Health Tech News This Week – January 28, 2023

What happened in health care technology this week, and why it’s important.

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ChatGPT in health care: 5 burning questions about the buzzy new tool

If the buzz is to be believed, ChatGPT seems poised to upend everything from high school essays and news articles to computer coding and scientific research. I’ve already discussed the frenzy about ChatGPT in a previous post. In this Stat article (subscription required), Brittany Trang provides a five-question guide to the technology and potential use cases in healthcare.

“As a society we tend to focus so much on innovation and what we perceive as quality improvement, we don’t spend quite enough time thinking through the ethics. I think we have time and space to do both if we cared.”

Kellie Owens, Assistant Professor of Medical Ethics, NYU Grossman School of Medicine

Why it’s important – Early experiments in health care have medical ethicists and other onlookers worried about putting too much trust in a tool that still gets answers wrong. Experts told STAT they’re concerned, too, about issues of informed consent and the potential to deepen distrust in medicine by lowering the barrier to creating misinformation.

Infographic of the week – This comes from The Economist and highlights how digital health tools can support Universal Health Coverage. The information was drawn from a 2021 study by the World Bank.

Image Credit: The Economist

An ALS patient set a record for communicating via a brain implant: 62 words per minute

Brain interfaces could let paralyzed people speak at almost normal speeds. Antonio Regalado reports on this recent research in his article in MIT Technology Review online. Eight years ago, a patient lost her power of speech because of ALS, or Lou Gehrig’s disease, which causes progressive paralysis. She can still make sounds, but her words have become unintelligible, leaving her reliant on a writing board or iPad to communicate. Now, after volunteering to receive a brain implant, the woman has been able to rapidly communicate phrases like “I don’t own my home” and “It’s just tough” at a rate approaching normal speech. That is the claim in a paper published over the weekend on the website bioRxiv by a team at Stanford University. Other researchers have not formally reviewed the study. The scientists say their volunteer, identified only as “subject T12,” smashed previous records by using the brain-reading implant to communicate at a rate of 62 words a minute, three times the previous best.

Why it’s important – While some skeptics have asked whether measuring from more neurons at one time will make any difference, the new report suggests it will, especially if the job is to brain-read complex movements such as speech. The Stanford scientists found that the more neurons they read from at once, the fewer errors they made in understanding what “T12” was trying to say. The path forward will likely include more sophisticated implants and closer integration with artificial intelligence. I’ve written previously on the potential of brain-computer interfaces. You can read that post here.

Study: New VR sensory room reduces anxiety in people with intellectual disability

MobiHealthNews’ Adam Ang reports on a new VR program with interactive sight, sound, and touch experiences that has helped improve outcomes for adults with neurodevelopmental disabilities, including autism and intellectual disability. This is based on the latest study, touted to be the first of such, done by researchers from the Western Sydney University and University of Wollongong, The Disability Trust, and technology company Devika. The five-month preliminary study evaluated the viability and benefits of using Devika’s Evenness VR Sensory Space technology as an intervention tool among 31 adults with different neurodevelopmental disabilities and their carers. Its findings were published in the Nature Scientific Reports Journal. Based on pre and post-scores of the users, the technology helped reduce their anxiety and, in particular, lowered depressive symptoms among participants with depression.

Why it’s important – The study demonstrates the potential of VR to promote the implementation of sensory rooms as an effective intervention tool for persons with neurodevelopmental disabilities. As VR emerges as an assistive tool for many health and wellness activities, the researchers stressed the importance of evaluating its usefulness and benefits, which had been largely unexplored in previous studies.

Podcast of the week – Returning to my roots in medical technology, my recommendation this week is The Radiology Podcast. In this episode, host Daniel Arnold talks about the world of medical imaging with Brian Casey, Editorial Director of Casey Insights, a consulting firm offering content development and consulting services for the medical imaging industry and founding Editor-in-Chief of Brian discusses his career in radiology, bearing witness to how the radiology industry has changed and the launch and growth of Brian and Daniel also chat about why Brian started Casey Insights and his vision for growing it, how he approaches stories and his audience, and his thoughts on AI and technology in radiology. Brian has been one of the top reporters in the medical imaging world for years and continues to provide insights into the developments in radiology and AI. You can listen to the podcast here.

Big Tech’s layoff binge stinks. Let’s hope it leads to a little discipline

Tech reporter Harry McCracken authored this piece in Fast Company’s Plugged In newsletter. The hot new trend in tech is more sobering than scintillating. Last week, Microsoft and Google parent Alphabet joined Meta and Amazon in announcing they would lay off thousands of people. Among the biggest, best-known tech companies, only Apple has (so far) managed to avoid such a sweeping reduction of its workforce. The downsizing of Big Tech is a most unfortunate development for the thousands of staffers who are being shown the door, sometimes in grossly insensitive ways. But McCracken contends that the layoffs could even lead to them making better decisions about future products that will benefit us all.

Why it’s important – It’s no fun skimming Twitter and LinkedIn and seeing talented people disclose that they’ve lost their jobs, sometimes after many happy and productive years. But as I suggested in a previous post, there may be an opportunity to have these tech professionals move into healthcare and create benefits for both the individual and our industry. I’ve already seen many posts on LinkedIn announcing new positions as tech workers explore the many opportunities to apply their skills to help us solve some of the pressing issues we face.

Nvidia’s AI Tech Designs Proteins Never Seen in Nature, Pointing Way to New Therapies

A collaboration between Nvidia and startup Evozyne produced novel versions of a human protein never before seen in nature but with enhanced function and the same safety as the native protein. The research lays the groundwork for potential new therapies for a rare inherited disorder. Frank Vinluan brings us the story in MedCity News. The research results were announced during the recent J.P. Morgan Healthcare Conference in San Francisco. The Nvidia and Evozyne research focused on the phenylalanine hydroxylase (PAH) protein family. PAH is an enzyme needed to break down phenylalanine, an amino acid found in certain foods. PAH deficiency leads to a rare disorder called phenylketonuria (PKU), in which phenylalanine levels build up in the body and cause neurological impairment. Patients with this inherited disorder manage it by maintaining a strict diet that avoids phenylalanine-containing food.

When engineering therapeutic proteins, scientists aim to make changes that enhance the protein’s function without compromising its safety. In the research described by Nvidia, Evozyne created a PAH protein with 51 mutations. Despite all of those changes, that protein was still able to achieve a two-and-a-half times enhancement in functionality compared to native human PAH, Powell said. Going further, the technology was able to design a PAH protein with 167 mutations. Despite changing more than half of the protein, that version of PAH still retained its function.

“With this ability for us to explore an essentially infinite space of proteins, to now be able to find the proteins with the function you desire while maintaining other properties that you also desire, like the safety of the proteins, that’s what these methods are absolutely unlocking,”

Kimberly Powell, Vice President, Health Care, Nvidia

Why it’s important – PKU has few FDA-approved therapies. BioMarin Pharmaceutical markets two: the small molecule drug Kuvan and Palynziq, an engineered enzyme designed to substitute for the deficient PAH. But using these drugs does not eliminate the need for patients to continue dietary restrictions. Other companies are in various stages of development with potential PKU therapies that could help patients who don’t respond to the currently available BioMarin products. Homology Medicines is in early-stage clinical testing of a gene-editing therapy that replaces the disease-causing gene with a functional one. PTC Therapeutics has reached late-stage clinical testing with a small molecule drug for PKU. Earlier this month, Jnana Therapeutics received FDA permission to begin a Phase 1 trial of a small molecule drug candidate for the metabolic disorder.

Seven technologies to watch in 2023

Nature selected seven scientific tools and techniques poised to have an outsized impact on science in 2023. Out of those, here are the ones that could be relevant in medicine and healthcare.

  • Single-molecule protein sequencing – Most proteomic analyses use mass spectrometry, a technique that profiles mixtures of proteins based on their mass and charge. These profiles can quantify thousands of proteins simultaneously, but the molecules detected cannot always be identified unambiguously, and low-abundance proteins in a mixture are often overlooked. Now, single-molecule technologies that can sequence many, if not all, of the proteins in a sample could be on the horizon — many of them analogous to the techniques used for DNA. Although single-molecule protein sequencing is only a proof of concept at present, commercialization is coming fast.
  • CRISPR anywhere – The genome-editing tool CRISPR–Cas9 has justifiably earned a reputation as the go-to method for introducing defined changes at targeted sites throughout the genome, driving breakthroughs in gene therapy, disease modeling, and other areas of research. But there are limits as to where it can be used. Now, researchers are finding ways to circumvent those limitations.
  • Single-cell metabolomics – Metabolomics — the study of the lipids, carbohydrates, and other small molecules that drive the cell — was originally a set of methods for characterizing metabolites in a population of cells or tissues but is now shifting to the single-cell level. Scientists could use such cellular-level data to untangle the functional complexity in vast populations of seemingly identical cells. But the transition poses daunting challenges.
  • In vitro embryo models – The journey from fertilized ovum to fully formed embryo has been mapped in detail at the cellular level for mice and humans. But the molecular machinery driving the early stages of this process remains poorly understood. Now a flurry of activity in ‘embryoid’ models is helping to fill these knowledge gaps, giving researchers a clearer view of the important early events that can determine the success or failure of fetal development.

Top 14 Use Cases of Natural Language Processing in Healthcare

Finally, this week here’s an article from Maruti Tech Labs highlighting fourteen use cases of Natural Language Processing in healthcare. NLP illustrates how artificial intelligence policies gather and assess unstructured data from the language of humans to extract patterns, get the meaning and thus compose feedback. This is helping the healthcare industry to make the best use of unstructured data. This technology facilitates providers to automate the administrative work, invest more time in taking care of the patients, and enrich the patient’s experience using real-time data.

Image Credit: Maruti Techlabs

Why it’s important – Natural Language Processing in healthcare is not a single solution to all problems. I’ve written before about the use of voice-enabled technology in healthcare. NLP is a foundational element that supports the use of those technologies. Although the healthcare industry still needs to improve its data capacities before deploying NLP tools, it can enhance care delivery and streamline work considerably.

We Need To Fix The “Triple-demic” In The Healthcare Workforce Now

“The system is flawed. It’s grinding us. It’s grinding good docs and providers out of existence.”

Keith Corl, M.D, Assistant Professor of Medicine, Brown University
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Author’s note: This is not a post about technology. I’m deeply concerned about the current state of our healthcare workforce, and recent newsfeed articles only point out that the situation is getting worse. And it’s not just about burnout, which is covered extensively in the press, in research publications, and at conferences around the world. It’s broader than that. I’ve borrowed the term “triple-demic” to characterize the current situation to include moral injury and physical threats to healthcare workers as the key issues demanding immediate action.

Roughly 2.9% of healthcare workers quit their jobs in November 2022, equating to about 600,000 resignations, according to new data from the Bureau of Labor Statistics. That’s the second-highest quit rate in recent healthcare history, only behind the 3.1% rate in November 2021. Burnout from caring for Covid-19 patients, rigorous work schedules, and stagnant or low wages continue to push many hospital nurses, technicians, nursing home staff, and others to switch to other healthcare settings — or leave the profession entirely. Three major factors contribute to these resignations: burnout, moral injury, and physical threats. Burnout has received most of the attention throughout the pandemic. But the other two factors also need to be addressed to fix the problem. Some thoughts on each follow.


Burned-out healthcare professionals are more likely to leave practice, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor patient interactions and when burned-out caregivers suffer from impaired attention, memory, and executive function. A survey conducted by an AHRQ-funded project, the MEMO—Minimizing Error, Maximizing Outcome—Study (AHRQ grant HS11955), found that more than half of primary care physicians report feeling stressed because of time pressures and other work conditions. Some of those work conditions are shown in the graphic below:

Image Credit: AHRQ

“The nation’s health care delivery systems are overwhelmed, and nurses are tired and frustrated as this persistent pandemic rages on with no end in sight. Nurses alone cannot solve this longstanding issue and it is not our burden to carry.”

Ernest Grant, PhD, RN, FAAN, President of the ANA

Moral Injury (MI)

Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical, and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.” Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care. Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

That idea resonates with clinicians across the country. The response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, and endless clicking on electronic health records.

“We have come to believe that burnout is the end stage of moral injury, when clinicians are physically and emotionally exhausted with battling a broken system in their efforts to provide good care; when they feel ineffective because too often they have met with immovable barriers to good care; and when they depersonalize patients because emotional investment is intolerable when patient suffering is inevitable as a result of system dysfunction.”

The Moral Injury Institute

Healthcare workers suffer an injury at the hands of each other: the medication error ignored at the nurse’s station, the doctor who orders unnecessary procedures, and the technician who is forced to carry out morally questionable orders. This regular violation of ethics, winking at incompetence, and hypocritical prosecution of employees ‘outside the clique’ drags down an organization’s culture. Healthcare workers are so blind to the effects of moral injury that they call their cognitive dissonance ‘professional detachment’ and label the effects they suffer ‘burnout and fatigue’ rather than guilt and anger. The impact on the healthcare worker of human trauma should not be downplayed: the opportunities to address trauma and suffering bring providers into the system. It is when the system itself inflicts suffering that the healthcare worker experiences MI.

A less discussed aspect of moral injury is shaming in the healthcare profession. The best discussion of the issue is this recent video from Dr. Zubin Damania. He interviews Dr. Emily Silverman, a UCSF hospital physician and host of the popular podcast The Nocturnists. They dive into shame and emotional repression in doctors, healthcare professionals, and beyond. It is a lengthy discussion but well worth the investment of your time. (And read the comments thread too. Interesting observations from healthcare professionals worldwide on the shaming issues they’ve faced.)

YouTube Video Credit: ZDoggMD

If you want to learn more about the topic, here are some additional resources to explore:

  • The Nocturnist Shame Series
  • More on Dr. Silverman
  • The Shame Space – An international network of professionals who use creative storytelling and research to advance shame awareness, shame resilience, and shame-sensitive practice in healthcare, with the overarching goal of creating more connected, authentic, and safe healthcare systems for all. The Shame Space was formed in 2022 by scholars studying shame at the University of Exeter, Duke University, and Duke-NUS Medical School.

Physical Threats

The seriousness of this issue was reinforced last week in an article written by Michael Dowling, President & CEO, Northwell Health, in Beckers Healthcare titled: The unthinkable priority now facing hospitals.

In his opinion piece, Dowling highlights this “additional and disturbing priority — one that, I would argue, we never imagined. We now must protect our hospital patients and employees from the growing threat of intimidation and violence. There has been a dramatic spike in staff assaults, with many leading to serious injury and some leading to death.” (How have we gone from nightly 7 pm balcony applause and cheering for healthcare workers during the pandemic to physical assaults in their workplace?)

“People are proud of their bitterness now.”

Peggy Noonan, Wall Street Journal, 2019

The number of injuries from violent attacks against medical professionals was already on the rise pre-pandemic, increasing 86 percent from 2011 to 2018, according to the Bureau of Labor Statistics. In a spring 2022 survey by National Nurses United, nearly half of the hospital nurses (48 percent) reported rising workplace violence, more than double the 21.9 percent who responded as such a year prior.

Dowling has already taken action to address the problem. At Northwell, they call this new priority “The Safe Place Initiative.” It includes the following actions, investments, and measures:

  • An investment in educating visitors, patients, and team members on proper behavior and how to promote dignity, respect, and understanding. Thousands of pieces of informational signage and posters are prominently displayed, emphasizing that harassment and verbal or physical assault will not be tolerated. Signs are also on display that reminds all visitors that this healing place — the hospital and ambulatory facility are weapon-free zones.
  • A comprehensive investment in training employees on what to do in a potential active shooter situation, on how to de-escalate a potentially violent situation, and on how to “stop the bleed” in the case of such a circumstance. Over 50,000 of our employees have already received this training.
  • The enhancement of security in all locations by increasing the presence of security personnel, as well as increasing video surveillance and alarm systems.
  • The installation of weapon detection technology at the entrance of our facilities.
  • Education for staff on how to recognize signs of domestic and partner violence and enhanced support offerings to team members impacted by such violence.

“Now is the time to champion kindness, respect and compassion. Times like this call for even greater generosity of spirit, the “better angels” of our nature. Positive leadership unites, promotes mutual trust, builds confidence and is optimistic.”

Michael Dowling, President & CEO, Northwell Health

I have tremendous respect for the work that Mr. Dowling is doing at Northwell. Action, not just words. Leadership, not just platitudes. We need more of this.

I’m not sure that I have good answers to these critical issues. I suspect that there is not one solution that will fit every situation. But my hope in writing this post is to raise awareness of the seriousness of these issues, put a different frame around the various elements, and drive a deeper conversation around how we can solve these challenges before we lose more dedicated professionals because of frustration, exhaustion, and intimidation. These good people deserve nothing less.

Digital Therapeutics (DTx) in Healthcare – What Does the Future Hold?

“This is a whole new modality of care. If you think about the biggest subjects addressed by these apps, it’s behavioral health, and that’s where access is our biggest problem. And, here we are pushing behavioral health out to everyone’s phone. So that’s a lot of potential.”

Matt Fickie, M.D., Senior Medical Director, Highmark
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Digital therapeutics, or DTx, is a rapidly growing field that is poised to revolutionize the way we deliver remote patient care. By utilizing mobile apps and other digital technologies, DTx offers a convenient and cost-effective alternative to traditional in-person therapies, empowering patients to take control of their health and wellness. I’ve written on the topic in a previous blog post, but advances in the field make me believe that 2023 will be an important year in the area’s development.

Most current DTx solutions address the monitoring or treatment of chronic diseases, which are the leading driver of the nation’s $4.1 trillion annual healthcare spending. DTx solutions are typically delivered through smartphone apps. This makes them more accessible by providing treatment directly to patients’ homes and removing any stigma that some individuals, for example, may associate with substance abuse and mental health.

“By putting tools in the hands of individuals who are interested in their health, we’re empowering people to learn, understand and take action on their own.”

Ed Likovich, CEO at Nymbl Science

Five years ago, the Food and Drug Administration (FDA) cleared the first Prescription Digital Therapeutic (PDTx). PDTx are digital therapeutics prescribed by a physician and paid for by the individual’s health insurance. They are used to treat a wide range of conditions, from schizophrenia, atopic dermatitis, chronic insomnia, attention-deficit/hyperactivity disorder, and substance and opioid addiction. In 2022 CMS implemented a new Level II Healthcare Common Procedure Coding System (HCPCS) code for “prescription digital behavioral therapy,” which makes it easier for commercial and Medicaid plans to cover these therapies. Additionally, Congress is considering legislation called the Access to Prescription Digital Therapeutics Act. This bipartisan bill would establish benefit categories for certain digital therapeutics, so Medicare, Medicaid, and other public payers could reimburse them. This critical roadblock is currently blocking the way toward further adoption.

Software mobile health apps are now classified as medical devices in Europe, requiring increased regulation and safety verification. These regulatory changes encourage consumer trust, uptake, and acceptance of these products as a legitimate form of medical care. In Germany, there is now a system for reimbursing patients who purchase DTx apps as a form of treatment. This could be a valuable incentive for patient adoption of remote care. This DTx adoption trend is expected to continue, with GlobalData predicting the approval of 70 new Class II mobile health apps in 2023.

Despite its potential to transform healthcare, bringing DTx to patients is complex. Companies must provide robust clinical trial data to be approved by regulatory agencies, including the U.S. Food & Drug Administration (FDA), which can sometimes take years and require a large amount of capital. It’s essential to remember that even before physicians prescribe prescription digital therapeutics, they want to know that they deliver results – and that they are covered by insurance. Much of this can be accomplished by providing figures that prove DTx can reduce costs for payers, but it is often time-consuming to pull the data together, adding yet another hurdle to overcome. Currently, one-off contracts with state Medicaid plans remain the only public coverage of PDTx, and large commercial payers have remained hesitant to cover digital therapeutics. To be successful, business models should allow for reimbursement so that therapeutics are accessible to those in need.

It is important to note that the success of DTx will depend on several factors, including the development of effective and user-friendly technologies, the availability of reliable and secure data systems, and the ability to demonstrate clinical effectiveness and cost-effectiveness. It will also be essential to ensure that these technologies are accessible and affordable for all individuals, regardless of their location or socio-economic status.

While the use of DTx is still in its early stages, it has the potential to revolutionize the way healthcare is delivered and received. We’re looking at a world that eliminates the need for syringes and needles, supports more remote monitoring, focuses on older adults’ health and wellness, and deploys behavioral health to solve complex health problems.

Image Credit: IQVIA

The potential for DTx to improve patient outcomes and reduce healthcare costs has not gone unnoticed by investors. Venture financing in the field reached nearly $500 million in 2021. GlobalData’s TMT Predictions report for 2023 anticipates that digital therapeutics will be a key emerging health tech theme for investment.

Image Credit: Global Data Tech, Media and Telecom (TMT) Predictions 2023

Big Pharma has also noticed, with many major pharmaceutical companies investing in DTx platforms to tap into this growing market. DTx offers the next significant form of remote treatment and will continue to grow in importance as we look to improve healthcare delivery in the digital age. As the field continues to evolve and mature, it will be interesting to see how DTx is integrated into the broader healthcare ecosystem and its impact on patient outcomes and care delivery. With significant investment from both the private and public sectors and regulatory changes facilitating the adoption of DTx, we will likely see even more innovative and effective digital therapeutics solutions emerge in the coming years. By adopting and embracing digital therapeutics at scale, pharma, healthcare providers, and other life science players can improve the quality of lives of patients across the globe.

Current market map – Digital Therapeutics companies – From CB Insights, December, 2022

Image Credit: CB Insights, December, 2022

Although they may not currently be as widespread options as traditional therapies, researchers expect digital therapeutics to have a significant impact across multiple medical specialties. As such digital-based tools and programs gain more backing from clinical tests, they will be seen as viable alternatives for practitioners who can turn their use into everyday practice. Just like physicians have been prescribing lifestyle changes for appropriate ailments for centuries, they will similarly prescribe smartphone apps and digital health technologies. And this shift towards DTx will not be because of the technology itself but because they have been proven to work for patients.

Health Tech News This Week – January 21, 2023

What happened in health care technology this week, and why it’s important.

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FDA Clears AI-Powered MRI to Screen Cancers Without CT

A new AI-powered MRI application used to screen head and neck cancers has been cleared by the U.S. Food and Drug Administration (FDA). Helen Huang covers the development in her article in IoT World Today. Royal Philips developed MRCAT (Magnetic Resonance for Calculating Attenuation), which allows clinicians to use MRI machines as the only imaging required for a radiotherapy treatment plan for soft tissue tumors of the head and neck. The AI model can display images with density information usually observed with CT scans. A single, high-resolution MR scan can provide a high level of detail in under three minutes.

Why it’s important – People have been working on MR-based radiation planning for years with limited success. To have an FDA-cleared application for some of the most challenging tumors is a real breakthrough. The superior soft tissue imaging of MR, together with advances in the integration and orchestration of data, including the use of artificial intelligence, promise greater clarity and less subjectivity in planning radiotherapy for head and neck cancer. In addition, the equipment can also be used to treat cancers in the pelvis, prostrate, and brain by calculating radiation doses and positioning patients for radiation treatments.

Infographics of the week – The first infographic this week is from Insider Intelligence and provides a timeline of investments made for in-home health since August, 2021.

Image Credit: Insider Intelligence

The second infographic is from Dr. Bertalan Mesko and team at The Medical Futurist Institute. it outlines key features of digital health.

Image Credit: Dr. Bertalan Mesko, The Medical Futurist Institute

The rules, laws, and policy digital health needs to know to stay ahead this year

Let’s face it. Healthcare regulations can be pretty confusing and outright overwhelming at times. With so many different rules, regulatory bodies, and constantly evolving guidance, it’s hard to keep track of it all, especially given the hieroglyphic-level interpretation needed to parse even the shortest and simplest legal texts. Marissa Moore and Brendan Keeler compiled this high-level overview of some of the most pressing regulatory/policy concerns for health tech right now in the Second Opinion newsletter.

Why it’s important – This is, by far, the best summary of the critical regulatory issues that need to be understood for 2023. Terrific work that I’ll refer to often throughout the year.

Podcast of the week – My recommendation for this week is the current episode of the Fixing Healthcare podcast: An unfiltered look at ChatGPT and medicine. Hosts Dr. Robert Pearl and Jeremy Corr interview Dr. Zubin Damania (aka ZDogg, MD) on the topic. The internet (and nearly every American industry) is abuzz with a new phenomenon called ChatGPT (Generative Pre-trained Transformer), a great artificial intelligence chatbot launched in November 2022 with an uncanny ability to generate human-like text. Recent headlines tell of the potential havoc this AI can inflict: “ChatGPT writes medical research abstracts that can fool scientists” and “Use of ChatGPT in counseling sessions is raising ethical questions.” Dr. Z lauded ChatGPT’s ability to write a convincing Doc Vader script—a scary thought for the nation’s No. 1 healthcare satirist. But what else can AI accomplish? In this Unfiltered episode of Fixing Healthcare, cohosts Jeremy Corr and Dr. Robert Pearl join ZDoggMD to talk about hyper-realistic AI and explore its influence on American healthcare.

Image Credit: Fixing Healthcare Podcast

The seismic shift that has brands like Sony & Sennheiser disrupting the hearing aids market

After the FDA cleared the way for hearing aids to be sold over the counter, CES was full of new devices from brands big and small. Chris Morris in Fast Company reports that there were OTC hearing devices from familiar tech companies—and many more from companies that aren’t so familiar—in various shapes, sizes, and prices. It’s a rush that makes sense. But just as in any other field that is new in tech, not all companies charging into the augmented-hearing market are likely to survive.

“The challenge with what we’re seeing in the OTC market is there are a lot of new entrants that are putting out what we consider schlock. I think over the next year, those will be weeded out pretty quickly.”

Nick Laudico, SVP and head of corporate strategy, Eargo

Why it’s important – The World Health Organization warns that by 2030, nearly 630 million people worldwide will have a hearing disability. By 2050, that could jump to 900 million, in part because of regular exposure to loud sounds at work and in our personal lives (such as by listening to music with earphones). Currently, 15% of American adults ages 18 and older—37.5 million people—report some trouble with their hearing. But it will be important to see independent validation of the effectiveness of these various options.

“Smart Patch” Could Be Used to Detect Alzheimer’s

Researchers have developed a minimally invasive “smart patch” to detect proinflammatory biomarkers of neurodegenerative disorders, including Alzheimer’s disease, within skin interstitial fluid. Kevin Sullivan from Swansea University described the research in this post on Neuroscience These patches are comprised of arrays of tiny needles (microneedles) designed to break the skin barrier – in a minimally invasive manner – and monitor the biomarkers of clinical significance. They can be self-administered for point-of-care diagnosis at GP practices or even at home.

Why it’s important – This breakthrough in advancing transdermal capability would mean ‘smart patches’ could be used to detect specific biomarkers within skin interstitial fluid (ISF) in a “bloodless” manner and has the potential to change the landscape of early neurodegenerative disease detection.

Google Research and DeepMind develop AI medical chatbot

Digital Health’s Cora Lydon reports that Google Research and DeepMind have developed a large language model for the medical community, which could generate safe and helpful answers using datasets covering professional medical exams, research, and consumer queries. The AI-powered chatbot, MedPaLM, combines HealthSearchQA, a free-response dataset of medical questions found online developed by Google and DeepMind, with six existing open-question answering datasets. The six other datasets come from MedQA, MedMCQA, PubMedQA, LiveQA, MedicationQA, and MMLU. MedPaLM addresses multiple-choice questions and answers posed by both medical professionals and non-professionals.

Why it’s important – While this is a crucial step, and the results significantly improved over other similar models that have been investigated, according to a paper published by the AI tool’s researchers, MedPaLM could have a key role to play in clinical applications following some refinement. The report stated that the Google tool “performs encouragingly but remains inferior to clinicians.”

Why do researchers think a cough medicine could help treat Parkinson’s?

Beth Jo Jack in Medical News Today reports that researchers discovered that ambroxol, a cough medicine available over-the-counter in many countries, increases levels of GCase, a protein that allows cells to better remove waste proteins, including alpha-synuclein, which is a biomarker for Parkinson’s disease. During a phase 2 clinical trial, researchers found ambroxol was safe and well tolerated. A phase 3 clinical trial of ambroxol will begin this year. It will follow 330 participants with Parkinson’s at between 10 and 12 locations in the U.K. The study will take both Parkinson’s patients who have mutations in the GBA1 gene — the most common genetic risk factor for Parkinson’s disease — and Parkinson’s patients with no genetic link.

“The reason that this study is of interest is the investigators are looking for something that may slow the disease progression in Parkinson’s, which is something that would be quite important and is something that’s missing from our armamentarium.”

Michael Okun, M.D., National Medical Advisor, Parkinson’s Foundation

Why it’s important – A 2019 global estimate suggests that over 8.5 million individuals are most likely living with Parkinson’s, according to the World Health Organization (WHO). It’s important to note that this is very early-stage research and whether there is long term benefit to this treatment is still to be determined. Also, this cough medication is not cleared for sale in the U.S. by the FDA.

On a side note – One thing I like about articles published in Medical News Today online is that in addition to listing the author, they also list the individual who fact-checked the article. For this article that was Alexandra Sanfins, Ph.D. Kudos for including that information.

January is Glaucoma Awareness Month – How Technology Can Help in Detection & Treatment

“Normally for glaucoma, we’re monitoring pressure two to four times a year with patients coming in every three to six months for a pressure check in the clinic, and it’s just a single spot reading. At home with this device, you get multiple readings over continuous days, so it’s a more accurate representation of their pressure in real life. You can catch spikes in pressure that you might miss from that one in-office check.”

Leo Seibold, MD, Associate Professor of Ophthalmology, University of Colorado School of Medicine
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Glaucoma is an age-related chronic optic neuropathy and the leading cause of irreversible blindness worldwide. Predictions report that in 2040 the number of people with glaucoma worldwide will reach almost 112 million, disproportionally affecting Asian and African countries. A significant challenge in trying to tackle glaucoma-related blindness is to identify those with this eye disease before they become symptomatic.

Glaucoma is diagnosed clinically by detecting the characteristic changes of the optic disc and can be confirmed with a corresponding visual field (VF) defect. However, the clinical diagnosis of glaucoma is subjective and relies on the examiner’s experience. A particular challenge for detecting glaucoma is the wide variation of optic disc structure and size in the population. Therefore, there is an urgent need for novel and accurate techniques to detect glaucoma that can be used in different settings.

Fortunately, we are witnessing new practical applications of artificial intelligence (AI), including advances in complex artificial neural networks (ANNs) and constant innovations in daily-used devices such as smartphones, laptops, electronic tablets, wireless communications, etc. Here is a quick review of some new technologies that improve glaucoma diagnosis and treatment.


There are several well-recognized risk factors for glaucoma, including elevated IOP, older age, ethnicity, and family history of glaucoma. Of all risk factors, the level of IOP is the most important one and is the only one that can be modified with treatment. The risk of developing glaucoma rises with increasing IOP. This is supported by the fact that those patients presenting with advanced disease at diagnosis are more likely to have higher IOP. Higher IOP is also a risk factor for disease progression.

Self-monitoring of chronic diseases, such as monitoring blood glucose levels for diabetes mellitus and measuring blood pressure in hypertensive patients, can be effective for informing patients when their current treatment is not sufficiently effective, thereby giving them a sense of control over their condition along with improved disease control. The ability to measure IOP at home throughout different periods of the day will enable physicians to identify potential failures in treatment and possibly improve the prognosis for the patient. The self-monitoring approach could bring significant patient benefits, such as symptom management and improved quality of life.

Peak IOP and IOP fluctuations have been identified as risk factors for the development and progression of glaucoma. Diurnal fluctuations of IOP are highly unlikely to be observed during clinical visits. The Icare home tonometer is based on the principle of rebound tonometry. No topical anesthetic is required, and there is minimal risk of corneal injury. It may be an option for some glaucoma patients to monitor their IOP better at home and aid in managing their condition.

New technologies, such as sensors and wireless devices, present promising tools that enable continuous monitoring of IOP. One of the first platforms used was the SENSIMED Triggerfish contact lens sensor (Sensimed AG, Lausanne, Switzerland). This soft silicone contact lens is provided with a circumferential sensor that consists of 2 platinum-titanium strain gauges designed to measure changes in the radius of curvature of the cornea. A microprocessor transmits an output signal to a wireless antenna on the periocular surface. A cable wire transfers the data to an external portable recorder. The SENSIMED Triggerfish is noninvasive, but the data’s clinical value is uncertain.

Fundal Imaging

Assessment of the damaged optic nerve and retinal nerve fiber layer is a crucial method to detect glaucoma. Stereoscopic fundus examination by an expert clinician is considered standard practice. Automated imaging systems, particularly optical coherence tomography (OCT), are now widely used for glaucoma diagnosis. However, OCT examinations involve high costs, which may not be affordable by some healthcare providers. The advent of digital photography has made it easier and cheaper to acquire and process optic disc images. Nonmydriatic stereoscopic cameras are particularly useful for evaluating the optic disc and helping detect disease progression. Using image processing, relevant features, such as the optic disc and blood vessels, can be analyzed and provide helpful information. Advanced mobile phone technologies enable remote health care delivery and have been proposed as useful tools in glaucoma detection. Newer smartphone devices have high-powered computational functions, cameras, image processing, and communication capabilities, and they have been developed as an inexpensive retinal photography tools.

One example of a successful combination of fundal imaging and smartphone technology is the Portable Eye Examination Kit (PEEK) Retina (Peek Vision, London, United Kingdom), a smartphone camera adapter developed by Bastawrous et al. This portable mobile phone retinal imaging system is low-cost and easy to use for minimally trained users. The PEEK Retina can capture excellent-quality optic disc and retinal images and has recently been validated for optic nerve imaging in population-based studies in the developing world. Multiple other adapters have been developed to convert modern smartphone cameras into fundus and anterior segment cameras, thus reducing their costs and increasing potential adoption. These include the D-Eye system from Italy (D-Eye S.r.l, Padova, Italy) and the Ocular CellScope (Cellscope Inc, San Francisco, CA) from the United States.


Full-threshold automated perimetry (e.g., Humphrey, Octopus) is routinely used to confirm the diagnosis of glaucoma and monitor disease progression. Alternatives to clinic-based standard automated perimetry have been developed, often to facilitate home monitoring. Smartphones and tablets have been shown to be suited for vision testing, and they can communicate with other wireless platforms sending data automatically for analysis.

Although there are substantial challenges associated with home tonometry, including the calibration of monitors (e.g., securing a constant illumination intensity and size of the stimuli), determining the reliability of the test, and maintaining participant concentration, at the moment it is possible to perform VF tests using a tablet-based procedure. In addition to the role of detecting glaucoma, new perimetry technologies using tablets or portable computers have been designed to facilitate patients performing unsupervised perimetric tests as part of a home-monitoring program. Similar strategies have been tried successfully in patients with age-related macular degeneration and with promising results.

The glaucoma screening application called Visual Fields Easy (VFE) is available for the iPad and can be downloaded for free. The VFE showed promising capacity compared with diagnosis based on a Humphrey 24-2 SITA-Standard outcome. The VFE test evaluates 96 test locations (24 per VF quadrant) across the central 30-degree radius in 3 minutes on average, and the testing distance is 33 cm. The test results can be directly printed or emailed using Wi-Fi from the iPad. VFE worked well for identifying moderate-to-severe disease.

Cambridge Consultants has developed a smartphone glaucoma screening technology called Viewi that could be used in a clinic setting or from patients’ homes. The Viewi system includes a smartphone app, a Bluetooth finger button, and a headset that holds smartphones. The smartphone is slid into the viewer, the app is started, and the patient can hold the button in 1 hand, pushing when a light flash is seen. The app runs a suprathreshold static perimetry test. The test results are displayed in an intuitive format on the smartphone and can be shared instantly with healthcare professionals.

Artificial Intelligence

Using ANN and other AI strategies as glaucoma diagnostic tools are becoming a reality. Several techniques have been used to automate the glaucoma detection process. Moorfields Eye Hospital’s collaboration with Google (Alphabet Inc, Mountain View, CA) DeepMind aims to create a general-purpose AI algorithm that can look at OCT scans and diagnose age-related macular degeneration and diabetic retinopathy. VISULYTIX recently introduced PEGASUS (Visulytix Ltd), a new deep learning-based AI technology. It consists of an inexpensive smartphone clip-on optic nerve scanner that looks at several features within fundus images and provides information about the health of the optic disc. PEGASUS can be used not only for glaucoma detection but also for diabetic retinopathy and macular diseases.

Although the number of AI successes in glaucoma will likely grow in the near future, some promising applications are far from their clinical validation. Deep learning AI algorithms might allow the assimilation of multiple composite test results obtained at one screening visit to optimize diagnostic performance at a low cost.

Genetic Testing

There have been an increasing number of genetic studies on glaucoma recently, mainly due to a substantial reduction in the cost of high-throughput genome-wide genotyping platforms. In glaucoma, it seems that genetic testing may be helpful in some circumstances, such as screening of family members in OAG affecting young people with an apparent autosomal dominant inheritance. It has been proposed that genetic testing may help predict conversion from ocular hypertension to glaucoma or help predict disease progression, but the validation of these observations is required. Several international collaborations are currently ongoing, trying to understand the genetic components of glaucoma better. However, at the moment, genetic testing of broader populations is not justified.

New technologies for glaucoma detection have emerged, but their potential value and adoption greatly depend on the setting and the potential use of the test. Possible adoption of teleglaucoma and portable tablet or smartphone-based technologies is expected to facilitate glaucoma detection and management in remote and underserved populations.

Health Tech News This Week – January 14, 2023

What happened in health care technology this week, and why it’s important.

Image Credit:

New Technology Visualizes Radiation Therapy Dose in Real Time

First up this week is this article in Aunt Minnie that was recommended by my friend and colleague Christopher Farr. U.S. researchers say they have developed a new 3D imaging prototype for visualizing real-time radiation dose in patients undergoing radiation therapy. They published the results of their study on January 2 in Nature Biotechnology. The prototype is based on ionizing radiation acoustic imaging (iRAI), a noninvasive imaging technology that reconstructs radiation doses using acoustic waves. These waves stem from the absorption of pulsed x-ray beams in soft tissue. In testing, the system provided real-time 3D visualization of the radiation dose delivered to a patient with liver metastases.

“In future applications, this technology can be used to personalize and adapt each radiation treatment to assure normal tissues are kept to a safe dose and that the tumor receives the dose intended.”

Kyle Cuneo, ME, Radiation Oncologist, University of Michigan, ‘Ann Arbor

Why it’s important – Successful radiation therapy in cancer patients is contingent on delivering sufficient radiation doses to tumors while sparing surrounding normal tissues. Maximizing tumor control while minimizing toxicity requires that the planned radiation dose is delivered accurately. This development could be gamechanging. To quote Chris:

“If they can turn this idea into a product, they have opened up the holy grail of rad therapy. Individual treatment that can be customized and verified on the fly. Other folks have tried to do it for proton therapy using PET, but this method works for x-ray and uses ultrasound so should be much cheaper and applies to far more treatments (linacs generate high energy x-ray). This is potentially Nobel prize important.”

Christopher J Farr, Personal Correspondence

Array Behavioral Care announces $25M funding round led by CVS Health

CVS Health joins Array’s earlier investors in supporting the company, including Wells Fargo Strategic Capital, Harbour Point Capital, Health Velocity Capital, OSF Healthcare, HLM Venture Partners, and OCA Ventures. Jessica Hagen reports on this development in her article in MobiHealthNews. The funding will help Array scale its virtual behavioral therapy platform, which the company says CVS Health will allow it to do faster.

Why it’s important – Mental healthcare continues to make up a significant portion of telehealth visits. A 2022 analysis by the Kaiser Family Foundation of 126 million patients revealed 39% of telehealth outpatient visits were for a mental health or substance use diagnosis. The article lists other providers in the mental telehealth space, which has grown as demand for services has increased during the pandemic.

Infographics of the week – This graphic, initially created by the World Health Organization, and reprinted with permission in an excellent report Enhancing Equitable Access to Assistive Technologies in Canada, from McMaster University, outlines key issues in the development of assistive technologies. Assistive technologies are becoming increasingly important as the older adult population increases and the prevalence of disability rises. However, more focus must be given to lowering the barriers to adoption to make it more affordable, accessible, and inclusive.

Image Credit: World Health Organization, McMaster University report, page 11

The second infographic this week comes from Dr. Tazeen Rizvi. I am very impressed with the quality of his work and the topics he chooses to cover. This graphic on AI Challenges reviews the common issues related to AI and machine learning which include values and biases reflected in data, potential bias across the development and deployment process, transferability, legal, moral and professional responsibility, and, critically, patient/end-user experience and outcomes.

Image Credit: Dr. Tazeen Rizvi

Researchers crawled search engines and searched the dark web to find out the true extent of healthcare ransomware attacks

Fierce Healthcare’s Annie Burky reports that researchers from the University of Minnesota and the University of Florida measured attacks on healthcare delivery organizations from 2016 to 2021, publishing their findings in the December issue of the JAMA Health Forum. During the study period, 374 attacks were identified as exposing the personal health information (PHI) of 41,987,751 individuals—more than 10% of the U.S. population. According to the study, annual attacks doubled from 43 to 91, while PHI exposure increased more than 11-fold, from approximately 1.3 million in 2016 to more than 16.5 million in 2021. In these attacks, about half of healthcare organizations could restore backups. While findings show that only 15.8% of these attacks seemed to result in PHI being sold on the dark web, Neprash thinks that number is only a fraction of the truth.

“It took a long time to get healthcare providers to adopt electronic health records and now here is this threat to them. The more comprehensively networked you are, the more vulnerable that network can be to a cyberattack. So it does feel kind of like an unintended consequence of finally convincing everybody to switch to digital records.”

Hannah Neprash, Ph.D., Study Co-Author

Why it’s important – Despite hospitals being the most well-known victims of healthcare-directed cyberattacks, the JAMA study found that clinics were the most common healthcare delivery organization to experience a ransomware attack, followed by hospitals, ambulatory surgical centers, mental/behavioral health organizations, dental practices, and post-acute care organizations. More than half of all attacks affected multiple facilities. In an earlier post, I pointed out that ransomware and cybersecurity are top-of-mind issues for healthcare systems in 2023. Mitigating risk is a major focus of boards and executives around the country.

Podcast of the week – The Fixing Healthcare podcast series began its eighth season with an interview with Dr. David Feinberg, currently chairman of Oracle Healthcare, former CEO of Cerner (acquired by Oracle in 2022), and previous head of both Google Health and Geisinger. They discuss the difference that strong leadership can make, both for patients and clinicians. You can listen to the episode here.

Image Credit: Fixing Healthcare Podcast

New Oral Drug Lowers Cholesterol by 70%

A team from University Hospitals and Case Western Reserve University has identified a small-molecule drug that effectively reduces cholesterol by 70% in animal models. These findings, published in the journal Cell Reports, represent a new approach to managing cholesterol and may have implications for cancer treatments.

Why it’s important – Cholesterol lowering is one of the most important therapies to prolong life and protect people from heart disease, which is still the number one cause of morbidity and mortality in the Western world. In addition to impacting the field of cholesterol metabolism, the findings may impact patients with cancer, as emerging evidence suggests targeting PCSK9 can improve the efficacy of cancer immunotherapies.

Videos of the week – This video from Cable Labs titled The Near Future, Step Inside shows how internet experiences that we’re accustomed to today will soon give way to tomorrow’s fully immersive virtual world. The latest film in CableLabs’ Near Future series illustrates a day in the life of one family of four—at home, at work, in learning, and at play—as they encounter the integrated technologies that will power the future. These innovations are already in the works, setting all of us up for richer opportunities and seamless interactions in our personal and professional lives in the years to come. The second video shows the technologies behind the Step Inside video.

YouTube Video Credit: Cable Labs
YouTube Video Credit: Cable Labs

Hinge Health launches physical therapy house calls

Hinge Health announced the expansion of its clinical capabilities with the launch of a physical therapy house call service. Starting in Chicago, followed by a nationwide rollout, it will be the nation’s first fully integrated model for musculoskeletal (MSK) health that combines digital with in-person care.

Image Credit: Hinge Health

“Integrating digital and in-person care is a leap forward in bridging care gaps and reimagining a healthcare model that works for everyone.”

Daniel Perez, co-founder and CEO, Hinge Health

Why it’s important – Digital care has eliminated wait times and increased healthcare access for millions globally. Yet many Americans – from Gen Z to retirees – prefer complementing a digital experience with in-person visits. This is especially true for back, joint, or muscle pain, where in-person evaluations can substantially enhance downstream digital care.

Top Verily executives depart amid leadership shakeup and layoffs

Matthew Herper in Stat reports (subscription required) that Verily, a health technology company spun out of tech giant Alphabet, announced Wednesday that it is restructuring its management team and business and cutting 15% of its workforce. According to a memo exclusively obtained by STAT, Amy Abernethy, the former Food and Drug Administration official that Verily brought on to advance the use of technology in speeding up clinical trials, will be elevated to president of product development and chief medical officer. Verily also confirmed to STAT that co-founder and onetime chief medical officer Jessica Mega, a longtime public face of the company, has left Verily. Vivian S. Lee, a radiologist and former health system executive who joined Verily in 2018 as president of health platforms, has also left the company.

Why it’s important – The changes represent a new focus for the organization. The company has recently shifted its focus to the technology and infrastructure needed to support clinical trials. Verily has bolstered those efforts by bringing on experts like Abernethy, who joined the company in 2021 after serving as FDA’s principal deputy commissioner and acting chief information officer. The company has hired other regulatory experts, including former policy director Joe Franklin and senior technical adviser Laura Roe. Last fall, Abernethy told STAT the company is building tools to support “the 2022 model of clinical trials,” such as online consent forms to streamline health research and systems to help recruit clinical trial participants and manage study sites. Abernethy said those tools, along with Verily’s work to enable health data collection with its Study Watch and other tools, could help researchers work toward better real-world evidence generation.

The US Just Greenlit High-Tech Alternatives to Animal Testing

Animal testing has long been necessary for a drug to gain approval by the US Food and Drug Administration—but it may be on its way out. A new law seeks to replace some lab animal use with high-tech alternatives. Emily Mullen reports the development in her article in Wired online. The FDA Modernization Act 2.0, signed by President Biden at the end of December with widespread bipartisan support, ends a 1938 federal mandate that experimental drugs must be tested on animals before being used in human clinical trials. While the law doesn’t ban animal testing, it allows drugmakers to use other methods, such as microfluidic chips and miniature tissue models, which use human cells to mimic certain organ functions and structures.

“I don’t think the organ-on-chip will do it all. I think we’ll need a battery of different, complementary tests.”

Jeffrey Morgan, Professor of Engineering, Director, Center for Alternatives to Animals in Testing, Brown University

Why it’s important – An estimated 90 percent of drug candidates in clinical trials never reach the market, and drugs that target the brain typically have an even higher failure rate. These inconsistencies, combined with the time, expense, and ethical issues associated with using animals, have led scientists to develop alternative testing methods that aim to recapitulate human physiology better. These include microfluidic organs-on-chips—clear, flexible polymer gadgets about the size of a computer memory stick that contain different kinds of human cells and push fluid through tiny channels to mimic blood flow.

Some Observations on Digital Health @CES 2023

“The digital health summit is a very prominent part of the overall experience. We’re starting to see the lines between regulated medical devices and health, wellness, lifestyle devices converge.”

Joel Goldsmith, Director, Digital Platform, Abbott Diabetes Care
Image Credit: Consumer Technology Association

Every January, thousands of “techies” descend on Las Vegas to attend the annual Consumer Electronics Show to see what new things are on display and geek out on the futuristic technologies (some of which will probably never reach the market) that are demonstrated.

Digital health was at the forefront of this year’s Consumer Electronics Show, with notable speakers, announcements, events, exhibitors, and even a startup pitch competition. It isn’t easy to cover all of the products and features shown, but after reviewing all the reporting and checking out some of the companies websites, here are a few that I found interesting.

There was an odd obsession with smart toilets this year – At this year’s show, a quartet of companies is showing off urine analysis tools designed to be used at home by the general public. Most of them are built for your toilet, testing your urine for many easy-to-identify maladies.

The most talked-about gadget at CES was indeed Withings’ U-Scan. The company showed off a device that sits on the dry part of your toilet bowl and samples some of your trickle as you urinate. Once that fluid is captured inside the device, it runs a sample through a microfluidic cartridge (with reaction paper) and uses a reader to look at the result. Once completed, the results are sent to your phone, with suggestions on what you might do to improve your health. When it’s eventually released, U-Scan will offer a cartridge for menstrual cycle tracking, as well as one to monitor your hydration and nutrition levels.

Image Credit: Withings

Korean company Yellosis graduated from Samsung’s startup incubator some years ago and has already produced the Cym Boat personal urine testing kit. At the show, it also showed off its next-generation product, Cym Seat, which uses a metal arm to hold a paper stick under a person as they urinate. Once completed, it slides the strip in front of an optical scanner, and after a minute, the results are pushed to your phone. But this device, expected to launch by the end of 2023 and cost around $1,000, automates the existing process rather than adding anything new.

Vivoo, which also offers a reaction-paper stick that a smartphone app can analyze, is building its own toilet-mounted hardware, which pushes a urine stick into the toilet bowl and then pulls it back in once it’s collected a urine sample. An optical scanner then reads the reaction squares before depositing the stick in a collection bin for disposal later.

Finally, there’s Olive, which is taking a dramatically different tack. The device harnesses spectroscopy rather than reaction paper, with hardware that sits under your toilet seat and a bank of LEDs flashing toward rear-mounted photodiodes. The potential for such a technology is far greater than reaction paper, and some studies have pointed to being able to identify infection with it.

My take – I’m not sure how large the addressable market would be for these smart toilets. There are issues, including around data security, especially for menstrual cycle tracking in countries like the US. Companies that could expose fertility data will need to be mindful of the legal context that is presently in place post-Roe. Will these devices be accurate enough for the jobs they’ve been bought to do? And will the conclusions they provide be worthwhile? There’s a lot to work through before these products become ubiquitous in bathrooms worldwide.

Next is a medical-grade smart ring from Movano. After announcing the Movano ring at last year’s CES, healthcare solutions company Movano Ring upped the ante this year with its new smart ring, Evie. If cleared by the FDA, the ring will be the first consumer wearable that is also a medical device. Evie is designed to give women a full picture of their health, including resting heart rate, period and ovulation tracking, sleep stages, SpO2 levels, skin temperature variability, and more.

Image Credit: Movano Health

“We are bringing together medical grade biometric data and insights in a comfortable and contemporary wearable that allows women to take ownership of their unique health journey.”

Dr. John Mastrototaro, CEO of Movano Health

My take – Movano Health is going after Oura, the market leader in this wearable segment. While it is nothing revolutionary, it is a good step forward in the market of subtle wearable tech. It will be interesting to see how long the FDA process takes – especially since the company is touting Evie as a medical-grade wearable device.

Can taking a selfie potentially save your life?NuraLogix’s Anura app demonstrates the usefulness of a selfie with its technology that can check vital signs using a cell phone camera. The app uses artificial intelligence to offer about 1,000 diagnostics with a 30-second selfie. The diagnostics include heart rate, blood pressure, stress levels, blood sugar levels, and more. The app is available on both the Apple and Google app stores.

Image Credit: NeuraLogix

My take – Despite the claims, there’s a big disclaimer on their website that reads:

Disclaimer image

For Investigational Use Only. Anura™ is not a substitute for the clinical judgment of a health care professional. Anura™ is intended to improve your awareness of general wellness. Anura™ does not diagnose, treat, mitigate or prevent any disease, symptom, disorder or abnormal physical state. Consult with a health care professional or emergency services if you believe you may have a medical issue.

Real-time wearable hydration monitorEpicore Biosystems unveiled its new Connected Hydration sweat patch and mobile app at the 2023 CES. Connected Hydration is the first electronic wearable that continuously measures sweat fluid and electrolyte losses while monitoring skin temperature and movement. To prevent hydration, an alarm goes off on the device when wearers’ fluid loss exceeds two percent of body weight. According to Epicore, the device is intended for people who work in harsh conditions, athletes grappling with extreme heat, and people living through severe heat waves.

Image Credit: Epicore Biosystems

My take – At first glance, this device might appear to have limited market appeal. But the statistics around this problem are staggering. The harmful effects of high temperatures diminish physical and cognitive performance, leading to a staggering 170,000 work-related injuries and 2,000 fatalities annually in the United States. The increasing temperatures also reduce productivity, with total global labor productivity expected to decrease by more than 18% if temperatures rise by 1-3 degrees Celsius. Excessive environmental heat also takes a financial toll, costing employers upwards of $79,000 in worker compensation per affected worker.

Technology to help people with speech issuesWhispp demonstrated its AI-powered smart speech amplifier app and technology. The company’s mobile app converts whispered speech, vocal cord-impaired speech, and severe stutters into a person’s natural voice in real time. This allows users to make themselves heard anywhere while maintaining their freedom of movement.

YouTube Video Credit: Whispp

My take – The technology developed by this Netherlands-based company can aid the more than 500,000 people in the U.S. who have severe issues with voice disorders or stuttering or cancer patients who have difficulty speaking.

Portable virus detector – Opteev Technologies debuted its affordable and convenient breath analyzer, Virawarn. According to the company, the compact and reusable device can detect COVID-19, Influenza, and RSV in less than 60 seconds. Virawarn uses a silk-based biosensor that attracts the electrical discharge of respiratory viruses and an artificial intelligence processor that filters out any potential inaccuracies. Users turn it on, blow twice into the mouthpiece, and an LED notification light will indicate a positive or negative result in under 60 seconds. ViraWarn is reusable and comes with multiple biosensor replacement cartridges that only require being replaced after a positive result or after a period of 2 – 3 weeks of daily usage.

Image Credit: Opteev Technologies

My take – The company just submitted ViraWarn to the US Food and Drug Administration (FDA) for Pre-Emergency Use Authorization (Pre-EUA). Breath is one of the most appealing non-invasive sample types for diagnosing infectious and non-infectious diseases. Exhaled breath is very easy to provide and is less prone to user errors. Breath contains several biomarkers associated with different ailments that include volatile organic compounds (VOCs), viruses, bacteria, antigens, and nucleic acid. Results with COVID-19 detection were highly successful, with 95% Sensitivity and 90% Specificity.

Also, assistive technologies were prominently featured at CES this year. The need for assistive technologies is increasing and is likely to grow due to at least four interrelated reasons: an aging population, increases in the prevalence of disability, increases in the burden of chronic disease, and the corresponding increased load placed on caregivers.

L’Oréal announced plans to release late this year Hapta, a computerized makeup device with motion controls, to help people with limited arm mobility apply lipstick.

YouTube Video Credit: L’Oreal

The Scewo Bro is an adjustable-height wheelchair designed by roboticists and inspired by luxury vehicles. The device is about the same size as a traditional powered wheelchair, but it has two wheels and a pair of tank-like treads for rocky terrain and stair climbing. When approaching stairs, users tap a button. Laser sensors detect how steep the stairs are, and the chair automatically adjusts for the climb. The company tested it with several hundred wheelchair users and tweaked the design based on their feedback.

Image Credit: Scewo AG

Samsung Electronics is adding a mode to new TVs which can outline shapes and content for visually impaired viewers. Relumino Mode is a new picture mode from Samsung that is specially adapted for the visually impaired. When activated, this picture mode highlights contours, lines and colours, making the picture easier to interpret. For a person with normal vision, it may resemble a cartoon-like filter, but for a person with impaired vision, this may be exactly what is needed to decipher and understand the action.

Image Credit: Samsung Electronics

Toronto-based eSight showed its coming wearable for people with vision impairment caused by macular degeneration, glaucoma and other eye conditions.

Image Credit: eSight Eyewear

My take – Older Americans represent a growing audience for assistive technology and fuel a growing demand for increased accessibility in other products. The spotlight on accessible technology also comes as Americans face a financial strain, which might drive people to put “need” purchases over “want” purchases. And while the price tag for innovative assistive devices is often initially too high for many people who need them, startups are trying out subscription payment models for gadgets that insurance won’t cover.

Finally, for a terrific review of the key technologies featured in the age-tech space, I highly recommend this post from Keren Etkin, gerontologist, entrepreneur and author of The AgeTech Revolution – a book about the intersection of tech and aging. Keren’s blog is my go-to resource for all things age-tech related.

2023 looks to be a pivotal year for digital health companies as macroeconomic conditions continue to push investors’ demand for profitability over growth. At the same time, customers (in the form of patients, providers, employers, and insurers) are looking for technologies that prove their clinical worth and deliver seamless care journeys. Point solutions are out of favor as patents, providers, and employers are looking for integrated solutions that combine critical data with analysis tools into a comprehensive data set that reduces costs, improves care provider productivity, and improves clinical outcomes. Companies that cannot provide clear evidence that they can meet these requirements will struggle in this environment.

Digital/Computational Pathology – Ready For Primetime?

“Digital pathology empowers the pathologist. We are no longer chained to the location of the histology lab. On top of that, digital pathology opens up a whole new set of informatics and image analysis tools that we are just now starting to create.”

Jonhan Ho, Director of the Dermatopathology Division and the Fellowship Director, University of Pittsburgh Medical Center, and Founder of KiKo, Knowledge in Knowledge out.
Image Credit:

In this digital age, it may come as a surprise that in one of the most advanced healthcare markets in the world, primary pathological diagnosis remains conducted by pathologists peering down the lens of a microscope. Digital pathology is, by now, indisputably the future of the field. Although some are still reluctant to accept its place in the lab – and despite its slow adoption in many institutions – the digital slide image is slowly replacing the glass slide on the microscope’s stage. The flexibility, accuracy, and potential to deploy ever-improving informatics and image analysis tools make digital pathology an attractive option.

Digital pathology is not a new concept. Its history goes back around 100 years when specialized equipment was first introduced, and images from a microscope were captured onto a photographic plate via a camera. Telepathology emerged around 50 years back; however, over the past decade, pathology has undergone a real digital transformation, gradually shifting from an analog to an electronic environment. Here’s a timeline showing the development of digital pathology:

Image Credit: and

My former colleagues at Sg2 and I have been talking about the benefits of implementing a digital pathology solution in health systems as far back as 2012. At that time, professional societies like the College of American Pathologists (CAP) were skeptical. But our extensive experience in the development of radiology digitization convinced us that the lessons we learned in implementing Picture Archiving and Communications Systems (PACS) in radiology could be transferred to pathology. The two disciplines share a lot in common. Here are some of those areas:

  • Both are visual disciplines that rely on the skill of the reader in the interpretation of the study.
  • Both have become increasingly more sub specialized through the years.
  • Both are critical components in determining a diagnosis.
  • Both are facing shortages of skilled professionals sufficient to meet the demand for services. Pathologists have the second highest percentage of active practitioners aged 55 or older – and while many are beginning to retire, fewer new pathologists are moving into the field to offset the shortfall. According to one study, by 2030, the number of active pathologists may have dropped by 30 percent compared to 2010. In some parts of the globe, the shortage of pathologists is shocking. Workload demands are also on the rise. The number of new cancer cases managed by pathologists rose 41.73% in the U.S. between 2007 and 2017. In contrast with physician specialties, “…a pathologist’s workload is not capped by a specific number of patients [who can be seen and treated], but rather expands to encompass all case materials generated by their clinical colleagues”. This results in overwork, diminishing quality, and diagnostic variability.
  • Both have a requirement to store large amounts of information that must be accessed frequently during the patient’s care pathway.
  • Both have a requirement that the data be available in multiple locations for review by multiple members of the care team.

Before examining the benefits and challenges in implementing digital pathology solutions, the projected market growth, and the major players, some basic information on the workflow differences between the traditional approach and the digital approach is essential.

Comparing traditional versus digital pathology workflows

A typical traditional pathology workflow is a complex series of events, including a manual review of glass slides that ultimately results in diagnosis. However, analyzing stains on a glass slide is lengthy and complicated. This whole process might take several days to weeks and might cause damage to slides during transit. It also becomes difficult for the pathologist to search for old slides, images, and case information in the archives of hospitals. In addition, the results depend on the specialty and not on the personal judgment or mental state of the pathologist, as it may lead to a lowering the level of accuracy.

Digital pathology has been introduced to overcome numerous limitations associated with traditional pathology. Digital pathology is a computerized, image-based (digital slides) system for managing and interpreting information. The digital slide is a complete representation of a glass microscope slide, which can be viewed at any magnification, including intermediate magnifications not available on standard microscopes. The slides can be accessed remotely anywhere in the world to deliver consistent, rapid, and accurate results, as compared to traditional methods. The workflow difference between conventional and digital pathology is shown in the graphic below.

Image Credit:

Next, it is helpful to understand the critical drivers in favor of the adoption of digital pathology solutions versus some of the barriers that have stood in the way of widespread adoption to date. I have found this graphic to be an excellent summary of those elements:

Image Credit: Signify Research

For the US market, two of the most significant barriers to adoption are highlighted above – both revolve around the significant costs associated with digitization. However, the costs of network architecture and storage have decreased exponentially in recent years. And as I mentioned above, many organizations can leverage the existing network infrastructure and archiving solutions in radiology to support the digital pathology program. Finally, as will probably come as no surprise to those familiar with the U.S. health system, lack of reimbursement is the other barrier to adoption. While single-payer markets like Western Europe and the UK, Nordics, and the Netherlands, in particular, established digital pathology networks and workflows via large-scale governmental funding and legislative aid, the US market has historically received no such support.

But change may be on the horizon on the reimbursement front. The recent announcement of new add-on CPT digital pathology codes has caused a stir. After many years of lobbying, the College of American Pathologists (CAP) successfully petitioned the American Medical Association (AMA) to create 13 category III codes. Currently, pathology is reimbursed via a technical component (TC), professional component (PC), or a “global” combination of the two. If industry speculation is to be believed, additional reimbursement will come in the form of an addition to the technical component of the review. These codes went into effect on January 1st, 2023, and while they currently offer no additional compensation, they do offer officials the chance to begin tracking and reporting the impact of digitalization.

A note of caution, however, Category III codes do not have an assigned relative value. Therefore payments for these services or procedures are based on the policies of payors and not on yearly fee schedules. Category III codes also rarely receive national pricing from Medicare. While reimbursement for digital pathology may be possible soon, it’s not guaranteed. Several unanswered questions remain, such as how long will it take for payors to review the data accumulated by the codes, and are any more (for example, Code I) being considered? Crucially, the most important of these questions, how much reimbursement will be, is yet to be answered.

The current lack of reimbursement does not necessarily mean that a business case cannot be made to deploy a digital pathology solution. One recent study was conducted at Poplar Healthcare, an anatomic pathology group in Memphis, with 25 pathologists. Poplar is beginning to realize the benefits of digital pathology and WSI in its daily workflow. Here are the five benefits they have learned from their implementation:

  • It lowers costs by eliminating the need to ship glass slides to remote pathologists.
  • It improves the productivity of remote pathologists, because the whole-slide images can be sent instantaneously to a pathologist along with the case information, and both are viewable at the same time within their case viewer.
  • It allows remote pathologists to share digital images for second opinions, consults, or to refer difficult cases back to their subspecialists for review or for interdepartmental review.
  • It provides faster turnaround time for results, which helps them gain new clients.
  • It provides a platform to increase revenue by delivering services to customers seeking to reduce their histology costs and incorporate whole-slide imaging. Under a model in which Poplar Healthcare works remotely with anatomic pathologists located within physician practices, some of its revenue comes from doing the technical component (TC), some comes from the professional component (PC), and some come from doing both TC and PC (or global). They’re currently reviewing additional revenue streams by providing services overseas, starting with dermatology.

Also, in a paper published by the National Center for Biotechnology Information (NCBI), a study analyzed how implementing a digital pathology system can significantly cut costs. Five years after implementing a digital pathology system, expected savings were estimated at $12.4 million for a laboratory with 219,000 accessions per year. For a large academic-based healthcare organization, there was approximately $18 million in savings upon fully implementing a digital pathology solution.

Companies in Digital Pathology

The global digital pathology market size was valued at USD 926.9 million in 2021 and is expected to expand at a compound annual growth rate (CAGR) of 7.5% from 2022 to 2030.

Image Credit: Grand View Research

The market is segmented into hospitals, diagnostic labs, biotech and pharma companies, and academic and research institutes based on end-use. The hospital’s segment accounted for the largest revenue share of more than 36% in 2021, owing to the high adoption of digital scanning techniques in hospitals for faster diagnosis and better patient compliance.

Image Credit: Grand View Research

The market is usually sub-segmented into hardware, software, and storage segments. You can see the breakout by sub-segment in the graphic below.

Image Credit: Fortune Business Insights

Major players, such as Danaher and Hamamatsu Photonics, Inc., held a dominant market share in 2021. These companies are increasingly undertaking various strategies, such as new product development, extensive collaborative strategy, and M&A, to gain a higher market share. For example, in April 2021, Leica Biosystems partnered with Paige to integrate its digital pathology platform with the latter’s AI-enabled research oncology software. This would extend access to computational pathology products for translational and clinical in select countries across North America and Europe regions. In April 2021, Philips partnered with Ibex Medical Analytics to combine its digital pathology solutions with the latter’s AI-powered Galen platform, thus enhancing its offerings. Leading American biotechnology company Inspirata Inc., Dynamyx™ is the company’s flagship end-to-end digital pathology solutions streamlining image digitization and delivering essential case allocation, outsourcing functionality, and real-time collaboration. In March 2022, the FDA awarded Inspirata clearance for Dynamyx software for primary diagnosis in place of a traditional glass slide. Oxford University Hospitals Cellular Pathology department completed 100% digitization of histology slides with the help of Philips. And recently, FUJIFILM Corporation (President and CEO, Representative Director: Teiichi Goto) announced the company has entered into an asset purchase agreement to acquire the global digital pathology business of Tampa, Florida-based Inspirata, Inc. Upon completion of this agreement, Inspirata’s Dynamyx® digital pathology technology, employees and customers will become part of Fujifilm.

Then you have the lab companies like Labcorp and Quest Diagnostics. Both offer a “digital pathology as a service” business model. Labcorp provides both bright-field and fluorescent digital scanning services using slide scanning platforms to generate high-quality whole-slide images of your glass slides. The images can then be used for various endpoints ranging from pathologist review to digital image analysis and archiving. Quest Diagnostics (NYSE: DGX) and Paige announced a collaboration designed to unlock the potential of artificial intelligence (AI) to improve and speed the diagnosis of cancer and other diseases that rely on pathologic assessment. The collaboration involves analysis using Paige’s proprietary machine learning expertise of pathology diagnostic data and digitized slides from Quest Diagnostics and its AmeriPath and Dermpath businesses to uncover cancer markers and other diseases. Using these insights, the parties intend to develop new software products, which, following regulatory approval, will be marketed to pathologists, oncologists, and other providers to support disease diagnosis. Near term, the parties also intend to license the insights to biopharmaceutical and research organizations to aid biomarker discovery, drug research and development, and companion diagnostics.

The Future of Digital/Computational Pathology

Technology, both in scanning and IT, has finally met the requirements for digital pathology in terms of software maturity and network, computing, and storage capability. Whereas digital pathology enables more efficient workflows, computational pathology will take the field one step further, allowing pathologists to use digital images in more varied and efficient ways. There are many definitions of Computational pathology; however, the one cited in the article “Computational Pathology: An Emerging Definition” is a holistic way of looking at this space. The author defines computational pathology as an approach to diagnosis that incorporates multiple sources of data (e.g., pathology, radiology, clinical, molecular, and lab operations); uses mathematical models to generate diagnostic inferences; and presents clinically actionable knowledge to customers. This vision goes beyond an informatics-centric view and leverages the core competency of pathology and the ability to communicate clinically actionable knowledge effectively. In the future, smart image recognition algorithms could help streamline pathologists’ workflows and help them to focus on the things that matter most. Pathologists will use their hands less and their eyes more, analyzing more data in less time with improved efficiency and accuracy combined with improved prognostics and therapeutic diagnostics across a global network.

“Digital pathology represents the most transformational change in anatomic pathology since the introduction of the light microscope.”

Joaquin Garcia, M.D., Mayo Clinic Division of Anatomic Pathology, Chair, Digital Pathology Practice Subcommittee in Laboratory Medicine and Pathology.

Digital pathology isn’t a replacement for the pathologist; it’s an enhancement. Not only to the practice but to the individual pathologist and the industry. In a recent post, I offered this equation as a framework for determining whether action will occur when introducing new technologies:

Image Credit: Graphic, H. Soch, based on a concept created by Alex Lindsay, Office Hours. Global

The gist of the equation is that action occurs when the vendor can demonstrate that the possibilities in implementing the solution exceed the current circumstances. How does that play out in the case of digital pathology? The key “possibilities” in digital pathology implementation include the following:

  • Revolutionizing the way we treat cancer and what we know about it.
  • Improving the time and accuracy of diagnosis.
  • Greater management and effectiveness of lab staff
  • Automizing tedious tasks without sacrificing the quality of work
  • Enhanced collaboration and sharing via virtual meetings and cloud components
  • Digital storage can transform the workspace of the laboratory
  • Making the discipline more quantitative

So, it is way past time to implement digital/computational pathology in daily clinical practice. I think that mainstream digital pathology adoption is, therefore, no longer a question of “if” but “when” and “how.”

Health Tech News This Week – January 7, 2023

What happened in health care technology this week, and why it’s important.

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A Drug to Treat Aging May Not Be a Pipe Dream

Andrew Steele in Wired reports that in 2023, we may see the first drug that targets the biology of aging itself. By the end of 2023, one of these ideas will likely be shown to work in humans. One strong contender is “senolytics,” a class of treatments that targets aged cells—which biologists call senescent cells—that accumulate in our bodies as we age. These cells seem to drive the aging process—from causing cancers to neurodegeneration—and, conversely, removing them seems to slow it down and perhaps even reverse it. More than two dozen companies are looking for safe and effective ways to get rid of these senescent cells in people.

Why it’s important – Aging is responsible for over two-thirds of deaths globally—more than 100,000 people daily. This is because, counterintuitive though it may sound, the chief risk factor for most of the modern world’s leading killers is the aging process itself. Futurist Peter Diamandis, M.D. has written extensively on age extension and senolytics in his blog. He even has a newsletter devoted to longevity research. And he has started several companies researching the possibilities of postponing or even reversing cell death. It’s cutting-edge technology and will take some years to develop. Critics counter that the societal impact of extending the human lifespan indefinitely will increase the disparity between rich and poor and will generally be bad for society. Stay tuned.

Infographic of the week – Dr. Tazeen Rizvi writes that digital transformation is a continuous, complex, and multidimensional process linked to social, economic, and technological factors beyond traditional clinical settings. Health leaders, innovators, and entrepreneurs must understand that implementing #healthtechnology is not only about developing new innovative #healthsolutions but also about changing the mindset, culture, and existing processes. The best starting point is addressing an immediate issue and putting the patient at the center of the #transformation process. Realizing the full potential of digitally enabled care will require fundamentally rethinking how care models are designed, implemented, and scaled to solve many of the challenges of today’s health system.

Image Credit: Dr. Tazeen Rizvi

First ‘Vagina-on-a-Chip’ Will Help Researchers Test Drugs

Scientists have developed what they say is the world’s first “vagina-on-a-chip,” which uses living cells and bacteria to mimic the microbial environment of the human vagina. It could help to test drugs against bacterial vaginosis (BV), a common microbial imbalance that makes millions of people more susceptible to sexually transmitted diseases and puts them at risk of preterm delivery when pregnant. Ida Emilie Steinmark covers this development in her article in Scientific American online. Researchers at Harvard University created their unique chip, described in Microbiome: an inch-long, rectangular polymer case containing live human vaginal tissue from a donor and a flow of estrogen-carrying material to simulate vaginal mucus.

“This is an opportunity to bring women’s health into the modern times, using modern technology.”

Achyuta Nori, M.D., St. George’s, University of London

Why it’s important – Vaginal health is challenging to study in a laboratory setting partly because laboratory animals have “totally different microbiomes” than humans do. So-called organs-on-a-chip mimic actual bodily function, making it easier to study diseases and test drugs. In this case, the tissue acts like a real vagina in some critical ways. It even responds to changes in estrogen by adjusting the expression of certain genes. And it can grow a humanlike microbiome dominated by “good” or “bad” bacteria.

Innovative Nanochip Could Treat Traumatic Muscle Loss

Researchers at the Indiana University School of Medicine have developed technology that has the potential to be a treatment for traumatic muscle loss. This technology has previously been shown to transform skin tissue into blood vessels and nerve cells. Tissue nano transfection is a nanochip device that is minimally invasive and able to reprogram tissue function by delivering specific genes in a short amount of time through the use of a harmless electric spark. A new study published in Nature Partner Journals Regenerative Medicine tested tissue nano transfection-based gene therapy as a treatment to deliver a gene known to be a major driver of muscle repair and regeneration.

Why it’s important – Volumetric muscle loss is the traumatic or surgical loss of skeletal muscle that results in compromised muscle strength and mobility. Incapable of regenerating the amount of lost tissue, the affected muscle undergoes substantial loss of function, thus compromising the quality of life. A 20 percent loss in mass can result in up to 90 percent loss in muscle function. Current clinical treatments for volumetric muscle loss are physical therapy or autologous tissue transfer (using a person’s tissue), the outcomes of which are promising but call for improved treatment regimens.

YouTube video of the week – Dr. Bertalan Mesko posted this video with his top seven medical innovations for 2023. Of all the “important tech forecasts for 2023”, I think Dr. Mesko’s selections are based on solid evidence and, in many cases, on his personal experience with the technology. Interesting choices this year.

YouTube Video Credit: The Medical Futurist

Withings Unveils Urine Analysis Device That Sits in Your Toilet Bowl

Withings announced at CES 2023 that it is developing a miniaturized platform to analyze urine at home. Katie Adams, in her article on MedCity News that the device, called U-Scan, sits within a toilet bowl and assesses specific biomarkers found in urine. It consists of a pebble-shaped reader and a changeable analysis cartridge designed to evaluate specific biomarkers. The device automatically captures small amounts of urine and channels it into the analysis cartridge, which quickly begins chemical analysis. U-Scan automatically transmits readable results via Wi-Fi to Withings’ app. The device is being developed for the consumer sector as well as the professional medical market. For the consumer market, Withings will sell a U-Scan with an analysis cartridge for women’s monthly cycle tracking and a U-Scan with a cartridge for nutrition and hydration monitoring. Each U-Scan starter kit will be priced at $499. There is an additional subscription cost of $30 per month, which provides customers with automatic cartridge refills every three months.

YouTube Video Credit: Withings

Why it’s important – More than 3,000 metabolic biomarkers can be assessed via urine, which makes it one of the gold standards of health assessment. Analyzing these biomarkers can help diagnose and monitor certain diseases like diabetes, chronic kidney disease, kidney stones, and urinary tract infection. Presently [U-Scan’s analysis cartridges] can be tailored to analyze a combination of markers such as pH, specific gravity, ketones, vitamin C, albumin, and creatinine.

Point-Of-Care Biosensor to Detect Oral Cancer

Conn Hastings in Medgadget reports that researchers at the University of Florida have created a point-of-care biosensor that can rapidly detect a biomarker for oral cancer. The device uses test strips, such as those used in blood glucose tests, to spot cell proliferation regulating inhibitors of protein phosphatase 2A (CIP2A). This protein biomarker can reveal the presence of oral cancer. The device requires a liquid sample that is introduced to the end of the test strip, where it runs into channels that contain antibody-covered electrodes. The antibodies are specific for CIP2A, and antibody binding changes the electrodes’ electrical signal, providing a readout if the protein is present.

Why it’s important – If oral cancers can be detected early, the prognosis is frequently quite good. For instance, the researchers behind this latest technology report that oral cancers that are localized and approximately 2 centimeters or less in size can readily be treated, and the corresponding five-year survival rates are over 90%. Moreover, such cancers are readily accessible in the oral cavity for clinicians to investigate and view them. These malignancies are, therefore, good candidates for a point-of-care diagnostic device that could be used in remote locations that do not have ready access to conventional diagnostics. The technology could be helpful in low-resource or remote regions where access to traditional lab testing equipment is unavailable.

Massive Apple headset leak reveals new details and confirms earlier rumors

The Information claims to have once again received insider information from sources close to Apple who are familiar with the development of Apple’s XR headset. The Information confirms some earlier rumors, including that the headset will have an outward-facing display that shows outsiders the facial expressions of the headset wearer. This feature is supposed to reduce the feeling of isolation when the headset is put on. The screen is said to consume little power and offer a low refresh rate, comparable to the Apple Watch’s always-on mode.

Why it’s important – All sign point to 2023 being a big year for AR in technology. Many tech pundits are waiting for Apple to release the details of their product which could drive adoption, even if the initial price point could be over $3,000, depending upon the configuration. Stay tuned.

Time to Expand Remote Sensing Technology Use in Sports?

“It was basically an eye opener for so many parents who have children who love football. Parents might be a little bit more hesitant wanting their child to play if that’s going to happen. It’s unreal.”

Harry Carson, Former Linebacker, New York Giants, on Damar Hamlin injury
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On the New Year holiday, while the country was enjoying a half-century-old mass ritual known as Monday Night Football, millions of people – myself included – were left watching Buffalo Bills safety Damar Hamlin fighting for his life near the 50-yard line. As we pray for his recovery, it’s appropriate to ask ourselves: can we, in good conscience, keep embracing this game? And, is there a better way to use real-time technology to monitor the health of athletes in all areas of sport?

Image Credit: Getty Images

People have been wrestling with this question for over a decade, as science has shed light on football’s health consequences. Chronic traumatic encephalopathy (CTE) was once an obscure entry in medical textbooks. Now, it’s the neurological disease associated with repeated blows to the head, known for afflicting more than 300 former NFL players and perhaps hundreds more (the condition can only be definitively diagnosed post-mortem).

“The sport of football is inherently dangerous.”

Kevin Farmer, University of Florida

And Hamlin’s injury is just the most recent example. Hamlin’s injury occurred mere months after Miami Dolphins quarterback Tua Tagovailoa suffered a gruesome concussion-related event when he began seizing on the field following a play—which occurred just weeks after he collapsed due to a separate concussion following a brutal hit in an early season game. In the preseason, the NFL finally tested new helmets designed to prevent concussions. Reports from the league suggest they were effective, but no move has been made to require them in the regular or postseason.

While Hamlin didn’t suffer a head injury (many medical experts suspect his heart stopped due to commotio cordis, an extremely rare but sometimes fatal disruption to heart rhythm resulting from a blow to the chest), it raises the issue of whether real-time monitoring technology can be used more effectively to prevent severe injuries from occurring during games.

A recent peer-reviewed study demonstrates the feasibility of utilizing medical-grade sensors for collecting and monitoring real-time digital biomarkers on elite athletes in live competitions. The peer-reviewed study, Real-time Digital Biometric Monitoring During Elite Athletic Competition: System Feasibility with a Wearable Medical-Grade Sensor, was conducted in professional squash matches in 2019-2020 in cooperation with the Professional Squash Association. The findings demonstrated the capability to reliably capture clinically valid data from medical-grade wearable sensors on athletes exhibiting extreme motion and supraphysiologic characteristics in live competition.

“There is a clear extrapolation to other sports, athletes and venues, but more importantly, the opportunity for real-time observations, reactions, adjustments, refinements of performance, and ultimately predictions derived from sensor data,”

Giulio Bognolo, M.D., Chief Medical Officer and Head of Human Data Labs, SD Labs

In professional team sports, collecting and analyzing athlete-monitoring data are standard practices to assess fatigue and subsequent adaptation responses, examine performance potential, and minimize the risk of injury or illness. GPS trackers sewn into athletic uniforms feed back real-time information on NFL players’ balance, speed, acceleration, and motion. Early signs of injury to soft tissues are readily detected, letting coaches relieve players before serious problems arise. Impact monitor stickers attached to players’ bodies alert coaches and trainers to invisible signs of potential concussion, brain trauma, over-exertion, or injured muscles, tendons, and ligaments.

But that assessment happens during practice sessions and during the recovery period following the actual game itself. The groundwork has been done with the NFL linking up with Zebra Technologies to add monitoring tags to the shoulder pads of all players. The real game-changer will be when this data is made available to coaches during live matches. Is there a case to be made that real-time monitoring should be incorporated into the game? I think we’re at a point where the usual arguments put forward against it are disappearing.

Image Credit: Zebra Technologies
  • Cost – The cost of real-time medical-grade sensors has dropped exponentially over the last five years. And for professional sports teams, where billions of dollars are spent each year, the costs are a pittance.
  • Size & Weight – Sensors and devices for athletes must be almost invisible and weightless, as well as flexible, durable, and impact resistant. Medical grade sensors today are smaller than ever, and their weight is negligible – especially if they are incorporated into clothing.
  • Interference with performance – Today’s medical grade sensors can be easily incorporated into the player’s uniforms and have minimal impact on performance.
  • What they are measuring must be accurate and actionable – Devices already in use are measuring over one hundred human metrics, including heart rate, metabolism, stress load, core temperature, and physical impact from trauma. Researchers are forging ahead, designing devices that will be available soon to more accurately measure hydration levels and deeper aspects of physical stress and metabolic function
  • Player privacy concerns – Many argue that understanding an individual player’s performance stats, physical challenges, and recovery times could be used in contract negotiations, trade talks, and performance incentives. Just as in healthcare, some privacy regulation (like HIPAA) needs to be in place and enforced.

Sports teams are quickly learning how wearable sports technology can improve their team’s performance and save players from injury and illness. But we must take advantage of today’s technology to better protect these elite athletes during the game. In professional sports, where billions of dollars are spent annually, the cost of implementing real-time, in-game monitoring for all athletes is a pittance. And as we experienced on Monday night, it only takes a few seconds for it to stop being a game—and start being about life and death.