M-Health forging Ahead

Here are some great articles from mobilehealthnews.com on the uptake of mobile health solutions, particularly using the iphone:

Roche decides it’s time to enter mHealth. Roche Diagnostics inked a deal with Glucose Buddy iPhone app developer Healthagen, because Roche believes that the time to get into the wireless health market is now. While the company’s Accu-Chek educational program for diabetics is a far cry from meter integration for mobiles, Roche plans to work toward integrating glucometers in the future.

Interview: Mayo Clinic forges its mobile strategy. Every major provider of health services and information is trying to figure out how best to go mobile. Scott Eising, director of product management for Mayo Clinic’s Internet Services offered a peek behind the curtain at Mayo to discuss how the not-for-profit, integrated medical practice is planning to do just that. It covers basic functions mhealth is likely to use such as symptom checkers, and find a doctor, as well as more complex things like health and wellness trackers. Great article for anyone going into the mHealth sector. Best quote, “It’s a ways out but the key is not to wait until it gets here“.

Aetna: Ultimate goal is health info on-the-go. Aetna’s Head of Digital Engagement Strategy and Innovation Robert Heyl understands that health decisions mostly occur while people are going about their daily lives, so that’s why his ultimate goal is to take the information in SmartSource, Aetna’s online patient portal, and bring it to the mobile platform.

Interview: Google Health on mobile is criticial. Google Health Product Manager Roni Zeiger makes it clear that mobile phones, connected devices and mHealth applications will become a crucial part of Google’s health plans moving forward.

Fixing America’s Health

There is no quick fix. But I admire Obama for getting his hands bloody. If the least he achieves while in office is a debate near the scale we are having, I think he’s done better than most. To have so many industry leaders offering cost-concessions is already quite a coup.

WSJ has offered a few great articles of late that give an overview of the aims, the history and the objections to Obama’s reform.

First up, they answer ten key questions about the overhaul. It begins with, what is the problem anyway? Their answer – high costs and a lack of coverage. They also point out that the oft-quoted figure of 46 million without health-coverage is artificially inflated.

Their second point is that there is one point of universal agreement -compensation should be outcomes-based, not based on the quantity of procedures. Easily said, difficult to do.

The next question is about Democrat/Republican differences. While I don’t know if the divide is straight down the middle as suggested, there certainly are some strong dissenters in the Republican camp. Bobby Jindal thinks the reform will make the same mistake Hillary did in ’93 and ’94 – philosophical over-reach and lack of consensus building. Then he reinforces WSJ’s second point – that pay should be performance based. Closely tied to that is the need for consumer choice guided by transparency (including electronic health records).

The final points really say two things: it will be expensive, and it will probably happen this time around despite a history of failure.

WSJ's Summary

Obama has taken to highlighting the example of places like the Cleveland Clinic. The clinic has got many things right, and most notably, is involving patients more in their own care by allowing them, for instance, to upload their own information into their health records.

Pharma 2020: PwC Analysis

PwC’s latest industry synopsis offers some of the bleeding obvious, but also a few gems that I think companies are perhaps not too aware of.

The clincher for me is in the following excerpt:

Management guru Clay Christensen has convincingly demonstrated how disruptive innovations in various industries have dismantled the prevailing business model, by enabling new players to target the least profitable customer segments and gradually move upstream until they can satisfy the demands of every customer – at which point the old business model collapses.

Pharma is currently undergoing just such a period of disruptive innovation. By 2020, most medicines will be paid for on the basis of the results they deliver – and since many factors influence outcomes, this means that it will have to move into the health management space, both to preserve the value of its products and to avoid being sidelined by new players.

Indeed there is some partnering occurring. we are seeing pharma team up with devices groups and enlist all sorts of health-related technology companies.

The report mentions that several companies have already attempted to create disease management offerings, but met with no success. It highlights the shift towards outcomes measurement and personalized medicine.

My personal view is the following:

The ‘disruptive innovation’ will ultimately be consumer driven. Already consumers are trying to take control of their health related information and better measure the success of their treatments. In the same way that doctors will increasingly become partners in managing health (moving away from dictating treatments), industry will have to learn how to partner with patients.

Therefore the obvious next question is how industry, and particularly drug companies, can begin to partner with consumers? The answer, to me, is that the greatest asset pharma companies have is access to the drug-related information people need. Pharma’s greatest value in the chain of treatment is not in R+D, clinical trials, or health technology assessment – it is ultimately that as managers of the treatment-related information, it is in the best position to decide how a drug or other treatment can be used.

If they can link this knowledge to individuals health data then they can superceed other players.

To do this pharma needs to begin looking at information systems that will allow them to measure individual patient outcomes and provide adaptive feedback. It may require investment in the EHR space and other technologies such as mobile apps.

There are some barriers to dealing directly with consumers, more in countries like Australia than in the USA. This is then the first step – understand how this collaboration is going to work and what other players we need to engage to make it work.

For another synopsis of the PwC publication see FiercePharma.

Facebook better than Games

From 6minutes.com.au:

Youngsters should put down the gaming console and log onto Facebook to improve their wellbeing, an Australian study has found.

The study, which surveyed over 900 adolescents aged between 13 and 19, found that Victorian youngsters spend more than two hours watching television each day, followed by 35 minutes playing video games and nearly 20 minutes on the computer.

Those who played video games rather than using the computer showed poorer health and higher levels of psychological distress, and computer users showed slightly lower behaviour problems than non-users.

While games may stimulate aggressive behaviour and reduce social involvement, the study notes that surfing the net may, in fact, encourage social networks and improve mental health.

“E-mailing and instant messaging are an important means of communication and interaction… Boys who spent more time on the internet and doing homework reported a more active lifestyle and higher self-perceived social support to those who used the computer for playing games,” the report’s authors say in Academic Pediatrics.

It’s kind of like saying ‘doing something is better than doing nothing’!

Another Medical Search Tool: Quertle

Looking for a new way to search the literature?

From www.quertle.info:

More than simple keyword searching: Quertle goes beyond simple term matching to identify the most salient information in the literature. Using a combination of linguistic methods, Quertle finds facts defined within documents, creating its own database of nearly 150 million relationships, and is able to report the ones that are relevant to your query. Quertle’s approach is based on a thorough understanding of biology and chemistry and was built from the ground up to address the unique needs of this technical literature.

Power Terms™: Quertle is able to extend its extensive biological and chemical sciences underpinnings to the definition of “Power Terms™” that represent a class of entities. For example, the Power Term™ called $Proteins represents all protein names, thus enabling unique queries such as “what $Proteins regulate cell cycle?”. Try it!

Easy exploration: Quertle provides a set of useful filters directly on the results page to help you navigate and explore the results. The “Key Concepts” filter automatically lists key concepts found in the result set so you can quickly focus in on concepts of interest. When a Power Term™ has been included in the query, the “Key Concepts” filter presents members of the Power Term™ class to answer your question. For the above example, all proteins that are involved in the regulation of cell cycle will be presented.

What content does Quertle cover?
Quertle uses MEDLINE® as provided by the National Library of Medicine. Additional document sources are coming. Let us know what you think we should add next.

Who is behind Quertle?
Quertle has been created by biomedical scientists, chemists, and linguistic experts, who have many decades of experience with research and finding relevant information to support that research.

Only Moore’s Law can save Big Pharma

An interesting article by Bill Frezza – read below:

If ever there was an industry at risk of being sunk by not one but three category five hurricanes, it’s the pharmaceutical industry. Whether it’s on the political, economic, or scientific front this major contributor to our nation’s financial and physical well being is headed for wrenching transformations.

Politically, Big Pharma is at the mercy of all three branches of an increasing hostile government. The executive branch, through its regulatory agencies, has raised the cost of product development to astronomical heights. The judicial branch, through its class action machinery, has made the penalty for delivering anything short of zero-defects untenable. And the legislative branch, on its way to becoming the industry’s monopsony purchasing agent, is hell bent to drive prices down to the marginal cost of production.

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Economically, Big Pharma continues to deliver less and less for more and more. A new blockbuster cancer drug is almost never a cure. The “good” ones have no effect on most patients besides making their hair fall out while helping some “fortunate” subset die in 15 months instead of 12. For some advanced biologics, this pathetic result comes with a sticker price of $100,000. The only reason there are any customers at all for products this bad is that someone else is paying the bills.

Scientifically, the classic drug discovery paradigm has reached the end of its long road. Penicillin, stumbled on by accident, was a bona fide magic bullet. The industry has since been organized to conduct programs of discovery, not design. The most that can be said for modern pharmaceutical research, with its hundreds of thousands of candidate molecules being shoveled through high-throughput screening, is that it is an organized accident. This approach is perhaps best characterized by the Chief Scientific Officer of a prominent biotech company who recently said, “Drug discovery is all about passion and faith. It has nothing to do with analytics.”

Does this sound like science to you?

The problem with faith-based drug discovery is that the low hanging fruit has already been plucked, driving would be discoverers further afield. Searching for the next miracle drug in some witch doctor’s jungle brew is not science. It’s desperation.

Read the rest of the article here.

PubGet – a new search tool

Ever been frustrated by the myriad of links and publishers pages you have to wade through to access a PDF? PubGet now allows you to cut out the middle man and get the file directly. It automatically checks your access rights from your home institution and delivers you straight to the paper of interest.

Personal Genomics is Here!

Most people believe it is still pie-in the sky, even the stuff of science fiction. But at a recent consumer genetics show, Illumina CEO Jay Flatley unveiled their new personal sequencing service valued at $48,000.

At first glance this seems like a lot. But I believe this may already be a cost effective preventative health measure for some people. If delineating your genetic risk allowed you to predict likely future health related events, wouldn’t you be better prepared and in a position to, say, avoid income loss?

If other sequencing technologies such as that of Pacific Biosciences (story here) progress as hoped, the time and cost required for a sequence will drop dramatically within a few years. Already, Illumina’s system offers 30-fold coverage (better than that of the original human genome sequencing project only 9 years ago!), so quality of sequence does not seem to be an issue.

Navigenics, 23andMe, deCODEme and Knome are all partnering with Illumina to provide interpretation and predictive studies of the genetic markers. It is only a matter of time before the data pool increases and the power of the analysis increases. Illumina also believes their foray will catalyze the infrastructure and physician education necessary for genetic information to become more meaningful.

Websites that Rate Doctors having an Impact

In a world where patients can sound off about their doctors at RateMDs.com, Yelp, DrScore, Angie’s List, Vitals.com and some 35 other sites, what’s a doctor to do? In some cases, they’re striking back by demanding that patients sign contracts prohibiting them from making online comments in any media outlet without prior written consent from their practice.For more details read this Washington Post piece.

This trend is only just beginning is Australia where RateMDs.com now has quite a few Aussie doctors on it’s books. But it will change the way doctors operate, just as feedback should.

Some doctors are particularly concerned about the issue. In 2007, the Australian Medical Association condemned the idea. A company in the USA called, Medical Justice, offers a sample privacy agreement starting a $495 and monitors online comments for its 2,000 members. The general feeling is that online comments may do serious damage to a doctor’s reputation while revealing little about their real skills.

There has been some discussion about medical performance indicators in Australia for some time. There was talk of uploading information about a doctor’s mortality, complication and infection rates. This idea was squashed, particularly by surgeons who feared the stats might be misinterpreted where some surgeons do more difficult cases etc.

My view is that there is no way doctors can stop this trend. Feedback will happen some way some how. Where once it was through the daily gossip mills, now it’s online. This is all part of the consumer revolution that will bring, to use another mans term, disruptive innovation to medicine.

Mobile Phones the next Health Platform

Mobile phones could be the next major platform for personal health monitoring tools, experts say.

In the future, people could use mobile phones to share, store and add information to their personal medical records. In addition, people with chronic conditions could use special add-on devices to monitor diabetes, blood pressure or oxygen levels in their blood.

In an iHealthBeat Special Report by David Gorn, experts discussed the potential applications of mobile health monitoring technology.
http://www.ihealthbeat.org/special-reports/2009/mobile-phones-could-store-electronic-health-records-boost-personal-health-monitoring.aspx