Health 2.0

Yesterday’s CCTSI Informatics Seminar was presented by Dr. Diane Skiba on Health 2.0 Tools; how the ‘wisdom of crowds’ from Web environments is influencing health care and academia. Yes, despite the resistance, Web 2.0 is penetrating health care. Dr. Skiba’s message is that, with healthcare becoming more consumer driven, Web 2.0 technologies will continue to make inroads with or without full clinical acceptance. It is therefore incumbent upon healthcare providers to adopt the technologies so that the information and knowledge requirements of patients and their families can be served more effectively.

Personal Health Records (PHR) such as Google Health and Microsoft HealthVault, online patient communities such as PatientsLikeMe and health oriented Web sites such as WebMD and Revolution Health are growing rapidly, Americans are relying more on online sources for healthcare information than their physicians. The need and value of this resource is well established, it’s now a question of how the medical community intends to work with it.

Dr. Skiba also pointed out the need to meet the needs of the future nursing staff members most of whom are now in school and are submersed in social networking and online collaboration tools. These current students have developed learning and work processes are more aligned with Web 2.0 technologies than traditional methods. How will these future nurses be recruited and integrated into medical institutions unless the institutions adopt new the information technologies?

Finally, the amount of information being accumulated in PHRs, online patient communities, health wikis and blogs is increasing at an exponential rate and will continue for the foreseeable future. How can this knowledge be effectively used by clinicians to the benefit of future patients? In this respect, online health information is little different than the vast amounts of information being accumulated in other sectors. But if the potential exists for lifesaving therapies to lie hidden in the health data sources it makes these sources much more valuable.

Lijit Unplugged

A fun and, dare I say, educational event hosted by Silicon Flatirons tonight featuring Todd Vernon and Walter Knapp, the CEO and COO respectively of Lijit. This is part of the Entrepreneurs Unplugged series, a chance to introduce local Boulder entrepreneurs to CU students, faculty and community to get their entrepreneurial juices flowing.

Lijit's mission is to provide super cool services to online publishers of all sizes that help them understand their readers better and create a business around their passion. It’s featured right here on this blog. Lijit not only provides search capability for blogs, it links to the blogger's network to provide levels of authority in the search results.

This method of leveraging social networks to refine search results adds up to better targeted advertising, i.e. double the click through rate of Google Ads.

According to the two executives, Boulder still gets 80% of its venture funding from out of state. They didn’t go into any great detail on how those funds were distributed, but the upshot is that most profits flow out of state once a liquidation event occurs. Another issue they mentioned with the Boulder startup environment is that it’s easy to start, difficult to exit.

The audience was enthusiastic, perhaps cooking up new entrepreneurial efforts for the future.

Personalized Medicine at Medco

In a recent press release, Medco Health Solutions announced that it is partnering with the FDA to study the applicability of personalized medicine methodologies to prescription drug treatment. Medco is the nation’s leading pharmacy benefit manager and the announcement signals the continued mainstreaming of pharmacogenomics in healthcare.

Medco and the FDA will jointly develop research projects, programs and strategies in the area of pharmacogenomics, the science of using a patient’s genotype to predict their response to drug treatments.

Medco’s objective is to advance pharmacy care and take some of the guesswork out of the prescription process. Specifically, the objectives of the program are to address:

Safety of prescription drugs
Physician participation in pharmacogenomic testing
Usefulness of tests in prescribing
Quantifying prescription information about drugs

Central to the research studies will be Medco’s extensive database of pharmacy claims. Medco is already involved with pharmacogenomic studies including Warfarin at the Mayo Clinic and tamoxifen with LabCorp.

Adam’s Next Big Venture

Kudos to Adam Rubenstein, blogger extraordinaire, for landing a plum job at cutting edge pharmacogenomic firm ARCA biopharma. In addition to typing his fingers to the bone on seventeen blogs, Adam has been raising money for Fitzsimons BioBusiness Partners, getting MycoLogics off the ground and consulting with High Country Venture. Working at one place may seem like a vacation.

Good luck Adam!

The Progressive Blockbuster

Retiring CEO of GlaxoSmithKline Jean-Pierre Garnier has published his thoughts on the shifting pharmaceutical business model in this month's Harvard Business Review. True to his roots, Garnier advocates returning the management of R&D to the scientists.

But Garnier doesn't stop at restoring R&D management to scientists; he also has some strategies for reorganizing the drug development process. The first is to separate the processes of creating first-in-class from best-in-class drugs. Although discovering a first-in-class may be more satisfying scientifically, pharmas incur less risk and equal, or greater, rewards from best-in-class.

These two R&D processes are currently intertwined in most pharmas which, according to Garnier, leads to reduced productivity in both processes. Of course many of the functions of the processes are shared; complete separation would be impossible, but improved performance could be achieved with a concerted effort.

Garnier's next idea is what he calls "progressive blockbuster." Blockbuster status is the goal that every pharma is seeking yet is becoming more elusive as we enter the smaller patient populations of the personalized medicine era. Enter the progressive blockbuster. This is a drug that has been tested on a carefully selected sub-group of patients which have been shown to benefit and have low side-effects from the drug. The FDA would approve the drug only for patients in this specific sub-group. Once the drug has been approved and marketed to this sub-group, additional sub-groups can be added one by one as they show good results and safety. Eventually you will be marketing to enough sub-groups to make it a blockbuster. Voilà: the progressive blockbuster.

It does sound a bit more palatable to the general population than the current situation; where you begin with a blockbuster population and wait for adverse events to occur. But correlating patient response to genetic profile or phenotype will remain a tough nut to crack.

The Promises of Web 3.0

Put off by the unfulfilled hype of Web 2.0, some in the knowledge management community are now clamoring for Web 3.0. Dr. David J. Roberts, Chief Scientist at iBASEt, writes in Oracle's Profit Online that Web 2.0 technologies aren't really worth the bother and that the real value sought by enterprises lies in Web 3.0 technologies.

The compelling promise offered by Web 3.0 technologies is the ability to make inferences between contextually linked information thereby pulling new, creative combinations out of knowledge bases automatically. This is the holy grail of knowledge managers; to get machines to be able to reason, even just slightly, would offer a great deal of value.

With such a compelling value proposition as reasoning will Web 3.0 technologies render Web 2.0 worthless? There are still some very large obstacles to Web 3.0 as Roberts has described, i.e. machines can't handle ambiguity and major pieces of the Web 3.0 language (ontologies) have yet to be produced.

But is the interim value of Web 2.0 technologies really that low? Web 2.0 technologies provide integration for well defined processes, and it’s the fact that they must be well defined that renders them inflexible and in need of constant maintenance. Yet this integration is indeed quite valuable, too valuable to be left on the shelf until Web 3.0 is ready for prime time. The future world of Web 3.0 is indeed rosy but don't count Web 2.0 out just yet.

Consumer Genome Tests

With the U.S. Senate passing the Genetic Information Nondiscrimination Act (GINA) last week the bill now moves on to President Bush for signature into law. One more impediment to the genomics age will be removed. Does this pave the way for personal genomics companies such as 23andme and Navigenics?

The Wall Street Journal took up the issue of accuracy with these consumer products last week. As with many new (although I can't really call it disruptive) technologies, this one is somewhat of an expensive novelty. The main criticism seems to be a lack of accuracy in identifying just what genetic diseases an individual may be susceptible to. Although there are numerous tests for susceptibility to heart disease, the current genetic tests don't provide much more accuracy than can be provided by measuring blood pressure.

Some fairly rare genetic diseases do show up clearly on the tests, e.g. a condition associated with a higher instance of blood clotting: factor V Leiden. There is a gray area where the tests will indicate a higher susceptibility to a disease but don't go so far as to say you will contract it. This would be valuable to an individual by allowing them to increase their level of monitoring and taking preventative measures.

So far the insurance companies have yet to buy in on the whole genome tests although they have been covering disease specific tests such as those for breast cancer prognosis.

What the personal genomics companies are selling now is information, information in a quantity and form with which scientists and clinicians, let alone consumers, can barely get their arms around. As Howard McLeod, professor of pharmacology at the University of North Carolina, is quoted as saying "You get a lot of information but very little knowledge." The real challenge, and true value, will be to extract knowledge from these tests.