Getting Physicians Involved in Digital Health

Getting Physicians Involved in Digital Health

Ben Schwartz, MD

Meet Ben Schwartz, MD, an orthopedic surgeon who’s dived into digital health.

podcast available

Dr. Schwartz is a board-certified orthopedic surgeon specializing in surgical and non-surgical treatment of hip and knee arthritis. He has extensive experience in digital health and serves as a chief innovation officer for Healent, an early-stage healthcare technology company. He also holds mentorship positions with incubators and accelerators, as well as advisory roles. He’s a prominent voice on LinkedIn and other social media platforms.

The Promise of Technology

MDisrupt: What got you interested in digital health?

Ben Schwartz: I had a pretty traditional practice for the first 10 years of my career. I’ve always been fascinated by computers and gadgets and new ways of doing things. About two or three years ago, I became aware of this whole world of digital health, which was maturing. We have this healthcare system that doesn’t work in a lot of ways. We have technology that works in other aspects of our lives, but we’re not really utilizing it well in healthcare. How do we adopt technology in healthcare to make things better?

MDisrupt: You’re a top voice on LinkedIn and your posts really get the conversation started. What impact do you think you’ve had?

Ben Schwartz: When I started to become interested in this, I was your traditional orthopedic private practice surgeon outside of a major metropolitan area. I didn’t necessarily come across people in digital health. LinkedIn became a great way to open doors.

MDisrupt: You wrote, “Big tech doesn’t need healthcare. Does healthcare need big tech?” What’s your answer?

Ben Schwartz: I don’t think healthcare necessarily needs big tech. We know healthcare needs to do a better job incorporating technology, because we lag behind other industries. I do think big tech has the potential to address a lot of issues in healthcare, from an access as well as a technological standpoint. You’re talking about some of the biggest, most resource-rich companies in the world and one of the biggest problems we’re facing, not just in this country, but in the entire world. 

Google and Apple have shown interest in healthcare. Whether that persists I don’t know. The clinics that Apple supposedly was trying to open up were really fascinating—it’s disappointing to hear that maybe that didn’t work. Amazon is doing their typical approach of starting slowly and testing use cases and gradually building. 

“Digital health tools are coming”

MDisrupt: What kind of trends are you seeing among your colleagues around innovation in healthcare?

Ben Schwartz: There are definitely pockets of physicians who are very innovation-minded. And then you have more traditional physicians who are just so busy that when they hear about technology and innovation, they roll their eyes and equate it with the EMR that’s just going to make their lives more complicated. Or they think that it’s hard to prove the use case or the value. But more and more we’re seeing physicians who are entrepreneurial who are either going to come up with their own solutions or work with companies who embrace solutions. I think that’s going to become the norm.

And if you are a physician who’s resistant to technology or innovation, now is the time to reconsider. Because artificial intelligence is coming, these health tools are coming. Patients are going to want them, health systems are going to start embracing them. The future may belong to physicians who are more innovative and entrepreneurial and embrace these things.

Consult clinicians early and often

MDisrupt: Say you were at dinner with a digital health entrepreneur, and they ask, “What do I need to consider to get my product to market?” What would you tell them?

Ben Schwartz: It’s a matter of addressing true pain points. If you don’t have experience in real-world healthcare, you may say, “Oh, I have this great product that addresses this pain point.” But if you don’t understand how healthcare is actually delivered, there are barriers you may not have considered. It’s important to make sure your solution really can be incorporated into a workflow. And how do you prove return on investment? How do you monetize it?

These are the things you want to figure out early on. A great way to do that is incorporate people who have real-world experience early on in the process. Start building your clinical team early on so you don’t get too far down the road in the wrong direction and have to start over.

MDisrupt: Bridging that gap can be pretty difficult.

Ben Schwartz: It’s a challenge. Most physicians are not on an island where they can make unilateral decisions. So how do you incorporate it into a hospital, or a health system, a physician practice, and get everybody on board? If there’s one person who puts up resistance, that can table the whole thing. There’s not an easy answer. It’s a challenge that digital health companies face and that’s why often they go to an employer or a payer, because it’s easier to make traction there.

We need physicians involved and using these products. At the end of the day, a lot of times physicians or patients are the end users, but they’re not necessarily seen as the way forward for these ideas to really gain traction and be viable.

The growing network of physician innovators

MDisrupt: Can you describe the doctor innovator phenotype?

Ben Schwartz: They are people who aren’t satisfied with the status quo. But rather than just decrying the challenges or feeling burnt out, they think, “There’s a problem, let’s figure out a way to solve it. Maybe I can design my own solution, maybe I can partner with somebody who’s developing a solution.” Those people are out there—on Twitter, on LinkedIn, at hackathons. They’re doing advisory work and they’re joining digital health companies.

MDisrupt: Is that phenotype fostered in medical school?

Ben Schwartz: The current generation of doctors in medical school are very tech savvy. They are learning about this stuff in medical school. I get so many young medical students or residents who reach out to me and say, I have an interest in this, how do I get involved? Which is great to see because that’s really going to help adoption. You’re going to have people who are innately willing to embrace this, with the medical background to guide the development of these solutions.

What’s essential to a health innovation?

MDisrupt: When you look at a new health product, how do you evaluate what’s important?

Ben Schwartz: Number one, does the health product really bring something new to the table? Does it solve a problem? Does it bring something that’s clinically relevant, clinically validated? Is it something that can be easily incorporated into a workflow, as opposed to a piece of technology that’s making things more complicated? To me, the best technology is elegant, it works in the background, or it integrates very seamlessly into what you’re already doing. And then it really makes meaningful change. 

And again, unfortunately with the reality of our system, there’s got to be some eye towards return on investment and how do you make sure that this is something you can incorporate and it’s not cost-prohibitive or bring something to the table from a value standpoint.

MDisrupt: Do you see a lot of positive headlines around the pandemic having helped to bolster digital health? 

Ben Schwartz: My concern is that as we—hopefully—move to a post-pandemic environment, [we examine] Did we go too far towards telehealth? I worry that there’s an overcorrection. There are certain things that telehealth or virtual solutions aren’t going to be able to address. And some patients really do want that traditional doctor-patient relationship. It doesn’t have to be for everything, and maybe healthcare technology and digital health can replace some of the inefficient, expensive things we’re doing. But at the end of the day, the doctor-patient relationship is at the core of healthcare. 

Top innovative US health systems leading the way

MDisrupt: You wrote, “If you’re developing a tech-enabled healthcare solution and counting on physicians to embrace it, this issue should be front and center in your product design and go-to-market strategy.” MDisrupt is connecting innovators with clinical experts. Do you see health innovators trying to get clinical early adopters to use the technology before it’s out there?

Ben Schwartz: You have to find the individuals willing to embrace it. And there is, as far as I know, no central resource of a list of hospitals, health systems, physicians that are open to this kind of thing. And there are so many companies out there—the same people can’t be trying to adopt 50 different tools because they’re known as more forward-thinking. So I think it’s coming, I think it’s slow. I think hospitals and health systems are realizing that they have to get on board with healthcare technology and innovation. I don’t think they know exactly yet how best to do that. Some of the more innovative health systems like Stanford, Intermountain Healthcare, Cleveland Clinic, Mayo Clinic will really be the leaders on that. And then it will diffuse out to the rest of the system.

Digital tools supporting traditional healthcare

MDisrupt: What is your dream digital health tool for orthopedics?

Ben Schwartz: Orthopedics is procedure-focused. A lot of the innovation happens [around] surgical robots, or tools and equipment that we can use in the operating room. We’re seeing a shift towards value-based care. Hip and knee replacements are so commonplace and cost, particularly Medicare, a lot of money. We’re understanding that we have to do a better job of preparing patients for surgery, making sure they’re healthy enough for surgery, and making sure they understand the process of recovery. I think we are going to see educational tools like we’re trying to build with Healent. I think we’re going to see post-operative remote patient monitoring tools so that we can keep a close enough eye on patients to identify a problem and intervene earlier.

I think we will see more innovation outside the operating room in orthopedics as we see more adoption of value-based care. It’s about preparing people for treatment and also supporting them afterward. Digital health can fill that void.

MDisrupt: What does a doctor-patient relationship look like today? And what will it look like in the future?

Ben Schwartz: It gets frustrating sometimes to hear about how so-called traditional physicians are really bad at their job.  If you’re outside that system, it’s easy to throw stones. But there are people on the front lines fighting these battles and doing the best they can within the system.

The doctor-patient relationship has been eroded over the last 20 years by things like EMRs, increasing administrative hoops to jump through, declining reimbursement, and increasing overhead. That doesn’t get enough attention from digital health—can we build tools to [bolster] that doctor-patient relationship? Whether it’s through documentation, natural language processing, or a better EMR, it would be great to see more of those tools come to light. Let’s build tools that really support what works about traditional healthcare, restore that doctor-patient relationship and focus on those physicians that are willing to evolve and be agents of change.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

And check out our blog and services!

6 Big Themes from HLTH 2021

6 Big Themes from HLTH 2021

Mona Schreiber

Our team chose HLTH 2021 as our first conference to attend since the pandemic began. It was a fantastic experience—here are 6 big takeaways.

Practicing clinicians need to be here

What’s the easiest way to get a digital health solution adopted into clinical practice? Solve a real challenge, integrate seamlessly into the clinical workflow, and enhance both patient and clinician experience (we’re taking “Do no patient harm” as a given). This might sound like a lot to strive for, but all these elements are essential. We noticed that the majority of panels and conversations at HLTH were among entrepreneurs and CXOs. While medical expertise was showcased, we didn’t hear from many practicing clinicians who see patients day in and day out about their perspectives on these trends and solutions. We at MDisrupt know that involving clinicians early and often in your healthcare solution yields better and faster adoption. So let’s stop discussing healthcare in silos and make sure all stakeholders have a seat at the table and a voice in the process of digital health development. We’re all united in addressing the same challenges.

Health equity is on everyone’s mind

New health care delivery models like telemedicine are here to stay—entrepreneurs at HLTH made that very clear. Many top payers have even announced virtual-care-specific plans to be launching soon. That’s great for those with reliable internet connection who know how to use technology. But conversations among entrepreneurs and payers revolved around how to reach those who haven’t been reached yet, to enable a more inclusive experience. This included discussions on payment models beyond self-pay and  ways to reduce barriers to health literacy based on socio-economic background. From our perspective, the conversations around health equity are important—but now it’s time to move beyond conversation and into action. 

Implementing available solutions into the current system is hard

Right now, consumers have access to a plethora of digital health solutions. But there’s a huge gap between what consumers can access and what actually gets used and is clinically useful in the healthcare setting. Furthermore, the consumer/patient experience becomes very disjointed once they bring digital health solutions to healthcare providers with no knowledge or experience of these solutions. Often the potential health outcomes and the ROI of the solution are not clear. The current solution for this is that the big players in healthcare like to test solutions with ‘Pilots” However the term “death by pilot” was heard a lot during HLTH. Our favorite quote came from Chrissy Farr’s interview with Alan Lotvin MD, who is EVP of CVS Health; he said, “Big companies in healthcare like to torture small companies.”

Payers, providers, health systems, and employers all agree that we need a better system of vetting evidence based digital health solutions. How do we solve this? At MDisrupt, we believe that missing from our industry is a unified standards system for digital health to assess the real-world clinical performance of these products. We intend to focus on this monumental challenge over the next few years.

Healthcare’s tech shift was super-accelerated by the pandemic

This was the first conference we’ve attended where a testing protocol was implemented at the conference. Every single person who attended had to be tested. And we have to credit HLTH, as the process was relatively fast and efficient. Deployment happened through an app, human guides helped us through the process, and an onsite testing system delivered results to us in 20 minutes via our apps. This is a demonstration of just how far we have come in digital health in just two years. It showed us that we can bring lab testing closer to the consumer at scale, we can make it more efficient and more convenient, we can take care of people where they live and where they work. Now that we know it can be done, imagine if this could be applied to all areas of healthcare!

Mental health is no longer an afterthought

The pandemic changed the way we think and talk about mental health. Treatment and services for conditions that were once stigmatized, with care available primarily for severe cases, are now becoming part of the norm. . Leaders in mental and behavioral health came together at HLTH to discuss improving delivery models, like telemedicine; integrating mental health practices into a complete healthcare plan, and, best of all,making these changes mainstream. There’s still a long way to go in reaching the masses, but it was clear that technology can make it happen.

The need for human connection is so real

As we registered for HLTH, we were asked to choose a wristband that signaled how you wanted to be greeted:

  • Green bands signaled that you were ok with hugs and handshakes
  • Yellow bands signaled that you preferred fist elbow bumps
  • Red bands signaled a no touch-greeting.

By the end of the first day, the basket of green bands was completely empty, with the majority of us selecting them. After two grueling pandemic years—in which many of us have been in lockdown and seen the suffering and loss of many people close to us—it was clear how much we all needed human contact. There was a lot of welcome hugging and handshaking as folks who hadn’t seen each other for over two years reconnected. The unspoken feeling between us was that we are all in this together, and that we are the changemakers for a better future.

To quote this year’s HLTH motto: ”Dear Future, we are coming for you.”

If you want to dive into more interesting topics related to healthcare, check out our blog at MDisrupt.

At MDisrupt, we believe that the most impactful health products should make it market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

How 23andMe’s Acquisition of Lemonaid Health Changes Personalized Healthcare

How 23andMe’s Acquisition of Lemonaid Health Changes Personalized Healthcare

ruby.gadelrab

MDisrupt CEO and founder Ruby Gadelrab on why the combination of the two companies is so promising.

Integrating genetics into primary care—for real

On Friday, 23andMe announced its acquisition of Lemonaid Health, the telehealth upstart and drug-delivery service, “in a bid to make its personalized genetics approach part of patients’ primary care,” stated Fortune.

Between 2014 and 2017, I worked at 23andMe as VP of commercial marketing. It was there that I learned the principles of consumerized healthcare. Everyone in the company had a maniacal focus on the consumer experience. Every decision we made as an executive team was through the lens of “How does this positively impact the consumer experience?”

The acquisition of Lemonaid Health is a bold move by 23andMe. I believe that it is rooted in adding value to the consumer experience and has the potential to change the way we approach primary care.

What makes the 23andMe and Lemonaid acquisition so interesting?

Mastering consumer engagement

23andMe has mastered consumer engagement. It was one of the first companies to make genetic information simple and accessible to consumers and to demonstrate that individuals were willing to pay for information on both health and ancestry, with over 11 million consumers buying the tests. 23andMe was the first company to get FDA authorization to sell genetic tests directly to consumers without clinicians being involved in the process. And the company did a fantastic job of communicating the information in reports in a simple and engaging way. Furthermore, they engaged consumers in research, with an over 85% consent rate.

Clinicians are a core part of consumer healthcare

During my time at 23andMe, as consumers became more interested in the health reports that 23andMe provided, they started to take them to their healthcare providers to discuss. The problem was, most healthcare providers had no idea what the report was or what its clinical utility might be. Further, healthcare providers had no time to try and make sense of it in a 20-minute visit. This broke the consumer experience and made it difficult for the valuable information in the 23andMe report to be actionable within our current healthcare system. One of my roles was to create a “23andMe for Medical Professionals” program in an effort to educate clinical early adopters on what the reports meant.

Consumers taking their reports to their healthcare providers created frustration everywhere. Consumers were frustrated that valuable genomic data in their 23andMe report was not taken seriously by their healthcare providers. Healthcare providers were frustrated that they were receiving data outside the standard of care that they did not know how to use or have the right infrastructure to integrate into their patients’ care. The company was frustrated because the healthcare providers’ reactions and underutilization of the 23andMe report ruined their consumers’ experience.

This issue underscores the importance of involving healthcare providers early and often as digital health innovations are built and deployed—something that’s an essential pillar of our work at MDisrupt.

Timing is everything

Genetic information is useful both clinically and personally, and yet traditional healthcare is about ten years behind medical genomics research. This can be attributed to the perceived lack of clinical utility for many genetic tests on the market as well as the “two-year problem.” This is a problem of economics and the ROI of genetic testing. Whoever pays for preventive genetic testing doesn’t get the benefit of it, because people change employers and providers at least every two years.

Post-COVID-19 pandemic, health systems have even less incentive to take an interest in genomics. These days, they have bigger problems: making up the revenue they lost during the pandemic and taking care of the patients whose medical treatment got delayed in the pandemic.

23andMe has the right idea. The only way to create an incredible consumer experience, and to make genomics part of the decision-making process in healthcare, is to own the pipes that can deliver true healthcare—meaning bringing healthcare providers into the process.

This does two things. First, it gives consumers a place to go to discuss their healthcare, genomic data included. Second, it allows a genetic testing company to deliver additional health services to its consumers (i.e., their own telemedicine channel). Having clinicians as part of the genomics journey is the only way to improve the consumer/patient experience, and make genomics meaningful in healthcare.

Genomics + telemedicine + therapeutics = a new category of genomically powered healthcare

Interestingly, it is the combined efforts of two digital health companies and not a genomics company and a healthcare system that may be able to truly integrate genomics into healthcare.

And with 23andMe, it doesn’t stop there. Remember that the company has made significant efforts and investments into therapeutics with a $300M investment and partnership with GSK in order to redefine the process of drug discovery and potentially get drugs to market faster.

This is why the acquisition of Lemonaid Health by 23andMe is so fascinating. 23andMe, with its genomics data, consumer engagement, therapeutics efforts, provider network, and telemedicine platform can potentially become the path to truly individualized clinical care. We’ll be watching closely to see what happens next with this new category of genomically-powered healthcare.

If you want to dive into more interesting topics related to healthcare, check out our blog at MDisrupt.

At MDisrupt, we believe that the most impactful health products should make it market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Using Digital Health Tools to Strengthen the Doctor-Patient Relationship

Using Digital Health Tools to Strengthen the Doctor-Patient Relationship

Arti Thangudu

Meet Arti Thangudu, MD, an endocrinologist pioneering a new model of patient care.

podcast available

Dr. Thangudu is a triple board-certified physician and endocrinology, diabetes, and thyroid specialist at Complete Medicine. She takes an evidence-based approach to care, focusing on the patient and their lifestyle, and uses a membership-based model of practice.

Putting the doctor-patient relationship first

MDisrupt: Tell us how you turned from practicing physician to physician-entrepreneur.

Arti Thangudu: I completed my endocrinology fellowship at the University of Pittsburgh Medical Center. When I graduated, I landed my dream job as an attending physician at the largest endocrinology private practice in the world. I had tons of patients and was seeing more than 30 a day.

I came into medicine to take care of people, and I chose endocrinology because it’s very relationship-based. But with 30-plus patients a day, that relationship is broken down. I thought, “Is this what I see myself doing for the rest of my life?”

In this fee-for-service model, doctors get rewarded for seeing more patients. The quality of care does not get rewarded. Better-quality care takes more time. And it’s not what the healthcare system wants us to do. The incentives are for us to see more patients and order more tests because that brings more money into the system.

I just wasn’t about that. And so I started my practice, Complete Medicine, which strives to break down the barriers to healthcare that I saw in the insurance-based model.

MDisrupt: What is your clinic trying to solve?

Arti Thangudu: The breakdown of the relationship between physician and patient and the lack of pricing transparency. For example, you go to a doctor and you have no idea how much you’re going to pay or how much your insurance is going to cover. And you get a bill two weeks later, another bill two months later, another bill three months later. And they’re all way higher than you expected. My practice is membership-based. Patients have unlimited visits. They can call me, they can text me, they can email me between visits. We can do virtual visits, we can do phone visits.

And our prices are transparent. The patient knows on day one how much they’re going to pay. We have negotiated cash pricing on labs and imaging. Patients can use insurance if they want to, but our prices are usually about one-tenth of what they would be with insurance. And there are no surprise bills.

The patients have better outcomes when they’re working with a physician they can trust and lean on and reach out to when they’re having trouble. So with my diabetes patients, we’ve had stellar outcomes—lots of patients coming off insulin, reducing their need for medication, just getting overall healthier, because good care delivers good outcomes.

Lifestyle medicine: caring for the whole patient

MDisrupt: What is lifestyle medicine?

Arti Thangudu: Lifestyle medicine integrates evidence-based nutrition, exercise, management of stress, sleep hygiene, cessation of bad habits. When I was in private practice, I noticed that people weren’t getting better. As an endocrinologist, I knew that nutrition and diabetes go hand in hand. During my endocrinology fellowship, nutritional training, for me, was 30 minutes with the dietician. That is insufficient for any doctor, especially somebody trying to call themselves a diabetes expert.

I realized that if I was going to create a more patient-centered practice, nutrition had to play a big part. And so I got certified in nutrition. And I also got board-certified in lifestyle medicine. These are all such important things that are bypassed by traditional medical training. When you can teach a patient why they should make lifestyle changes, and can be there to support them, they’re much more likely to make the changes and get themselves to better health.

A life-changing digital health tool

MDisrupt: How do you incorporate digital health tools into lifestyle medicine for your patients?

Arti Thangudu: The majority of my patients have diabetes. We use continuous glucose monitoring (CGM). And it has been fantastic. With these CGM devices, we can see the patient’s blood sugar in real time. So I can see exactly what their blood sugars have been doing all day, and they can too. And they don’t have to use a fingerstick anymore.

Studies have shown the more times a patient takes a blood sugar, the better control they have, but more importantly, the better quality of life they have. And so now with these CGM systems, they can input what they ate. You can see exactly how foods, exercise, and sleep affect them and the patient gets real-time feedback.

I have informally studied my own patients. This is not a randomized controlled study. But I did a small study on patients whose intervention was continuous glucose monitoring and lifestyle coaching. And those patients dropped their hemoglobin A1c by 2% after three months. That’s like a 50% reduction in their risk of complications from diabetes. It’s also cost-effective. Every 2% somebody decreases their A1c, it saves the healthcare system at least $4,000 per year—although it could be much more than that. And in that little study, 75% of my patients who were taking insulin were off of insulin by the end.

It’s a huge improvement in quality of life, health, and cost. Can you imagine using this little tool, and then you go from four shots of insulin a day to none, just by changing your lifestyle? That’s really motivating.

Making digital health better

MDisrupt: What are some of the biggest challenges in digital health?

Arti Thangudu: One is the evidence base. There are a lot of at-home lab tests, or testing that you can order online direct-to-consumer. They say they’re evidence-based, but then when somebody who’s a physician or scientist reads that evidence, they can recognize that it’s not at all evidence-based.

A lot of healthtech products are done in a silo and the physician is practicing in a silo. There’s no connection between the patient’s physician and the technology. And physicians don’t know how to interpret the data given to the patient from these tech solutions. If the physician can’t help interpret the data, it makes the patient lose trust.

If there’s a solution that wants to be really big, we need to get the patient’s physicians on board. Or the tech companies need to have a physician that they can send patients to who understands that tech. If we work together as physicians and a digital health team, we can make these products all the more robust and meaningful for patients. Digital health has so much potential—we can’t alienate doctors from it, because it’s the future. We, as physicians, have to get on board, and we have to make these digital tools usable by both patients and physicians. We can do so much together.

MDisrupt: What is your dream digital health tool for lifestyle medicine?

Arti Thangudu: If we could integrate the continuous glucose monitor plus our patients’ dietary and exercise logs, and then create an AI-sourced daily feedback model for them, supported by a health coach or nurse and into the clinical model—with the physician in that same team—that would be amazing for patients with diabetes. I know there are tools getting pretty close to that, but it seems like still there’s a bit of limitation with the physician being part of the team.

Doctors and patients as allies

MDisrupt: What will the doctor-patient relationship look like in 10 years?

Arti Thangudu: My hope is that we, as a community, recognize the value of that relationship. And we as patients and physicians fight to get it back, because doctors and patients are on the same side.

Patients feel frustrated. They’re rushed through their appointment and they blame the doctor because that’s the person in front of them. We need to take a step back and say, “Well, the system is making this doctor have to see 35 patients a day to keep their office open.”

If that same doctor could be in a situation where they saw 12 patients a day, would they be able to deliver better care? The answer, 99.9% of the time is, absolutely. I’ll tell you a story. I consult for a company that takes care of retired police and fire. I have more time to take care of these patients because it is not an insurance-based clinic.

I saw a patient for hypothyroidism and pre-diabetes. After I spent 20 minutes with her, taking a really thorough history, she said, “Doctor, I have to tell you something. You’ve seen me before.” And I was like, “Really? When?” And she said, “In your old clinic. It was really rushed—I must’ve spent three minutes with you. I never went back because the experience was so bad.” I was horrified! I said, “I hope I can make it up to you.” She said, “You already have. I recognize that you were put in a bad situation. Now I’m really excited to be on this journey with you.”

The same doctor can be put in a bad situation or a good situation, and that’s going to affect the care they provide. And so for things to improve in the future, the system really, really needs to change. We as doctors and patients need to recognize that the system isn’t necessarily helping us and maybe move outside of the system until the system decides to catch up. And really be our own advocates.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We connect digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our experts span the healthcare continuum and can assist with all stages of health product development: regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

And check out our blog and services!

How Precision Medicine Can Transform Healthcare

How Precision Medicine Can Transform Healthcare

Bernard Esquivel

Meet Bernard Esquivel, MD, PhD,
a leader in precision medicine.

podcast available

Dr. Esquivel is a clinical immunologist-allergist and international business leader with expertise in developing new markets in genomics and precision medicine. He’s the founder and president of the Latin American Association of Personalized Medicine, ALAMP.

A passion for precision medicine

MDisrupt: Tell us how you turned your passion for precision medicine into a career.  

Bernard Esquivel: During my medical training, I learned about the role our genetic information can play in influencing disease development. Once I started practicing medicine, I tried to start testing my patients, and understanding their genes, and then find a way to implement that into my workflow.

That’s when I noticed that, number one, it was very hard to find [genetic] tests. Number two, it was very hard to access the information needed to understand and clinically implement decisions based on that information. And number three, my colleagues thought that I was talking about Star Wars or some dark science.

So, facing those barriers, back in 2014 a colleague of mine and I founded the Latin American Association of Personalized Medicine (ALAMP). The aim was to share knowledge to foster the implementation of precision medicine.

I interacted with a lot of key opinion leaders (KOLs) globally from different fields of precision medicine. And I learned how they were implementing precision medicine, pharmacogenomics, cancer molecular testing, health wearables, and so on. Long story short, for the last 12 years I’ve been 100% into precision medicine, to find a way to bring these fantastic new tools closer to the patients.

Precision vs. personalized medicine

MDisrupt: How do you define precision medicine, and how do you see it as different from personalized medicine?

Bernard Esquivel: If we use the definition that cancer.gov has for precision medicine, it’s a form of medicine that uses information about a person’s own genes or proteins to prevent, diagnose, or treat diseases. But I think there are missing parts to this definition. One of them is “predict.” That’s where I believe precision medicine is heading: to predict, by using data from patients, subpopulations, larger groups, and N-of-1s, and using new technology such as machine learning, to predict how a patient will respond.

Also, precision medicine is not only about genetic information anymore. For example, there are different “omics”—metabolomics, epigenomics, nutrigenomics, proteomics, and also the social determinants of health that are crucial as well. Personalized medicine is specific to the patient.

Getting precision medicine adopted

MDisrupt: What are some obstacles to a widespread adoption of precision medicine?

Bernard Esquivel: The first barrier is the way we run clinical trials. We need to continue following an evidence-based approach, meaning we need to show clinical validity, clinical utility, clinical actionability, and so on. But precision medicine is unique because you may be talking about a single individual with a lot of data points.

The second barrier is about implementation and clinical actionability. For example, in pharmacogenomics, some genetic variants of CYP450 enzymes may impact how the patient will respond to certain medications. You need to take that to the next level: “What can I do next? Is there any other option for that patient? Are there clinical guidelines to help me to customize the dose for that specific patient?” That’s clinical actionability.

The third barrier is, precision medicine needs to be user-friendly for the provider as part of our day-to-day tools. If we don’t implement precision medicine data sets into the clinical workflow, it’s going to be a hard stop.
And last but not least is cost-effectiveness. We need to show that it makes sense to invest in the molecular testing and technological platforms that we need.

MDisrupt: When do you see us being able to bring all that information together to give an individualized view of the patient?

Bernard Esquivel: Within the next five years. I think we are getting there in terms of connectivity and data management. The milestone for the next five years is going to be about ethics—how those corporations are going to be managing, handling, and protecting your information as a patient.

Pharmacogenomics (PGx) in precision medicine

MDisrupt: What’s the ideal implementation of PGx in the health care delivery model?

Bernard Esquivel: Pharmacogenomics is a fantastic example of how precision medicine has evolved. One of the barriers has been the lack of standardization. We need to be sure that our [variant] coverage is as similar as possible in order to compare apples to apples.

The other one is about how you interpret that data, the phenotyping calls. How are you calling [a particular] genetic variant and what are the clinical implications? Several organizations are doing outstanding work trying to tackle those problems. And I strongly believe that champions of pharmacogenetics are and will continue to be the pharmacists.

PGx success

MDisrupt: Is there an example of a health system that has been successful in implementing a PGx program?

Bernard Esquivel: Yes, several. St Jude’s Hospital has been a pioneer in implementing PGx into the electronic medical record and having expert pharmacists help other providers implement it. Also Mayo Clinic with its center for individualized medicine.

The Netherlands is a fascinating example of a countrywide PGx implementation. They use a single electronic medical record for the entire country. They already have a specific PGx piece that will follow the patient wherever they go. They’re publishing data on how they are saving money countrywide by using pharmacogenomics.

How digital health innovators can improve precision medicine

MDisrupt: When you think about precision medicine, what could digital health innovators do more of and what are they not doing enough of?

Bernard Esquivel: Number one will be having a smooth workflow in terms of integration. Then, once you’ve got all those data sets, how are you going to start organizing that information? You need to allow new technologies such as machine learning to start making predictive models, then [integrate] that information with genomics, microbiome, exposure, behaviors, clinical tests, even patient contributed data. And then find ways to connect all that to clinical information and deliver it to the final user. I know it sounds hard, but many people are working on this right now.

MDisrupt: What advice would you give a founder interested in precision medicine solutions?

Bernard Esquivel: Have the right experts working with you. If you don’t make that investment at the beginning, it’s going to be way more expensive “learning during the flight.”

With the right team on board, I recommend three pillars: Number one, the regulatory landscape—look into the regulatory requirements, talk about your idea with the regulatory agency.

Then, invest in developing the right evidence behind your product. And number three is clinical actionability: You can go-to-market with the minimal viable product, but you need to always be thinking of how this information will trigger action from the clinical standpoint.

Healthcare’s future

MDisrupt: What do you think the health system is going to look like in 10 years?

Bernard Esquivel: We know that the way we are spending money in healthcare is not working. So everything will change into value-based care and precision medicine will play a critical role there.

At MDisrupt we believe that the most impactful health products should make it to market quickly. We help make this happen by connecting digital health innovators to the healthcare industry experts and scientists they need to responsibly accelerate product development, commercialization, adoption, and scale.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.

Overly White Genetic Databases = Decades More Health Disparities

Overly White Genetic Databases = Decades More Health Disparities

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MDisrupt CEO and founder Ruby Gadelrab on how more inclusive genetic databases can reduce health disparities and bring precision medicine to everyone.

The precision medicine problem no one talks about

Precision medicine has long been a promise of the The Human Genome Project (HGP). Humans are 99.9% genetically similar, but it is the 0.1% difference that holds the key to the causes and potential cures of our diseases. The goal of the HGP was that by building genetic databases large enough to allow scientists to see the patterns and variations in the 0.1% difference in our genetics, we could give healthcare providers “immense new powers to treat, prevent, and cure disease” through precision medicine (pharmacogenetics, cancer screening and diagnostics, and much more). However, nearly 20 years later, this promise of better diagnostics and personalized therapeutics is only a reality for those of European descent. That’s because most of the world’s genetic databases consist primarily of genomes from people of European descent – and yet we know that individuals of other ancestries suffer from certain genetic diseases at a much higher prevalence.

So, how did we get here?

3 reasons genetic databases are biased

First, the genome studies conducted that led to building the first genetic databases, the genome-wide association studies (GWAS) were done in the United States and, to a lesser extent, in Europe. A 2009 analysis of the GWAS studies showed that 96% of participants were of European descent.

Second, recruitment of participants in scientific research is notoriously difficult. The faster researchers recruit, enroll, and consent participants, the faster they get the data and can publish. Participants in the GWAS studies were mostly volunteers who lived near well-funded academic institutions, and who had the motivation and the means to travel to those institutions. This resulted in the study populations not being representative of the diversity of the US population. Very few institutions tried or were able to build trust with underserved and underrepresented populations in order to successfully enroll them in the studies. The majority of the studies were conducted by scientists who identified as white. In fact, according to the National Institutes of Health (NIH), only 7% of all NIH R01 Grants were awarded to Black American and Latinx scientists.

During the GWAS era, I worked as the head of international marketing for Affymetrix (now Thermo Fisher Scientific). Affymetrix was a leading manufacturer of microarrays, the technology used to conduct GWAS research. Even back then, we were concerned about the European bias in genetic studies, so my team and I spent 2009 to 2012 traveling around the world meeting with ministers of health and major research institutions, encouraging them to fund and build genetic databases representative of their own populations. Some of these initiatives did eventually take off—notable examples include The Saudi Genome Program, H3Africa and the China Genome Project.

Third, over the last five years, new types of genetic databases emerged from the private sector. More than 26 million people purchased direct-to-consumer genetic tests. While these products have done wonders for accessibility of genetic information, they are also cost-prohibitive for underserved populations and sold by companies that are primarily US-based. This has resulted in new genetic mega-databases that, once again, are biased to people of European descent.

Private sector solutions

Individuals of African descent are highly underrepresented in genetic databases and yet genetic diversity in Africa is higher than any other region in the world. What’s more, African populations have the highest burden of disease due to Africa’s complex population history; large variations in diet; climate; and elevated exposure to infectious disease.

To their credit, some private sector genetic testing companies have tried to address this gaping disparity in genetic databases.

23andMe had the right idea and tried to address the problem through The African Genetics Project, which sought to recruit and provide detailed ancestry results to 23andMe customers of African descent.

The Nigeria-based company 54Gene is also seeking to equalize precision medicine by creating the world’s largest biobank of African genomes, which will be used to build the next generation of diagnostics and therapeutics.

Even so, we have made only marginal improvements in the diversity of our genetic databases. In 2020, a study conducted under the H3Africa Consortium showed that sequencing 426 individuals from 13 African countries resulted in the discovery of over three million novel genetic variants. This implies that we haven’t even scratched the surface of discovering the clinically important variants from those of African and other non-European descent.

5 ways to address health disparities in precision medicine 

So what can be done to address the critical issue of underrepresentation in genetic databases? Here are the key areas that I believe will lead to change:

1. Proactive recruiting.

Genetic researchers should be proactively recruiting underrepresented populations for future studies. This will require some non-traditional methods of recruitment into the studies,including engaging key community stakeholders and building trust in historically mistreated and underrepresented minority populations. Initiatives must also include community outreach and education (e.g., the creation of multilingual recruitment materials). Without this, there is no way we can make precision medicine equitable.

2. Do the right studies.

A continued and concerted effort is needed to conduct studies that address specific underrepresented populations, similar to the methodology in the H3Africa study mentioned above. We must take a systematic approach to ensure that the entire global population’s genetics are appropriately and proportionately represented in genetic databases.

3. Create incentives.

Government funding agencies must build incentives for those who are recruiting and researching diverse cohorts. This includes the rebalancing of research funding for minority scientists.

4. Increase private sector investment in minority founders.

Important efforts to build non-Eurocentric genetic databases may actually come from the private sector, similar to the approaches that 23andMe and 54Gene are taking. However, implementing this on a larger scale would require a significantly increased level of investment into Black American and Latinx company founders, who received only 2.6% of all VC investments in 2020.

5. Build diverse leadership.

Both academia and the private sector must actively recruit diverse leadership teams—not just as entry-level and mid-level managers, but also in leadership roles, in the C-suite, and on boards of directors. Diverse teams are better at decision making, better at brainstorming, and better at creating products that represent a bigger proportion of the population.

We must do better

In 2020 and 2021, the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and several other Black Americans, along with hate crimes against Black and Asian communities—and in conjunction with the ongoing COVID-19 pandemic—have shone a spotlight on systemic racial disparities and inequities, which are also inherent in our healthcare system. European bias in genetic databases has huge implications for the health of individuals of non-European descent. It has the potential to contribute to decades of health disparities if we continue down this path. Without the changes outlined above, the genetic data we use to create the next generation of diagnostics, disease risk assessments, and therapeutic interventions will continue to make precision medicine available only to those of European descent. If we don’t address this now, history will hold us accountable.

 

At MDisrupt we believe that the most impactful health products should make it market quickly. We do this by uniting digital health companies with experts from the healthcare industry to help them accelerate their time to market responsibly.

Our expert consultants span the healthcare continuum and can assist with all stages of health product development: This includes regulatory, clinical studies and evidence generation, payor strategies, commercialization, and channel strategies. If you are building a health product, talk to us.