The American College of Cardiology (ACC), one of the world's leading cardiological organizations, is looking for Israeli digital health and medical device startups. The organization wants to cooperate with these companies and learn from them how to connect technology companies with health companies, as is done naturally in Israel. Several leading figures in the ACC are now visiting Israel in order to attend an event organized by the Haifa Economic Corporation and the Israel Innovation Institute at which 40 digital health and medical equipment startups will present their ideas. The team of experts has spent a few hours with each startup and will eventually select 10 of them for cooperation. At least four of the selected companies will conduct a joint pilot with the ACC.
"We aren't just holding a technology competition here. We're not judging the ventures. We have spent hours with each startup," says ACC chief innovation officer Dr. John Rumsfeld. "Many companies are offering the world more data, but just bringing data is no good. To what decisions will this information contribute? What algorithm will be used to analyze the information? How do you bring the information and the recommendation to the right person at the right time? One of our worries is that a range of companies will develop an application or service, but that no company will integrate them."
According to the US experts, following several decades of stunning breakthroughs, the pace of improvement in medical equipment and drugs for cardiology is slowing. "We think that the companies are trying to look more at comprehensive solutions combining equipment with monitoring," Rumsfeld says
"Globes": Can this approach have as good an influence on health as a new device or drug?
Rumsfeld: "We don't know. This is what the companies say, but it has to be proved. We're delighted to work with the Innovation Institute, because it can connect companies' technology to the health funds. In this way, you can know which patients are in bad condition and need intervention and which patients need no intervention and should not be disturbed.
"The main question is not just what the best treatment is; it's also how to administer it to the patient in a better way that they did 20 years ago. In the US, we are gradually overcoming the problem we had in the national medical record. We also have a problem with payment models, which still pay according to the number of procedures carried out, not their results. That is why, for example, we aren't managing to introduce the use of remote monitoring devices and medicine could make things much easier for patients and also save lives, because trials have not yet been conducted showing that this is effective for the health system. Through remote medicine, we can learn which patients should be disturbed and which patients should be left alone."
Is over-treatment a problem that people are worried about in the era of continuous monitoring?
"Right now, we ostensibly have too much information. We don't know what to do with it, but the problem is not the information. Our goal is to constantly introduce more and more information, but to make fewer alerts with it - only what we need."
"We really want to improve the moment when people leave the hospital to start rehabilitation. There's a lot to be done at this stage in order to prevent the patient's rapid return to the hospital. Dealing with this stage has to be multidisciplinary, involving monitoring, home treatment, and systems that do coaching in order to instruct and improve the patients' motivation to persist with the treatment," says ACC executive VP Brendan Mullen.
Too little investment in prevention
According to Rumsfeld, information-based companies currently invest too much in producing for improving the quality of life and sports performance and too little in the real market - prevention and treatment of diseases. "This trend began because regulation of data-based products was stringent, and companies whose founders came from the technology industry knew how to market to consumers, not how to market to hospitals and insurance companies, so this was what they preferred to deal with. Regulation is improving, however, and companies have started to realize that the way to this market doesn't go just through the consumer. The consumer has no interest in putting the data into the system.
"In Israel, health companies and technology companies have succeeded in combining forces in order to devise technologies for the clinical market, which will really use them. In Israel, no one is afraid to say, 'We're a digital health company.' In other places around the world, technology and health simply don't meet. We're learning from you, and hope that we'll be able to replicate this success in the US. We want to take what works in Israel to the US market, and then to the whole world."
The Innovation Institute is a joint venture of the Ministry of Economy and Industry and the Digital Israel organization aimed at installing breakthrough technologies in the public sector. It is currently focusing on four areas: digital health, transportation, education, and food and agriculture. "All of these areas will change following the information revolution," says Innovation Institute executive director Dr. Jonathan Menuhin. "Our ability lies in promoting the entrepreneurs, bringing knowledge, and creating cooperative efforts. Entrepreneurs are individuals, and we're trying to enable them to benefit from quality of life as if they were part of a large company."
Menuhin says that in digital health, the biggest challenge for Israeli startups is to install their systems at organizations outside Israel. "They conduct pilots only with one or two organizations, and sometimes these are Israeli organizations, which are excellent in installing such systems, but which do not necessarily reflect the considerations of organizations elsewhere in the world," he states. "We'll get help from ACC in promoting pilots at leading hospitals to prove technological feasibility, and they'll also provide guidance in writing protocols for the trials. Later, the plan is for things to also work in the other direction: foreign companies will come to do clinical trials in Israel," he says. The two tracks can be supported by the new government digital health program, to which NIS 1 billion was recently allocated.
"Worried about side effects, not heart attacks"
During the Innovation Institute's event, people from the ACC spoke with "Globes" about trends in treatment of heart attacks. According to Rumsfeld, in the past 20 years, statins, the popular drugs for reducing cholesterol, have become the foundation stone of cardiology. "They are really changing the risk of getting heart disease," he says. "When I worked as a young doctor, before statins were common, I was told that the chances of surviving a heart attack were 30%. This figure has simply vanished. A lot of questions were raised about side effects, but most of these phenomena didn't appear in controlled clinical trials.
"A relatively small number of people experienced muscular pain, which is completely reversible. You can stop the drug, and no damage is caused. This doesn't mean that everyone should take statins. There's no need to start adding them to drinking water, as I once heard someone recommend. Today, they recommend taking them not only for high cholesterol, but also on the basis of combined risk profile analysis, of which cholesterol is only a part."
Are doctors aware enough of the side effects?
Rumsfeld: "People worry too much about these side effects and too little about the heart attacks. I'm worried that people report side effects and immediately decide to stop the drug without consulting a doctor. Maybe the specific muscular pain has nothing to do with the drug, or maybe it can be treated by lowering the dosage. There were patients who told me that they got a headache from a statin. This doesn't appear in any studies. In a case like this, I recommend clarifying the source of the headaches without discontinuing the drug. In the end, however, it's the patient's decision."
A few years ago, a new category of drugs for treating heart disease entered the market. How do they measure up against statins?
"The new drugs are appropriate when the combined risk is very high, or when the statin doesn't help or really causes unbearable side effects. It's good that we have substitutes, but statins are still more researched drugs, very effective, and the price is also significant."
Published by Globes [online], Israel business news - www.globes-online.com - on May 1, 2018
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