SplashX Invent Health Precision Health is 9/27, Thursday

Bambi Francisco Roizen · September 25, 2018 · Short URL: https://vator.tv/n/4c29

Apple Watch 4; Helix seeks partners to broaden DNA tests; How would you define Precision Health?

For once, I know what I want for Christmas - an Apple Watch 4.

Last week, I sat down with founders of a precision medicine startup who were all sporting fitness trackers, a clear indication they valued data collection. Admittedly, I'm one of the few without a wearable fitness device (save for the occasional heart rate monitor), the most popular wearable in 2017, according to Statista, which projects sales to top $3 billion by 2022 in the U.S. That's changing.

Since I've been reading up on precision medicine and precision health in preparation for our Precision Health salon on the evening of September 27 at HP headquarters in Palo Alto, I've become a convert. I want to track data about my health! 

Hence my selection of an Apple Watch (for Christmas), which has new features, such as fall detection (if you fall, Siri will call 911 - though this feature has been offered by iBeat for some time) and a built-in EKG (though Alivecor has had an EKG wristband in the market). 

There are critics who say the information is not that accurate, and there are those who praise the watch -- "How Apple Watch saved my life." But you'll get both sides as the technology improves. In my son's "Little Kids First Book of Why" book, the inventor of TV says he always told his kids not to watch TV because there was nothing good to watch. In like vein, the information may be spotty and scant now, but over time, it'll blow our minds.

In fact, we're in for a long journey toward organizing and gathering the data for precision medicine. That's why we're hosting our salon on September 27 at HP headquarters in Palo Alto. We want to know how precise we're getting at diagnostics and treatments. We want to know what kinds of data have helped the most. And what kind of new data are we collecting.

Ahead of the event this Thursday (JOIN US), here's my brief roundup of interesting stories around the topic of precision health.

The new ECG Watch could do more harm than good

A good piece in Wired that raises the point that EKG (electrocardiography - a way to capture the electrical activity of the heart) tests of asymptomatic patients were common at annual physicals until the cost/benefit analyses showed this practice impractical. Wired cites an editorial in the Journal of American Medicine. The piece also cites a 2012 recommendation by an independent volunteer panel of national experts in disease prevention to not perform ECG screening in asymptomatic adults at low risk for heart disease. The group, called US Preventative Services Task Force, maintained that position in 2018.

Why this position? "Possible harms are associated with screening with resting or exercise ECG, specifically the potential adverse effects of subsequent invasive testing," according to an abstract published in JAMA. In other words, paranoia may run rampant. 

This is a great quote captured by Wired. "The more democratized you make something like ECG, he says, the more you increase the rate of false positives—especially among the hypochondriac set," said cardiologist Theodore Abraham, director of the UCSF Echocardiography Laboratory. 

Read more. 

Helix in search to broaden its suite of DNA tests

I'm excited to have Chris Glode, Chief Product Officer at Helix, join us this Thursday. evening. As the head of product at the DNA testing and platform company, Chris is seeking partners to broaden Helix's suite of DNA tests. Currently the company has 35 tests of your genes to come up with all sorts of insights, such as a personalized diet plan, an assessment of your athletic ability to your risk for getting late-onset Alzheimer's.

I asked Chris what he's looking for in partners.

Here's what he said: "Our four core categories are Health, Ancestry, Entertainment, and Wellness.  Within each of them, there’s potential for such a rich range of experiences. On the health side, we’re helping companies who specialize in research and/or clinical DNA tests to make them available directly to customers.  We have a team with deep expertise in designing, building, and marketing consumer products that can help them with this transition. We have a number of great applications from partners in the Ancestry category today, and we think that this area holds tremendous potential as well for future partners - it’s certainly where many consumers are beginning their DNA journey today.  The Entertainment vertical already has some really interesting products on Helix and we see that growing rapidly, especially since the objective can be more fun and education and less serious. Within Wellness, we have partners that have incredible phenotypic data sets around fitness, weight loss, athletic performance, and nutrition that have the potential to make new discoveries and incorporate them into new products that can help people live a better life. The possibilities are nearly endless when you look at the sum of all the categories."

Read more.

Atul Butte managing Priscilla Chan and Mark Zuckerberg's $10M gift

I'm excited to also have Atul Butte join us at our Precision Health salon this Thursday evening, September 27 at HP headquarters in Palo Alto. Atul is the director of UCSF's Institute of Computational Health Sciences, which received a generous gift this summer. 

Last October (almost a year ago today), Atul was appointed to the Governor's Advisory Committee for Precision Medicine. 

Priscilla Chan and Mark Zuckerberg gave $10 million to UCSF this summer to help fund an effort to merge data on 15 million patients across five UC medical campuses in one database and uses artificial intelligence to make sense of this data. The goal, according to a write-up in the San Francisco Chronicle, is to "detect patterns in disease development" in order to find better treatments. One example is looking at people profiles to see how they've responded to certain drugs and apply those case studies to people with similar profiles. This is something already done at a much smaller scale, but obviously something advanced algorithms can do with larger sample sizes. The probability of a certain drug being effective for a particular profile may look poor when looking at 500 cases, but may look more positive when looking at 5,000 cases.   

Why is AI taking off? Data availability. Besides our medical history from EMR, we now have genomic data of our DNA and more current / fresh data from our wearables that monitor our glucose levels, blood pressure and heart. 

Last October (almost a year ago today), Atul was appointed to the Governor's Advisory Committee for Precision Medicine. 

Read more.

How does Virta Health make money?

I'm also excited to have James McCarter, Director of Research, at Virta Health join us this Thursday. From a positioning standpoint, Virta is one of my hero companies. It seeks to reverse Type 2 diabetes with lifestyle changes vs medications. I'm a big fan of any company trying to promote lifestyle and behavioral changes over medications. Virta sells its behavioral management services to self-insured employers. Its solution is continuous remote care. 

Patients televisit with a doctor and receive a personalized treatment plan, plus a health coach. Patients have access to their health coaches via their smartphone. A patient can even text their health coach daily to ask questions such as, "I'm going out to dinner, what do you recommend I order?" Not only can patients have access to their coaches and physicians, but physicians and scientists can have access to a person's vital signs. Virta's clinical team then can analyze on a real-time basis a person's weight, mood, cravings, etc. and adjust treatments - nutrition, or medications, if a patient is on medications, or behavior. A patient is monitored until type 2 diabetes is reversed or goes into remission. Dr. McCarter calls this "wrap-around intervention," with Virta becoming the patient's long-term metabolic health specialist. The solution can remove a person off medications in under 70 days. Wow. Interesting to note that Virta hasn't treated anyone over 70, or anyone in active chemotherapy. Check out Dr. McCarter's slide deck about Virta.

For Virta's commercial agreements with enterprise customers, the company goes at risk for its fees with half of payments based on achieving success at one year - retention and specified A1c reduction. It's $2500 at enrollment and $2500 at the end of one year. In the second year, prices are cut in half and are again at risk based on patient performance.

Read more on Virta's business model.

What does Precision Health mean to you?

I believe Lloyd Minor from Stanford School of Medicine coined the term "Precision Health." Since it's not as common as precision medicine, I asked our guests and speakers at our upcoming Invent Health salon on Precision Health, to define the term.  

Here's some responses:

James McCarter, Virta Health:

Precision Health allows individualization of medical intervention by responding to phenotype in real time.

James Hardiman, Partner, DCVC:

Right intervention at the right time for the right patient.

Amy Raimundo, Partner, Kaiser Ventures

Precision Medicine” is the better matching of treatment to a specific patient’s needs using all available tools. We don’t see the concept of precision medicine as new, but what is new is the tools (ie. computational power, genomics, etc) that we can apply to get even better at this.

Damin Hostin, CEO, Precision Medicine Alliance

Precision Health uses data from multiple areas from genetic code to ZIP Code to form cohorts of populations that need specialized interventions to either optimize health or mitigate risk. In the high acute setting- this is precision Medicine -  to turn the tide of the worst diseases. I think we all hope to move people out of the latter into the former category.

DNA tests and horoscopes?

Not to be too much of a cynic. But...

I agree that DNA test information will be useful over time (and perhaps to some extent today), but in the early stages of any innovation, there's definitely a high level of skepticism.

In some ways, these tests seem as far-fetched and dubious as horoscopes. Not a novel view, the BBC first pointed this out five years ago

Astrology is a belief that the alignment of stars and planets affect our personality and who we are. The critique is that these character traits they assign to different signs are found in most people. I'm a Sagittarian, so apparently I'm inclined to search for the meaning of life. That's great. That sounds like me. But how true is it that my horoscope defined me and/or others born around the same time? Or isn't it fair to say that we all are predisposed to searching for our meaning in life? And if that's the case, what's the new insight about me? More importantly, should Sagittarians follow the suggested lifestyle choices, such as marrying a Leo since the personalities of these two types are a good match? Ultimately, I think more insight into who we are is good. But knowing my children will have zero athletic ability in golf but are destined to be the world's best mountain climbers, would probably not lead me to dissuade them from playing golf nor will it push me to take them mountain climbing every weekend.

Until I'm clear on the actionable insights, I'd probably not be a buyer of these DNA tests now. But that doesn't mean I don't see them adding some value for others.

Image source: Fossbytes, BBC, Stanford 

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Bambi Francisco Roizen

Founder and CEO of Vator, a media and research firm for entrepreneurs and investors; Managing Director of Vator Health Fund; Co-Founder of Invent Health; Author and award-winning journalist.

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Jim McCarter

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MD PhD scientist, entrepreneur, head of research at Virta Health, founder of Divergence & The Young Scientist Program, Aspen Institute fellow, Adjunct Professor of Genetics at Washington University

James Hardiman

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Parter at Data Collective

Hiliary Critchley

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Christopher Glode

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Digital product management lead with deep experience in fitness, health and location-based services. My career has focused on mobile, web, wearable and IoT products and platforms serving consumers, enterprises, and developers.

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