Category: Devices

Listen app: ResApp diagnoses respiratory ailments

published date
April 28th, 2016 by

ResApp-Logo-50px

I’m intrigued by an Australian company, ResApp that has developed a smartphone app to diagnose respiratory diseases by analyzing the sound signatures of coughs. The company has just completed an oversubscribed fundraising round, so I guess I’m not the only one who finds it interesting.

I interviewed the CEO, Dr. Tony Keating via email, and his answers are below. Meanwhile, check out the demo for their consumer-facing product.
[vimeo 140138524 w=640 h=360]

What is ResApp? from ResApp Health on Vimeo.

Q1. What unmet need does ResApp serve? How big is the need?

ResApp is developing digital health solutions for the diagnosis and management of respiratory disease (e.g. pneumonia, bronchiolitis, asthma, COPD). We estimate that every year more than 700 million doctor visits result in the diagnosis of a respiratory disease within the OECD, in the US the number is 125 million visits. Pneumonia in particular costs the US hospital system $10.5 billion annually. The World Health Organization estimates that nearly 1 million children die of pneumonia in the developing world every year, with a large portion attributed to the lack of availability of a low cost diagnostic tool. 

Current diagnosis of these disease is costly and time consuming (consider that an x-ray for pneumonia diagnosis in the US costs more than $200 and can take up to an hour in an emergency department), and there are also many areas where current diagnostic tools are unavailable. Our initial focus is to provide an accurate remote diagnostic capability to telehealth where even the stethoscope is not available to physicians. 

Q2. How does the system work?

ResApp’s technology is based on the premise that cough and breathing sounds carry vital information on the state of the respiratory tract. We use machine learning algorithms that analyze the sound of a patient’s cough. Our algorithms are able to match signatures that are within a patient’s cough with a disease diagnosis. An analogy might be how speech recognition algorithms match speech to text, or how Shazam’s algorithms look for signatures in music to identify the artist and title. 

Q3. Who came up with the idea? How?

The technology was developed by Dr Udantha Abeyratne and his team at The University of Queensland. Dr Abeyratne and his team have been engaged in the R&D of the technology since 2009. They were initially funded by a grant from The Bill and Melinda Gates Foundation to investigate if mobile phones could be used to diagnose pneumonia in the developing world. The initial idea was to take the latest advances in speech recognition technology and couple them with physicians’ in-depth knowledge of cough and breathing sounds to develop a diagnostic test that could be delivered at low cost to patients in the developing world. 

Q4. You started as a telehealth app but are now looking to serve physicians for in-person visits, such as in the emergency room. Why?

Our focus remains on providing a remote diagnostic test to be used alongside a telehealth consultation. However we have seen great interest from physicians for use in in-person visits, such as in the ER. The potential of our technology to provide an instant and highly accurate differential diagnosis of respiratory disease is seen as a way to greatly improve the diagnosis and treatment of their patients. In addition, healthcare payers could potentially realize significant cost savings versus traditional diagnostic tests (such as chest x-ray). 

Q5. The app doesn’t require any additional hardware. Is a smartphone really good enough to serve as a medical device?

Our clinical study, run out of two major Australian hospitals, has demonstrated very high levels of accuracy (both sensitivity and specificity) in diagnosis from recordings taken using the microphone on the smartphone. We are simply using the smartphone as an efficient platform for delivering a clinical-quality medical diagnostic device. The FDA has approved over 100 mobile medical apps, including a number that diagnose a disease. 

Q6. Your initial focus is on diagnostics. Do you also plan to offer tools for ongoing management? 

Yes, our recent fundraising allows us to accelerate our plans to develop tools for ongoing management of the chronic respiratory diseases asthma and COPD. We see an opportunity to potentially measure the severity of these conditions on a more regular basis than what is done today. We also see the opportunity to deliver these management tools to all smartphone users who suffer from these conditions, without the need to purchase additional hardware (or perhaps also just as importantly, without the need to carry a second device). 

Q7. What geographic markets are you serving? Are you worried you are spreading yourself to thin?

Our focus is the US telehealth market, although our recent funding extends our US market into the in-person use by a physician. In both of these instances, we are still providing the diagnostic result to the physician, not directly to the patient, so our clinical studies and FDA submissions are essentially unchanged. We have recently seen growth in telehealth, in particular in Europe and Australia and will be working through the regulatory process in those regions in parallel to the US regulatory process.

Q8. What’s to prevent someone else from copying what you are doing?

The university has filed a patent application (which ResApp has a worldwide exclusive license to) describing the method and apparatus of respiratory disease diagnosis using sound. The machine learning algorithms that we use also require a significant amount of high quality clinical data, which we have generated from our multiple clinical studies. 

Q9. Anything else to add?

ResApp’s technology, originally developed by a world-class team at one of the world’s leading universities, provides an opportunity to deliver a clinical-quality medical diagnostic test for respiratory disease to everybody who has a smartphone in their pocket. While we’ve talked a lot about the opportunities in the US, Europe and Australia, we must remember that there are also billions of people in the developing world who do not have access to quality healthcare. We have recently partnered with a leading global humanitarian organization to help bring a high accuracy, low cost diagnostic test for pneumonia to those people and to try to reduce the number of children who die from pneumonia and other respiratory diseases every year in the developing world. 

By healthcare business consultant David E. Williams, president of Health Business Group.

How crazy is Ted Cruz's FDA reform proposal?

published date
January 4th, 2016 by

ID-100355683

I don’t think very highly of Senator and Republican Presidential candidate Ted Cruz, but his proposal to loosen the drug approval process is at least worth discussing. If you haven’t heard, Cruz’s RESULT Act proposal is as follows:

  • FDA to grant reciprocal approval of “life-saving” drugs and devices from regulatory agencies in developed countries including EU, Israel, Australia, Canada and Japan. FDA would have only 30 days to review and approve
  • Congress can override FDA decisions with a majority vote

Basically he is trying to make it easier to get drugs and devices on the market. There are a number of problems with this approach, which are pointed out by my most of the respectable analysts. Objections include:

  • FDA may just reject the applications anyway since 30 days is not a long enough time to review and they may object to procedures used elsewhere
  • Insertinbg Congress directly into the process undermines the scientific basis of the decision
  • Trial sponsors may seek the jurisdiction with the lowest standards or fastest review times, imperiling safety for Americans
  • It would hurt US economic development by shifting development resources overseas
  • We would be ceding our sovereignty to foreigners
  • FDA is already pretty fast and responsive and has programs for compassionate use and acceleration of the approval process when warranted

These are all reasonable, and yet I was struck by the fact that almost all the commentators use  the Thalidomide debacle as their one and only example.  See for example STAT, The FDA Group Blog, and Harvard Law Blog, which are the top articles that come up under a Google search for “Ted Cruz FDA proposal.”

Thalidomide was approved in Europe as a sleeping pill and for morning sickness but rejected in the US. It caused serious birth defects, with thousands of people affected in Europe but not the US. Great example but we’re talking 1956. Remember 1956? I don’t. But to give you some perspective it was just two years after food rationing was lifted in the UK and nine years before Medicare was established. Soviet troops rolled into Hungary to crush the uprising there.

I don’t hear people citing 1956 examples about anything else in healthcare.

A more serious discussion could be held on the balance between safety and efficacy in FDA approvals. Cruz’s impulses might be better directed to that debate. Maybe it’s ok for FDA to approve any product that’s safe, and not force sponsors to prove efficacy. Sponsors would still want to demonstrate efficacy, but they’d need to do so for healthcare payers, not the FDA.

That’s not as simple as it sounds either. Here are some of the challenges:

  • The biggest payers are Medicare and Medicaid, so even if you take FDA out of the business of judging efficacy the government is still involved
  • In many situations, safety is relative, not absolute. I might accept a modestly effective cancer drug that kills 1 percent of those who take it, while I wouldn’t accept a cure for toenail fungus with the same death rate. But it’s also important to protect cancer patients from dangerous drugs. A recent NYT article about the death from cancer of the wife of the FDA’s head of oncology included this important and under-appreciated point: “Cancer medicines not only often fail to save patients but can accelerate their deaths and make their last weeks far more painful”
  • Safety and efficacy are individualized. (Cruz seems to recognize this.) Some drugs will be effective for only a small population; similarly safety issues don’t always apply across the board. I would want access to a drug that could cure me even if it could kill someone else, especially if there were a companion diagnostic to sort out who will be helped and hurt

Overall I think the FDA is doing a good job of managing the conflicting pressures it faces. Some parts of FDA (such as the groups with responsibility for HIV and oncology) do a better job than others.

I really would like to see Cruz’s proposal spur a more productive debate and not simply be dismissed out of hand.

Image courtesy of vectorolie at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Clerio Vision takes a step past LASIK (podcast)

published date
November 2nd, 2015 by
Clerio Visio CEO, Mikael Totterman
Clerio Visio CEO, Mikael Totterman

Clerio Vision is developing a non-invasive, tissue-sparing laser technology that corrects vision by modifying the reactive index of the cornea. It’s the third med-tech spinout from the University of Rochester for CEO Mikael Totterman and is starting to get some press, including this BioTuesdays piece. I’m on the company’s board of directors.

I caught up with Mikael recently to discuss the company’s progress.

  • (0:20) Clerio is developing a laser technology for refractive eye surgery. We already have LASIK. Do we need another approach?
  • (2:44) So LASIK has downsides, but you also use lasers. What’s the difference?
  • (3:35) How do you test something like this? What testing has been done?
  • (4:51) If the technology is so promising, why did Bausch & Lomb stop development?
  • (6:30) What steps have you taken with the company since its founding?
  • (7:55) When can we expect to see a product on the market?
  • (8:56) This is at least the third company you’ve spun out of U of R. What is the biggest lesson that you learned and how are you applying these insights to Clerio?
  • (11:00) What sort of development costs are required for commercialization? How are you funded?
  • (12:08) What else should I know?
  • (13:25) When you make modifications to intraocular lenses for cataracts, do you do it before or after implantation?

By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

Emotion tracking tools –only for trivial purposes?

published date
September 22nd, 2015 by
Who am i?
Who am i?

I was surprised that the Boston Globe’s (Waltham firm helps computers learn empathy by mapping the human face) highlighted such unimportant opportunities for the technology. Here’s what MIT Media Lab spinoff Affectiva is doing, according to the Globe:

  • Helping companies measure emotional responses to advertising
  • Spitting out pieces of chocolate for Hershey’s when someone smiles at the machine

Maybe that’s not so bad for initial applications, but what’s down the road sounds pretty unimportant as well

“If a student got stuck on a tough math problem, an empathetic school computer would recognize the confused look on his face, and instantly offer additional help. An office laptop might see that a worker is bored, and suggest that he take a coffee break or play a simple computer game. A TV that notices that nobody laughed at last night’s Adam Sandler movie might suggest Woody Allen next time.”

Give me a break. A much more profound application for these tools will be to give people better insights into others’ emotions in live one-on-one and group interactions. It will be especially helpful for people with autism and Asperger’s, but it will also be useful for the average person to better understand how others react to them. The technology could (and I assume will) be built in to a next generation of Google Glass or similar.

I know some people who could use such a tool.

I’m not suggesting anything that hasn’t already been thought of, but the Globe should have done a better job reporting on this.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

An inspiring product development tale

published date
July 17th, 2015 by
Just do it
Just do it

The times they are a changing, and in some ways for the better. Nike is releasing a new sneaker designed for people with disabilities who have trouble putting regular shoes on by themselves. The idea for the shoe came from a teen with cerebral palsy who wrote a letter to Nike that ended up with the CEO. A related request came from a Nike employee who had suffered a stroke.

The company then spent three years to design a sneaker with what USA Today calls “an elongated wraparound zipper system to allow a wearer to open close the show with one hand.” They collaborated with the teen to perfect the design.

This isn’t some clunky looking, medicalized shoe. Instead, the Zoom Soldier 8 Flyease is a variation on a Lebron James basketball shoe. It’s cool and stylish.

Advocates for the disabled are pleased, because Nike can make a significant impact on quality of life with this product, and because it represents a new phase of acceptance for people who are a little different. I won’t be surprised if the shoe is a big hit –there are lots of people who have physical challenges of various types who might really like it.

If Nike can make money on the concept, that’s good news for everyone because it will demonstrate that this is a profitable opportunity, which will encourage others to compete.

The situation reminds me somewhat of the highway safety movement a generation ago. Although the problem of avoidable automobile deaths was there if you looked for it, the auto industry –with the exception of Volvo– wanted nothing to do with it. But once the public started to express an interest in safety, the world changed, and car companies started to compete on safety as well as styling and power.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.