⏭️Chris' Newsletter: No. 5 | Apple, prescription fights, pain, pediatric care, & podcasts
What's happening and what's next in digital health & hardware
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Good Morning!
Busy week all around, so didn’t have a chance to put together a refined framing. I did however get to take a look at this digital health briefing from the Economist Intelligence Unit (EIU) and I think it’s safe to say I’ll be incorporating some ideas there into my framing… in the future :)
Have a great week!
Chris
👩⚖️ Regulatory
a16z podcast: How to Pay for Healthcare Based on Health Great conversation with CEO of BCBS North Carolina (who previously worked in innovation at Center for Medicare Services). Candid talk about how things do (and don’t) get done, some innovative programs currently under consideration, and how firms should approach payers.
💸 Healthcare Economics
A framework for evaluating telehealth ROI. This is fiendishly complex and it’s good to start seeing documentation (like the AMA guide published last week) helping firms navigate properly. Interesting here is how the incentives and cost structures are different between academic hospitals, community hospitals, private practices, etc.
“Hospitals tell the public they want to… reduce the number of patient admissions…But the truth is they still want their inpatient beds filled whenever possible.” Old-ish article, but underscores the tension between payers and large institutions. Those incentives aren’t going to change quickly.
Fights over prescription data. Surescripts (part-owned by CVS), a handler of electronic prescriptions, is cancelling a relationship with ReMyHealth over alleged abuses. ReMyHealth has a deal with PillPack (owned by Amazon) to supply them with prescription history, a dataset that makes Pillpack much more usable and accurate. I’m sure there are legitimate claims, but this feels more like a competitive move than anything else.
👩⚕️ Care Delivery
Brave Care raises $5M for pediatric urgent-care centers. The Y-Combinator backed company sees an opportunity in the 30M/year pediatric emergency room visits… 96.7% of which were treat-and-release. The most interesting thing to me is that they have the opportunity to build their EHR from the ground up, and so have the opportunity to offer a really great experience. I hope they come to Coolidge Corner :)
⌚ Wearables and Apps
Virta’s Type 2 diabetes reversal has received a coversage agreement with Blue Cross of CA. Virta’s treatment is multi-pronged approach that includes a keto-based dietary system, a smart scale, app-based health coach, and online community. The diverse approach is at odds with the way many firms see themselves (i.e. “Digital Therapeutic”, “Device”, etc.).
🧪Labwork
Healthy.io raises $60M for phone-enabled at-home urinalysis. The kit uses a dipstick that changes color, a reference card, and a phone to take a picture of both. Can be used for aid in diagnosing ketosis, kidney disease, bladder cancer, etc.
🛠️ Hardware
Microsoft issued a patent for liquid-powered hinges. The application seems aimed at foldable displays, and the implementation is really cool. Reminiscient of the Handbook of Compliant Mechanisms.
Syntiant is producing a speech-recognition chip that’s certified for Alexa. As chips like this one (which is reportedly in Fitbit’s new Versa 2) become easier to integrate, producers of traditionally unconnected devices (e.g. stethoscopes, bp monitors) will be increasingly pressured to integrate this kind of interaction, lest their competitors get there first. The data that results will be a huge boon for whoever own that voice assistant. (speaking of which… mozilla has an open-source voice project)
The Apple Watch Series 5 has an always-on display. It looks like they accomplished it by a combination of dimming, lighting up few pixels (black pixels don’t consume power on OLED panels), and reducing the driving frequency. The result looks really nice, and always-on has rightly been a goal of apple’s for a while.
👩🔬 Commercial Trials & Partnerships
Apple is launching heart, hearing, and menstrual cycle studies. The studies leverage the new research app for apple watch which will let users contribute their data more easily. Given Apple’s installed base (900M iPhones), any step they take into a particular disease state is noteworthy for all the players in that space. Doubly interesting is the move into hearing and menstruation (spaces seemingly poised to grow as I mentioned last week)
👨🏽🎓 Academic Studies
Human speech may have a universal transmission rate: 39 bits per second. This bottleneck is the motivating factory behind all the Brain-Computer Interface (BCI) tech you see in the news.
🔒Privacy and security
Sperm banks struggle with anonymity promise in the consumer DNA testing era. Long ago I considered sperm donation (ultimately didn’t). At that time (early 2000s) I couldn’t have imagined consumer DNA testing being so prevalent. This is an important lesson: life is long and medical data (especially DNA) is much more persistent than all the other data we’ve become used to protecting.
Facebook has a vulnerability that can expose it’s users group memberships. Facebook groups have become a key part of many people’s lives, but none so much as those fighting chronic illnesses, since people are usually the only one in their immediate circle that is fighting with that particular illness. Being identified as a member of one of these groups could result in individuals being “outed” against their will.
Menstruation apps often share some very private data. These apps aren’t alone of course, but they are widely used and the information in them can apparently be quite sensitive.
😖 Mental Health, Pain, and Addiction
The International Association for the Study of Pain (IASP) is proposing a new definition of pain. The current/proposed definition’s are listed below 👇. It’s unclear to me how these changing definitions could affect treatment, so I will be interested to keep an eye on it. Still, with all the focus on mental health and the opioid crisis, changes like this seem poised to have a notable impact.
Current: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Proposed: An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.
Meanwhile, researchers can measures a patient's pain by analyzing brain activity. The device in question uses functional Near-Infrared Spectroscopy (fNIRS).
Lastly, Karuna Labs raises $3M for a VR platform to fight chronic pain. There are a lot of firms working on diagnostics and pain management with VR. It’s unclear who the winners are, but there almost certainly will be some.
📃 Other Things
Geologists uncover history of lost continent buried underneath Europe
Petri Bio is a new accelerator for biotech. Will provide support and $250k over the 12-month program
HealthIQ gives low-cost life insurance to people with healthy lifestyles. I promise this isn’t an ad, but I was reminded of this company recently. I got life insurance from them last year and got a meaningfully lower cost insurance than my already-low plan. Their approach was low-tech (check my health, give me a health quiz), but their product is indicative of the new financial advantages that will come to people who are healthy as health trajectories become increasingly quantifiable
📖 Books I’m reading
Surveillance Capitalism by Shoshana Zuboff (almost done… it’s a beast)
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 :)