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June 25, 2019
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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.

Consumers get another digital home health offering as Tyto Care and Best Buy launch TytoHome

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Best Buy is partnering with the Israeli technology Tyto Care to become the official retailer for the company’s all-in-one digital diagnostics kit through its physical stores in California, the Dakotas, Ohio and Minnesota and through its online store.

Tyto previously sold its technology through healthcare plans, making its handheld examination device with attachments that act as a thermometer, a stethoscope, an otoscope and a tongue depressor available to families with insurance that wanted to reduce the cost of checkups through remote monitoring. The company’s handheld device comes with an exam camera so it can prompt users on where to position the device to get the most accurate readings.

 

Now, through Best Buy, consumers can buy the company’s kit for $299.99. Through a partnership with American Well, users of the TytoHome kit have access to the company’s LiveHealth Online consultation service (if they live outside of Minnesota or the Dakotas). Which means patients can use the device to perform a medical exam and send the information to a physician for a diagnosis any time of the day or night.

As part of the deal, Tyto Care is partnering with additional regional health care systems to provide medical care to consumers throughout the country. The first is Sanford Health, a Minnesota-based not-for-profit health system operating in Minnesota, North Dakota and South Dakota. 

For Best Buy the move builds on the company’s attempts to move quickly into providing digital healthcare services just like it provides technical support through its Geek Squad.

Last year the company bought GreatCall, which sells connected health and emergency response services to the AARP crowd.

“We’re excited to partner with Best Buy, LiveHealth Online, American Well and regional health systems to extend our on-demand telehealth platform across the U.S., enhancing primary care delivery,” said Dedi Gilad, the chief executive and co-founder of Tyto Care, in a statement.

The company, based in Herzliya, Israel, has raised $56.7 million to date from investors including Sanford Health, the Japanese Itochu Corp., Shenzhen Capital Group, Ping An, LionBird, Fosun Group, Orbimed and Walgreens.

The company said at the time that it would use the cash to expand in the U.S. and to other international markets in Asia and Europe.

“These strategic partnerships will enable us to gain further momentum and accelerate our growth, deepening our foothold in the U.S. and other new strategic markets,” said GiladTyto Care said in a statement at the time.

Ro, a direct-to-consumer online pharmacy, reaches $500M valuation

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Venture capitalists have valued direct-to-consumer telehealth business Ro at $500 million with an $85 million Series B financing, sources confirm to TechCrunch.

The fresh round of funding comes seven months after Ro — widely known for its men’s health brand Roman, a cloud pharmacy for erectile dysfunction — made headlines with an $88 million Series A. 

Ro didn’t immediately respond to a request for comment.

The company’s outsized Series A, led by FirstMark Capital, was used to launch and scale its second digital health brand, “Zero,” a treatment plan meant to help men and women quit smoking. Zero sells a $129 kit complete with a month’s worth of prescription cessation medication Bupropion, nicotine gum and access to an app used to track progress.

Its latest infusion of capital will likely be used in part to support its third personalized health brand, Rory, a purveyor of women’s health products the business unveiled last month. Targeting menopausal women, Rory offers six products treating four conditions — including prescription medication and supplements for hot flashes, over-the-counter treatments for insomnia, prescription vaginal estrogen cream and an all-natural water-based lubricant for vaginal dryness and Latisse, which helps grow eyelashes — which are available for purchase and direct-to-consumer delivery.

“Right now, we have [millions] of women experiencing menopause,” Rory co-founder Rachel Blank told TechCrunch last month. “They are walking around and frankly, their vagina hurts and they are uncomfortable. Really, what we are building at Rory is a lot of the educational content around this to let women know they have choices and they can take control during this phase of life where they feel like their bodies are rebelling against them.”

When asked whether Ro was fundraising to bolster the new effort, Blank, a former investor at Ro-backer General Catalyst, declined to comment. Curiously, a source with knowledge of Ro’s fundraising said there was no mention of the imminent launch of its women’s brand, Rory, in its pitch to VCs earlier this year.

Ro was started by a trio of entrepreneurs: Rob Schutz, Saman Rahmanian and chief executive officer Zachariah Reitano in 2017. Reitano had previously co-founded a Y Combinator -backed startup called Shout, Rahmanian is a co-founder of the WeWork-acquired business Managed by Q, and Schutz worked as the vice president of growth for Bark&Co before building Ro.

The startup initially launched under the name Roman, which became its flagship brand when the business adopted the umbrella name Ro last year. Roman offers men a $15 online doctor’s consultation, which, if they are an appropriate candidate, gives them access to an instant prescription for Viagra, Cialis or generic drugs that can be filled at Roman’s in-house cloud pharmacy.

In a 2017 interview with TechCrunch’s Josh Constine, Reitano said he began experiencing ED at 17-years-old: “I think in a good way I’ve become numb to the embarrassment,” he said. “I remember the embarrassment of having the condition with no solution, and that’s much worse than sharing the fact that I had it and was able to fix it myself.”

Ro has previously raised $91.1 million in venture capital funding, hitting a valuation of $154 million with its Series A, according to PitchBook. Its investors include Initialized Capital, Box Group and Slow Ventures, as well as angels like Y Combinator partner Aaron Harris, Benchmark’s Scott Belsky and the chief executives of Casper, Code Academy and Pill Pack.

Founded just two years ago, Ro was amongst the first of a new cohort of men’s health businesses supported by VCs. Hims, one of the leading brands in the space, has similarly landed big rounds of capital from top-tier investors. Most recently, Hims brought in $100 million at a $1 billion valuation from an undisclosed growth-stage fund.

Several other companies, including Numan, Manual and Thirty Madison, have raised capital to support men with hair loss treatments and ED medications delivered to discreetly their doorsteps, among other products.

Two former Qualcomm engineers are using AI to fix China’s healthcare problem

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Artificial intelligence is widely heralded as something that could disrupt the jobs market across the board — potentially eating into careers as varied as accountants, advertising agents, reporters and more — but there are some industries in dire need of assistance where AI could make a wholly positive impact, a core one being healthcare.

Despite being the world’s second-largest economy, China is still coping with a serious shortage of medical resources. In 2015, the country had 1.8 physicians per 1,000 citizens, according to data compiled by the Organization for Economic Cooperation and Development. That figure puts China behind the U.S. at 2.6 and was well below the OECD average of 3.4.

The undersupply means a nation of overworked doctors who constantly struggle to finish screening patient scans. Misdiagnoses inevitably follow. Spotting the demand, forward-thinking engineers and healthcare professionals move to get deep learning into analyzing medical images. Research firm IDC estimates that the market for AI-aided medical diagnosis and treatment in China crossed 183 million yuan ($27 million) in 2017 and is expected to reach 5.88 billion yuan ($870 million) by 2022.

One up-and-comer in the sector is 12 Sigma, a San Diego-based startup founded by two former Qualcomm engineers with research teams in China. The company is competing against Yitu, Infervision and a handful of other well-funded Chinese startups that help doctors detect cancerous cells from medical scans. Between January and May last year alone, more than 10 Chinese companies with such a focus scored fundings of over 10 million yuan ($1.48 million), according to startup data provider Iyiou. 12 Sigma itself racked up a 200 million yuan Series B round at the end of 2017 and is mulling a new funding round as it looks to ramp up its sales team and develop new products, the company told TechCrunch.

“2015 to artificial intelligence is like 1995 to the Internet. It was the dawn of a revolution,” recalled Zhong Xin, who quit his management role at Qualcomm and went on to launch 12 Sigma in 2015. At the time, AI was cereping into virtually all facets of life, from public security, autonomous driving, agriculture, education to finance. Zhong took a bet on health care.

“For most industries, the AI technology might be available, but there isn’t really a pressing problem to solve. You are creating new demand there. But with healthcare, there is a clear problem, that is, how to more efficiently spot diseases from a single image,” the chief executive added.

An engineer named Gao Dashan who had worked closely with Zhong at Qualcomm’s U.S. office on computer vision and deep learning soon joined as the startup’s technology head. The pair both attended China’s prestigious Tsinghua University, another experience that boosted their sense of camaraderie.

Aside from the potential financial rewards, the founders also felt an urge to start something on their own as they entered their 40s. “We were too young to join the Internet boom. If we don’t create something now for the AI era, it will be too late for us to be entrepreneurs,” admitted Zhong who, with age, also started to recognize the vulnerability of life. “We see friends and relatives with cancers get diagnosed too late and end up  The more I see this happen, the more strongly I feel about getting involved in healthcare to give back to society.”

A three-tier playbook

12 Sigma and its peers may be powering ahead with their advanced imaging algorithms, but the real challenge is how to get China’s tangled mix of healthcare facilities to pay for novel technologies. Infervision, which TechCrunch wrote about earlier, stations programmers and sales teams at hospitals to mingle with doctors and learn their needs. 12 Sigma deploys the same on-the-ground strategy to crack the intricate network.

Zhong Xin, Co-founder and CEO of 12 Sigma / Photo source: 12 Sigma

“Social dynamics vary from region to region. We have to build trust with local doctors. That’s why we recruit sales persons locally. That’s the foundation. Then we begin by tackling the tertiary hospitals. If we manage to enter these hospitals,” said Zhong, referring to the top public hospitals in China’s three-tier medical system. “Those partnerships will boost our brand and give us greater bargaining power to go after the smaller ones.”

For that reason, the tertiary hospitals are crowded with earnest startups like 12 Sigma as well as tech giants like Tencent, which has a dedicated medical imaging unit called Miying. None of these providers is charging the top boys for using their image processors because “they could easily switch over to another brand,” suggested Gao.

Instead, 12 Sigma has its eyes on the second-tier hospitals. As of last April, China had about 30,000 hospitals, out of which 2,427 were rated tertiary, according to a survey done by the National Health and Family Planning Commission. The second tier, serving a wider base in medium-sized cities, had a network of 8,529 hospitals. 12 Sigma believes these facilities are where it could achieve most of its sales by selling device kits and charging maintenance fees in the future.

The bottom tier had 10,135 primary hospitals, which tend to concentrate in small towns and lack the financial capacity to pay the one-off device fees. As such, 12 Sigma plans to monetize these regions with a pay-per-use model.

So far, the medical imaging startup has about 200 hospitals across China testing its devices — for free. It’s sold only 10 machines, generating several millions of yuan in revenue, while very few of its rivals have achieved any sales at all according to Gao. At this stage, the key is to glean enough data so the startup’s algorithms get good enough to convince hospital administrators the machines are worth the investment. The company is targeting 100 million yuan ($14.8 million) in sales for 2019 and aims to break even by 2020.

China’s relatively lax data protection policy means entrepreneurs have easier access to patient scans compared to their peers in the west. Working with American hospitals has proven “very difficult” due to the country’s privacy protection policies, said Gao. They also come with a different motive. While China seeks help from AI to solve its doctor shortage, American hospitals place a larger focus on AI’s economic returns.

“The healthcare system in the U.S. is much more market-driven. Though doctors could be more conservative about applying AI than those in China, as soon as we prove that our devices can boost profitability, reduce misdiagnoses and lower insurance expenditures, health companies are keen to give it a try,” said Gao.

Healthcare by 2028 will be doctor-directed, patient-owned and powered by visual technologies

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Visual assessment is critical to healthcare – whether that is a doctor peering down your throat as you say “ahhh” or an MRI of your brain. Since the X-ray was invented in 1895, medical imaging has evolved into many modalities that empower clinicians to see into and assess the human body.  Recent advances in visual sensors, computer vision and compute power are currently powering a new wave of innovation in legacy visual technologies(like the X-Ray and MRI) and sparking entirely new realms of medical practice, such as genomics.

Over the next 10 years, healthcare workflows will become mostly digitized, with wide swaths of personal data captured and computer vision, along with artificial intelligence, automating the analysis of that data for precision care. Much of the digitized data across healthcare will be visual and the technologies that capture and analyze it are visual technologies.

These visual technologies traverse a patient’s journey from diagnosis, to treatment, to continuing care and prevention.They capture, analyze, process, filter and manage any visual data from images, videos, thermal, x-ray’s, ultrasound, MRI, CT scans, 3D, and more. Computer vision and artificial intelligence are core to the journey.

Three powerful trends — including miniaturization of diagnostic imaging devices, next generation imaging to for the earliest stages of disease detection and virtual medicine — are shaping the ways in which visual technologies are poised to improve healthcare over the next decade.

Miniaturization of Hardware Along with Computer Vision and AI will allow Diagnostic Imaging to be Mobile

Medical imaging is dominated by large incumbents that are slow to innovate. Most imaging devices (e.g. MRI machines) have not changed substantially since the 1980s and still have major limitations:

  • Complex workflows: large, expensive machines that require expert operators and have limited compatibility in hospitals.

  • Strict patient requirements: such as lying still or holding their breath (a problem for cases such as pediatrics or elderly patients).

  • Expensive solutions: limited to large hospitals and imaging facilities.

But thanks to innovations in visual sensors and AI algorithms, “modern medical imaging is in the midst of a paradigm shift, from large carefully-calibrated machines to flexible, self-correcting, multi-sensor devices” says Daniel K. Sodickson, MD, PhD, NYU School of Medicine, Department of Radiology.

MRI glove-shaped detector proved capable of capturing images of moving fingers.  ©NYU Langone Health

Visual data capture will be done with smaller, easier to use devices, allowing imaging to move out of the radiology department and into the operating room, the pharmacy and your living room.

Smaller sensors and computer vision-enabled image capture will lead to imaging devices that are being redesigned a fraction of the size with:

  • Simpler imaging process: with quicker workflows and lower costs.

  • Lower expertise requirements: less complexity will move imaging from the radiology department to anywhere the patient is.

  • Live imaging via ingestible cameras: innovation includes powering ingestibles via stomach acid, using bacteria for chemical detection and will be feasible in a wider range of cases.

“The use of synthetic neural network-based implementations of human perceptual learning enables an entire class of low-cost imaging hardware and can accelerate and improve existing technologies,” says Matthew Rosen, PhD, MGH/Martinos Center at Harvard Medical School.

©Matthew Rosen and his colleagues at the Martinos Center for Biomedical Imaging in Boston want liberate the MRI.

Next Generation Sequencing, Phenotyping and Molecular Imaging Will Diagnose Disease Before Symptoms are Presented

Genomics, the sequencing of DNA, has grown at a 200% CAGR since 2015, propelled by Next Generation Sequencing (NGS) which uses optical signals to read DNA, like our LDV portfolio company Geniachip which was acquired by Roche. These techniques are helping genomics become a mainstream tool for practitioners, and will hopefully make carrier screening part of routine patient care by 2028.

Identifying the genetic makeup of a disease via liquid biopsies, where blood, urine or saliva is tested for tumor DNA or RNA, are poised to take a prime role in early cancer screening. The company GRAIL, for instance, raised $1B for a cancer blood test that uses NGS and deep learning to detect circulating tumor DNA before a lesion is identified.

Phenomics, the analysis of observable traits (phenotypes) that result from interactions between genes and their environment, will also contribute to earlier disease detection. Phenotypes are expressed physiologically and most will require imaging to be detected and analyzed.

Next Generation Phenotyping (NGP) uses computer vision and deep learning to analyze physiological data, understand particular phenotype patterns, then it correlates those patterns to genes. For example, FDNA’s Face2Gene technology can identify 300-400 disorders with 90%+ accuracy using images of a patient’s face. Additional data (images or videos of hands, feet, ears, eyes) can allow NGP to detect a wide range of disorders, earlier than ever before.

Molecular imaging uses DNA nanotech probes to quantitatively visualize chemicals inside of cells, thus measuring the chemical signature of diseases. This approach may enable early detection of neurodegenerative diseases such as Alzheimer’s, Parkinson’s and dementia.

Telemedicine to Overtake Brick-and-Mortar Doctors Visits

By 2028 it will be more common to visit the doctor via video over your phone or computer than it will be to go to an office.

Telemedicine will make medical practitioners more accessible and easier to communicate with. It will create an all digitized health record of visits for a patient’s profile and it will reduce the costs of logistics and regional gaps in specific medical expertise. An example being the telemedicine services rendered for 1.9M injured in the war in Syria.4

The integration of telemedicine into ambulances has led to stroke patients being treated twice as fast.  Doctors will increasingly call in their colleagues and specialists in real time.

Screening technologies will be integrated into telemedicine so it won’t just be about video calling a doctor. Pre-screening your vitals via remote cameras will deliver extensive efficiencies and hopefully health benefits.

“The biggest opportunity in visual technology in telemedicine is in solving specific use cases. Whether it be detecting your pulse, blood pressure or eye problems, visual technology will be key to collecting data,” says Jeff Nadler, Teldoc health.

Remote patient monitoring (RPM) will be a major factor in the growth of telemedicine and the overall personalization of care. RPM devices, like we are seeing with the Apple Watch, will be a primary source of real-time patient data used to make medical decisions that take into account everyday health and lifestyle factors. This personal data will be collected and owned by patients themselves and provided to doctors.

Visual Tech Will Power the Transformation of Healthcare Over the Next Decade

Visual technologies have deep implications for the future of personalized healthcare and will hopefully improve the health of people worldwide. It represents unique investment opportunities and we at LDV Capital have reviewed over 100 research papers from BCC Research, CBInsights, Frost & Sullivan, McKinsey, Wired, IEEE Spectrum and many more to compile our 2018 LDV Capital Insights report. This report highlights the sectors that power to improve healthcare based on the transformative nature of the technology in the sector, projected growth and business opportunity.

There are tremendous investment opportunities in visual technologies across diagnosis, treatment and continuing care & prevention that will help make people healthier across the globe.

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