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Christina Liu

Why “Radiopharmaceutical” Should be Part of your Healthcare Vocabulary

By JAY T. RIPTON

Not to sound too alarmist, but the radiopharmaceutical industry is on the verge of an explosion. But don’t worry; it’s not the type of explosion one often associates with nuclear materials… I love those movies too! It’s the beginning of a new wave of innovation for the diagnosis and treatment of certain cancers and other diseases.

This new radiopharmaceutical boom quite literally has the life sciences industry in a nuclear arms race of sorts, as companies like Y-mAbs, Novartis and others are pushing through clinical trials for the next blockbuster for the treatment and detection of hard-to-treat diseases like medulloblastoma and metastatic castration-resistant prostate cancer. But all this excitement has many wondering, “what are radiopharmaceuticals anyway?”   

Radiopharmaceuticals are simply a group of pharmaceutical drugs containing radioactive isotopes. They are being used primarily for the treatment and detection of certain types of cancers, but they are also being developed for cardiac disease as well. And what makes radiopharmaceuticals so unique is that they can be targeted to extremely precise areas in the human body.

Although gaining ground with more precision today, this type of therapy actually began in the 1940s with I-131 – which has become an important agent for the treatment of benign and malignant thyroid disease. The development of radiolabeled antibodies began in the 1970s, and Radium-223 dichloride was approved by the FDA in 2013 for the treatment of castrate-resistant metastatic prostate cancer. Lu-177 PSMA is one of several recent developments that are making their way through FDA approvals.

“The radiopharmaceutical industry has actually been around for some time, but today it is at a tipping point,” says SpectonRx president Anwer Rizvi. “Over the next few years, it is estimated that our industry will triple. With more radiopharmaceuticals making their way through clinical trials and FDA approval, we are starting to see more data that highlight their effectiveness. This is why we are now starting to see more life sciences organizations committing real resources to radiopharmaceuticals.”  

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#Healthin2Point00, Episode 215 | Monogram, LetsGetChecked, Transcarent, Lenus, and Ada

Amazon Cares already has customers, Clover has become a meme stock, Transcarent has got a Series B that they closed already, and OneDrop has hit 25 billion biometric data points – what the hell is going on in digital health? Today on Health in 2 Point 00, we still have lots of deals to cover. Monogram, an end-stage kidney disease company, raises $160 million. LetsGetChecked raises $150 million in a Series D – all of these at-home testing companies are getting a push because of COVID. Next, Lenus raises €50M in a Series A, making it the biggest ever single A round in Denmark. Transcarent gets $58 million in a Series B already, and Ada Health raises $90 million for their symptom assessment chatbot. —Matthew Holt

UpHealth Hits the NYSE: CEO & President on SPAC Merger Completion, Virtual Care Competition & More

By JESSICA DaMASSA, WTF HEALTH

Another virtual care company hits the New York Stock Exchange as UpHealth ($UPH) emerges from the combined merger of UpHealth Holdings and Cloudbreak Health with the GigCapital2 SPAC. We’ve got UpHealth’s CEO Ramesh Balakrishnan and President Jamey Edwards here on “Listing Day” to catch us up on the strategic developments and integrations that have occurred since UpHealth’s SPAC IPO was first announced at the end of 2020.

You might remember this deal as the one that brought together six different companies across four of the fastest growing areas of digital health: global telehealth, integrated care management, digital pharmacy, and behavioral health. The story there is still the same, but the value proposition around the combined offering has gelled. UpHealth views itself as a partner to local healthcare providers around the world who need a hand building the integrated digital care model needed to meet growing patient demands and economic realities of a “digitally transformed” healthcare experience. How is this different than what we’re seeing from other publicly-traded telehealth companies like Amwell, Teladoc, and Hims? Or, what about those telehealth-empowered retail giants like Amazon, Walmart, and CVS Health who, like UpHealth, see a lot of upside in the duality of both making care more convenient digitally, while also seamlessly integrating with local in-person care centers? We’ve got all the talk you’ll want about UPH’s positioning, business model, revenue guidance (still $180M-190M for 2021) AND even some client name dropping (Amazon? Really?!) as the stock hits the market.

Bonus: Want to go deeper into this deal? For more on UpHealth, check out our earlier chat with Chairman Chirinjeev Kathuria, Jamey Edwards, and Al Gatmaitan from February 2021. The link is right here: https://youtu.be/50PIVdUjnPU

Hey, How About Starship Earth?

By KIM BELLARD

I missed the job announcement on the company website.  I missed it again when the company posted the job on Linkedin.  I missed it when Eric Ralph tweeted that the posting was “probably the coolest job posting I’ve read in years.”  Fortunately, though, I follow Isaac Kohne (MD, PhD), and I did see his tweet:

Yes, I’m talking about SpaceX.  Yes, the job is for a “Starship Medical Engineer.”  Yes, it’s to help SpaceX’s mission to Mars, whenever that might be.  Who knows, the job might even entail going to Mars, although that’s not spelled out. 

I am not, of course, remotely qualified for such a job.  In fact, I don’t even know anyone who might be.  But I agree with Mr. Ralph that it’s probably the coolest job posting I’ve seen in years, maybe ever.  And I even more agree with Dr. Kohne: it could be an “opportunity to rethink a bigger broken system.”

Hint: I don’t think he’s talking about just the SpaceX mission. 

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#Healthin2Point00, Episode 214 | One Medical acquires Iora, plus funding for HumanFirst & many more

Today on Health in 2 Point 00, Jess pokes fun at me because my primary care provider has acquired a Medicare provider – One Medical buys Iora Health for $2.1 billion in stock. This deal is curious because these are two very different organizations. Next, HumanFirst (formerly Elektra Labs) raises $12 million in a Series A, bringing their total to $15 million, working on distributed clinical trials. Medallion raises $20 million in a Series A to address barriers for digital health providers around state licensing rules, and Aunt Bertha raises $27 million working on the social determinants of health and getting social care resources to patients. Finally, Grand Rounds and Doctor on Demand acquire Included Health, an LGBTQ+ focused care navigation platform. —Matthew Holt

The Art of Medicine is Not an Algorithm

By HANS DUVEFELT

The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a cookie cutter activity. It has been a personalized craft, based on the science of the day, practiced by individual clinicians for diverse patients, one at a time.

Unlike industrial mass production, where everything from raw materials to tools to manufacturing processes are standardized and even automated or performed by robots, physicians work with raw materials of different age, shape and quality in what is more like restoration of damaged paintings or antique automobiles.

The Art of Medicine involves knowing how and with which tools to take something damaged or malfunctioning and make it better. There are general principles, but each case is different to at least some degree. In many cases there are different ways to improve something that is malfunctioning, but patients may prefer fixing certain aspects of a complex problem because of their individual needs.

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U.S. Science Embrace of Wuhan “Gain-Of-Function” Viral Research Proved A Slippery Slope

By MIKE MAGEE

The truth hurts.

Eighteen months into a disaster that has claimed 3.5 million lives around the globe, the truth is seeping out. Human error likely caused the Covid pandemic, and America’s Medical-Industrial Complex was right in the middle of it.

Signs of a “great awakening” have emerged from various corners in the month of May.

On May 14, UNC’s top virologist, Ralph Baric, who worked closely with Wuhan chief virologist and batwoman extraordinare, Shi Zhengli, signed on with 17 other scientists to a Science editorial that demanded a reexamination of Covid’s causality writing “theories of accidental release from a lab and zoonotic spillover both remain viable.”

On May 26, Francis Collins, head of the NIH, which funded in part Zhengli’s risky bat virus research (more on that in a moment), admitted to Congressional investigators that “we cannot exclude the possibility of some kind of a lab accident.”

And on June 3rd, on MSNBC’s Morning Joe, the ever-present Tony Fauci advised all who would listen “to keep an open mind.” What he would like us to open our minds to is not a Chinese run weaponized microbe conspiracy, but simply scientific recklessness and human error.

It’s now well established that three Wuhan virology scientists were hospitalized in the Fall of 2019 with Covid. But the initial report from the Wuhan Municipal Health Commission, China, of this cluster of cases of pneumonia was only released on the last day of 2019.

It took only 50 more days for the tight knit group of global research virologists to get their act together and pen a Lancet editorial in which they stated “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin,” and that they  “overwhelmingly conclude that this coronavirus originated in wildlife.”

Their coordinator-in-chief was one Peter Daszak, chartered power broker within the U.S. Medical Industrial Complex and president of New York based EcoHealth Alliance which was a major funder of Shi Zhengli’s work in Wuhan.

Daszak is known for adopting militarized terms in the battle against global infectious diseases. In 2020 he wrote in the New York Times, “Pandemics are like terrorist attacks: We know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen. They need to be handled the same way — by identifying all possible sources and dismantling those before the next pandemic strikes.”

Daszak’s argument that risks involved in Shi Zhengli’s Wuhan bat viruses were justified as defensive and preventive was convincing enough to the NIH and the Department of Defense that his EcoHealth Alliance was funded from 2013 to 2020 (contracts, grants, subgrants) to the tune of well over $100 million – $39 million from Pentagon /DOD funds, $65 million from USAID/State Dept., and  $20 million from HHS/NIH/CDC.

As veteran Science reporter Nicholas Wade deciphered in a classic article in Science – The Wire, “For 20 years, mostly beneath the public’s attention, they had been playing a dangerous game. In their laboratories they routinely created viruses more dangerous than those that exist in nature. They argued they could do so safely, and that by getting ahead of nature they could predict and prevent natural “spillovers,” the cross-over of viruses from an animal host to people. If SARS2 had indeed escaped from such a laboratory experiment, a savage blowback could be expected, and the storm of public indignation would affect virologists everywhere, not just in China.”

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#Healthin2Point00, Episode 213 | Babylon’s SPAC IPO, plus big raises for Thirty Madison & Intrinsic

Today on Health in 2 Point 00, we’re talking about our new conference in September: Policies, Techies, & VCs: What’s Next for Health Care. On Episode 213, Jess ask me about some massive deals. Thirty Madison gets $140 million – they are now a unicorn. Babylon Health is going public via a SPAC – $575 million expected to be raised during this with a $3.6 billion valuation. Coming out of stealth, Intrinsic raises $113 million in the eCommerce space — and Dr. Oz is in this one. —Matthew Holt

#Healthin2Point00, Episode 212 | DayTwo, Hello Heart, Pack4U, and Curebase

Today at Health in 2 Point 00, Jess and I are presenting at the Going Digital: Behavioral Health conference today — tune in later for that. On Episode 212, our buddies at DayTwo get $37 million for the gut microbiome. Hello Heart raises $45 million, bringing their total to $68.2 million – this is for high blood pressure management. Pack4U, which is like the knockoff version of Pill Pack, raises $20 million. Swedish telemedicine company Doktor.se raises $50 million, and Curebase raises $15 million for decentralized clinical trials. —Matthew Holt

Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare

By HANS DUVEFELT

My nurse regularly gets at least 50 voicemails every day, many saying “please call me back”.

I have one patient who frequently tests the patience of our clinic staff by calling multiple times for the same thing. He is the most dramatic example of what seems to be a widely held belief that physicians, nurses and medical assistants sit at their desks and answer phone calls all or most of their time. But when we do, we are often hampered by busy signals, phone tag or “voice mail not set up”. Electronic messaging isn’t a panacea, because patients don’t necessarily know what we need to know in order to answer their questions correctly and efficiently at first contact.

Pharmacies, too, create duplicate requests that bog down our workdays. In my EMR, if an electronic refill request doesn’t get a response the day it comes in, the “system” sends a repeat request every day until it gets done. This is one reason I look like I am further behind on “tasks” than I really am. To top it off, every single refill request generated by the “system” comes with a red exclamation point next to it. This happens even when a patient has just picked up their last 90 day refill – a case where I theoretically should have 89 days to respond. Meanwhile, my system has no way of flagging truly urgent refill requests. This “alarm fatigue” is common in EMRs today.

The business model in today’s healthcare is that reimbursable activities (seeing patients in person or via telemedicine) are scheduled back to back, all day long. There is a universal assumption that this will still provide enough slack to deal with prescription refills, phone calls, incoming reports and the further ordering and feedback to patients prompted by them. And did I mention EMR documentation? Multitasking, or rather, constantly switching between different kinds of tasks, is not a sane or efficient way to work.

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