Categories: Healthcare

10 Mar 2017

After 21 years, I’m done with my chronic disease. Here’s that story

After 21 years, I'm done with my chronic disease. Here's that story

Just as I turned an adult, I was diagnosed with high blood pressure.

One day, as I ran up the stairs of my engineering college, I had an urge to throw up.

I told my family about it. We soon visited a doctor.

When checked, my BP was high. The doctor promptly put me on a beta-blocker to protect me from heart disease.

That was more than 21 years ago.

Of course, we went through the protocols of ruling out secondary causes.

Years rolled by.

At no point, did we (my doctors, my family or I) think of testing whether I really needed medication. It actually sounds risky to even think of it.

Slowly I knew that my body developed a dependency on the beta-blocker, a class of drugs that block the effect of stress hormones. So that the heart works less harder. When I missed taking it, my body would somehow tell me. Slight discomfort. Irritability.

For the most part, I hid my condition from everyone. Never talking about it. As if it were a shameful thing. May be I thought people would think less of me.

The possibility of overcoming a chronic condition like high blood pressure never occurred to me. Not even once.

It took 17 years before I woke up.

There’s always a wakeup call

During the summer of 2013, I was on a long, difficult trek in Bhutan. While descending back to Gasa Dzong, a town that seemed in a rush to modernize, I noticed that my body was beat up.

My eyes caught a bad infection. Muscles ached. I coughed every five minutes. I was completely exhausted. Somewhat annoyed with my body.

I visited a hospital on my return. After tests, they suggested that I had early onset of asthma. I was prescribed a nebulizer and medications. They also wanted to tinker with my hypertension meds.

As a good patient, I complied. But, while puffing on my nebulizer, I knew something was off. It wasn’t the way I wanted to live.

4 steps that freed my body from high blood pressure

One of my doctors made me think differently about hypertension by saying:

High blood pressure means that your body’s engine revs at a different speed than average. It does not mean that you have some debilitating heart condition.

Open, sometimes longwinded clinical conversations helped me lose unnamed fears and believe in the possibility of a healthier body. It changed my mindset.

The wakeup call after the Bhutan trek made me approach my health issues head-on. However, what actually helped were steps that were already underway.

The Mindfulness Step

I’ve had some form of regular mindfulness practice since 2003. It has made all the difference. It became the foundation for every other step.

As a patient, I inherently understood that there were certain triggers that led to high blood pressure.

Say, it would be something that someone said. I would brood quietly about it for days. The resulting anger or irritation would manifest into physical discomfort, perhaps higher blood pressure.

Meditation helped cut this deadly chain. From accumulation of negative emotions to simply observing and letting go. Now I had a method to regularly drop the baggage I would’ve earlier pointlessly carried.

The resulting awareness also made it easier to take the steps of diet and exercise.

The Physical Step

I began trekking outdoors regularly. The mountains made me curious about the capacity of the human body.

That curiosity helped me make choices that improved my physical strength.

Exercise became a natural part of life. Once I began enjoying it, I could not stop from myself from staying active.

It was a sea-change from the sedentary lifestyle I had led for the first 10 years of my pill-popping, chronic disease journey.

The Diet Step

When we consider the heart together with other vital organs such as stomach, liver, lungs, and kidneys, we understand the body’s correlations better.

When I eat fatty food, my stomach requires the heart to pump more blood because it takes longer to digest. When I don’t eat enough fiber, my intestines require more blood to clean the gut. Liver, our chemical factory, works harder to clean up the toxins we introduce into the body (sometimes in the form of prescription drugs).

These correlations matter but aren’t discussed enough in medical rooms.

Understanding my stomach’s role in blood pressure, helped me change my food habits. Eating in time. More fruits and vegetables. Less processed food. Reducing salt.

The Clinical Step

While I’ve always consulted doctors to keep my body in check, finding the right doctors took a long time. It happened by chance.

Unlike most patients, I had no presenting symptoms that needed a quick fix. What I wanted was a long-term fix for my body.

Finally I found a cardiologist in a different city. I had to fly in for consults.

While he’s highly renowned, he doesn’t fit easily into the modern healthcare fraternity. Believing that less is more, he seems on a mission to moderate the use of medicine.

At 78, he’s as sharp and bright as ever. His clinical wisdom shines in its simplicity:

It’s not what you eat that kills you; it’s what eats you that kills.

He does a meticulous physical exam (eyes, tongue, hands, chest, back, feet, ankles, veins). The act of taking a blood pressure measurement becomes a craft in his hands.

My tapering took 2 years. From 2015 to 2017. Very slow and methodical.

From 5mg to 2.5mg for almost a year and a half. Normal.

Then to a quarter for 4 months. Normal.

Then to nothing.

Remember these two things

On my last visit, before he sent me away with no prescription, he casually told me to remember two things.

Continue doing a little bit of yoga or exercise every day.

Then the cardiologist said something that’s hard to forget. Words I’d never heard in a clinical setting.

Do some good for someone else every day. I can’t tell you exactly why it’s linked to keeping blood pressure in control but it is.

_

Originally featured in LinkedIn Pulse Healthcare, by Praveen Suthrum, President & Co-Founder, NextServices

09 Jan 2017

Upgrading/Moderating: Two Evolving Views of Healthcare

Upgrading/Moderating: Two Evolving Views of Healthcare

As I reflect on what I learnt in 2016, I see two somewhat conflicting world-views of health: upgrading and moderating.

One promotes upgrading the human body much like software. In this case, our biological processes can be considered as algorithms that can be improved upon. The other view calls for moderating our dependence on medicine by influencing elements surrounding health, such as food and environment.

Let’s consider both views.

Upgrading the human body

I first heard this phrase from Yuval Noah Harari whose work has deeply influenced me this past year.

Even though the underlying goal of medicine has been about sickness, the industry is increasingly moving towards upgrading the human body. For example, Testosterone therapy doesn’t cure any debilitating illness but still comes under the purview of medicine.

An upgrade we’ve taken for granted is how we manage chronic conditions, such as hypertension and diabetes.

At a more complex level, longevity companies (such as Calico and Human Longevity, Inc.) aim to upgrade us by fixing genes that result in disease.

Our expectations from medicine are evolving from  fixing sickness to  managing conditions to  upgrading the human body.

Much like how we regard smartphones as a necessity today, people will begin to expect upgraded bodies as a new norm. Productivity-enhancing drugs (lookup nootropics popular among Silicon Valley geeks), implantable chips, mind-calming substances (cited as a titanic tool in Tim Ferris’ new book Tools of Titans), genetic modifications and even nanobots that traverse our bloodstream could be part of the new deal.

Through such upgrades, we are expected to become better versions of ourselves – perhaps like Bradley Cooper in the movie Limitless.

via Peaknootropics

Moderating Medicine

Upgrading seems to have exciting benefits. I could continue gorging on pizza, even as I wait for the industry to upgrade me. Win-win, as they say.

Are we missing something?

The last 50 years of pharmaceutical evolution has shown that quick-fix upgrades invariably have downsides too. I know because of a tiny hypertension drug that I consumed for 20 years. It changed my physiology in a way that I can’t clearly describe.

I became acutely aware of my dependence on the beta-blocker when I started tapering-off from 5mg/day to 2.5mg/day under the guidance of a well-regarded cardiologist about a year ago. During first several weeks of tapering, I experienced withdrawal symptoms – irritability, flutter in the chest, sleeplessness and mood swings even while my readings showed normal.

Last November (one year later), my cardiologist tapered it further from 2.5mg to 1.25mg. I experienced similar withdrawals but for a shorter duration. After a meticulous physical exam, he had sniggered, “Even while standing, your BP is 120/80!”

Latest blood pressure guidelines suggest that I may never have had hypertension to begin with (140/90 is the new norm). It’s disorienting to know that I upgraded to fix a bug that never really existed. [Read 4 Disturbing Trends in Healthcare for more details].

But tapering-off is hard work. It requires you to exercise, eat right and in time, meditate, sleep well and skip fun things like binge-drinking into the night.

Wouldn’t you much rather upgrade?

Upgrade or moderate?

Even if driverless cars could examine our health soon, it’s not all that clear if our advances will upgrade our bodies cleanly without introducing new bugs that require new fixes.

The modern grocery store gave us convenience but deeply altered what we eat. We now have easy access to a fiber-less, fatty-sugary-salty diet that was unthinkable just a few generations ago.

New lifestyles have led to new diseases prompting us to look for better upgrades. We are stuck in a loop – perhaps to the point of no return. Yuval Noah Harari supposes that our ongoing upgrades will evolve homo sapiens into an altogether newer species that could only be part-human. Ahem.

I guess we must find the balance between these worlds of upgrading and moderating. In it are hidden opportunities to think about healthcare differently.

How much do we upgrade and buy into new problems? How much do we moderate and work towards better health?

As a wise-one once said, it’s all in our hands.

*

My notes from earlier years: 2016201520142013.

Industry notes:

 
 
Originally featured in LinkedIn Pulse Healthcare, by Praveen Suthrum, President & Co-Founder, NextServices

19 Sep 2016

4 disturbing trends in healthcare

4 disturbing trends in healthcare

It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3D printers that print human tissues or contact lens that detect glucose levels. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the healthcare industry.

Here are four trends that are changing healthcare but on the surface are too unsexy for us to care about.

Trend 1: The doctor-patient trust is at an all-time low

Relationship between doctors and patients has transformed from the one where the doctor intimately grasped our history by treating everyone in the family to a transaction-based activity. Patients have changed from care receivers needing sympathetic treatment to care buyers with high demands. Most would rather have doctors unclog their arteries with a pill than listen to advice on lifestyle changes.

Doctors on their part are stuck between two ends.

On one hand, doctors inherit a Hippocratic oath that calls for warmth, sympathy and preferring prevention of disease over cure. On the other hand, they are pressured by new needs of ROI in the medical business, which calls for monetization of expensive resources (often required to meet new demands from patients).

The end result is a system that’s low on trust. Hundred years ago all that patients were usually given were placebos (and sometimes morphine) and it worked because they trusted the doctor giving them. Today, the situation is quite different with an altered patient-doctor equation. The high cost of low trust results in a very expensive model, which is what we have brought about in every healthcare system world over.

Trend 2: More testing is leading to disease management vs fixing

Amidst a background of low trust, both doctors and patients have increased their reliance on testing from pathology to imaging to radiology. At an earlier time, doctors relied more on an intuitive sense based on examining presenting symptoms and conducting thorough physical exams. However, such an approach today could invite lawsuits from patients when a gut-call without data goes wrong.

Therefore, we not only have greater number of tests for every disease condition but also an overall increase in the total number of lab tests performed. In the US alone, we perform close to 20 million tests per day. While the premise of lab tests is prevention of disease, the reality is an associated over-treatment that results in ongoing disease management. This trend of becoming lifelong patients is likely to continue as we find more ways to capture data from the body.

Trend 3: New findings are putting past guidelines into question

After recent findings, the US Preventative Task Force, considered a gold standard for screening, recommends that women go through annual screening for breast cancer after age 50 instead of an earlier guideline of age 40. This puts into question the decision by millions of patients who went through annual mammograms based on earlier recommendations.

Not just for breast cancer but guidelines for high blood pressure have also changed. JNC 8 guidelines now recommend drug intervention if blood pressure is 140/90 mm Hg or higher (not 120/80 mm Hg as was/is widely regarded).

This means that millions of people on BP medication, including me, never had a condition to start with.

New cholesterol guidelines call for prescribing statin drugs based on a specific risk-factor calculator and not on LDL cholesterol numbers. Guidelines for hormone replacement therapy for women who reached menopause, pap smear tests for cervical cancer, and prostate cancer screening for men have also changed. Adding to the confusion, not all doctors or medical societies agree with these changes.

As a former hypertensive patient I feel obtuse for having popped a pill for two decades. Doctors on their part must feel disoriented too – having implemented earlier guidelines so surely and now having to implement new guidelines not so surely. It’s another shift that alters the doctor-patient relationship.

Trend 4: Our environment is changing the rate at which we get disease

The more modern our environment, the greater seems to be our longterm disease-risk. From refined oil to sugar that pours, we’ve managed to create food that looks great on the outside but has in turn messed with our insides. We’ve managed to make our cows give more milk, sometimes without calves. We can create plump chickens in a few weeks, albeit without normal bone-structures. We’ve created disease-monsters on our dining table by consuming fat-rich, fiber-less, salty diets, often precipitated by fast food.

What we believed to be advances hitherto seem to have now altered the natural course of our bodies.

From 2001 to 2009, Type 1 and Type 2 diabetes significantly increased among children and teenagers. Puberty age has steadily dropped. A study conducted between 1989 and 2005 indicated a one-third drop in average sperm count. Among the 56 million people who died worldwide in 2012, WHO says that 68% died because of non-communicable diseases (NCDs pertain to heart disease, cancers, diabetes, and chronic lung diseases) – an increase of 8% from year 2000. Rich countries fare worse – 87% of people die because of NCDs.

We can always argue whether we have enough conclusive data to link these changes to our environment but it’s not difficult to observe that there’s a shift at play around us.

Changing the questions we ask

As unexciting as they may seem, these trends are disrupting our industry for good. We can choose to ignore them and reserve our enthusiasm for the next medical toy. Or we can accept the obvious reality that something’s a little off here and play more evolved roles as patients, doctors, clinicians, technologists and business people by changing the questions we want answers for.

In an emerging world of self-driving cars that may even monitor our health, we seem to have the resources to find answers to any question we choose to ask. All we have to do then is ask different questions.

Originally featured in LinkedIn Pulse Healthcare, by Praveen Suthrum, President & Co-Founder, NextServices

 

23 Jul 2016

How healthcare became sick-care and what can be done about it

How healthcare became sick-care and what can be done about it

A doctor in Massachusetts was treating a woman in her 80s for indigestion. When the doctor asked what medications she was on, she revealed a plastic grocery bag full of drugs. “I do not know what I take, but I take all these,” she said, her whole body quivering. There might have been about twenty drugs in the bag – a few from each of the specialists she must have been visiting.

If one closely observes the medical operations in many parts of the world, it becomes clear that an industry whose primary concern has become that of sick-care, but not of healthcare. The healthcare business proposition fails to remain exciting when we become its customer. It is then that we realise that we are stuck in self-defeating quicksand where we are not confident enough to entrust our bodies to a system and expect to be fixed. Trust amongst patients and their providers is at its lowest in almost every part of the world.

Despite concerns, we seem to have taken to sick-care well as a society. Most patients are happy to absolve the responsibility of staying healthy when an entire industry promises to find a fix for all evils. Bizarrely, our industry is fuelled by patients who continue to smoke, eat without thinking and lead sedentary lives, but expect to be taken care of when they fall sick. It is whom doctors routinely see after spending a decade or more in pursuing medical education.

Healthcare, get your mojo back

Every time a patient seeks care, there is an opportunity to change how we function as an industry. Instead of merely prescribing a fix, we can begin by asking questions that take us deeper into the process of care. Is her environment causing her to fall sick? What is her genetic data indicating? What does her microbiome reveal about her gut? What role does stress play in her condition? How can she be educated to help herself? How do you reach other patients like her through her data? Certain conditions require fixing, but there are several others that require healing. For example, a broken hand needs fixing but hypertension needs long-term healing. Chronic conditions, which seem to plague the society are managed better through lifestyle changes than medications alone..

Changes are needed in the healthcare policy that supports an ecosystem in keeping its population healthy and not just fixing the sick. An industry that gets paid based on medical transactions cannot be expected to reduce those encounters. When we flip the equation to make hospitals into control-towers that track disease before people fall sick, we begin to move away from our dependence on patient volumes.

Technology is key in reversing how to change the focus from sickness to health. Till now, technology was used as a means to complete the billing, conduct clinical examinations or store medical records. But, there is a need to go use technology to connect the dots that influence our health. Through environmental information, an asthma patient could be forewarned about ‘asthma hotspots’; that he or she traverses during a commute. Devices that prompt us to breathe when our heart rate goes up might help us manage stress. Diabetes can be better controlled when we see a continuous graph ofglucose levels captured through sensors. Electronic health records could become pathways that connect patients to doctors remotely, extending access to care at the time of need. A zip code map of patients whose vital signs are out of line could help providers address symptoms even as they manifest.

Getriatric care can be monitored through homes with sensors that track movement. Smartphone-based lab tests can control early conditions of heart disease through primary care rather than expensive specialized care. We could utilise drones routinely as a part of emergency medicine. 3D printing could improve compliance by making patients “touch and hold” their diseased organs.

Hospital in a mall

A woman wanted to replace the cast on her broken hand and visited what could be called a new age hospital in the Delhi metropolitan area. She was welcomed by a gloved doorman who seemed to belong to a St. Regis than to a local hospital. Being a holiday, the outpatient area was closed but she found signs to a multiplex movie hall and “retail therapy” to relax caregivers, lest they tire of caring for their sick! The biggest surprise was waiting in the emergency area, neither was the hospital equipped to cut open the cast nor did it have doctors on call to render care. But they had a spa!

Preventing patients from falling sick sounds utopian but converting a hospital into a mall is not what is needed. The hospital-mall demonstrates that it’s not resources that is lacking, but the mindset to channel the means towards keeping people healthy. For its own sake, the medical industry needs to wake up and get its mojo back.

Originally published on Economic Times,  by Praveen Suthrum, President & Co-Founder, NextServices. 

05 Jan 2016

Breaking Bad: Healthcare can be simpler if we want it to be

Breaking Bad: Healthcare can be simpler if we want it to be

Running up the stairs of my engineering college in Manipal one day, my head started spinning and I had this intense urge to throw up. A few days later a family physician diagnosed me for hypertension and promptly put me on a beta blocker after ruling out secondary causes. I continued popping that pill day after day and year after year. I trusted the diagnosis without a second thought.

That was 20 years ago. Over the years, my life slowly moved from sedentary to active and from stressful to mindful. Meditation and trekking in the mountains unexpectedly made me more curious about the capacity of my mind and body. My work and interests took me through several medical explorations – from top hospitals in Manhattan to Buddhist monasteries in the Himalayas to upscale medical centers in the Middle East to rural clinics in South Africa to Chinese hospitals in Laos. I tinkered with the future of medicine through programs at Singularity University and MIT. In the end, I wondered what exactly it meant for someone to be healthy.

A couple of months back, I met a well-regarded cardiologist in his late 70s to discuss both my medical condition and explorations. He exhibited the wisdom that comes with vast medical experience – of listening intently to the patient with an alert mind. He skillfully and methodically examined my principal organs and the suppleness of my veins. Finally, almost as a peculiar climax to my story, he said I may never have had hypertension. He went on to suggest that we must be careful in applying reductionist ideas to the ever-changing chaos of the human body.

I’ve observed our healthcare systems at work on the inside as an entrepreneur and on the outside as a patient. I’ve tried to separate chaff from the grain. Here are a few things I learnt.

1. The disease-target-pill paradigm is changing.
Over the last 50 years, our obsession with medications has ballooned out of proportion. According to Siddhartha Mukherjee (author of The Emperor of All Maladies: A Biography of Cancer), our current way of medical treatment of have disease, take pill, kill something needs to be re-imagined. Of over 1 million chemical reactions in our body, only 250 can be targeted by our entire pharmacopeia. We need to address the sources of ill-health rather than finding band-aids to diseases.

2. You are much more than your own genes.
Micro-organisms outnumber human cells 10 to 1, each carrying its own DNA. Just our gut has 100 trillion ‘bugs’ that we know too little about – we just know they can influence conditions from obesity to depression. What’s more, Rob Knight, the Director of the Microbiome Initiative at UCSD says each of us has our own microbiome fingerprint making us even more unique. I suspect that this microbiome marker is a moving target changing with environment and time. We may be able to influence it more than being able to catch it.

3. The space around you influences your health.
From air to food to habits to stress to sleep to exercise, the spaces we live/work in are hugely responsible for our health outcomes. Playing for half an hour in the sun makes us more alive than coffee ever would. People we associate with play a big role in our health behaviors (and vice-versa). Where our food comes from, how and when it’s consumed is almost as important as what we consume.

4. The body is within the mind, not the other way round.
Unlike the brain which we can reach more directly ( see this creepy demo of taking away someone’s free will and controlling their arm using a DIY kit ), the mind seems to be beyond any tangible reach. Unless of course, we use breath and mindfulness practices to center our faculty of consciousness, which in turn impacts our entire physical body.

5. Health inheritance is something that we pass on.
For a simple check on your risk factors, list the conditions of your parents, grandparents, uncles, aunts and siblings. This is our health inheritance. We don’t easily recognize that we add to this inheritance and pass it on. Think of genes as the software that we actively program everyday through our behaviors and environment. We then pass this code to perpetuity through our offspring.

Health largely by itself is simple and so are the conditions to maintain it. In a recent company workshop, I asked my colleagues to define health and we didn’t get beyond being disease free. Then I changed my question. I asked how people knew if their kids were sick or healthy. Pat came the responses: a child who is sick is dull, cranky, doesn’t eat or sleep well and a child who’s healthy is cheerful, enthusiastic and has a definite positive vibe.

Yet we find it difficult to apply this unambiguous definition of health to ourselves, leave alone our complicated healthcare systems. But we need to.

 

Originally published on Economic Times,  by Praveen Suthrum, President & Co-Founder, NextServices. 

06 Oct 2015

Healthcare providers desperately need our help

Healthcare providers desperately need our help

healthcareprovidersdesperatelyneedourhelp

In country after country, I witness the same sad situation: caring, often-brilliant men and women toil in the healthcare industry to care for others, but to do so they must battle the system itself. That system has lost sight of what matters, which is humans caring for other human beings.

To simplify things a bit, every healthcare system on Earth has three main stakeholders:

Patients
Physicians and clinicians
Administrators

These stakeholders have to operate within a process that goes something like this:

A disease manifests itself in a human body
Diagnosis
Cure
Payment

Three groups of people interacting in a four-step process. How complicated can it be?

You already know the answer. Our healthcare system has become so complicated that few understand how it actually works and almost no one knows how to fix what is undoubtedly a broken system.

All three stakeholders would love it if technology and bureaucracy could get out of the way and allow physicians and clinicians to help patients. But the details have become so unnecessarily complex and convoluted that common sense has disappeared. For example, administrators, in doing their jobs, tell physicians they need to perform more procedures. Physicians end up comparing themselves to their colleagues on the basis of how many procedures they have done, or even how much money they have earned.

Patients are, to be honest, often baffled beyond belief.

Take me, for example. I’m now 40, but at age 21 I was diagnosed with high blood pressure. For over a decade, I’ve managed my “condition” in part with medications that have side effects. But still, my health is good. For example, I love to trek in the mountains and have gone as high as 6,050 meters.

Recently, new blood pressure treatment guidelines came out (JCN 8 – Evidence-Based Guideline for the Management of High Blood Pressure in Adults). They changed the classification of what constitutes “high” blood pressure. I know because my career revolves around healthcare, not because the system made this clear to me.

The disarray is not just with chronic disease but also cancer and other conditions. A recent cover story of Time magazine talks about doctors rethinking breast-cancer treatment – more medicine isn’t necessarily a good thing.

In some respects, technology functions like a miracle. We have the potential to connect billions of people who lack basic healthcare with medical knowledge and expertise around the world. Not long ago, my colleague’s wife – she lived in a remote village – tragically died simply because she didn’t gain access to a doctor until her condition was beyond treatment. We need to eliminate such tragedies.

In other respects, technology is handcuffing patients, physicians and clinicians, and administrators alike. Our system is far too complex. It is convoluted, and downright crazy.

In many respects, healthcare is simple. Excluding accidents and certain acute conditions, the human body knows how to heal itself, if you provide it a healthy environment in which to do so.

Give a person clean water. Teach them to wash their hands. Teach them to eat a reasonable amount of healthy food, and to get a reasonable amount of exercise. When a condition requires treatment – say, a broken bone – treat it promptly.

The cure for our overly complex healthcare system isn’t more complexity. It’s less. We need to get everything out of the way of talented people who genuinely wish to devote their lives to helping others.

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Jason Rosenberg/Flickr

05 Mar 2015

5 Startup ideas for virtual reality medicine

5 Startup ideas for virtual reality medicine

fivestartupideas

 

Just as with Mobile and Wearables, we are at the cusp of yet another technology becoming a big part of our daily lives. Revolutionary technology cooks for a long time in research labs, starting in spurts before finally taking the leap mainstream. After its long journey from the days of the Sensorama in the 1950s, Virtual Reality (VR) is ready to get real.

Google recently led a $542M investment in Magic Leap, a VR company. Microsoft wowed everyone with its HoloLens. Facebook purchased Oculus last year. Samsung partnered with Oculus and launched Gear VR. Sony announcedMorpheus for our PS4s in 2016. Even HTC with Vive talked about letting you “get up, walk around and explore your virtual space”. And then there are 374 Chinese manufacturers already selling VR devices on Alibaba. Yes, VR could potentially become an industry in its own right.

What’s Virtual Reality Anyways?

We are already living a virtual life through Facebook, Skype, YouTube, Whatsapp, Amazon, LinkedIn and so on. These virtual worlds have permanently altered our real worlds. The new technology would simply make our virtual experiences so immersive that it would become difficult to distinguish between what’s real and what’s not (read this layman’s guide to VR).

Secretive startup Magic Leap is building a device (below, an image from their patent application) that would beam images directly onto our retinas so that we can see virtual elephants jumping on our palms (see video above).

Microsoft’s HoloLens is a wearable computer that makes holographic projections around our physical space and lets us manipulate them using our hands – moving them around, drawing, constructing. Other devices are variations of these visions – making our perceptions of the virtual more real in a very 3D way.

We would truly enter the realm of science fiction when VR gets other sensory capabilities such as that of touch (through haptic technology, think Wearables 2.0) or even smell (such as the olfactory phone where you can text a coffee sniff to a friend). Here’s an intriguing holy grail for VR:

After one passes on, his great-great-great-grandchildren can enter a “holodeck,” sit on the long-deceased ancestor’s lap, tell him about their day, experience his avatar tell a story, give a hug, and provide advice. A quite reasonable facsimile of a person’s dynamic tendencies can be preserved indefinitely in virtual reality.Blascovich, Jim; Bailenson, Jeremy (2011-04-05). Infinite Reality: Avatars, Eternal Life, New Worlds, and the Dawn of the Virtual Revolution (p. 145). HarperCollins. Kindle Edition.

5 Startup Ideas For VR Medicine

Mobile app stores have long established the way forward for the spread of new technologies – create developer platforms to build apps that encourage rapid adoption. VR platforms would do the same to attract new users from a variety of industries. Unlike in earlier years, the healthcare industry is on a hot new pursuit to embrace new technology. Here are 5 startup ideas that would take advantage of this brewing VR revolution.

1) Democratizing surgical systems. A few years ago, I played with the da Vinci robotic surgical system at Intuitive Surgical’s offices. Looking through a viewfinder that expanded vision, I used my fingers to control multiple robotic arms. With my enhanced psychomotor skills and other superpowers, I felt a little like Goddess Kali with multiple hands. The big hurdle for the spread of this technology has been cost.

New VR systems combined with dropping costs of sensors and robotics would democratize the manufacture of similar surgical systems. It would be possible to dramatically enhance the capabilities of surgical instruments through increased fidelity and finer control systems making surgery minimally invasive. Add deep learning algorithms and haptic feedback to the mix and we could have surgical instruments that aid surgeons while performing procedures.

2) Enhancing physician training. Dr. Vipulroy Rathod from Endoscopy Asia has trained over 400 gastroenterologists globally. He recently started an online portal called Endoscopy Guru that provides thousands of physician trainees access to possibly one of the largest archives of endoscopy videos. In the future, trainees would wear VR gear and find themselves standing next to Dr. Rathod in the operating room. Using haptic medical gloves (see image again from Magic Leap’s patent application), they might even feel the scope entering a patient’s gut. These training programs would be archived for perpetuity so that future generations of doctors can understand how endoscopy and several other procedures evolved over time.

VR simulation has long been used in aviation and military training – it would firmly find its place in medicine once the bottlenecks of cost and complexity are removed.

3) Building psychosomatic applications. An increasing body of researchpoints to psychosomatic reasons (influence of mind over body) for several ailments. Through personal experience, we know that certain memories and thoughts have physical manifestations. Thoughts of fear make our hearts beat faster, guilt exhibits itself in the stomach region, sexual thoughts in the erogenous zones, sadness around the throat and so on.

Virtual Reality is directly suited for manipulating physical experiences. There would be several applications that provide the desired immersive, mental stimulus to result in a tangible physical outcome. For example, when a patient in physical therapy sees herself running normally, she would recover faster.Virtually Better is a great illustration of the potential of immersive clinical care. They developed Virtual Iraq, a virtual reality simulation environment that helps soldiers deal with post traumatic stress disorder (see video to learn how it actually feels).

4) Increasing patient compliance. One of the biggest problems in medical care is patient compliance. We routinely fail to stick to diets, take medicines in time and get ourselves screened regularly. In the future, we would use visually-enriched VR applications to keep ourselves in check, just as we use wearablestoday.

During a session at Singularity University, Larry Smarr (often called The Patient of the Future) passed around a 3D printed model of his colon. I was amused holding the model, turning it around to see what a problematic colon actually looked like. The fact is visualizing symptoms increases patient compliance – when we see our hearts clogged, we would listen to our doctors better. With VR gear, we would sit with our doctors, spin around our organs and see the link between compliance and health. And with a desktop 3D printer, our doctor could even print them for us to take home and admire!

5) Making remote healthcare delivery happen. Medical treatment typically goes through a series of steps from identifying presenting symptoms, capturing subjective and objective medical data, diagnosing and chalking out a plan. With the aid of data and visualization tools, it’s possible to deliver care remotely today. Companies such as American Well, Doctor on Demand and Teladoc have demonstrated that there is demand for virtual care and a way to deliver it effectively. Virtual Reality could dramatically make this experience more real.

Through the use of medical haptic gloves (think of gloves with lots of sensors), a patient can be touched remotely helping a doctor get sensory feedback during a physical exam. When a patient and doctor see each other sitting or standing in front of them, the experience is very close to a normal office visit. Aided with EHR data and remote lab tests enabled through microfluidics devices, it may even be possible to deliver healthcare remotely most of the time and to places where healthcare is not accessible.

What to do next?

Buy a Google Cardboard kit to experience VR for under $15 or even better, fold your own with everyday items like cardboard, lenses, magnets, velcro and a rubber band. Then experience Paul McCartney perform “Live and Let Die” in 360 degrees, with stereo 3D in what’s called a cinematic VR. Then startup.

 

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Andrew Beeston

09 Jan 2015

What my DNA tasted like

What my DNA tasted like

whatmydnatastedlike

 

Ever since I read Richard Preston‘s description of the taste of his own DNA, I was curious to sample mine. Not that what I read sounded tasty – just very gooey and quirky. An opportunity presented itself couple of years ago at Singularity University when visitors from Biocurious (a biology hackerspace in the bay area) conducted a DNA-extraction workshop.

The process of extraction is straightforward. Lyse the cells in your cheeks, degrade the protein with protease (a salty mixture), pour the cell-adulterated mixture into a test tube, invert it a few times, break down proteins by warming the tube in your hand, add ethanol to the mixture and sit still for 5 minutes. In just a few minutes, whitish blobs of DNA coagulate. Using a pipette, you can suck it up and put it in a necklace (see mine in pic).

What My DNA Tasted Like

Insipid but on the side of salty. Vaguely sharp. Viscous. When I sucked some, blobs of DNA hung around for a bit on my tongue and slipped away quickly into some dark corner of my gut.

More than the tasting, it was bizarre to carefully extract genetic software – passed down by kind ancestors so that my body could build its own hardware – and simply swill it down. For a moment, I wondered where it would end and what that meant. But I quickly dismissed those thoughts and walked to the nearest water cooler.

*

You can buy a genetic extraction kit here. Of course, you can taste it too!

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

13 Jun 2014

Trends that transform electronic health record systems to healthcare delivery platforms

Trends that transform electronic health record systems to healthcare delivery platforms

10globaltrends

The healthcare industry has spent the past several years building, implementing or fixing electronic health record systems (EHRs) with the primary objective of storing patient records digitally. Viewing EHR systems as static, storage bins belies the potential they have to fundamentally change how healthcare is accessed and delivered.

Let’s examine a few trends that can change medicine.

1. Explosion of medical data

According to IBM, we generate 2.5 quintillion bytes of data daily and have created 90% of world’s data in the last two years. The vast majority of this data constitutes medical information created by devices, health records, wearable computers, imaging systems, lab results, radiology reports, insurance claims and so on. But this is just the macro perspective. In the future, we will also have an explosion of micro data such as genomic data and data from other biomarkers that provide signals of future diseases. Medicine is becoming a data sciencelending itself to be understood through the aid of algorithms.

2. Digitization of a field makes colocation redundant

An ATM makes a bank redundant. Kindle let’s you buy books from anywhere. 3D printing transforms manufacturing just as iPods have changed the music industry. It’s only a matter of time when medical data travels seamlessly over the Internet to make colocation of a patient and doctor redundant.

3. Moving towards the Internet of Medical Things

Nest, a learning thermostat is a great demonstration of what is possible when a device is Internet-enabled – you can control it over your phone, customize it to your needs and save costs along the way. Just as Nest, there are several medical devices that can send data over the Internet. GE’s Vscan ‘shows’ the heart andScanadu’s Scout captures physiological data and sends it to a smartphone via Bluetooth. In due course, every medical device will have its own IP address – allowing it to be accessed and controlled from anywhere. Furthermore, there are several smartphone contraptions as demonstrated by Smartphone Physical that could make remote healthcare delivery possible.

4. Drones for Drugs

Amazon PrimeAir expects to routinely deliver goods using drones by 2015, by which time the FAA is expected to formulate its rules for unmanned aerial vehicles. Matternet wants to do that to deliver food and medications to remote areas – they recently experimented in Haiti and Dominican Republic to deliver 2.2 pounds of goods over 12.4 miles. It isn’t far fetched to imagine that our prescriptions will be fulfilled by a drone.

5. Doctors rely on data more than ever

Twenty years ago, if you complained of mild chest pain your doctor would have possibly given you an aspirin and asked you to return the next day if the pain persisted. Not anymore. Today the same doctor is likely to order an electrocardiogram, CT scan, x-rays of the abdomen and stomach, blood tests and then give you an aspirin after. Without delving into the reasons for this behavioral change, let’s simply be aware that doctors are more open to suggestions through data.

6. Video communication has become common

Last month, Microsoft demonstrated a real-time translated conversation via Skype between an employee speaking in English in Seattle and another speaking in German. It was a breakthrough, giving an idea of the future of global communication that would break language barriers. American Well, Teladoc and similar companies are early examples of medical care based on video. At my company, we are experimenting with remote healthcare delivery from Michigan to Sri Lanka using video and EHR data.

7. Patients are sharing more and more

Using services as patientslikeme and Crohnology, patients are providing great insights about medications, care plans, diet for specific disease conditions. In the future, medical knowledge may greatly rely on crowd-sourcing of disease information. We will discover newer ways to tackle today’s medical problems.

*

Connecting the dots

If we consider EHRs as nodes that interconnect patients, doctors, devices, labs and so on instead of as storage systems, we can visualize a dynamic flow of medical information. But data by itself is chaotic – we need insight to make it useful and pertinent. When we utilize analytical tools such asIBM Watson that can cull out wisdom from information, the EHR is transformed into an intelligent system.

Let’s connect these dots for a heart patient. Using the patient’s historical data, family data and micro data (e.g. through DNA tests) and data from devices that the patient wears, the EHR alerts the doctor before she falls sick. For example, by analyzing longitudinal data from BP, heart rate, activity and sleep, it suggests and enables a video-call for the patient and doctor. The doctor then examines a realtime ultrasound of the heart over the EHR and prescribes suitable medications. Latest evidence based guidelines assist the process of care. The EHR then triggers a drone to deliver drugs from the pharmacy to the patient. The data from the entire episode is continuously fed back into the network for future episodes of care.

Taking a leaf from another high risk industry such as flying, we never realize that a pilot mostly does not fly the plane. The plane flies on its own – the pilot is merely navigating it with the aid of an expert system that analyzes millions of data points at the same time. If medicine borrows and accepts similar ideas, we have the potential to transform the EHR to scale and deliver healthcare to millions of patients.

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

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