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Christina Liu

The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine

By HANS DUVEFELT

Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe.

Medicine has started to move from an in-person only profession to one that finally recognizes that clinical assessment and treatment have fewer boundaries than people assumed. A patient of mine with newly diagnosed mastocytosis had a productive first consultation with an immunologist hundreds of miles away right from her own living room.

Efficiency increased when we could handle straightforward clinical issues electronically, even over the telephone, and still get paid. We were liberated from the perverted and miserly view by insurers that services not delivered in person should be free, as if fast food restaurants couldn’t charge for food at the drive through.

We delivered more virtual services to allow patients the safety of staying at home and avoiding lobbies, waiting rooms and exam rooms where airborne particles might linger.

Yet, when a primary care or mental health patient is in crisis or a person with new symptoms needs to be evaluated, a video visit is sometimes not enough. Step by step, we improvised screening protocols, not knowing which would be efficient or relevant as we didn’t know quite how the coronavirus behaved and transmitted.

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Docs are ROCs: a simple fix for a “methodologically indefensible” practice in medical AI studies

By LUKE OAKDEN-RAYNER

Anyone who has read my blog or tweets before has probably seen that I have issues with some of the common methods used to analyse the performance of medical machine learning models. In particular, the most commonly reported metrics we use (sensitivity, specificity, F1, accuracy and so on) all systematically underestimate human performance in head to head comparisons against AI models.

This makes AI look better than it is, and may be partially responsible for the “implementation gap” that everyone is so concerned about.

I’ve just posted a preprint on arxiv titled “Docs are ROCs: A simple off-the-shelf approach for estimating average human performance in diagnostic studies” which provides what I think is a solid solution to this problem, and I thought I would explain in some detail here.

Disclaimer: not peer reviewed, content subject to change 

A (con)vexing problem

When we compare machine learning models to humans, we have a bit of a problem. Which humans?

In medical tasks, we typically take the doctor who currently does the task (for example, a radiologist identifying cancer on a CT scan) as proxy for the standard of clinical practice. But doctors aren’t a monolithic group who all give the same answers. Inter-reader variability typically ranges from 15% to 50%, depending on the task. Thus, we usually take as many doctors as we can find and then try to summarise their performance (this is called a multi-reader multicase study, MRMC for short).

Since the metrics we care most about in medicine are sensitivity and specificity, many papers have reported the averages of these values. In fact, a recent systematic review showed that over 70% of medical AI studies that compared humans to AI models reported these values. This makes a lot of sense. We want to know how the average doctor performs at the task, so the average performance on these metrics should be great, right?

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Bayer G4A Agents of Change: Watch the Panels, Meet the Co’s that Got Deals

By JESSICA DaMASSA, WTF HEALTH

Bayer G4A, the global life science company’s digital health innovation arm, held their splashy “Agents of Change” event last month to not only introduce their latest cohort of health tech partners, but to also demonstrate the pharma co’s commitment to digital transformation. The entire C-suite of Bayer’s Pharma division became a panel itself — marking the first time the full leadership team of a major pharmaceutical company appeared together to talk strategically about tech’s role in shaping the pharma business model of the future. 

The rest of the program’s agenda teased out G4A’s priorities: consumer health, health disparities, women’s health, and investing. Matthew and I both moderated “star-studded” panels with health tech greats: he tackled health tech investment, ridiculous valuations, and advice for startups with a powerhouse crew of investors, while I led my women’s health panel past the usual talk of period-tracking and into a real push for a paradigm shift in thinking about what actually constitutes women’s health data. Rounding out the program were fascinating discussions about health equity and access led by Indu Sabiaya, and a ‘who’s-interviewing-who-here’ fireside about patient-centered tech with OneDrop’s Jeff Dachis and DiabetesMine founder Amy Tenderich, both entrepreneurs with diabetes who have a lot to say about how most tech misses the mark when it comes to grappling with patient needs in everyday life.

And… if you’re curious about what Bayer G4A actually invested in and who they decided to sign partnership agreements with, check out my exclusive WTF Health interviews featuring these companies by way of the playlist below. 

Spoiler Alert: Not a single digital therapeutic. 

What else could there possibly be for a pharma co to invest in? Watch and see. But, so you know a bit about what you’ll be getting into:

  • Caria is women’s health startup focused on menopause 
  • Sweetch is using just-in-time-interventions linked to mobile data to help “outsmart” chronic diseases
  • ONCARE is a care plan content management platform that lets any healthcare provider upload a care pathway that a patient can then follow via an app on their phone
  • Decipher Biosciences is using genomic testing to disrupt the way prostate cancer is diagnosed and treated 
  • Elly is helping improve the quality of life for cancer patients and those with chronic disease by way of educational and motivational content delivered via voice technology

The “Right” to Health Care in America

By MIKE MAGEE

I’ve been working on a Spring lecture for President’s College at the University of Hartford titled, “The Constitution and Your ‘Right to Health Care’ in America.” 

My description reads, “This lecture explores the recent political history and legal controversy surrounding attempts to establish universal health coverage in America. “Is health care a right?” viewed within the context of the Bill of Rights and especially the 9th and 10th Amendments?”

Self-described libertarian-conservative John R. Graham, a health policy analyst in the Trump administration’s HHS, writing on the topic in 2010 stated that, “As a non-lawyer, my understanding is very simple: The Ninth Amendment states that ‘the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.’ So, if you claim a ‘right to health care,’ there’s nothing in the Constitution that denies your claim. Indeed, libertarians and conservatives should be more willing to concede a ‘right to health care,’ because once it’s defined as a right, the entire weight of the Constitution comes down against federal (and perhaps even state) control.”

This bit of semantics crash-lands with common sense, as it did in my own state in 1965 when the Supreme Court in a 7 to 2 decision (Griswold v. Connecticut) dismantled an 1873 Comstock Law that prohibited married couples from buying and using contraceptives. Writing for the Court, Justice William O. Douglas declared that “specific guarantees in the Bill of Rights have penumbras, formed by emanations from those guarantees that help give them life and substance.” Though marital privacy was not mentioned in the Bill of Rights, legal analysts have suggested that Douglas was asserting that logic dictated that marital privacy “is one of the values served and protected by the First Amendment through its protection of associational rights, and by the Third, the Fourth, and the Fifth Amendments as well.”

Justice Goldberg concurred at the time, writing: “The language and history of the Ninth Amendment reveal that the Framers of the Constitution believed that there are additional fundamental rights, protected from governmental infringement, which exist alongside those fundamental rights specifically mentioned in the first eight constitutional amendments. . . . To hold that a right so basic and fundamental and so deep-rooted in our society as the right of privacy in marriage may be infringed because that right is not guaranteed in so many words by the first eight amendments to the Constitution is to ignore the Ninth Amendment and to give it no effect whatsoever.”

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CRAZY AMERICA: Health Insurance Covers Testing When You Are Well But Not When You Are Sick

By HANS DUVEFELT

Insurance is the wrong word for what we have here. Our private health insurance system’s prioritization of sometimes frivolous screenings but non-coverage for common illnesses and emergencies is a travesty and an insult to typical American middle class families.

State Medicaid insurance for the underemployed has minimal copays of just a few dollars for doctor visits and medications. From my vantage point as a physician, it is the best insurance a patient can have. They cover almost everything and it is clear to me how to apply for exceptions or follow their step care requirements. I cannot say that about most other insurers.

Most employed people have the kind of commercial health “insurance” that covers an annual physical and certain screening tests at no cost, but requires people to pay the first several thousand dollars of actual sick care expenses out of pocket. This is, in my opinion, insane. It causes delays and omissions in diagnosis and treatment.

A shining example of this bizarre arrangement is the screening colonoscopy. It is free as long as it is normal. If a patient has a polyp removed, which if unchecked could turn cancerous, future health care costs for treating colon cancer are eliminated. But the patient gets billed for the early cure.

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Michelin Star Medicine: Food Start-Up Epicured Delivers Meals for GI & Chronic Condition Care

By JESSICA DaMASSA, WTF HEALTH

Food-as-Medicine startup, Epicured, looks and acts a lot like the consumer meal delivery startups booming during this pandemic (think Freshly, which was just acquired by Nestle for $1.5B) but with one important difference: all the meals are based on diets that have been clinically validated as treatments for chronic disease. The three year old company got its start in GI disorders, turning complex Low FODMAP diets, gluten-free diets, etc. into home-delivered, ready-to-eat dishes that patients with Crohn’s disease, Colitis, IBS, IBD, celiac, or other gastro conditions could actually integrate into their daily lives. (Just Google the list of restrictions on a Low FODMAP diet and imagine the lack of adherence over a 6-8 week period while trying to calm an IBS flare-up…)

Richard Bennett, Epicured’s CEO & co-founder, stops by to talk about why he believes this more convenient, yummy, and easy solution will not only continue to win the hearts of healthcare consumers, but why, ultimately, healthcare payors will look to invest more into innovation around nutrition, particularly as its proven to help with other, more common and costly conditions like diabetes, renal disease, and cancer. Backed in part by Mount Sinai (which not only invested in their seed round, but also lent their GI team to the co-design a special IBS menu), Rich let’s us know a bit about some yet-to-be-released clinical study results AND how Epicured has taken a page out of the “digital therapeutics playbook” by partnering with AbbVie to wrap their solution around one of the pharma co’s drugs as a way to improve medication adherence. Chicken Cacciatore wins over companion app any day!

#Healthin2Point00, Episode 172 | MedArrive, PointClickCare, Consejo Sano & FOLX Health

Today on Health in 2 Point 00, we’ve got quite a diverse set of companies to cover. MedArrive, which is Dan Trigub’s company – the former CEO of Uber Health – raises $4.5 million. Jess also asks me about PointClickCare acquiring Collective Medical, connecting data from EMRs in the acute care space into their long term care solution (I interviewed both companies on THCB Spotlights here). Consejo Sano quietly raised $17.1 million for their patient engagement and communication solution for the Hispanic community, and FOLX Health raises $4.4 million to provide care to LGBTQIA+ folks. —Matthew Holt

#Healthin2Point00, Episode 171 | Massive deals & a massive IPO

Today on Health in 2 Point 00, we have a huge IPO coming up – JD Health, a Chinese company which has a valuation of $28 billion, could raise up to $4 billion in its upcoming IPO. On Episode 171, Jess asks me about Everlywell raising $175 million in a Series D for at-home testing, everyone’s favorite keto startup Virta Health raising $65 million bringing its valuation to a billion, Olive Health already putting their funding raise to good use by acquiring Verata Health, and dtx company Click Therapeutics raising $30 million. —Matthew Holt

#Healthin2Point00 Episode 170 | Olive, WithMe, Andor & more

Today on Health in 2 Point 00, Jess & I are together in Marin County before Jess sets off! On Episode 170, Jess asks me about Olive raising $225 million following a recent raise as well, WithMe Health closing a $20 million Series B, Andor Health getting an undisclosed amount in a Series A with an investment from M12, Microsoft’s venture fund, Upfront Healthcare raising $11.5 million in a Series B, and Voluntis – which is a publicly traded DTx company in France – raising $7 million. —Matthew Holt

Healthcare on the Edge

By KIM BELLARD

Perhaps you read about, or were directly impacted by, the massive, multi-hour Amazon Web Services (AWS) outage last week.  Ironically, AWS’s effort to add capacity triggered the outage, although apparently was not the root cause.  It’s no surprise that AWS sought to add capacity; it, like most cloud service vendors these days, has seen skyrocketing growth.  Even healthcare has jumped into the cloud in a big way.

But, as the outage reminds us, sometimes having core computing functions done in far-off data centers may not be always a great idea.  Still, we’re not about to go back to local mainframes or networked PCs.  The compromise may be edge computing. 

Definitions vary, and the concept is somewhat amorphous, but goal is to move as much computing to the “edge” of networks, primarily to reduce latency.  PwC predicts: “Now, with the rise of IoT, the centralised cloud is moving down and out, and edge computing is set to take on much of the grunt work.” 

As they describe it:

With edge, instead of pushing data to the cloud to be computed, processing is done by devices ‘at the edge’ of your network. The grunt work is done closer to the user, at an edge gateway server and then select or relevant data is sent to the cloud for storage (or back to your devices).

The oft-cited example is self-driving cars; you really don’t want the AI to wait a single millisecond longer than necessary to make a potentially life-saving decision.  An article in Nextgov pointed out:

Thus, a Tesla isn’t just a next-generation car; it’s an edge compute node. But even with Tesla, a relatively straightforward use case, building and deploying the edge node is just the beginning. In order to unlock the full promise of these technologies, an entire paradigm shift is required.

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