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June 16, 2019
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Biofourmis raises $35M to develop smarter treatments for chronic diseases

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Biofourmis, a Singapore-based startup pioneering a distinctly tech-based approach to the treatment of chronic conditions, has raised a $35 million Series B round for expansion.

The round was led by Sequoia India and MassMutual Ventures, the VC fund from Massachusetts Mutual Life Insurance Company. Other investors who put in include EDBI, the corporate investment arm of Singapore’s Economic Development Board, China-based healthcare platform Jianke and existing investors Openspace Ventures, Aviva Ventures and SGInnovate, a Singapore government initiative for deep tech startups. The round takes Biofourmis to $41.6 million raised to date, according to Crunchbase.

This isn’t your typical TechCrunch funding story.

Biofourmis CEO Kuldeep Singh Rajput moved to Singapore to start a PhD, but he dropped out to start the business with co-founder Wendou Niu in 2015 because he saw the potential to “predict disease before it happens,” he told TechCrunch in an interview.

AI-powered specialist post-discharge care

There are a number of layers to Biofourmis’ work, but essentially it uses a combination of data collected from patients and an AI-based system to customize treatments for post-discharge patients. The company is focused on a range of therapeutics, but its most advanced is cardiac, so patients who have been discharged after heart failure or other heart-related conditions.

With that segment of patients, the Biofourmis platform uses a combination of data from sensors — medical sensors rather than consumer wearables, which are worn 24/7 — and its tech to monitor patient health, detect problems ahead of time and prescribe an optimum treatment course. That information is disseminated through companion mobile apps for patients and caregivers.

Bioformis uses a mobile app as a touch point to give patients tailored care and drug prescriptions after they are discharged from hospital

That’s to say that medicine works differently on different people, so by collecting and monitoring data and crunching numbers, Biofourmis can provide the best drug to help optimize a patient’s health through what it calls a ‘digital pill.’ That’s not Matrix-style futurology, it’s more like a digital prescription that evolves based on the needs of a patient in real-time. It plans to use a network of medical delivery platforms, including Amazon-owned PillPack, to get the drugs to patients within hours.

Yes, that’s future tense because Biofourmis is waiting on FDA approval to commercialize its service. That’s expected to come by the end of this year, Singh Rajput told TechCrunch. But he’s optimistic given clinical trials, which have covered some 5,000 patients across 20 different sites.

On the tech side, Singh Rajput said Biofourmis has seen impressive results with its predictions. He cited tests in the U.S. which enabled the company to “predict heart failure 14 days in advance” with around 90 percent sensitivity. That was achieved using standard medical wearables at the cost of hundreds of dollars, rather than thousands with advanced kit such as Heartlogic from Boston Scientific — although the latter has a longer window for predictions.

The type of disruption that Biofourmis might appear to upset the applecart for pharma companies, but Singh Rajput maintains that the industry is moving towards a more qualitative approach to healthcare because it has been hard to evaluate the performance of drugs and price them accordingly.

“Today, insurance companies are blinded not having transparency on how to price drugs,” he said. “But there are already 50 drugs in the market paying based on outcomes so the market is moving in that direction.”

Outcome-based payments mean insurance firms reimburse all outcomes based on the performance of the drugs, in other words how well patients recover. The rates vary, but a lack of reduction in remission rates can see insurers lower their payouts because drugs aren’t working as well as expected.

Singh Rajput believes Biofourmis can level the playing field and added more granular transparency in terms of drug performance. He believes pharma companies are keen to show their products perform better than others, so over the long-term that’s the model Biofourmis wants to encourage.

Indeed, the confidence is such that Biofourmis intends to initially go to market via pharma companies, who will sell the package into clinics bundled with their drugs, before moving to work with insurance firms once traction is gained. While the Biofourmis is likely to be bundled with initial medication, the company will take a commission of 5-10 percent on the recommended drugs sold through its digital pill.

Biofourmis CEO and co-founder Kuldeep Singh Rajput dropped out of his PhD course to start the company in 2015

Doubling down on the US

With its new money, Biofourmis is doubling down on that imminent commercialization by relocating its headquarters to Boston. It will retain its presence in Singapore, where it has 45 people who handle software and product development, but the new U.S. office is slated to grow from 14 staff right now to up to 120 by the end of the year.

“The U.S. has been a major market focus since day one,” Singh Rajput said. “Being closer to customers and attracting the clinical data science pool is critical.”

While he praised Singapore and said the company remains committed to the country — adding EDBI to its investors is certainly a sign — he admitted that Boston, where he once studied, is a key market for finding “data scientists with core clinical capabilities.”

That expansion is not only to bring the cardio product to market, but also to prepare products to cover other therapeutics. Right now, it has six trials in place that cover pain, orthopedics and oncology. There are also plans to expand in other markets outside of the U.S, and in particular Singapore and China, where Biofourmis plans to lead on Jianke.

Not lacking in confidence, Singh Rajput told TechCrunch that the company is on course to reach a $1 billion valuation when it next raises funding, that’s estimated as 18 months away and the company isn’t saying how much it is worth today.

Singh Rajput did confirm, however, that the round was heavily oversubscribed, and that the startup rebuffed investment offers from pharma companies in order to “avoid a conflict of interest and stay neutral.”

He is also eying a future IPO, which is tentatively set for 2023 — although by then, Singh Rajput said, Biofourmis would need at least two products in the market.

There’s a long way to go before then, but this round has certainly put Biofourmis and its digital pill approach on the map within the tech industry.

Facebook releases a trio of maps to aid with fighting disease outbreaks

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Facebook this morning announced a new initiative focused on using its data and technologies to help nonprofit organizations and universities working in public health better map the spread of infectious diseases around the world. Specifically, the company is introducing three new maps: population density maps with demographic estimates, movement maps, and network coverage maps. These, says Facebook, will help the health partners to understand where people live, how they’re moving, and if they have connectivity — all factors that can aid in determining how to respond to outbreaks, and where supplies should be delivered.

As Facebook explained, health organizations rely on information like this when planning public health campaigns. But much of the information they rely on is outdated, like older census data. In addition, information from more remote communities can be scarce.

By combining the new maps with other public health data, Facebook believes organizations will be better equipped to address epidemics.

The new high-resolution population density maps will estimate the number of people living within 30-meter grid tiles, and provide insights on demographics, including the number of children under five, the number of women of reproductive age, as well as young and elderly populations. These maps aren’t built using Facebook data, but are instead built by using Facebook’s A.I. capabilities with satellite imagery and census information.

Movement maps, meanwhile, track aggregate data about Facebook users’ movements via their mobile phones (when location services are enabled). At scale, health partners can combine this with other data to predict where other outbreaks may occur next.

Above: movement maps of London and surrounding areas

And network coverage maps help to show where people can be reached with online messages — like those alerting to vaccination days or other health-related communications.

Of course, it’s hard to not overlook the irony involved of Facebook data and tech being used to help with outbreaks that, in some cases, Facebook had a hand in creating. The company for years allowed the spread of vaccine misinformation to spread across its network. Irresponsibly, it also allowed Facebook Pages and Groups that promoted vaccine skepticism or outright false claims to rank at the top of Facebook searches for related terms, like “vaccines.”

After time passed, it’s not surprising to find this spread of misinformation on Facebook and elsewhere resulted in measles outbreaks in the U.S. and abroad — a disease that had been eliminated as a major U.S. public health threat around 20 years ago. And despite repeated debunkings of false claims about the link between measles and autism by scientists, Facebook users — now feeling equipped by the internet to be experts on anything they can type into a search box — continued to spread misinformation at scale.

Once looped into the anti-vax communities, Facebook’s algorithms only further ensconced the skeptics into a world where only their opinions were correct, and they were surrounded by others who felt the same. This deepened their beliefs.

Today, the World Health Organization says vaccine hesitancy is now one of the biggest threats in global public health, citing the 30 percent increase in measles cases worldwide.

Above: network coverage map in Democratic Republic of Congo following the recent Ebola outbreak

Facebook only recently announced a plan to curb the spread of vaccine misinformation on its platforms, following government inquiries. But the health crisis it helped create by way of inattention is already well underway.

To be fair, Facebook is not the only platform corrupted by anti-vax misinformation — Pinterest, Twitter, YouTube, and Facebook-owned Instagram have also just taken measures to address the problem. But Facebook is the largest social network, and a highly influential platform.

Of course, vaccine-preventable diseases are only one of many crises (and potential crises) in public health, along with threats such as Ebola, antimicrobial resistance, influenza, dengue, HIV and many others. Access to more data can help health organizations in many areas.

This is not the first time Facebook has tapped its large data stores or other technologies to aid nonprofits and other researchers. The company has also provided aid organizations with anonymized location data for users in areas affected by disasters — including where people were marking themselves as safe, and where they were fleeing. In another humanitarian-related effort, Facebook has been working with A.I. to create population density maps, including most recently one showing the population of Africa.

“Epidemics pose a growing threat to lives and livelihoods,” said Vanessa Candeias, Head of Shaping the Future of Health and Healthcare at the World Economic Forum, in a Facebook announcement about the new maps. “Mitigating their risk and impact requires every tool in the toolbox.”

These Johns Hopkins students are slashing breast cancer biopsy costs

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Over 2 million women were diagnosed with breast cancer in 2018. And while the diagnosis doesn’t have to be a death sentence for women in countries like the United States, in developing countries three times as many women die from the disease.

Breast cancer survival rates range from 80% or over in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in low-income countries, according to data provided the World Health Organization.

And the WHO blames these low survival rates in less developed countries on the lack of early detection programs, which result in a higher proporation of women presenting with late-stage disease. The problem is exacerbated by a lack of adequate diagnostic technologies and treatment facilities, according to the WHO.

A group of Johns Hopkins University undergraduates believe they have found a solution. The four women, none of whom are over 21-years-old, have developed a new, low-cost, disposable core needle biopsy technology for physicians and nurses that could dramatically reduce cost and waste, thereby increasing the availability of screening technologies in emerging markets.

They’ve taken the technology they developed at Johns Hopkins University and created a new startup called Ithemba, which means “hope” in Swahili, to commercialize their device. While the company is still in its early days, the women recently won the undergraduate Lemelson-MIT Student Prize competition, and has received $60,000 in non-dilutive grant funding and a $10,000 prize associated with the Lemelson award.

Students at Johns Hopkins had been working through the problem of developing low-cost diagnostic tools for breast cancer for the past three years, spurred on by Dr. Susan Harvey, the head of Johns Hopkins Section of Breast Imaging.

While Dr. Harvey presented the problem, and several students tried to tackle it, Ithemba’s co-founders — the biomedical engineering undergrads Laura Hinson, Madeline Lee, Sophia Triantis, and Valerie Zawicki — were the first to bring a solution to market.

Ithemba co-founders Laura Hinson, Madeline Lee, Valerie Zawicki and Sophia Triantis

The 21-year-old Zawicki, who grew up in Long Beach, Calif., has a personal connection to the work the team is doing. When she was just five years old her mother was diagnosed with breast cancer, and the cost of treatment and toll it took on the family forced the family to separate. “My sister moved in with my grandparents,” Zawicki says, while her mother underwent treatment. “When I came to college I was looking for a way to make an impact in the healthcare space and was really inspired by the care my mom received.”

The same is true for Zawicki’s co-founder, Triantis.

“We have an opportunity to  solve problems that really need solving,” says Triantis, a 20-year-old undergraduate. “Breast cancer has affected so many people close to me… It is the most common cancer among women [and] the fact that women in low resource settings do not have the same standard of diagnostic care really inspired me to work on a solution.”

What the four women have made is a version of a core-needled biopsy that has a lower risk of contamination than the reusable devices that are currently on the market and is cheaper than the expensive disposable needles that are the only other option, the founders say.

We’ve designed a novel, disposable portion that attaches to the reusable device and the disposable portion has an ability to trap contaminants that would come back through the needle into the device,” says Triantis. “What we’ve created is a way to trap that and have that full portion be disposable and making the device as easy to clean as possible… with a bleach wipe.”

Ithemba’s low-cost reusable core-needle biopsy device

The company is currently in the process of doing benchtop tests on the device, and will look to file a 510K to be certified as a Class 2 medical device. Already a clinic in South Africa and a hospital in Peru are on board as early customers for the new biopsy tool.

At the heart of the new tool is a mechanism which prevents blood from being drawn back into a needle. The team argues it makes reusable needles much less susceptible to contamination and can replace the disposable needles that are too expensive for many emerging market clinics and hospitals.

Zawicki had been working on the problem for a while when Hinson, Lee, and Triantis joined up. “I joined the team when the problem was presented,” says Zawicki. “The project began with this problem that was pitched three years ago, but the four of us are really those that have brought this to life in terms of a device.”

Crucially for the team, Johns Hopkins was fully supportive of the women taking their intellectual property and owning it themselves. “We received written approval from the tech transfer office to file independently,” says Zawicki. “That is really unique.” 

Coupled with the Lemelson award, Ithemba sees a clear path to ownership of the intellectual property and is filing patents on its device.

Zawicki says that it could be anywhere from three to five years before the device makes it on to the market, but there’s the potential for partnerships with big companies in the biopsy space that could accelerate that time to market.

“Once we get that process solidified and finalize our design we will wrap up our benchtop testing so we can move toward clinical trials by next summer, in 2020,” Zawicki says.

Twitter launches new search features to stop the spread of misinformation about vaccines

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As measles outbreaks in the United States and other countries continue to get worse, Twitter is introducing new search tools meant to help users find credible resources about vaccines. It will also stop auto-suggesting search terms that would lead users to misinformation about vaccines.

In a blog post, Twitter vice president of trust and safety Del Harvey wrote “at Twitter, we understand the importance of vaccines in preventing illness and disease and recognize the role that Twitter plays in disseminating important public health information. We think it’s important to help people find reliable information that enhances their health and well-being.”

When users search for keywords related to vaccines, they will see a prompt that directs them to resources from Twitter’s information partners. In the U.S., this is Vaccines.gov, a website by the Department of Health and Human Services. A pinned tweet from one of Twitter’s partners will also appear.

One of Twitter’s new tools to stop the spread of vaccine misinformation

In addition to the U.S., the vaccine information tools will also appear on Twitter’s iOS and Android apps and its mobile site in Canada, the United Kingdom, Brazil, Korea, Japan, Indonesia, Singapore and Spanish-speaking Latin American countries.

Harvey wrote that Twitter’s vaccine information tools are similar to ones it launched for suicide and self-harm prevention last year. The company plans to launch similar features for other public health issues over the coming months, she added.

Earlier this week, the Centers for Disease Control and Prevention said measles cases in the U.S. had increased to 839. Cases have been reported in 23 states this year, with the majority—or almost 700—in New York.

Social media platforms have been criticized for not doing more to prevent the spread of misinformation about vaccines and, as measles cases began to rise, started taking measures. For example, YouTube announced earlier this year that it is demonetizing all anti-vaccine videos, while Facebook began downranking anti-vaccine content on its News Feed and hiding it on Instagram.

Journey launches its real-time group “Peloton For Meditation”

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Sitting silently with your eyes closed isn’t fun but it’s good for you…so you probably don’t meditate as often as you’d like. In that sense it’s quite similar to exercise. But people do show up when prodded by the urgency and peer pressure of scheduled group cycling or aerobics classes. What’s still in the way is actually hauling your lazy butt to the gym, hence the rise of Peloton’s in-home stationary bike with attached screen streaming live and on-demand classes. My butt is particularly lazy, but I’ve done 80 Peloton rides in 4 months. The model works.

Now that model is coming to mindfulness with the launch of Journey LIVE, a subscription iOS app offering live 15-minute group meditation classes. With sessions starting most waking hours, instructors that interact with you directly, and a sense of herd mentality, you feel compelled to dedicate the time to clearing your thoughts. By video and voice, the teachers introduce different meditation theories and practices, guide you through, and answer questions you can type in. Each day, Journey also provides a newly recorded on-demand session in case you need a class on your own schedule.

“‘I tried Headspace’ or ‘I tried Calm’ . With a lot of the current meditation apps, people go on but they drop off very quickly” says Journey founder and CEO Stephen Sokoler. “It means that there’s an interest in meditating and having a better life but people fall off because meditating alone is hard, it’s confusing, it’s boring. Meditating with a live teacher who can connect with you and say your name, who makes you feel seen and heard makes huge difference.”

Journey subscriptions start at $19.99 per month after a week-long free trial. That feels a bit steep, but prices drop to $7.99 if paid annually with the launch discount, or you can dive in with a $399 lifetime pass. The challenge will be keeping users from abandoning meditation and then their subscription without resorting to growth hacking and annoying notifications that are antithetical to the whole concept. Journey has now raised a $2.4M seed round led by Canaan and joined by Brooklyn Bridge Ventures, Betaworks, and more to get the company rolling.

Sokoler’s own journey could set an example of the possibilities of sticking with it. “Meditation changed my life. I was fortunate enough to move to Australia, find a book on Buddhism, and then I had the willpower to start practicing meditation every day” he tells me. “I lost 85 pounds. People ask me how I lost the weight and they expect me to say a diet like keto or Atkins, but it was because of the program I was in.” Suddenly able to sit quietly with himself, Sokoler didn’t need food to stay occupied or feel at ease.

The founder saw the need for new sources of happiness while working in employee rewards and recognition for 12 years. He built up a company that makes momentos for commemorating big business deals. Meditation proved to him the value of developing inner quiet, whether to inspire happiness, calm, focus, or deeper connections to other people and the world. Yet the popular meditation apps ignored thousands of years of tradition when meditation would be taught in groups that give a naturally ethereal activity more structure. He founded Journey in 2015 to bring meditation to corporate environments, but now is hoping to democratize access with the launch of Journey LIVE.

“You could think of it as a real-life meditation community or studio in the palm of your hand” Sokoler explains. Instructors greet you when you join a session in the Journey app and can give you a shout-out for practicing multiple days in a row. They help you concentrate on your breath while giving enough instruction to keep you from falling asleep. You can see or hide a list of screen names of other participants that make you feel less isolated and encourage you not to quit.

Finding a market amidst the popular on-demand meditation apps will be an uphill climb for Journey LIVE. While classes recorded a long time ago might not be as engaging, they’re convenient and can dig deep into certain styles and intentions. Calm and Headspace run around $12.99 per month, making them cheaper than Journey LIVE and potentially easier to scale.

But Sokoler says his app’s beta testing saw better retention than competitors. “If you’ve ever been to the New York Public Library, there’s so many books versus going to a local curated bookstore where something is right there for you. This is much more approachable, much more accessible” Sokoler tells me. “There’s a paradox of choice and having so many options makes it hard for people to stick with it and come back every single day.”

With our phones and Netflix erasing the downtime we used to rely on to give our brain a break or reflect on our day, life is starting to feel claustrophobic. We’re tense, anxious, and easily overwhelmed. Meditation could be the antidote. Unlike with cycling or weightlifting, you don’t need some expensive Peloton bike or Tonal home gym. What you need is consistency, and an impetus to slow down for fifteen minutes you could easily squander. We’re a tribal species, and Journey LIVE group classes could use camaraderie to lure us into the satisfying void of nirvana.

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