Issue 16: 23&Me, Opiates, Viz.AI, and more

D2C BRCA Testing

Consumer genomics juggernaut 23&Me recently got FDA approval to sell D2C spit kits that test for the BRCA1 and BRCA2 genes which are linked to breast cancer. Anne Wojcicki, the pioneering entrepreneur behind 23&Me has a long and rocky relationship with the FDA. Back in 2013 the FDA banned her company from providing health analysis and sent a scornful breakup letter to Anne. They probs also defriended each other on FB. But in 2015 after messaging back and forth the FDA reunited with 23&Me. But with all good things there’s a catch. The test only detects 3 out of the 1000 possible BRCA mutations leaving many possible patients unidentified. That being said it’s still a positive step in the right direction for future D2C oncology testing.

To Opioid or Not to Opioid?
OxyContin made by Purdue Pharma

Hold up! Before your patients go on popping those opioid pills for certain kinds of pain listen up! A study out of the University of Minnesota that was published this week found little difference between opioid and nonopioid medications in the treatment of chronic back pain or knee/hip osteoarthritis pain. The study looked at the treatment of 240 patients over a time period of 12 months and found that in the end there was really no difference between the two groups. In fact the opioid group had double the average number of side effects from medications. On a different note, don’t be surprised if you hear Purdue Pharmaceuticals tries to buy JAMA and make things like this disappear.

Viz.Ai Wins FDA Approval 
Viz.AI image from company website
AI startup Viz.Ai recently received FDA approval for their AI algorithm that can analyze CT scans to detect acute ischemia. The application analyzes CT scans using the same algorithms that detect cute little cats in youtube videos  to detect for blood vessel blockage.When the software detects a blockage it will send a message to a nearby neuroradiologists’s phone saying yo peep these images ASAP cause time is brain son. With Viz.Ai’s approval the FDA is essentially opening the floodgates for other AI applications to become readily available at hospitals.

Kenyan Doctors Protest
Kenyan healthcare workers protesting
In what can only be described as an epic fu*k up close to 500 doctors in Kenya are protesting after the wrong patient at a hospital received neurosurgery. But the real reason they are protesting is because the doctor who performed the procedure is getting suspended and the docs don’t think that’s right. The protesters think that it’s not the doctor’s fault but the fault of the hospital. The incident happened at Kenyatta National Hospital in Nairobi, which has received criticism for being substantially understaffed. Apparently there was no formal time-out performed before the procedure, the operating doctor did not communicate with the patient in pre-op, and the staff operated for HOURS before realizing they had made a mistake. The procedure in question was to remove a blood clot in the brain and the staff realized they had the wrong patient after they were unable to locate the clot. Thankfully the patient who actually had the clot is doing well and may not need surgery and the patient who got the accidental surgery is recovering well, but he’s probably pissed.

Image taken at HIMSS18 Conference
If there is one place doctors and developers get together in the same room and talk to each other, it’s at Healthcare Information and Management Systems Society (HIMSS). The annual global Healthcare IT conference this year is taking place in Las Vegas, where meaningful conversations and healthcare ideas are advanced with no distraction at all, I’m sure. Over 40,000 Hospital Chief Information Officers, investors, vendors, and a bunch of startup hopefuls have gathered to make healthcare a better place. Buzzwords such as AI, interoperability, security, innovation, telehealth, and precision medicine got every attendee feeling like they are somehow living in the future of medicine. And yes, every company sounds the same with their goal of somehow making healthcare data more actionable and smarter. Eric Schmidt, former CEO of Google’s parent company Alphabet, opened the Pacman-themed floor by a call to arms “Run to the clouds.” The message was clear: Hip tech and data companies are so beyond faxes and paper charts, but the hospitals are slowing healthcare down, and by the way, shame on you if you can’t budget for Epic or Cerner. Not to mention that they name-drop and are so matter-of-fact regarding Machine Learning and AI surpassing physicians. On another note, big boys like Apple, Google, and Amazon will be moving closer to get your health data, while Lyft and Uber Health will literally come and get you to the hospital.

Healthcare Information and Technology sounds fancy and relevant but HIMSS18 still feels more like an IT conference than a healthcare one. Let’s not forget who uses and benefits from these technologies on a daily basis. Perhaps true and timely change can take place when both physicians and future physicians are given more opportunities to engage in talks regarding implementation, innovation, and inspiration. A new call to arms is in need: “Providers to the clouds,” it’s time to stop playing catch-up.

Let’s Get Our Drugs from Canada
Generic image found on internet of Canadian flag and sthetoscope
Let’s face it drugs in the US can be outlandishly expensive. Some states are raging against the US pharmaceutical industrial complex by buying drugs in bulk from Canada. Pharmaceuticals  typically cost less in Canada due to government regulated price controls compared to the US where drug companies can pretty much charge whatever they want. Vermont, Utah, Oklahoma, and West Virginia have proposed creating an agency that will buy medicines in bulk from Canada, but they will also need approval from the federal government. #Buzzkill. Medicaid, which provides free health insurance to 75 million impoverished and disabled Americans is run by both the state and federal governments. Medicaid spending on medicines has grown at an unsustainable pace with a 13% increase in spending from just 2014 to 2015 to a value of $3.7 billion. To understand the price differences consider Gleevec (imatinib), a treatment for CML which costs around $10k in the USA, but in Canada the drug costs $2.4k. That’s still not cheap but its less outrageously expensive. The US has the most expensive healthcare system in the world and lets be real it’s not even that great. At least the states are trying something, but they’re also going to have to fight the powerful US pharma lobbying industry, which much to on-one’s surprise is adamantly opposed to importing drugs from Canada. They claim that importing drugs from Canada would be “unsafe”. The US pharma lobbying industry spent $277million in 2017 alone to influence public opinion. Regardless of this short term solution, it's becoming increasingly obvious that we need a better long term solution.