The Theranos Story, ch. 58: with HBO and ABC, let the mythmaking and psychiatric profiling begin! (updated)

This Editor thought that her next articles about Theranos would be trial coverage. There are court dates pending for Elizabeth Holmes and Not-So-Sunny Balwani–with the DOJ for 11 counts of wire fraud [TTA 16 June] and, for Mr. Balwani, with the SEC on (civil) securities fraud [TTA 15 March]. 

Instead, Theranos hits the headlines again. On 18 March, there’s the debut of an HBO documentary on Theranos. Titled The Inventor: Out For Blood In Silicon Valley (YouTube preview), we can treat ourselves once again to the SteveJobs-esque presence of Ms. Holmes, down to the unnaturally deep voice, blondined hair, and wide blue eyes, unpacking the deception and fraud that was part of the company from early days. But that’s not all! There’s a six-part ABC Radio ‘Nightline’ docu-podcast that started on 23 Jan and airs in six parts through February, which includes audio of depositions taken of board members, whistleblower Tyler Shultz, and patients affected by bad test results. (This Editor will give a listen on this alone.) Episode 5 and links to 1-4 are here via Yahoo.

On websites, we’re regaled with rehashes. The articles range from Teasing the Doc to Where The Ex (Balwani) Is Now (they don’t know) to What Is Her Net Worth (not $4.6 bn). There’s even a flurry of sensational podcasts and videos on YouTube–just Google them. 

Fascinating Fraud. There’s fascination in The Long Con perpetrated by the principals, and less examined, our tendency to Want To Believe. Many of us like legal procedurals and the drama inherent in them (the eternal appeal of the long-running Law & Order in several countries.) Let’s face it, there’s a substantial dollop of schadenfreude mixed in.

What we are witnessing is the building of a myth, increasingly divorced from the real world where it happened, and not improbably or with superpowers. 

Where it goes a little off the cliff. There is a curious article in Forbes that is written by a contributor who writes and teaches courses on stocks and entrepreneurship. He interviewed a former neighbor of Ms. Holmes, Richard Fuisz, MD. It turns out this psychiatrist, inventor, and former CIA asset knew her in childhood. The families were friends and Dr. Fuisz helped out her father when he hit a bad patch. There’s some sketchy profiling in this article, but it does make a fair attempt to get to the heart of the forces that put the gap in Elizabeth Holmes’ ethical makeup, including the Big Steal of Ian Gibbons’ IP. His position is somewhat complicated by a patent dispute (settled) between Dr. Fuisz (plus his son) and Theranos. He’s still hammering on at it on Twitter (@rfuisz).

What’s missing? Much credit to the estimable John Carreyrou, who broke the story in the Wall Street Journal and got his livelihood threatened a few times by Tough Lawyer Guy David Boies.

We’ve gotten to the point where the hard business analysis ends and the looser parts of psychologizing begins, as we attempt to understand why. The damage persists in funding of startups and for entrepreneurial women in health tech.

For this Editor, she looks forward to the warmer weather, when it’s expected when the Legal Action–and reality–resumes. 

Roy Lilley’s tart-to-the-max view of The Topol Review on the digital future of the NHS

Well, it’s a blockbuster–at least in length. Over 100 pages long, and in the PDF form double-paged, which will be a tough slog for laptop and tablet readers. It’s Eric Topol’s view of the digital future of the NHS and it’s…expansive. In fact, you may not recognize it as the healthcare world you deal with every day.

Our UK readers may not be so familiar with Dr. Topol, but here you can get a good strong dose of his vision for the NHS’ future as delivered (electronic thunk) to Secretary Hancock. I haven’t read this, but Roy Lilley has. You should read his 12 February e-letter if you haven’t already.

Here is a choice quote: It’s a mixture of science faction, future-now-ism and away-with-the fairies.

Here’s some background. The Vision’s been around for awhile. Dr. Topol thinks and talks Big Picture, in Meta and MegaTrends. His view is patient-driven, self-managed, with their genomic sequenced and at their fingertips, with the doctor empowered by their records, his/her own digital tools for physical examination, with AI to scan the records and empower a partnership model of decision-making.

Topol In Person is quite compelling. This Editor’s in-person take from the 2014 NY eHealth Collaborative meeting is a review of vintage Topol. His expansive, hopeful view was in contrast to the almost totalitarian view (and it is fully meant) of Ezekiel Emanuel, with his vision of the perfectly compliant, low choice patient, and squeezed like a lemon medical system. At that time, I concluded:

One must be wary of presenters and ‘big thinkers’–and these doctors define the latter, especially Dr Emanuel who looks in the mirror and sees an iconoclast staring back. Fitting evidence selectively into a Weltanschauung is an occupational hazard and we in the field are often taken with ‘big pictures’ at the expense of what can and needs to be done now. Both Drs Topol and Emanuel, in this Editor’s view, have gaps in vision.

A year later, I reviewed his article The Future of Medicine Is in Your Smartphone which came out at the time of ‘The Patient Is In.’ which was quite the succès d’estime among us health tech types. “The article is at once optimistic–yes, we love the picture–yet somewhat unreal.” It seemed to fly in the face of the 2015 reality of accelerating government control of medicine (Obamacare), of payments, outcomes-based medicine which is gated and can be formulaic, and in the Editor’s view, a complete miss on the complexities of mental health and psychiatry.

Back to Roy Lilley:

There is an etherial quality to this report, spiritual, dainty. The advisory panel is 70 strong.

Studies and citations galore, from the world’s top research organizations. The advisory board–I believe well over 70–there’s not a soul down in the trenches running a hospital. Government, academics, and a few vendors (Babylon Health, natch). A lot of emphasis on AI, genomics, and training for ‘collective intelligence’. After reading but a few dizzying, dense pages, I admire the vision as before, but wonder again how we get from here to there.

Roy’s essay is a must read to bring you back to reality. 

Digital health versus eHealth: ‘here we go again’ with the confusion and the differences. Plus Women in eHealth (JISfTeH)

Editor Donna (and Editor Steve before her) always likes a good dust-up about terminology. One of the former’s pet peeves is the imprecise usage of telemedicine (virtual visits) versus telehealth (remote patient monitoring of vital signs); she will concede that the differences have been so trampled on that telemedicine has nearly faded from use.

The Journal of the International Society for Telemedicine and eHealth (JISfTeH) makes a grand attempt to parse the differing definitions of digital health and eHealth in their opening editorial of this month’s (24 Jan) issueeHealth has fallen so far from use that the few times one does see it is in associations such as ISfTeH and the New York eHealth Collaborative. Even the World Health Organization, which has always been a fair arbiter for the industry, defined eHealth back in the salad days of 2005 as “the use of Information and Communication Technologies (ICT) for health”–broad, but workable. After a witty aside in defining digital health as “an area of healthcare focused entirely on fingers and toes” (plus), and examining the overly broad definitions of Eric Topol and Paul Sonnier, the authors Richard E. Scott and Maurice Mars seem to settle on this: that while digital health is given a  much broader but nebulous definition (to the point of linguistic absurdity cited in Mesko et al.), and may incorporate related technologies like genomics (another poorly defined term) and ‘big data’, it would not work without that ICT. And that at least there’s a settled definition for eHealth, as stated above, for which this Editor assumes we should be happy. In the author’s closing, “Will we be sufficiently motivated to rise to such a challenge-globally agreed universal definitions? If not ……here we go again …..”

This month’s journal theme is also Women in eHealth, with articles on Brazilian eHealth distance education, digital technology in midwifery practice, and how online social networks can work for drug abuse treatment referral. There’s also a change in format, with article links opening to full PDFs of each article.

The telehealth ‘entrepreneur’ whose $5 million funding bought stays at the Ritz and portfolios at Bottega Veneta

This curious and cautionary tale should be better known. A young entrepreneur named Keisha L. Williams from Ashburn, Virginia had an attractive proposition. She needed immediate funding to bring to the US an Austrian telehealth system described as “software that would allow doctors to remotely examine and talk with patients.” Ms. Williams had degrees in both law and electrical engineering, so credibility. She also had a story. The software was in ‘escrow’ in Austria. There were taxes and fees that had to be paid immediately. And she had family situations, financial and medical emergencies. In other words, she had a ‘great line of ‘stuff’ on the technology, urgency, and personally, a few tugs on the heartstrings.

Ms. Williams told this story enough times over four years, and to enough people who believed her–more than 50, who invested over $5.4 million.

What happened? 95% of the money was spent on over the top vacations to Bora Bora, Italy, the Bahamas, and Jamaica, plus the occasional yacht with ‘hand and foot services’ and shopping at top-end retail such as Bottega Veneta and Vuitton. $500,000 alone was spent on her girlfriend. About $300,000 was spent on the software.

The rest of the story involves 14 Federal fraud charges, four accomplices, and unwitting, likely vulnerable people who were talked into giving over their savings. Late in January, she was sentenced to 15.5 years in Federal prison.

Many of our Readers have started companies or worked with entrepreneurs who have a great story and need money. The stories touch our hearts–and sometimes our checkbooks. Apparently, Ms. Williams raised the money without exposing herself to anyone in the industry or private investors who would ask remotely leading questions. To us, this technology sounds hardly sexy–it’s telemedicine virtual visit software with maybe some remote patient monitoring thrown in. Yet to 50 people, who are now poorer or who were involved with the fraudulent scheme — it sounded really special. (The name is also common–there are quite a few people on LinkedIn with the same name, which may make life difficult for them.)

With the rising tide of telehealth, if your cousin or uncle has heard of a great way to visit your doctor over the phone and asks you if you’ve heard about it, you might want to ask Uncle to pass the pie as you switch the conversation to being on guard for fraudulent schemes. Washington Post (read the comments), Daily Mail, Seattle Post-Intelligencer, press releases 17 Oct and 18 Jan from the US Attorney’s office, Eastern District of Virginia

Where’s the evidence? Healthcare unicorns lack the proof and credibility of peer-reviewed studies.

Another sign that too many healthcare unicorns are decoupled from the rock-solid fundamental reality–that they work. Healthcare unicorns–those startups valued over $1 bn–are unicorns because they have patents, processes, or a line of business that has immense potential to be profitable. The standard in healthcare, unlike other tech, is the peer-reviewed study. Is this process or device effective based upon the study? Does this drug looks like it will work? Is this study validating, encouraging? Peer-reviewed research takes place before a drug or device goes into clinical trials — a precursor. It ensures a certain level of disclosure, validation, and transparency at an early stage.

Instead, these unicorns largely rely on ‘stealth research’–a term coined by Dr. John P.A. Ioannidis, the co-director of the Meta-Research Innovation Center at Stanford University (METRICS). He summed it up in his latest peer-reviewed paper, “Stealth research: lack of peer-reviewed evidence from healthcare unicorns” (co-authored with Ioana A. Cristea and Eli M. Cahan), published in the European Journal of Clinical Investigation 28 Jan: 

In 2014, one of us (JPAI) wrote a viewpoint article coining the term “stealth research” for touted biomedical innovation happening outside the peer-reviewed literature in a confusing mix of “possibly brilliant ideas, aggressive corporate announcements, and mass media hype.”

The term ‘stealth research’ was prompted to the author by the practices of Theranos–ironically, a company that started and was funded in the Stanford nexus. By the time Dr. Ioannidis’ viewpoint paper was published in JAMA in Feb 2015, Theranos had ballooned to a $9 bn valuation. His paper was the first to question Theranos’ science–and Theranos aggressively pushed back against Dr. Ioannidis, including their general counsel attempting to convince the author to recant his own writing. Three years later, we know the outcome.

This latest study concludes that there is a real dearth of peer-reviewed research among healthcare unicorns–and that it’s detrimental. It measured whether these unicorns published peer-reviewed articles and whether they publish highly-cited (in other publications) articles; compared them against companies with lower valuations; and whether founders or board members themselves impacted the scientific literature through their own citations.

The meta-study looked at 18 current and 29 exited healthcare unicorns. Highlights:

  • Two companies–23andMe and Adaptive Biotechnologies published almost half of all unicorn papers–196 combined
  • Three unicorns (Outcome Health, GuaHao and Oscar Health) had no published papers, and two more (Clover Health, Zocdoc) had published just one
  • Seven of the exited unicorns had zero to one papers
  • In fact, ‘there was a negative, non-statistically significant association between company valuation and number of published or highly-cited papers’

As our Readers know, Outcome Health had a little problem around artificially inflated advertising placement wrapped in health ed and placed in doctors’ offices [TTA 29 Jan 18]. Oscar and Clover Health are insurers. Zocdoc…well, we know their business model is to get as many doctors to sign up in their scheduling app and pay as much as possible. But it’s the drug and device companies that are especially worrisome in a stealth research model. The paper points out among other examples StemCentrx, bought for $10.2 bn in 2016 by AbbVie for its Rova T targeted antibody drug for cancer treatment, was halted at Phase III because it was not effective. Acerta Pharma, also focused on cancer treatments, was bought by AstraZeneca for $7.3 bn; two years ago, AstraZeneca had to withdraw the Acerta data and admit that Acerta falsified preclinical data for its drug.

The conclusions are that healthcare unicorns contribute minimally to relevant, high-impact published research, and that greater scrutiny by the scientific community through peer-reviewed research is needed to ensure credibility for the underlying work by these startups. “There is no need for numerous papers. Discrete pivotal, high-impact articles would suffice.”

This Editor returns to #5 on Rock Health’s Bubble Meter: high valuations decoupled from fundamentals. Based on this, the lack of publishing represents risk–to investors and to patients who would benefit from better vetted treatments. To these companies, however, the risk is in having their technology or researched poached–as well as the investment in time and money research represents.

The study authors point out several ways to minimize the risk, including collaborating with academic centers in research, validation without disclosing all technical details, secure patents, and contributing their technology to other research. A higher-risk way is to “withhold significant publications until successful validation from agencies such as the Food and Drug Administration (FDA) or the European Medicines Agency (EMA)” but usually investors won’t wait that long. ‘Stealth Research’ paper, TechCrunch review Hat tip to David Albert, MD, of AliveCor via Twitter

It’s Official: CES is now a health tech event (updated)

CES is now, officially, a health tech event. It’s not just the timing before CES of the flashy but apparently cratering JP Morgan annual healthcare investment conference in the absurdly pricey venue of San Francisco (FierceBiotech on the #MoveJPM backlash; the general disillusion with it expressed well here). It’s the fact that whatever mainstreaming health tech has actually accomplished, it’s far better represented in Las Vegas. Always a place of beginnings, endings, fun, gambles taken, lack of sleep, and sore feet, health tech fits right in, big or small.

CES reported that 2019 boasted an increase of 25 percent health-related exhibitors and a 15 percent increase in the amount of floor space dedicated to health tech. One winner was a big gamble by a small company–Living in Digital Times, which organizes and stages the Digital Health SummitTen years later, it turned out to be right place, right time for the founders who work hard to keep it on trend. Lifestyle, robotics, self-care, assistive tech (even exoskeletons), wearables, cosmetic “wellness” devices like P&G’s Opté, and Alexa-type home assistants/robots all now fit into the CES purview. Trial balloons by young companies, AI-powered concept devices from big companies, watches (including the Apple-beater Move ECG from the revitalized Withings TTA 10 Oct 18 and Omron’s HeartGuide), and robots all appeared. Samsung again brought out a brace of concept robots. Last year’s Best of CES ElliQ is finally available for pre-order after three years at a measly $1,500. The humanoid Sophia brought a kid sister, the equally creepy Little Sophia, both of whom failed during this CNET video. Yes, Pepper from Softbank made its appearance and apparently didn’t wilt as it did last year.

Sleep tech was another hot item, with a spin on sleep diagnostics or improvement from many products. A brainwave product, Urgonight from France, claims to be able to train your brain to sleep better. (Send one to Rick Astley who was a poster child for not Sleeping.)  Mental health is a natural crossover into sleep tech and robots, with a $5,000 Japanese robot, Lovot, capable of responsive cuddling and comfort.

Best of the coverage:

  • CNET has probably the best coverage and articles on health which stick to the facts (slim in some cases as they are); anyone who wants to catch up with the feel and flavor of this three-ring circus can start and stay there. Their full show coverage is here.
  • Dr. Jayne at HISTalk also did an excellent health-related product roundup in her Curbside Consult column.
  • Mobihealthnews also has a very long running list of health tech pictures and announcements as part of its limited coverage, including the mea culpas and promised transparency of onetime health ed unicorn Outcome Health [TTA 29 Jan 18].

Beyond the plethora of products encouraging ever more to come forward, what ones will even make it to market, far more be winners? Aside from the Samsungs and P&Gs, which of these young companies planting their stake at CES will be there next year?  As in past CES, the wheel goes round and round, and where it stops, nobody knows–not even the JPM investors. 

Is Babylon Health the next Theranos? Or just being made out to be by the press? (Soapbox)

There, it’s said. A recent investigative article by a Forbes staff writer, European-based Parmy Olson (as opposed to their innumerable guest writers), that dropped a week before Christmas Eve raised some uncomfortable questions about Babylon Health, certainly the star health tech company on the UK scene. These uncomfortable bits are not unknown to our Readers from these pages and for those in the UK independently following the company in their engagement with the NHS.

Most of the skepticism is around their chatbot symptom checker, which has been improved over time and tested, but even the testing has been doubted. The Royal College of Physicians, Stanford University and Yale New Haven Health subjected Babylon and seven primary care physicians to 100 independently-devised symptom sets in the MRCGP, with Babylon achieving a much-publicized 80 test score. A letter published in the Lancet (correspondence) questioned the study’s methodology and the results: the data was entered by doctors, not by the typical user of Babylon Health; there was no statistical significance testing and the letter claims that the poor performance of one doctor in the sample skewed results in Babylon’s favor.  [TTA 8 Nov]. 

The real questions raised by the Lancet correspondence and the article are around establishing standards, testing the app around existing standards, and accurate follow up–in other words, if Babylon were a drug or a medical device, close to a clinical trial:

  • Real-world evaluation is not being done, following a gradual escalation of steps testing usability, effectiveness, and safety.
  • How does the checker balance the probability of a disease with the risk of missing a critical diagnosis?
  • How do users interact with these symptom checkers? What do they do afterwards? What are the outcomes?

Former Babylon staffers, according to the Forbes article, claim there is no follow up. The article also states that “Babylon says its GP at Hand app sends a message to its users 24 hours after they engage with its chatbot. The notification asks about further symptoms, according to one user.” Where is the research on that followup?

Rectifying this is where Babylon gets sketchy and less than transparent. None of their testing or results have been published in peer-reviewed journals. Moreover, they are not helped by, in this Editor’s view, their chief medical officer stating that they will publish in journals when “when Babylon produces medical research.” This is a sad statement, given the crying need for triaging symptoms within the UK medical system to lessen wait times at GPs and hospitals. But even then, Babylon is referring patients to the ED 30 percent of the time, compared to NHS’ 111 line at 20 percent. Is no one there or at the NHS curious about the difference?

And the chatbot is evidently still missing things. (more…)

Just the Fax. Or Matt Hancock versus the Fax Machines (UK) (Updated)

Updated. Add fax machines to the Endangered Device list. The news that Health Secretary Matt Hancock has banned the NHS from purchasing new fax machines starting in January 2019, with a full phaseout of use by 31 March 2020, was this past weekend’s Big News in the UK health sector. This is to help force adoption of paperless methods such as apps and email, which is a noble intention indeed.

The remaining prevalence of fax machines in the NHS became a cause célèbre after the Royal College of Surgeons in July estimated that over 8,000 fax machines were still in use. The RCS takes credit for nudging trusts to ‘Ax The Fax’. Guardian

This Editor presumes that Secretary Hancock does not possess a printer, or find the need to print his records even for convenience–or posterity. (One wonders what he’s carrying in that folder or brief…) I also presume that he has never heard of electrical outages, data breaches, malware or ransomware which may make print records suddenly quite needed.

The Road to Perdition is Paved With Good Intentions. A wonderfully tart take on Mr. Hancock’s Fax Obsession is contained in Monday’s NHSManagers.net newsletter from Roy Lilley. He looks at why NHS offices and practices have stayed with fax machines–and the absurdity of such a ban when trusts and practices are attempting to squeeze every penny in a cash-strapped, failing environment:

  • It’s point to point and legally binding not only in medicine, but in law and finance–even in the US
  • They are on the desk, easy to use–requiring only plug in to power and a phone line, fax toner, and paper
  • They don’t need IT support
  • Compared to computers, printers, and internet service, they are wonderfully cheap

And paper-free isn’t a reality even in the US with EHR, tablets and smartphones widely used. Even HHS and CMS in the US require some paper records. Confidentiality and hacking–especially when tied to computer networks–are problems with fax, but the same can be said for computer networksOh, and if your systems are attacked by ransomware, it’s awfully handy to refer back to printed records and to be able to communicate outside of computer networks.

Mr. Lilley also points out that ‘No 18’, as he dubs the Secretary of State for Health, actually has no power to enforce his edict with trusts or GPs.

This Editor predicts a thriving market in used and bootleg fax machines–“check it out”, as the street hustlers say!

Other articles on this: Fortune, Forbes

It’s Alive! BlackBerry still Sparking with an ‘ultra-secure hyperconnectivity’ healthcare platform

And this Editor thought that BlackBerry had long since hung up the ‘Out Of Business Sign’. In this era of BYOD in healthcare and software systems like Blue Cedar that secure apps from these BYODs from the device past the server, the image of the ‘Crackberry’ persists–tiny keyboard, tiny screen, and the corporate governed phone. All these loathsome features have now transitioned to iPhone 6s (tiny keyboard, tiny screen, corporate apps, locked down and trackable everything). (So much for that ‘tech will set you free’ world promised by Steve Jobs in the ‘1984’ spot, replaced by Big Brother–Ed. Donna)

BlackBerry, as a company based in Ontario, Canada, endures as a software platform minus the devices. Much like Nokia, they have taken on the world of IoT in areas demanding tight security. Their latest introduction is the BlackBerry Spark, a software platform they claim will lead the Enterprise of Things (EoT) to “ultra-secure hyperconnectivity from the kernel to the edge”. Hyperconnectivity, in their definition, will enable secure IoT equipment with consumer friendly interfaces, leverage AI and manage smart ‘things’ regardless of operating system and existing platforms, and making military-grade security easy and intuitive for users. Spark will be available to companies (thus EoT) by the end of 2018.

BlackBerry has evidently latched on to a messy need–the lamentable lack of security in most consumer IoT devices. They have also identified the yawning gaps in security in almost every healthcare enterprise in connected devices. In Mobihealthnews, their spokespeople expanded on the technology as they are applying it to healthcare via a quantum-resistant code signing server, a new system using blockchain to deliver medical data and an operating system for secure medical devices. More details on how these are being used so far were cited in their most recent release:

  • A blockchain digital ledger for the Global Commission, an organization focused on diagnostics for children with a rare disease. One of the pilots concentrates on BlackBerry’s powering real-time, actionable analysis to shorten time to diagnosis.  
  • A new OS for medical, QNX OS for Medical 2.0. This is described as a real-time operating system for the development of robotic surgical instruments, patient monitoring systems, infusion pumps, blood analysis systems, and other safety-critical products that must pass stringent regulatory approvals.
  • With the Mackenzie Innovation Institute (Mi2), participating in research around comprehensive security, patient privacy and intelligent connectivity in healthcare IoT.
  • Skin cancer research in Australia with the Melanoma Institute Australia.

Certainly BlackBerry is aiming for a certain sweet spot in healthcare and finding some partners all over the world, though the US seems to be absent. Will they be able to ‘crack’ it and the rest of the world? Time will tell.

The Theranos Story, ch. 57: was it Silicon Valley and Startup Culture bad practices pushed to the max?

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2018/07/Rock-1-crop-2.jpg” thumb_width=”125″ /]Theranos is now formally in California insolvency proceedings (note on their website). Creditors may have enough awarded to them to go down to the local pizzeria to buy a slice or two. Hard lessons indeed for creditors and shareholders. But aside from the drama yet to come in the trial of Elizabeth Holmes and Sunny now Shady Balwani, a/k/a the Silicon Valley Trial of the Century, are there any further lessons to be learned?

For those of us who have not been closely following The Theranos Story, David Shaywitz’s kind-of-review of John Carreyrou’s Bad Blood coupled with a thought piece in Forbes is especially appealing. Even if you’ve been tracking it closely like your Editor, it’s a good read. He posits that in three key areas, Theranos exhibited Startup Culture and Silicon Valley Ethics (or lack thereof) at the very extreme in these areas:

  • Secrecy: extreme compartmentalization, siloing, stratification, and rigid definition of roles that prevent information sharing. No outsiders in, or peer-reviewed research out.
  • Promises, promises, promises: a rosy picture to the point of delusion that masks real flaws
  • I Want To Believe: for various personal reasons, investors, press, and supports need to believe

Secrecy can and should work for companies in keeping proprietary information and competitive advantage intact. All startup and early-stage companies have to paint a positive picture in the midst of pitched struggle. The glass is always half full not empty even when the bank account is, but when the old ‘fake it till you make it’ becomes too strong, papering over the truth is the thing and the institutional absence of tough self-scrutiny (or a professional kicker-of-holes) prevents companies from fixing obvious problems–you get a delusional organization like Theranos edging gradually, then very quickly, into outright fraud. Finally, Theranos’ supporters had their own reasons for wanting to believe the technology worked. 

He goes on to state that the fraud that Theranos perpetrated was not only financial and in harm to health, but also in the hope that change is possible in healthcare delivery, we can challenge the way it’s always been done and win, and that technology can be empowering.

Will we, as a result, in Mr. Shaywitz’s words, take the ‘hit to hope’ to heart and become ‘excessively chastened and overcautious”? This Editor tends to be on the overcautious side when it comes to technologies such as IoT and AI because the potential for hacking and bad use is proven despite the hype, but far less so in challenging incumbents–even it it resembles tilting at windmills till they buy you.   

Will l’affaire Theranos change the Silicon Valley and Startup Culture for the better? Here is my ‘hit to hope’–that this excessively aggressive, conformist, borderline irresponsible, and secretive culture could change. This Editor doubts it’s even entered their leaders’ ‘deep’ thoughts, despite this best-selling book.

A more typical review of ‘Bad Blood’ is by Eric Topol, MD (!) in Nature–who certainly borrowed ‘The Theranos Story’ from this series of articles!

CEO change at GE may mean delay or cancellation of GE Healthcare spinoff–for good or ill

The well-publicized and unvarnished dumping of GE‘s CEO John Flannery after only 13 months has led a leading research analyst to predict that the planned GE Healthcare spinoff will be delayed or even halted. Analyst Jim Corridore of CFRA stated on CNBC that incoming CEO Lawrence Culp, a recent board member who was CEO of Danaher, a scientific, industrial and healthcare conglomerate, may decide that the division should stay. 

At $19 billion in revenue with a profit of $3.4 billion, 15.8 percent of GE’s total sales and 43.2 percent of its operating profit in 2017, the wisdom of a GEHC spinoff always seemed doubtful. The selloff was in line with Mr. Flannery’s strategy of refocusing on GE’s industrial and energy business. However, this was not going terrifically well, at least in the BOD’s view, with a sluggish turnaround, shares dropping off the S&P 500 and the Dow Jones Industrial Average, projections of missing year-end targets, activist investor Nelson Peltz hovering, and exacerbated by problems at GE Power with its new line of natural gas-fired power turbines. Perhaps a few were doubly offended by the selloff of the corporate jets (relative pennies) as well as the expensive and frankly hard-to-justify corporate HQ move from Connecticut to Boston.

Mr. Culp is apparently well-thought of, having retired after a highly successful 14-year run at Danaher, but he has his work cut out for him. He will also need to quickly judge whether to continue the GEHC spinoff process or bring the cattle back into the fold, as the drive was well underway down the trail. Somehow, spinning off 40 percent of your operating profit seems strategically foolish given a plummeting share price.

A jaundiced opinion. Perhaps as an outsider, Mr. Culp can change the ‘death star’ culture at GE. This Editor, in her brief encounter with GEHC as part of an acquired company (Living Independently Group, developer of QuietCare, circa 2008-9) found their business practices and many of their people to be both ruthless and self-referential to the point of stumbling blindness. The LIG acquisition was part of an ill-considered and perhaps ego-driven experiment by GEHC’s CEO at the time to get into home, remote monitoring, and assisted living health, a developmental, small-scale, early-stage area. It was obvious that GE’s vaunted methodology and hospital-based acute care experience were worse than useless when it came to understanding what is still a developmental area. The home health businesses were sold, closed, or (in the case of QuietCare), spun off into a joint venture. That CEO and a few other people leveraged it well; LIG’s employees, shareholders, and others at GEHC did not. 

As Star Wars fans know, Death Stars are destroyed in the final reel.

3rings assistive tech will be ringing off next March (UK) (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/02/3rings-logo-only.jpg” thumb_width=”150″ /]Another assistive technology/TECS company decides that they have reached the end of the road.

Mark Smith, one of our Readers and Business Development Director of 3rings, which has been featured more than a few times in these pages over the past six years from Kickstarter days, this morning passed along the sad news that 3rings is closing. From Steve Purdham, the founder and chairman (and updated by him today 19 September):

It is with great regret and sadness that we have to inform you that we will be bringing the 3rings Care plug and Internet of Things sensor service to a close. 

After a journey of 6 years we have taken this decision because the technology adoption within the Social care market is extremely slow moving, which means that we are not able to attain a sustainable business model that would give the quality, and daily operational support that we believe is the minimum we would expect to deliver, to look after you, our customers.

Our customers including individuals, regional council’s and housing association’s that use 3rings as a safety net of care, are very important to us and this is the reason why we haven’t waited until the last moment to notify you of our decision.

With this in mind, we will be maintaining support for the 3rings care service, including the Plug and IOT sensors platform until Friday 1st March 2019.

Given the extended notice period we feel that this provides enough time for you to make alternative arrangements.

The 3rings team strongly believe in the world of IoT sensors and true digital solutions to provide a safety net of care, 3rings has always evangelised this as our goal, we know that digital safety nets of care will change the face of social care in the future. With that in mind we are still exploring alternatives and should anything change we will inform you at the earliest opportunity.

We are truly sorry to have to deliver this message, but can I personally thank you for your support, we are immensely proud to have helped so many families and vulnerable people, and to have saved lives through the 3rings service.

Your support for the 3rings product range made a massive difference, and we thank you for your understanding and commitment to providing to the safety net of care for your loved ones or clients.

Should you wish to clarify anything or have any comments then please don’t hesitate to contact me directly either by email on steve@3rings.co.uk or call me on 01260-222853 or my mobile 07899 803555.

Yours sadly
Steve
Steve Purdham · Chairman

Steve, in his separate note to this Editor, explained that they chose this four-month-plus winding down in order to responsibly look after their customers so that they have enough time to transition to other monitoring systems. Individual users of 3rings will be separately notified as well.

It was, as Mark said, a shock, but as this Editor noted in the Canary Care article from earlier today, in many ways the TECS/AT/telehealth business has not progressed much since 2006. The funding, technology, and consumer acceptance are all better since the early 2000s, but there is a lot more competition with not enough market takeup to warrant it. Even 3rings’ integration with the very trendy Amazon Echo and the IoT space showed innovation, but not the reward.

The social care area is more developed in the UK than the US as a concept. In the US, we speak more about ‘social determinants of care’, with one determinant–transportation–getting most of the action and the money. When you look at the truly disproportionate amounts of investment in certain hot companies with sexy tech, for instance a few ‘unicorns’–the now expired Theranos being the Poster Child–where far smaller amounts funding tech that works in real companies with real customers would do immediate good and would change things in the long term (longer than 18 months, which is the usual VC horizon), one wonders if we haven’t gone a little bonkers.

Yet those of us in the industry remain hopeful. As Steve Purdham said to me in a separate note, “the market has all the tools to change face of social care but the families and the existing structures are so glacial in the acceptance of this change. It will come and it will make a massive difference when it does.” We’re all trying.

We wish Steve, Mark, and the 3rings team all the best–and perhaps a White Knight will Save the Plug. Hat tip to Gerry Allmark of UK Telehealthcare as well for the information.

Weekend reading: the deadly consequences of unpredictable code

The Guardian’s end of August post-bank holiday/pre-Labor Day essay on how algorithms are morphing beyond the familiar if/then/else model we learned in coding school or in the IT engineers’ bullpen as you strained to understand how the device you sought to market actually worked is scary stuff, especially read in conjunction with the previous article about Click Here to Kill Everybody. We may be concerned with badly protected IoT, cybersecurity, and the AI Monster, but this is actually much nearer to fruition as it drives areas as diverse and close to us such as medicine, social media, and weapons systems.

The article explains in depth how code piled on code has created a data universe that no one really understands, is allowed to run itself, and can have disastrous consequences socially and in our personal safety. “Recent years have seen a more portentous and ambiguous meaning emerge, with the word “algorithm” taken to mean any large, complex decision-making software system; any means of taking an array of input – of data – and assessing it quickly, according to a given set of criteria (or “rules”).” Once an algorithm actually starts learning from their environment successfully, “we no longer know to any degree of certainty what its rules and parameters are. At which point we can’t be certain of how it will interact with other algorithms, the physical world, or us.”

What’s happening? Acceleration. What’s missing? Any kind of ethical standards or brakes on this careening car. A Must Read. Franken-algorithms: the deadly consequences of unpredictable code

IoT=Cyberdisaster, if we don’t chill innovation and secure it. It’s hip to be scared!

It’s hip to be scared and chill out innovation till we can secure it. That is the plain thought behind the new book Click Here to Kill Everybody, Bruce Schneier’s take on how IoT is going to wreck our lives. Basically, if it can be hacked, it will be, and the more we make dumb things smart, the easier this mischief will be able to hurt us–not our data, but our lives, health, and property.

As our Readers know, TTA has been calling out the threat to humanity since The Gimlet Eye lampooned Internet Thingys doing things against their will back in 2015 and more seriously here. (And yes, parking meters can be paid on a smartphone app in the resort burg of Cape May, NJ.) We have explored, for instance, how easy it is for Black Hats to exploit medical devices and to get into networks via fax machines and all-in-one printers.

Mr. Schneier is not a Luddite. For starters, he is a fellow at the Berkman Klein Center for Internet and Society at Harvard University and a lecturer in public policy at the Harvard Kennedy School. He is on the board of the Electronic Frontier Foundation and is chief technology officer of IBM Resilient, which helps companies prepare to deal with potential cyberthreats. But he can’t buy an unconnected new car (think of that eight-year-old Black Hat waiting to sabotage your steering) and you can’t get an unconnected DVR. It’s getting near-impossible to buy a dumb TV that doesn’t spy on you and to live a lifestyle that is fully disconnected unless you go ‘Life Below Zero.’

So what he is proposing is to ‘chill innovation’ as we do with medical devices and pharmaceuticals for safety’s sake. (Editor’s emphasis)

There’s no industry that’s improved safety or security without governments forcing it to do so. Again and again, companies skimp on security until they are forced to take it seriously. We need government to step up here with a combination of things targeted at firms developing internet-connected devices. They include flexible standards, rigid rules, and tough liability laws whose penalties are big enough to seriously hurt a company’s earnings.

Yes, they will chill innovation—but that’s what’s needed right now! The point is that innovation in the Internet+ world can kill you. We chill innovation in things like drug development, aircraft design, and nuclear power plants because the cost of getting it wrong is too great.

Thoughtful writing and point of view. This Editor would also make the argument about public sanitation, public water supplies, and somewhat in housing, although I would argue that the automotive industry pushed for ease of use (the self-starter) and safety long before the government was engaged, and we are sure Readers can cite more examples.

Just because we can do it technologically does not mean it is the safe, beneficial, and moral thing to do. The more you know about technology, the more you realize it’s good to be more fearful and less trusting of technology, an odd sentence for an health tech Editor to write. But she does like living in one peaceful piece. Think about that when you hear the next Rhapsody about All-Electric Self-Driving Cars, Trucks, and Scooter and How Wonderful They Will Be. MIT Technology Review

Best Buy update: ‘Assured Living’ assuredly up and running. And was this Editor’s in-store experience not typical?

Reader and Opinionator Laurie Orlov wrote this Editor to advise her that Assured Living was most definitely alive and well in Best Buy-land. The Assured Living page presents a variety of services, starting with a personal monitoring service (video) for an older adult that starts with a fairly standard pendant PERS (two way) and also creates an in-home network of motion sensors for doors, windows, and furniture installed by Geek Squad. These sensors send activity to a control panel which tracks activity and wellness patterns (sic!–as we know it’s algorithms and rules in the software). Within about a month, the system will send real-time automated alerts if something is out of the ordinary. The video then promises the usual ‘deeper insights’ into wellness and potential issues with the older person.

What doesn’t sound like QuietCare circa 2006, down to the need for installation, are the Wi-Fi camera in the doorbell and the automated remote door locks, the tie ins with the Mayo Clinic and UnitedHealthcare. 

We both speculated on the motion sensor set as being Lively Home (from GreatCall) –Laurie added possibly Alarm.com’s BeClose, which has supplied Best Buy in the past.

Assured Living is available only in limited markets (not listed) but you can get 10 percent off with AARP! But product packages go up to nearly $189.97 for a one time fee plus $29.99/month, not inclusive of that nifty doorbell camera and remote door locks.

One wonders if the reluctance of older adults to admit they need monitoring and consent to the installation is less than in 2006, when QuietCare’s and ADT’s sales people had difficulty overcoming the reluctance of a person living home on their own to be monitored by their (usually) child. Sometimes a sale would be made, the installer would come, and the installer would be shooed out after second thoughts. The genius of GreatCall was in making technology palatable to this market by assigning it a positive use, such as communicating with friends and direct personal safety, not someone minding her. Right now, the template is 2006 with a tech twist.

Drop in and visit Laurie Orlov on her Website We Like, Aging in Place Technology Watch. (She’s alarmed about chipping people too and frames it as more of a security and a moral issue than this Editor did, who prefers her chips to be chocolate and her cars to be driven by her alone.)

As to this Editor’s ghostly experience buying a TV in store, perhaps I should have invited a Best Buy rep over! Reader, former Marine flyboy, eldercare expert, and full time grandfather John Boden did and got a simple solution to an annoying problem. Read about it in comments on our prior article here.

Can Best Buy have an effective older adult strategy when they can’t sell a TV?

We noted last month that the acquisition of GreatCall by big box retailer Best Buy was the next step in a strategy targeting an older adult market niche, with goods and services promoting digital health and wellness, ‘solving technology problems and addressing key human needs across a range of areas.’ GreatCall will be managed as a separate division because, as their CEO admitted, ‘it is a different business’, presumably continuing to do what they do best–direct marketing. Longer term, what GreatCall was purchased for is to enable what they have touted to investors as “Best Buy 2020 that includes Assured Living, a program aimed at using the mobile web, sensors and other digital or smart-home healthcare technology to help adult children or caregivers remotely check in on the health and safety of aging residents at home.” The acquisition is expected to close this fall.  Digital Commerce 360/Internet Health Management  

But will this strategy, which requires a bit of personal service and problem solving, work in the field? The result of a simple search and transaction for a common electronic product wasn’t a promising predictor. This Editor went to a Best Buy in search of a new TV set to replace her aged and fritzing Panasonic (the kind with a cathode ray tube). It was a rainy Saturday night in Paramus NJ, the kind of night on which only Those Determined To Buy brave the traffic to shop. After a sweep of the aisles looking for that senior-oriented healthcare technology, finding none, she hit the TV displays, adjacent to the laundry dryers.

With space measurements and a tape measure in hand, she looked at smaller TVs. Having already determined that a 28″ would likely be best, but with no 28″ on display, she measured 32″ sets which maybe, maybe could fit the TV spot in the wall unit. Smart? Roku? What do these mean, and do I need them? 720 px? 1080 px?  This went on for about 30-40 minutes. In that time, not one blue-shirted salesperson stopped to assist a willing buyer who just needed a little help. So she went in search of one, finding exactly…none. Other shoppers looking at larger sets? Also non-assisted. After a few more sweeps of the aisles, stopping to marvel at an QLED’s resolution, feeling a bit ghostly and ghosted, she tapped out and left, vowing to buy a Samsung online–anywhere other than Best Buy.

If this can happen with a straight-forward electronic product with a relatively willing buyer…what will happen to a more complex sale with a lower level of understanding? Without a better level of customer service, all the corporate strategy talk will simply…flop.

Oh yes, that live link to Assured Living? It goes to a page that says “We’re sorry, something went wrong.”