Ned Anderson: The Digital Health Update by Paul Sonnier ⋅ Mar 25, 2017 ⋅ #266

Dear Group,

While the draconian Obamacare replacement bill put forth by President Trump and Republicans failed in spectacular fashion (apparently Americans want healthcare as a right), a separate bill that would allow employers to require genetic testing of employees is still in the legislative pipeline. In a NYT op-ed, Dr. Louise Arinson writes that the “Preserving Employee Wellness Programs Act” could result in “state-sanctioned health discrimination” of “genetic mutants” like her, including people who are overweight, diabetic, have high blood pressure, or poor exercise habits. As for an alternative or expansion of Obamacare that would drive down the $3.2T in U.S. healthcare spending (2015) and provide care to all Americans, economist Dean Baker has a few suggestions, including open source drugs (savings of $200-360B/yr), immigrant doctors (savings of $100B/yr), and a public option (savings of $20-29B/yr). While corporate welfare and protectionist trade policies that create inertia in these structural features of healthcare are unlikely to shift anytime soon, digital health’s external disruption can continue to chip away. One such solution is Nomad Health, which was just featured in the WSJ. Company founder Dr. Alexi Nazem says the company’s “goal is to be the Airbnb of health care”, thereby offering doctors a business-to-business path into the gig economy.

Paul Farmer, cofounder of Partners In Health and professor of global health and social medicine at Harvard University, has an op-ed in the NYT pointing out that humans aren’t winning the war on TB. With approximately 1.5 million deaths per year due to the disease, Tuberculosis is currently the No. 1 infectious killer (exceeding HIV), with early diagnosis and treatment being the biggest hurdles. Paul points to new drugs in development that may help in treatment, while on the detection side a new, low-cost blood test providing same-day results could help as could a new genome sequencing diagnostic.

By applying genetic testing to gain insights into results of different types of exercise for aging bodies, a study by Mayo Clinic researchers discovered that interval exercise trainers had nearly 400 genes activated and working differently as opposed to only 33 for weight lifters and 19 for moderate exercisers. Many of these genes may influence the number and health of our mitochondria, which serves as a sort of correction for cellular aging.

In a randomized clinical trial of patients using a mobile app to facilitate home monitoring following surgery, it was demonstrated to a statistically significant degree that app-users had fewer in-person visits for follow-up care during the first 30 days after hospital discharge as opposed to patients in the in-person follow-up care group.

In a 20-year-long study by researchers at UC Davis, it turns out that telemedicine saves time, travel costs, and improves air quality. It was calculated that telemedicine visits saved patients over 8 years of travel time, 5 million commuter miles, and $3 million in total costs. It’s important to note that when discussing healthcare cost reductions, the burden of patients should always be considered. Moreover, air quality is a major public health issue. Outdoor air pollution kills about 3.5 million people worldwide every year.

The unraveling of Theranos, the lab-on-a-chip blood testing startup that didn’t deliver on its technology promises, continues. The WSJ’s John Carreyrou, who, along with Christopher Weaver, has been the main investigative reporter on this story from day one, reports that the company is shielding itself from lawsuits by board members via offering them shares in the company taken from the personal stake of founder Elizabeth Holmes. Rupert Murdoch and famous lawyer David Boies have already taken the deal on their way out. Even Jim ‘Mad Dog’ Mattis, who Trump picked as U.S. Secretary of State, exited the board of directors back in January. Walgreens, a former partner has sued the company, as has the state of Arizona, which alleges that the company defrauded consumers. The unfortunate story of Theranos casts an undeserved cloud over the many other digital health lab-on-a-chip microfluidics technologies and companies. Here’s a partial list of nearly 300.

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