I. An Unexpected Experience
Just recently, my friend went to her PCP (primary care provider) to ask about her three new spider bites and inability to sleep, even while taking Benadryl and ZzzQuil, which are allergy/anti-itch and sleep medications, respectively.
Instead of prescribing her another drug to try, this doctor was smart and sought more information. Her doctor told her that she may be a part of a small subgroup of people who respond to Benadryl with hyperactivity and suggested she get genotyped before taking any antipsychotics.
My friend took the initiative to read up on the gene the doc was talking about and found out that CYP2D6’s protein product metabolizes ~25% of known drugs and “ultrarapid metabolizers” usually extra active copies of the gene. She was probably one of them and needed more of the drug for it to work!
And to think my friend had initially thought all her hyperactivity and inability to sleep was due to her intake of diet coke! Her cousin later shared that she too has the same issue with Sudafed, a similar drug for allergy/pain, so this knowledge benefited not only her but also her family!
Can you imagine a world where knowing which drug to take to nix your case of allergies, eczema, depression, etc is more straightforward and efficient, less costly and frustrating?
This summer, I’m participating in the Duke-sponsored Summer Innovation Program as a continuation of the Duke Start-up Challenge to further develop Iris, a cloud-based, software-as-a-service platform that provides physicians with the clinical decision support to personalize patient care with pharmacogenetics.
I am very excited about where this project is headed because research and understanding of how drugs are metabolized is rapidly developing. With each day I am working on Iris, it seems like more and more groups of scientists, doctors, techies and policy makers across the country are collaborating to apply genetics at the point of patient care. This sort of awareness is largely beneficial for Iris as it’ll help propel healthcare policy to favor development of medical software faster than Anna and I had initially expected.
Anna is currently based in San Francisco and I in NYC. Our choice in cities reflect the communities we are trying to get more connected to and learn about. At the beginning of the summer, Anna and I had come up with a list of concerns and ideas we wanted to dig deeper into and wrap our mind around by the end of the summer. Many of these ideas came from our late night 2AM conversations during which we threw ideas back and forth. We had a lot of fun coming up with these ideas and some were a bit out-of-the-box. More times than not, we did not fully agree with each other or had to pause between ideas to communicate where our idea came from as we come from different backgrounds (medicine vs tech). I like that despite it being 2AM, Anna and I took the time to explain our thoughts to each other and were unabashed to divulge even the craziest or silliest ideas with eachother. Looking back, these ideas gave us a lot more to work off of and strengthened our understanding of eachother.
Here are a few of the things I’ve learned:
1. At the beginning of the summer, while gathering research to hone in on our customer base and to develop our MVP, I learned that consumers find it “frustrating that these types of panels [that address genetic disposition to ADRs] have not been adopted more widely, since a lot of money is wasted on ineffective medications”. Getting confirmation that we are heading the right direction is always a plus. In fact, as of now, the most actionable benefit from getting genotyped is in our direction– in estimating drug response and metabolism.
2. We have also been working to narrow down the customers we serve, at least for now as we are just starting off. We have been looking at various ways to divide our customers, with one factor being age. I’ve learned that with age, the number of epigenetic marks from environmental influences increase. These epigenetic marks modify gene activation and protein levels and composition. Simply put, optimal treatment strategies might differ between individual patients but also change for an individual patient over time. What this means for Iris is that, in addition to the patient genotype, if we were to look at an elderly patient’s profile, having access to biomarkers that characterize a patient at a given time might be optimal for treatment. It can also get a bit more complicated.
3. There’s no easy way to transmit data between providers as there are HIPPA concerns around moving data even between doctor’s offices, let alone from doctors to the cloud. Reading and signing off these waivers are no fun, especially for doctors because of liability issues and the time it takes away from seeing patients. While EMR vendors, the software makers who manage patient health information, have not yet opened up to add-ons or apps, they are learning and reiterating their software to make it easier for transmission of patient data in much more innovative ways than the past.
4. Iris is working to offer doctors a way to keep track of medications when treating medically complex patients. Healthcare is an extremely local and fragmented industry. Local in that, policies vary across states and fragmented in that, patients see different providers and these providers don’t know eachother/talk to each other. Consolidation and keeping track of lengthy medication lists across specialties is an incredible concern for doctors at the moment.
5. User friendly design will continue to be our main selling point. I’ve learned that customers don’t know much about what they want. It’s hard for them to pinpoint what they want because they are not always up-to-date or knowledgeable about the forces that are changing trends in medicine. However, it is our job to keep thinking of ideas that they may or may not like and share it with them.
6. I’ve also been doing a lot of leisure reading on technology and keeping up with social media for doctors as well as those in healthcare tech. One of the books recommended to me by a doctor was The Creative Destruction of Medicine. I’ve learned a lot from this book, but this will have to be a topic for another blogpost!
With every journey, learning more about one-self parallels the importance of learning new knowledge. I’ll be starting first year at Duke School of Medicine in August. In addition to being super thrilled to have the opportunity to get backstage on what exactly Iris’ customer base want and need, I’ve unconsciously also been better able to see technology from the point of view of a doctor.
After signing some medical waivers and forms myself, getting check-ups, etc to prepare for my entrance into medical school, I’ve become more serious about my responsibility to patients as a future physician. I can understand and relate to why doctors can be so hesitant to try something different or to invest in another piece of technology, as computers and software with terrible design has been taking away their face-time with patients. The doctor-patient relationship is sacred to physicians and anybody developing technology in healthcare must understand that. My dream is that Iris can work towards changing doctors’ perception on technology and to change patient care through bridging medicine and innovative technologies!
P.S – I had a great time at the NYU-Yale accelerator program pitch-off with fellow New York City Dukies! The students’ passion and diligence reflected in the hard work they put into their start-up and their humorous personalities definitely got the judges during their pitch! Kudos to these young entrepreneurs! I even brought my younger sister along, who is interested in engineering and design, to inspire the next generation of thinkers!
Looking forward to dinner with fellow NYC SIP’ers this week!