Friday, 1 May 2020

Healthtech: What a time to be alive

The Beginning

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There has never been a more pressing moment in modern times for companies working in health technology to step up to the plate and find solutions that will enable people across the world to access better, more affordable healthcare. Innovation in the healthcare sector was on track to hit USD 504.4 bn by 2025 — at least in pre-corona times — and it could be worth far more than that in the future as technology continues to provide new ways of monitoring patients, collecting data, performing diagnoses, and assisting operations.

Using healthtech to treat covid-19

The world is awaiting a covid-19 vaccine with baited breath, but how close are we? Well, there’s good news and bad news. The good news? Scientists are working flat out to develop a vaccine. The bad news, though, is that vaccine development is far from straightforward and we could be waiting a long time before a remedy is found and made easily accessible to all corners of the world.

Vaccines for dummies: A vaccine stimulates the body’s immune system by exposing it to an agent that shares similarities with a disease-causing pathogen. This causes the immune system to produce antibodies, preparing it to fight the disease if it contracts it in the future. To achieve this scientists need to find a viable antigen, which could be obtained from other strains of the virus.

Wait, what’s an antigen? This is a weakened strain of the virus that the body’s immune system can recognize without the person actually becoming infected. Vaccines also include what’s known as adjuvants — an agent that heightens the reaction of the immune system to the antigen.

So what’s the hold-up? Any potential vaccine must be tested in several phases. First, studies are conducted on animals. Then, three stages of clinical trials are performed on healthy patients before regulators can give the green light to proceed. This process often takes 10 to 15 years, but US immunologist and public health adviser Anthony Fauci believes that a vaccine could be developed within the next year-and-a-half (watch, runtime: 1:34).

There are currently 70 potential covid-19 vaccines in different phases of production — including three that are already being tested on humans — according to the World Health Organization (pdf). The most promising appears to be an experimental vaccine developed by Hong Kong’s CanSino Biologics and the Beijing Institute of Biotechnology. Big pharma is also getting in on the hunt, with giants Pfizer, Inovio and Sanofi all in the early stages of vaccine development.

Some research labs and pharma companies are taking a different approach and exploring whether existing medication can treat the virus. There is still no consensus, but tests have yielded some interesting results:

Remdesivir is an antiviral medication that has been used to treat Ebola: A large-scale clinical trial launched last month to test a mix of remdesivir, lopinavir and ritonavir on 3.2k patients. Tests are also ongoing in the US on the use of remdesivir after a reported two-thirds of severe covid-19 cases showed improvement when it was used.

Japanese influenza medication favipiravir has drawn praise from Chinese medical authorities: Clinical trials saw 340 patients from Wuhan and Shenzhen test negative for covid-19 in only four days but the med seems to only be effective in cases that were caught early.

Australia is testing antimalarial drug chloroquine, and HIV-suppressing combination lopinavir/ ritonavir: All cases in early clinical trials of these medications have completely recovered from covid-19. But before we follow The Donald’s lead and start touting chloroquine as a miracle covid-19 cure, it’s worth remembering that scientists have yet to draw conclusive evidence that the patients’ own immune systems were not behind the recoveries.

A host of startups are experimenting with treatments. One therapeutics company, Celularity, recently received approval to begin a clinical trial using stem cells to bolster patients’ own immune systems. The idea of its CYNK-001 therapy is to give patients an infusion of “Natural Killer” white blood cells, to kill the virus and stop it replicating inside the body. The Mississippi Valley Regional Blood Center is trying plasma therapy — collecting plasma donations from recovered patients whose blood contains antibodies ready to fight the virus — and administering this to new patients through a transfusion. And Blue Ocean Robotics subsidiary UVD Robots is sending in robots that emit powerful UV-C ultraviolet light to destroy viruses, bacteria, and other germs on hospital surfaces.

The cutting edge

It seems the robots are actually coming to save us. From ‘bionic’ prostheses that offer the wearer better positioning through spatial awareness, to miniscule endoscopy bots that work like remote-controlled vehicles, robots are offering patients and doctors greater control than ever before. The da Vinci surgical system allows surgeons to operate machines that mimic their hand movements, offering greater dexterity and precision and reducing the invasive nature of surgery.

A necessary disclaimer: Robots don’t actually perform the surgery. We can only imagine the emails they receive.

Health workers are making better use of AI than ever before. AI is poised to transform the healthcare sector through automation and deep learning. Already it is powering implants that monitor patients’ vital signs. Machine learning analyses of complex wound images mean that problems can be detected earlier, helping to prevent unnecessary procedures like diabetes-related amputations. Clinicians can flag injury patterns consistent with abuse. Deep learning tools can automate the process of quantifying pathogens in blood samples, helping to identify people who are unknowing vectors of infection, and tracing their movements through smartphones. And some ambulances will soon be self-driving, with inbuilt mechanisms that turn traffic lights green so they can zip patients off to hospital.

Regeneration? It’s as easy as 1, 2, 3. Bioprinting uses cells from undamaged skin as personalized “ink” that can then be expanded with a hydrogel for dermal regeneration. A similar process can generate entire organs for transplant using cryogenic 3D printing.

Gene therapy is making great strides: Gene therapy involves the insertion of copies of healthy genes into a patient’s genetic code to counteract the effect of mutated or missing genes that can cause genetic disorders and illnesses. The genes can be injected directly into cells. The technique has courted controversy, and only received regulatory approval in the US in 2017 after years of research and development. It has mostly been used to help patients fighting cancer, but a version of the therapy recently developed by Bluebird Bio has shown some promise in curing a teenage boy in France of sickle cell disease. Meanwhile, another form of the treatment — known as Kymriah and Yescarta — has sent patients in the US with bone marrow cancer and lymphoma into long term remission.

Get to know your brain: Brain mapping is a way of discovering where cognitive and emotional functions take place in the physical brain. It can take place through infrared laser stimulation techniques, magnetic resonance imaging or 3D computer imaging. One of the most groundbreaking techniques used is a system known as Multiplexed Analysis of Projections by Sequencing (MAPseq) which uses genetic barcodes to map out neurons in the brain with greater specificity. It is hoped that this will shed light on how to better address conditions like schizophrenia and autism. Brain mapping can also be used for treatment like the safe extraction of tumors, reducing the risk to cognitive functions like speech and movement.

Immunotherapy: Medically-induced hyperactivity for your immune system. Immunotherapy is most commonly used in cancer treatment, where targeted antibodies, cancer vaccines, adoptive cell transfer and tumor-infecting viruses might all be used to prevent the spread of cancer, according to the Cancer Research Institute. Researchers at Yale are currently working to target cancerous cells more effectively. Some test trials have shown success, and opening up potentially better alternatives to radiation therapy.

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Your top 5

Your top 5 pieces of business and economic news in April:

  • Egypt will be the only country in the region to maintain growth as the world tips into recession -IMF: The IMF predicted that Egypt will be the only MENA country to see its economy expand, anticipating 2% GDP growth this year before a slight acceleration to 2.8% in 2021. This came in the lender’s latest World Economic Outlook which forecast the global economy to contract by 3% this year — the worst global recession since the Great Depression.
  • March’s PMI reading wasn’t overly reassuring: Non-oil private sector activity shrunk to three-year lows in March, with the PMI gauge falling to 44.2 from 47.1 in February.
  • No need to worry just yet, say credit rating agencies: Moody’s and S&P Global Ratings both maintained Egypt’s B credit rating.
  • Income tax filing deadline pushed: The presidency has ordered that the income tax filing deadline be extended for two months to 30 June to help businesses weather the corona storm. Guidance about which businesses are eligible for corporate income tax relief is set to be provided by the end of the month.
  • CBE takes its foot off the gas: The CBE left interest rates on hold in its first meeting following the record 300 bps cut in the middle of March.

Ethical issues in healthtech

More healthtech leads to ethical quandaries. AI in healthcare holds the promise of everything from improved diagnosis and treatment to tools that could transcribe medical records and assist in surgery. It might even predict future public health threats. But AI innovations could also encourage doctors to make dangerous ethical compromises. In particular, AI and emerging tech risk violating two key ethical fundamentals: patient privacy and confidentiality, and equal access to healthcare.

Exhibit #1 — AI can be dangerously biased: Bias is a real risk in AI because machines learn using historical data, and history isn’t exactly impartial. A 2015 Amazon job selection exemplifies this, with the algorithm used giving higher ratings to men because they had been selected most often in the past. A well-researched blog entry in Quantib applies this principle to healthcare. If an algorithm built to detect skin cancer is used on patients from different racial backgrounds, it needs to be trained on a dataset representative of all skin colors. Otherwise, deploying it in a hospital with diverse patients is surely out of the question.

Exhibit #2 — AI puts medical data at risk: Medical records are usually held by doctors and protected by strict confidentiality agreements. But when AI is involved, it can be harder for patients to understand how and why their data will be used. As healthcare becomes more deeply embedded in complex systems, getting patient consent for every procedure or step in data analysis will be even more difficult, says this Forbes Insights article. A potential workaround might be to remove personal identifiers from datasets, but according to a University of California study today’s anonymization tech isn’t yet up to par.

The answer might be to reframe traditional notions of confidentiality, recognizing that algorithm developers actually have legitimate reasons for accessing sensitive patient information, experts quoted by Forbes say. This would also mean better educating patients about can support individual and public health, so they are more comfortable with their medical information being viewed or used, argue AI advocates.

But would you really trust a robo doctor? Digital healthcare increasingly puts doctors in the role of “data clerks,” spending too much time working with databases and screens and less time interacting with patients, TechTalks’ Ben Dickson writes. The key question is, as AI advances, will it give doctors back some time by automating data entry, or go the other way and essentially replace them with algorithms?

The case for a digital code of ethics: It’s fair to argue that high tech healthcare creates the need for a so-called “digital code of ethics.” There are several reasons for this, including the fact that patients aren’t mere datasets and that we ought not let the business of medicine triumph over ethical medical care, health academic Eric Swirsky writes for US-based security magazine CSO. “AI has its positives, but it can be misused. So, having an ethical framework allows the proper use of medical databases,” University of New South Wales research ethics director Ted Rohr tells Healthcare IT News.

Healthtech startups in Egypt

Egyptian startups are making waves as healthtech emerges as a global trend. Here are some of the biggest success stories:

Chefaa saves you from hunting for medicine — in person or on the phone: Digital pharmacy app Chefaa allows users to scan prescriptions, order and pick up medicine, and check the correct dosage of what they’ve been prescribed. Launched in 2017, the startup has raised six-figure seed funding and is hoping to expand within and beyond Egypt.

Vezeeta aims to empower patients by treating them like consumers: Digital healthcare startup Vezeeta launched in Cairo in 2012 as a way to find, book, and rate doctors, and has since expanded its operations to cities across Egypt, Saudi Arabia, Jordan and Lebanon. It has most recently launched in Nigeria and Kenya. The company has also started rolling out two new products this year, ePharmacy and Tele-health, to make medical assistance available through the app.

And mental health is (rightly) being prioritized at last: Online therapy startup Shezlong, named after the chair a person might traditionally have sat on when seeing a psychologist, enables users to talk to therapists online through videoconferencing. The application launched in 2015 and now has around 150 therapists on its books, letting you filter to choose one that meets your needs. The startup was recently featured by Reuters for offering 150k free sessions to help people cope with anxiety or depression during the covid-19 pandemic.

Interested in more Egyptian healthtech startups? Check out this link featuring 15 of the biggest players in the market.

Global healthtech startups

The global healthtech startup scene is going from strength to strength:

  • Personalized implants for better diagnosis: Swiss Neurosoft Bioelectronics has developed personalized soft implants that can be used to diagnose various diseases, targeting the brain, the spinal cord, peripheral nerves, or other organs such as the heart or the gut, according to Venture Kick. Their first product in development is SOFT ECoG, soft implantable electrodes that mold to the human brain to record and stimulate the brain surface, and can be used to monitor epilepsy patients or during brain surgery.
  • Glowing cribs to treat babies with neonatal jaundice: Nigerian founder Virtue Oboro created Crib A’Glow after almost losing her firstborn to neonatal jaundice, a disease that can be fatal to babies if their livers are underdeveloped. Produced by Tiny Hearts Technology startup, Crib A’Glow is a solar phototherapy glowing crib that treats the disease. Since its inception in 2017, the crib has saved over 1250 babies.
  • Bluetooth jackets that detect pneumonia: Ugandan inventor Brian Turyabagye created the Mama-Ope jacket in response to the problem of misdiagnosed pneumonia, which kills half a mn children under five each year in sub-Saharan Africa, according to CNN. The jacket uses Bluetooth technology to measure body temperature, heart rate, and lung condition.
  • Big data for cost-effective blood therapy: AIDA Diagnostics is a Polish clinical decision support system startup that employs AI and big data to provide blood transfusion recommendations. AIDA estimates that its data-driven healthcare services could reduce blood therapy costs by 10% annually. The startup has raised EUR 177k since it was founded in 2019, and is expected to participate in clinical trials in Warsaw in 2020.
  • Quantum computing for more efficient pharmaceutical production: ApexQubit is a Latvian biotech startup that uses innovative AI and quantum computing technologies to streamline pharmaceutical production and automate drug Founded in 2018, the company was chosen among 9 others to take part in Dutch accelerator HealthInc earlier this year.
  • Using AI to reveal the “secrets of complex disease structures”: Scailyte AG is a Swiss-based biotech startup that uses AI for biomedical research, pharma discovery and single-cell data extraction. Founded in 2017, the company received EUR 2.4 mn in seed funding from Swisscom Ventures and Zürcher Kantonalbank in 2018 and was the recipient of 100k from the MassTech Switzerland accelerator program in the same year. Scailyte was also named among Forbes’ top 30 healthtech startups in the region.

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