Today on Health in 2 Point 00, we’re wishing Jess a happy belated birthday! On Episode 189, Jess asks me about DispatchHealth raising a massive $200 million Series D, bringing their total up to $403 million, providing in-home urgent care. TytoCare raises another $50 million for their Series D, bringing their total up to $155 million, providing tech-enabled health at home with their device and providers. Finally there’s a partnership with Highmark Health, Google Cloud, Verily, and OnDuo – what’s going on with this lot? —Matthew Holt
Above the Fold
Your Health Data May Be a NFT
By KIM BELLARD
I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing — how I could I resist?
There may even be a connection to health care.
You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April. What is new is that last month its creator “sold” it. You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?
That’s where NFTs come in. As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron. Non-fungible, then, means the item in question is unique, and this is where the “token” comes in. Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.
Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal:
Think of it like a digital passport that comes with an asset. They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.
Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann). Christie’s promises:
…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value.
NFTs have gone beyond art. The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000. Maverick’s owner Mark Cuban is a big proponent. “The tech is real,” he told CNBC. “The impact is real, and permanent.”
Continue reading…Kelsey Mellard, CEO Sitka
By MATTHEW HOLT
Kelsey Mellard is CEO of Sitka, one of the emerging companies that’s providing specialty consults online to primary care docs. They’ve been building a specialty care network that can be accessed by asynchronous video, slightly different to some of their competition. Most of their customers are capitated medical groups, like ChenMed, trying to reduce their spend on specialty physician care (as Kelsey calls it the “unmanaged Part B spend bucket”). I asked her how it works, where the company is going (think virtual care integration), and whether it will be needed in the future. (You can guess her answer to the latter!)
Pandemic Accelerants: Life Under the “New-Normal.”
By MIKE MAGEE
Confrontation is good. Governor Abbott’s “We are getting out of the business of telling people what they can and cannot do” was “Neanderthal thinking” as President Biden said. Insurrectionist Richard Bennett, whose feet sat on Speaker Pelosi’s desk two month’s ago, does need to cool his jets in jail awaiting trial. And states lagging in immunizing teachers, opening schools, and accelerating their vaccine efforts need to realize that they will be held accountable by voters in the near future.
That is surface turbulence, but quietly below the surface, there are other transformational forces underway fueled by pandemic accelerants.
How long would it have taken under normal circumstances to advance equitable access to broadband and tech devices for all students in America? A decade from now, would we have advanced teacher skills in long-distance learning to the degree we are now witnessing? And how many at-home workers will be willing to return to off-site offices in the near future?
These are just a few of the questions being considering as we return to “normal” or life under the “new-normal.” And while we are all doing our best to cope with the fear and worry that comes with change, most of our collective anxiety is now focused on economic security and jobs.
This past month we added 379,000 jobs. Sounds great, that’s if you ignore the fact that there remain 9.5 million fewer jobs in our economy compared to a year ago, or that first-time jobless claims rose last week. As former Federal Reserve economist Julia Coronado reported, “We’re still in a pandemic economy.”
Continue reading…Correlative Adventures with COVID
By ANISH KOKA
“The patient in room 1 should be a quick one, its an addon, they just need a prescription for ivermectin”
I’m a bit puzzled by this sentence from my assistant doing his best to help me through a very busy day in the clinic that I’m already behind in. I walk into the room, a script pad stuffed into my hand as I enter the room, to meet a very nice couple. The wife sits patiently with hands crossed on the exam table.
“So, you’re here for Ivermectin?”, I ask.
Why yes, a trip to Texas is planned.. COVID is in the air, the internet, and some important people who have ‘inside knowledge’ have raised doubts about the vaccine. Some other people who quite possibly could be the same people, have also suggested prophylactic ivermectin is the better bet to prevent these good people from catching COVID.
Ivermectin is a drug known to work against parasites. The virus angle relates to in vitro data that suggests Ivermectin inhibits the host importin alpha/beta-1 nuclear transport proteins, which are part of a key intracellular transport process that viruses use to enhance infection by suppressing the host’s antiviral response. In addition, ivermectin may interfere with the attachment of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein to the human cell membrane. Ivermectin demonstrates a broad spectrum of activity in-vitro against a variety of viruses like dengue, Zika, HIV, and yellow fever. Unfortunately, despite this in vitro activity, no clinical trials have reported a clinical benefit for ivermectin in patients with these viruses.
Ivermectin does inhibit Sars-Cov2 viral replication in cell cultures. However, pharmacokinetic studies suggest that achieving the plasma concentrations necessary for the antiviral efficacy detected in vitro would require administration of doses up to 100-fold higher than those approved for use in humans. Even though ivermectin appears to accumulate in the lung tissue, predicted systemic plasma and lung tissue concentrations are much lower than 2 µM, the half-maximal inhibitory concentration (IC50) against SARS-CoV-2 in vitro. Subcutaneous administration of ivermectin 400 µg/kg had no effect on SARS-CoV-2 viral loads in hamsters, though there was a reduction in olfactory deficit and a reduction in the interleukin (IL-6:IL-10) ratio in lung tissues.
Since the pandemic began, there have been a number of small randomized controlled trials of ivermectin in mild COVID patients that show more rapid viral clearance, but not too much else. The prophylaxis data is considerably more sparse, and is of the retrospective variety. Basically take a number of countries that use Ivermectin variably and compare the incidence of COVID in those countries.
Continue reading…A Plan to Conquer U.S. Drug Shortages
By JESSICA DALEY and WAYNE RUSSELL
COVID-19 has focused the nation’s attention on the risks associated with complex, global supply chains, particularly related to healthcare products and prescription drugs. While supply disruptions of personal protective equipment (PPE) captured headlines, the pandemic also compromised the drug supply chain. With much of the United States’ generic drugs manufactured overseas, exportation bans coupled with increased global demand created significant challenges for U.S.-based providers to secure basic, life-sustaining and life-saving therapies.
As an “easy” solution, many are now calling for manufacturers to produce medications domestically. While expanding investment in U.S. drug-making capacity is a vital component of a reliable supply strategy, moving the majority of production onshore is unrealistic.
Creating a dependable drug supply chain is a multi-faceted issue that requires a thoughtful, diversified strategy.
Repairing the Market is Job #1
Drug shortages have been pervasive for more than a decade – well before COVID-19’s onset. While shortages are triggered in a number of ways, arecent Food and Drug Administration (FDA) report says economics are a main causative factor.
Almost all shortage drugs are older, low-cost generics costing less than $9/dose. Because these products don’t generate blockbuster profits, manufacturers are less willing to invest capital to improve quality, build redundant capacity or source safety stock. Over time, market competition continues to erode price and further compress profits, leading to a war of attrition where competitive players exit the market – leaving behind as few asone or two manufacturers in many important categories.
Relocating production to the United States will not address generic drugs’ inherent profitability problem. Increased regulations, environmental and otherwise, could lead to higher production costs, which begs the question: will healthcare providers trade the potential for higher costs for predictability in supply?
Continue reading…THCB Gang Episode 45, Thursday March 4, 1pm PT – 4pm ET
Joining me, Matthew Holt (@boltyboy), on this week’s THCB Gang will be THCB regular writer Kim Bellard (@kimbbellard), medical historian Mike Magee (@drmikemagee), policy & tech expert Vince Kuraitis (@VinceKuraitis), patient safety expert and all around wit Michael Millenson (@MLMillenson), and consumer expert and current President of the Medical Board of California, Denise Pines.
Vaccines at warp speed, some “Neanderthal” state governors opening up, but also a pandemic bill passes the house with some health policy implications. Plus lots of fun and games in the world of digital health and startup health plans. We should have something to discuss!
You can see the video below live and the audio will be on our podcast channel (Apple/Spotify) from Friday
Wanna Buy Some Bitcoin
By KIM BELLARD
To healthcare organizations, digital currency is the thing you’re forced to deal with when your systems are held for ransomware. To the rest of the world, it’s increasingly starting to look like the future.
Tesla caused somewhat of a stir last month when it disclosed that it had bought $1.5b of bitcoin. It also said it would start accepting bitcoin payments for its cars. CEO Elon Musk added to the furor, saying: “I do at this point think bitcoin is a good thing. I’m late to the party, but I am a supporter of bitcoin.”
Most of us are late to the digital currency party.
Bitcoin’s market cap hit $1 trillion in mid-February, although it now hovers just over $900b, with Ethereum another almost $200b. Tesla is making more money from its bitcoin investment than from its core businesses. In the scheme of global financial markets, digital currencies are still small, but are not something any CFO should be ignoring.
Tesla is not the only major company accepting digital currencies; Overstock, Starbucks and Twitch do, as three wildly different examples. Twitter is thinking about paying vendors or even employees with bitcoin. Facebook expects to launch its own cryptocurrency this year.
I’m not aware, though, of any major healthcare companies accepting or paying with digital currencies. No Tesla-type breakthroughs in healthcare.
Continue reading…Moderna’s “Secret Sauce”
By MIKE MAGEE
This week J&J gained FDA approval for their 1-shot COVID vaccine, leading optimists like Pfizer Board member, Scott Gottlieb, to predict that we will have 100 million shots out there by the end of April, and on-demand offerings for the general public. In the race toward herd immunity, we could easily ignore a revolutionary change in pharmaceutical design and manufacturing occurring under our noses.
Case in point: Moderna – subject of a recent case study by Marco Iansiti, Karim Lakhani, Hannah Mayer, and Kerry Herman in the Harvard Business Review.
Moderna – labeled by its CEO as “a technology company that happens to do biology” – was founded in 2010, with $5.1 billion in venture capital backing, “designed from the ground up as a digital biotech company with a factory for in-house manufacturing capabilities.” Up to this point, as they entered their 11th year, they had not brought a single product to market.
Moderna was the child born of Cambridge-based Flagship, run by Noubar Afeyan, an MIT bioengineer and world leader in bio-instumentation. His raison d’etre was “radical innovation.” He not only wanted to do big things, but do them faster than anyone else. As he said, “Asking ‘What if?’ questions propels you far into the future. It may be unrealistic or overly optimistic, but that’s how radical innovation happens.”
To accomplish this outsized ambition, he invested in a four-step process:
1. Generate break-through innovation hypotheses (what-if’s).
2. Explore the hypothesis. If it looks good, set-up a prototype company.
3. If initials prove out, go permanent with a New Company.
4. If promising, spin it off as a Growth Company.
Continue reading…#Healthin2Point00, Episode 188 | MDLive, Devoted Health, Medisafe, January AI
Today on Health in 2 Point 00, we cheat a little bit and go overtime. On Episode 188, Jess asks me about MDLive getting acquired by Cigna’s Evernorth division, Devoted raising a whopping $380 million, Medisafe getting $30 million in a round led by Sanofi, and January AI raising $8.8 million bringing its total up to $21 million. —Matthew Holt
