The Digital Health Newsletter by Paul Sonnier
June 9, 2017
Greetings!
Dr. Margaret Chan, Director-General of the  World Health Organisation (WHO) warns that artificial intelligence (AI) in healthcare is being built by and for the wealthiest people in the world and that we need to make sure it also works for the poorest.  Speaking at the ITU and XPRIZE Foundation's AI for Good Global Summit, Dr. Chan asked: “What good does it do to get early diagnoses of skin or breast cancer if a country does not provide the opportunity for treatment or if the price of medicines are not affordable?”
Indeed, there are major economic-based disparities in access to diagnostics and treatments in all parts of the world. For example, as Nelson Schwartz at the NY Times recently reported, there's an egregious example here in the United States of a $40,000 per year concierge medicine service that provides clients with exclusive physician networking-based access to healthcare at, effectively, a medically-unjustified higher priority level than other patients receive.

Notwithstanding the many examples of disparities in access and benefits achieved from digital-based technologies alluded to by Dr. Chan, it's important to note the myriad examples of digital health that are democratizing and improving access to healthcare services for all stakeholders.

One example being deployed in Sub-Saharan Africa is nonprofit Peek Vision's smartphone-based eye exam, retinal imaging, and population vision screening platform. The system uses decision-making algorithms plus cloud-based automated data analysis and reporting. Peek has set up over 100 temporary eye clinics in Kenya and counts partners like the Kilimanjaro Christian Medical Centre and 18 primary health care clinics in the region, which provide eye healthcare services.
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"Digital health is the convergence of the digital and genomic revolutions with health, healthcare, living, and society." - Paul Sonnier

Statistics: There are 39 million blind people globally, and in low-income countries, 80% of blindness is curable. The two main causes of eye problems are cataracts and refractive errors.

HEALTHCARE
According to a new  Harvard study, the U.S. is one of world's worst when it comes to the health divide between the rich and the poor. Analyzing survey data on health and income in 32 countries, researchers found that poor Americans reported "worse health" significantly more than rich Americans. Nearly 40% of the poorest third stated that they had “fair or poor health”, which is compared to just 12.3% of the richest third. This places the United States in the bottom three out of the 32 nations in the report. Factors reportedly responsible for the gap include the high number of uninsured (especially prior to the Affordable Care Act) and fewer social safety nets.
Investigators from MassGeneral Hospital for Children and Harvard Vanguard Medical Associates conducted a Connect 4 Health trial to tackle childhood obesity. The focus was to educate parents and teens on decreasing screen time, improving diet quality, increasing physical activity, improving sleep, plus promoting social and emotional wellness. One group received just a monthly text message while another group was contacted every other month by health coaches plus received more frequent text messages and emails. BMI was slightly better in the latter group and improvements in health-related quality of life was significantly better.
By using a combination of brain scans and other measures, an algorithm is helping to forecast autism in babies as young as six months old. Combining the scan-derived brain activity data and behavioral test scores, researchers noted the differences between children with autism and those without it. Then, using just the brain activity data for a test infant, the algorithm was used to predict whether she would be diagnosed with autism by the age of two. By repeating this machine learning process over and over the computer was eventually able to identify 9 out of 11 children with autism. Moreover, it did not misdiagnose children who don’t have autism.

VIRTUAL REALITY (VR)
Two people spent  48 hours in VR to assess the arbitrary limits of its use time. According to Dean Johnson, every company that he invited to participate in the project turned him down because they "thought we'd die". A use case he describes is assessing pain while getting a tattoo, both while inside and outside of a VR environment. With the headset off being a pain benchmark of 10, he stated that it was reduced to a 6 or 7 while on. He also used an Apple Watch to measure his heart rate, which dropped from 103 to 74 BPM.
A controversial lab in Montréal, Canada is using VR to assess sex offenders. As Olivia Solon reports in The Guardian, the lab is under intense scrutiny from ethical committees and the police in Quebec. The stated intent is to use the VR system results "combined with other psychological assessments" and "build up a profile of the individual’s sexual preferences that can be used by the court to determine the risk they pose to society and by mental health professionals to determine treatment."
The virtual reality market is projected to reach $5 billion by 2021, according to PwC's annual Entertainment & Media Outlook forecast (the first time VR has been included in the report). This equates to an annual growth rate of 64%. As Paul Bond reports in The Hollywood Reporter, this represents nearly half as much as movies will generate at the box office, which will grow at a rate of just 1.2% (reaching $11.2 billion) over the same period of time. It's also expected that VR for video and movies will ultimately eclipse video games in market size. 
Participants in an out-of-body VR simulation study report lower anxiety about death compared to a control group. 
According to researcher Mel Slater, they "wanted to see what the effects were of establishing a strong feeling of ownership over a virtual body, and then moving people out of it, so simulating an out-of-body experience. According to the literature, out-of-body experiences are typically associated with changes of attitudes about death, so we wanted to see if this would happen with a virtual out-of-body experience."
ENABLEMENT
A new way to assist blind people and those with poor eyesight to navigate is being developed by MIT's Daniela Rus. The programmable wearable system uses a camera and belt to create a 3D image of the area in front of the person. By analyzing objects in the user's surroundings, the vibrating motors placed around the belt silently guide the user with modulated vibrations that convey specific information, like finding an empty seat in a crowded lecture theatre.
Seeking a method to overcome the unsustainable benefits of deep brain stimulation and levodopatherapy, researchers used spinal cord stimulation to help improve the gait of people with Parkinson's disease. Results of the procedure showed 50-65% improvement in gait and 35-45% in both  UPDRS III and quality-of-life scores. The researchers concluded that spinal cord stimulation at 300 Hz was well tolerated and led to a significant improvement in gait.
GENOMICS
Following a STAT news report in Feb, the FBI and officers from the inspector general’s office of the Department of Health and Human Services have raided the offices of Proove Biosciences. The company reportedly paid doctors to promote its genetic tests and questionnaires for determining a patient’s likelihood of becoming addicted to opioids. According to STAT's Charles Piller, a regulatory loophole allows some genetic testing companies to operate without government oversight on the medical value of their tests.

According to a new report from Transparency Market Research, the "Genomics Personalized Health Market" will be worth $25.1 billion by 2025. The firm segments the market as follows: Technology (NGS platforms, RT-PCR, Microarray, Sequencing and genetic analyzers, Others), Disease Test Type: (Oncology, Infectious, Orphan, Autoimmune, Obstetrics, Others), and End-User (Academics & Research Institutes, Diagnostic Centers, Others).

Note: At the time of this newsletter, a Becker's Hospital Review posting of this report incorrectly puts the number at $25.1 million, vs $25,112 million.
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