Series 2 and Series 3 units. It’s interesting to speculate on why this might be. The announcment appears to indicate that it’s associated with certain lots, so probably an assembly error or tolerance out of spec. Aluminum is softer than the other case materials so it’s possible a bang could chip the glass if the gap isn’t right, a chip that could propagate as shown. A good reminder of how critical it is to get the details right (and to ensure they stay right in production). Link
👩🔬 Commercial Trials & Partnerships
Verily (Google) and iRhythm are partnering to detect atrial fibrillation. Apple made a lot of noise with their ECG, but its spot-check nature (a compromise with it’s sleek, broadly appealing form-factor) makes it less valuable as a diagnostic tool for medium-to-high-risk patients. Link
👨🏽🎓 Academic Studies
96.5% of 19-year-old men in Seoul are short-sighted. Researchers suspect children need to spend 3 hours/day under light levels of at least 10k lux. (An overcast day can provide less than 10,000 lux and a well-lit office or classroom is usually no more than 500 lux. ) Link.
Biological age might be able to be reversed.Link
A.I. + a 12-lead ECG allows prediction of sex and estimation of age. If this was validated then maybe it could be used as a measure of the “biological age” mentioned above. Link
🔒Privacy and security
As health data becomes more portable and useful, abuse becomes more likely. A lot of loud voices on both sides of this: on one hand users should have a choice on who to share their data with (they’re trusted with their financial data after all), on the other hand, no data is as intimate as medical data, especially when you’re sick. Big winners will be those whose brand is associated with trust & security (Apple doing well here), and offer specs like End To End Encryption (E2EE) and possibly the “right to be forgotten” (like GDPR). Link
It appears China and others are sponsoring hacking efforts targeting healthcare data. The target appears to be cancer research, which makes it feel more like oft-reported IP espionage efforts from China. Still, it underscores the need for healthcare data security in general. Link
😖 Mental Health and Addiction
Ginger, mental wellness firm ,raised a $35M Series C. Like many, Ginger is eschewing direct-to-consumer services (here’s an old version of their site) and instead focusing on partnerships with large organizations such as employers and potentially national health services. Link
📃 Other Things
Across Europe, “Series A” rounds are getting bigger. Also there is a renewed appetite in Europe to have governments invest in home-grown startups. The lines between things like Japan’s “Vision Fund” and “State Capitalism” is getting blurry. Link & Link
People have higher expectations for the impact of future technology on their health. More so than on education, safety, inequality, etc. Link
Better ways to visualize error. Link
📖 Books I’m reading
Surveillance Capitalism by Shoshana Zuboff
Guns, Germs, and Steel by Jared Diamond
P.S. We should be better friends. Send me a note, I’ll buy you tea/coffee :)
P.P.S I just want to be right as soon as possible, so if you see anything that looks like a mistake, please comment :)