Moneyball Medicine

In 1978, Louise Joy Brown was celebrated as the world's first "test tube baby," born as the result of in vitro fertilization (IVF). Today, Brown is 44 years old, and what was a technological triumph in 1978 is almost routine today, with half a million babies born every through IVF. But Harry's guest this week, gynecologist and investor David Sable, thinks IVF still isn’t nearly as reliable or accessible as it should be. From his studies of infertility services, he’s convinced that society is on the cusp of bringing down the cost and raising the success rate of IVF, so that it can finally become an affordable solution for millions more people every year who want to start or grow their families. And he thinks one of the keys to the next big wave of advances in IVF will be artificial intelligence. As you’ll hear in this week's interview, Sable thinks most IVF labs today still operate almost like artisanal kitchens, with way too much riding on the judgment of individual doctors and technicians. He thinks machine

“LinkedIn meets ZoomInfo meets Zocdoc, but for doctors." That’s how H1 co-founder and CEO Ariel Katz describes the information service his company offers. It's a response to the fact that the healthcare is incredibly fragmented, with no central database or platform that everyone can use to share their professional profiles and get in touch with colleagues. (Physicians never adopted LinkedIn for this kind of networking because they just don’t switch jobs very often.) Without a central directory, patients can have a hard time find the right doctors, and doctors can have a hard time finding each other—say, when they might be searching for research collaborators. It’s an even bigger frustration for drug companies, who need to know which doctors can help them enroll the right patients for clinical trials. H1 is trying to solve all of those problems by building what Katz says will be the world’s largest graph database of people in healthcare. After participating in the 2020 batch of startups at the Silicon Valley i

If you walked into a typical life science research lab at a university or a biotech startup, you might be surprised to see how much paper is still laying around. A lot of researchers still keep records of their experiments and studies in paper notebooks—in fact, along with doctor’s offices, life sciences labs might be one of the last bastions of professional life that surrenders to digitization. But these labs are surrendering. And Harry's guest this week, Erwin Seinen, is helping to accelerate that shift. He’s the founder and CEO of a company called eLabNext, whose core product is a Web-based software platform called eLabJournal that includes tools for inventory and sample tracking, managing experimental protocols and procedures, and recording experimental results.Seinen spent years building e-commerce tools before he went back to school and got his degree in medical genetics. So he knew how to write software, and to streamline his dissertation work, he built his own electronic lab notebook tool. He says his

Harry's guest this week, Brian Pepin, says there haven’t really been any advances in the treatment of Parkinson’s Disease in a decade. The standard treatment is still the standard treatment—meaning various drugs to replace dopamine in the brain, since the loss of neurons that produce dopamine is one of the hallmarks of the disease.But there has been one important change during that decade. Thanks to new technologies, ranging from wearables like the Apple Watch to sophisticated deep brain implants from companies like Medtronic, we’re now able to gather a lot more data about what’s happening in the daily lives of patients with Parkinson’s, and how the disease is affecting their brain function and their physical movement. Which means there’s now the potential to make much smarter and more timely decisions about how to dose the drugs patients are taking, or whether they should think about joining a clinical trials.Gathering and analyzing that information and feeding it back to patients and their doctors in a user

In most hospitals, the practice of radiology went digital years ago. Today you'll rarely find a radiologist examining a broken bone or a fluid-filled lung on a sheet of old-fashioned X-ray film. But pathology isn't as computerized. For a variety of cultural, technical, and regulatory reasons, many pathologists still prefer to look at tissue samples the old-fashioned way, on a slide under a microscope.Philadelpha-based Proscia is working to change that—and open up pathology to the power of remote work and automated image analysis—by building a cloud-based infrastructure for storing and sharing scanned pathology images. Harry's guest today is Proscia CEO David West, who says there are still strong cultural barriers to the adoption of digital pathology, but "the community is realizing this can be really great for them and their discipline." West says easier scanning, higher resolution, faster image delivery, and the ability to review images from anywhere and tap the power of artificial intelligence are powerful

We use our smartphones to communicate, shop, navigate, watch videos, take pictures, share our lives on social media, track our exercise, and listen to music and podcasts. So why shouldn’t they also be the main interface to our healthcare experiences? That’s the question P.J. Jain started out with in 2010 when he left behind a career in networking and telecommunications to start a company dedicated to mobile health. Called Vibrent Health, the company went on to win a game-changing contract in 2015 to help the National Institutes of Health build a mobile data-gathering infrastructure for a giant research program called All of Us.That’s a 10-year project designed to gather medical data from more than a million people around the United States to help doctors make more customized health recommendations based on a patient’s environment, lifestyle, family history, and genetic makeup. If you’re going to try to recruit a million people into your research study and keep tabs on their health, and if those people are goi

Wet labs at life science companies look and work the same pretty much everywhere. They're full of incubators, refrigerators, centrifuges, liquid handlers, gene sequencers, DNA and RNA synthesizers, and all sorts of other complex equipment. And a lot of these machines are automated—but the larger workflow in a life sciences R&D lab is very much not automated. For the most part it’s individual researchers who decide how and when to use each piece of equipment, and individuals who move samples and materials back and forth between the machines. And that's a problem, because if you’re trying to collect evidence for a scientific paper or a regulatory filing or trying to manufacture a product that’s verifiably safe, you need to make sure that the same procedure gets carried out exactly the same way every time.Our guest this week, Artificial CEO David Fuller, believes that life sciences labs will always revolve around manual labor, but thinks there’s a way to orchestrate the process more precisely. Artificial mak

For people with common health problems like diabetes or high blood pressure or high cholesterol, progress in pharmaceuticals has worked wonders and extended lifespans enormously. But there’s another category of people who tend to get overlooked by the drug industry: patients with rare genetic disorders that affect only one in a thousand or one in two thousand people. If you add up all the different rare genetic disorders known to medicine, it’s a very large number; Harry's guest this week, Charlene Son Rigby, says there may be as many as 10,000 separate genetic disorders affecting as many as 30 million people in the United States and 350 million people worldwide. That's a lot of people who are being underserved by the medical establishment.Rigby is the head of a new non-profit organization called Rare-X that’s trying to tackle a systematic problem that affects everyone with a rare disease: Data. In the rare disease world, Rigby says, data collection is so inconsistent that each effort to understand and treat

Most fitness gadgets, like the Fitbit or the Apple Watch, encourage you to get out there every day and “close your rings” or “do your 10,000 steps.” But there’s one activity tracker that’s a little different. The WHOOP isn't designed to tell you when to work out—it’s designed to tell you when to stop. Harry's guest this week is Emily Capodilupo, the senior vice president of data science and research at Boston-based WHOOP, which is based here in Boston. To explain why the company focuses on measuring what it calls strain, rather than counting steps or calories, she reaches all the way back to the beginning of the company in 2012. That’s when founder and CEO Will Ahmed had just finished college at Harvard and was looking back at his experiences on the varsity squash team. Ahmed realized that had often underperformed because he had overtrained, neglecting to give his body time to recover between workouts or between matches. To this day, WHOOP designs the WHOOP band and its accompanying smartphone software around

When your doctor prescribes a new medicine, there's a pretty good chance that some snafu will crop up before you get it filled. Either your pharmacy doesn't carry it, or your insurance provider won't cover it, or they'll say you need "prior authorization," or your out-of-pocket cost will be sky-high. The basic problem is that the electronic health record systems and e-prescribing systems at your doctor’s office don’t include price and benefit information for prescription drugs. All of that information lives on separate systems at your insurance company and your health plan’s pharmacy benefit manager, or PBM. And that’s the gap that a company called RxRevu is trying to fix. Harry's guest on today’s show RxRevu CEO Kyle Kiser, who explains the work the company has done to bring EHR makers, insurers, and PBMs together to make drug cost and coverage information available at the point of care, so doctors and patients can shop together for the best drug at the best price.Please rate and review The Harry Glorikian S

Harry's guest Eric Daimler, a serial software entrepreneur and a former Presidential Innovation Fellow in the Obama Administration, has an interesting argument about math. If you’re a young person today trying to decide which math course you’re going to take—or maybe an old person who just wants to brush up—he says you shouldn’t bother with trigonometry or calculus. Instead he says you should study category theory. An increasingly important in computer science, category theory is about the relationships between sets or structures. It can be used to prove that different structures are consistent or compatible with one another, and to prove that the relationships in a dataset are still intact even after the data has been transformed in some way. Together with two former MIT mathematicians, Daimler co-founded a company called Conexus that uses category theory to tackle the problem of data interoperability. Longtime listeners know that data interoperability in healthcare, or more often the lack of interoperabilit

Harry's guest this week is Rohit Nambisan, CEO of Lokavant, a company that helps drug developers get a better picture of how their clinical trials are progressing. He explains the need for the company's services with an interesting analogy: these days, Nambisan points out, you can use an app like GrubHub to order a pizza for $20 or $25, and the app will give you a real-time, minute by minute accounting of where the pizza is and when it’s going to arrive at your door. But f you’re a pharmaceutical company running a clinical trial for a new drug, you can spend anywhere from $3 million to $300 million—and still have absolutely no idea when the trial will finish or whether your drug will turn out to be effective. Because there's little infrastructure for analyzing clinical trial data in midstream or spotting trouble before it arrives, some studies continue long after they should have been canceled, and positive data sometimes gets thrown out because of minor procedural flaws; in the end, 20 to 30 percent of the m

This week Harry continues to explore advances in "digital therapeutics" in a conversation with Paolo Pirjanian, the founder and CEO of the robotics company Embodied. They’ve created an 8-pound, 16-inch-high robot called Moxie that’s intended as a kind of substitute therapist that can help kids with their social-emotional learning. Moxie draws on some of the same voice-recognition and voice-synthesis technologies found in digital assistants like Siri, Alexa, and Google Home, but it also has an expressive body and face designed to make it more engaging for kids. The device hit the market in 2020, and parents are already saying the robot helps kids learn how to talk themselves down when they’re feeling angry or frustrated, and how to be more confident in their conversations with adults or other kids. But Moxie isn’t inexpensive; it has a purchase price comparable to a high-end cell phone, and on top of that there’s a required monthly subscription that costs as much as some cellular plans. So it feels like there

Can a video game help improve attention skills in kids with ADHD? According to Akili Interactive in Boston, the answer is yes. They’ve created an action game called EndeavorRx that runs on a tablet and uses adaptive AI  to help improve focus, attentional control, and multitasking skills in kids aged 8 to 12. And it’s not just Akili saying that: In 2020 the U.S. Food and Drug Administration agrees cleared EndeavorRx as a prescription treatment for ADHD, based on positive data from a randomized, controlled study of more than 600 children with the disorder. It was the first video game ever approved as a prescription treatment for any medical problem, and Harry's guest this week, Akili co-founder and CEO Eddie Martucci, says  it opens the way for a new wave of so-called digital therapeutics. Even as Akili works to tell the world about EndeavorRx and get more doctors to prescribe the game for kids with ADHD (and more insurance companies to pay for it), it's testing whether its approach can help to treat other form

Why is hibernation something that bears and squirrels do, but humans don’t? Even more interesting, what’s going on inside a hibernating animal, on a physiological and genetic level, that allows them to survive the winter in a near-comatose state without freezing to death and without ingesting any food or water? And what can we learn about that process that might inform human medicine?Those are the big questions being investigated right now by a four-year-old startup in California called Fauna Bio. And Harry's guests today are two of Fauna Bio’s three founding scientists: Ashley Zehnder and Linda Goodman. They explain how they got interested in hibernation as a possible model for how humans could protect themselves from disease, and how progress in comparative genomics over the last few years has made it possible to start to answer that question at the level of gene and protein interactions. The work is shedding light on a previously neglected area of animal behavior that could yield new insights for treating

In a day and age when it feels like there are drugs for everything—from restless legs to toenail fungus to stage fright—it's strange the drug industry has almost completely ignored one of our most important organs: our ears. Given that 15 percent of people in the U.S. report at least some level of hearing loss, you’d think drug makers would be doing more to figure out how they can help. Well, now there’s at least one company that is. Cambridge, Massachusetts-based Decibel Therapeutics went public in 2021 to help raise money to fund its research on ways to treat a specific form of deafness caused by a rare genetic mutation. Decibel is testing a gene therapy that would be administered only to cells in the inner ear and would provide patients with a correct, working copy of the otoferlin gene, which is inactive in about 10 percent of kids born with auditory neuropathy. Harry's guest this week is Decibel’s CEO Laurence Reid, who explains how the company’s research is going, and how Decibel hopes to make up for al

If you’re a parent, you’ve probably had this experience many times: Your young child has a high fever, and maybe a sore throat, but you don’t know exactly what’s wrong. Is it a bacterial infection, in which case an antibiotic might help? Or is it a viral infection, in which case, you just have to wait it out? The symptoms of bacterial and viral infections are often the same, and most of the time, even a doctor can’t tell the difference. Viral infections are more common, but sometimes, the doctor will prescribe an antibiotic anyway, if only to help the parents feel like they’re doing something to help. But what if doctors didn’t have to guess anymore? What if there were a fast, easy blood test that a doctor could run in their own office to look for biomarkers that discriminate between bacterial and viral infections? Well, that’s the seemingly simple problem that a company called MeMed has been working on solving for 13 years now. Recently MeMed’s first testing product got approval from the FDA, and now the com

In March of 2020, as SARS-CoV-2 was first sweeping the globe, Jacob Glanville joined Harry on the podcast to talk about the pandemic and how the kinds of antibody therapies being studied by his company Distributed Bio might help.  At the end of 2020, Charles River Laboratories bought Distributed Bio on the strength of its computational immunology platform—which automates the discovery of antibody therapeutics. But Charles River let Glanville spin off the research programs he'd been pursuing, which included neutralizing antibodies to treat influenza and coronaviruses. And now those programs have been rolled up into Centivax, a South San Francisco-based biotech startup where Glanville is once again CEO.  Glanville returns to the show this week to talk about what's gone right—and wrong—in the biopharma business during the coronavirus crisis, how the pandemic's end might play out, and why he sees such promise for antibody therapies against coronaviruses, drug-resistant bacteria, and even snake bites.Please rate a

Until recently, getting a blood glucose measurement required a finger stick. The whole process was so painful and annoying that only diabetics taking insulin bothered to do it regularly. But there’s a new class of devices called continuous glucose monitors, or CGMs, that make getting a glucose reading as easy as glancing at your smartwatch to see your heart rate. A CGM is a patch with a tiny electrode that goes into your skin to measure glucose levels in the interstitial fluid, plus a radio that sends the measurement to an external device like your phone. The devices are pain-free to use, and they’re rapidly coming down in price. Harry's guest today, Maz Brumand, is head of business at Levels, a startup that wants to use CGMs to help everyone understand how their choices about food and lifestyle affect their health.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to Th

Healthcare is one of those areas where more data is almost always better. And I talk a lot on the show about how data is helping doctors and patients make smarter decisions. But a lot of the data we’d still like to have is stuck in those arcane Electronic Health Record systems or EHRs that medical practices or hospital systems use to track their patients. These systems tend to be closed, proprietary, user-unfriendly, and incompatible with one another. And we've repeatedly made the case here on the show that EHR technology is holding back innovation across the healthcare market.That’s why we like to meet companies that are working to make EHR data more useful. And in this episode we welcome a pair of guests from a company called Verana Health that’s trying to do just that. The company recently brought in $150 million in new venture capital funding to help scale up its data services, which currently focus on the subspecialties of ophthalmology, neurology, and urology. Verana takes data on patients in these fiel