Wednesday, December 24, 2014

Elizabeth Holmes at TEDMED 2014

November 7, 2014
TEDMED - Youtube - Elizabeth Holmes at TEDMED.  Video.  Here.

Elizabeth Holmes on Theranos.  Summary - not verbatim.

I believe the individual is the answer to the challenges of healthcare.

We can't engage the individual in changing outcomes, unless individuals have access to the information they need to do so.

The right to protect the health and well being of every person -- of those we love - is a basic human right, a right defined in the United Nations declaration on human rights.

Yet, in the US today, healthcare is the leading cause of bankruptcy.  And the lack, the leading cause of the suffering that is associated with finding out to late in the disease progression, that someone you love is really sick.

I grew up spending summers with my uncle - he loved crossword puzzles and taught us to play football and loved the beach.  I loved him.  He was diagnosed with skin cancer which became brain cancer, and bone cancer.  He didn't live to see his son grow up.  I didn't get to say goodbye. 

We define diagnosis today as the determination of disease from its signs and symptoms.  Yet diseases begin so much earlier than symptoms.  We see a world where every person has access to actionable health information when it matters, and no one has to say "if only I'd known sooner."  No one has to say goodbye too soon.   

Technology is transforming our word, and transforming policy issues.  Today, lab information drives 70% of clinical decisions.  But until recently, in most states, you couldn't get copies of your lab results, for tests their MD ordered, EVEN if they paid for it.

Today I can buy a deadly animal - a viper - a military armored vehicle - a tank - but I can't order a blood based pregnancy test.  Or an allergy test.   Because - that could be DANGEROUS.  

A woman trying to conceive can't order a fertility test.  Someone worried about her risk, or partner's risk, of a sexually transmitted disease, an STI, can't order an STI test, but there are 110 million cases in the US today.

When people have access to information about their bodies, they can change outcomes. Type 2 diabetes - T2D - can be reversed by change in lifestyle, diet, and exercise.  But today 80M Americans are prediabetic, and 90% of them don't know.  

Another 15% of our health costs is associated with the choice to be compliant or not with prescriptions written for them.  

Engagement comes with knowledge.
Knowledge comes with access.

My life's work in building Theranos, redefine the paradigm, so people DON'T have to present with a symptom to gain access to information about their bodies.  And everyone, no matter money or where they live, has access to actionable information when it matters.

Over 11 years, we made it possible to run ANY laboratory test for 50-90% off of Medicare rates.   We made it possible to run comprehensive tests from a tiny sample, a few drops of blood.  From a finger.  (Shows device.)

And we've made it possible to eliminate the many tubes of blood traditionally drawn - from an arm.  The Nanotainer.  

We made it possible for information to be accessible - at the time and place it matters, close to where people live and see their physicians.  We've made actionable information accessible with a decentralized infrastructure, but with the analytics of a centralized framework.

40-60% of patients aren't complaint with a lab test request from their physicians.  They can't afford it.

Even if they have insurance, deductibles are so high that people aren't compliant.  People can't pay $200 out of pocket.

They're scared of needles, so they're not compliant.  It's a basic human fear.

They have inaccessibilty to the blood draw locations, and the times, they'd have to take off of work and can't do that.

We see a world where every person knows the price of the test before they get that test done, and every time.  

I remember listening to a woman at one of our wellness centers.  She talked about a conversation with her physicians.  She raised concerns about hereditary disease risk in her own family, asking for a series of tests.  The MD said, insurance won't cover that.  She still wanted it - at what cost?  MD didn't know.  She figured out, several thousand dollars.  Tests for which she was not symptomatic for the conditions - yet.  And she couldn't afford it.  People will go broke spending thousands of dollars out of pocket to get a test to understand their risk before they develop a condition.

A pregnant woman showed up at our location, she'd been turned away, she couldn't afford a test.  She was so scared.  I will remember her all my life.  She was scared we would turn her away.  When she say the cost of our tests, the gratitude on her face struck my heart.

No person should have to live with that fear.

We see a world in which no one has to go through the pain of phlebotomy.  I saw an email, the father of a girl, he talked about talking her to the hospital and they stuck her again and again in the search for the tiny vein.  I saw an elderly person, veins collapse, needing blood drawn from the hand - so much suffering.  And cancer patients, I talked to them, they can take the treatments, the radiation, but the fear and bruising and the transfusions caused by all the blood colelcted for their care [emotionally] breaks them and their caregivers down.

We make the cost of testing so low, any combination of tests can be run for the same cost that those tests would have cost individually before. They get the information they need at the time it matters.

We see a world where the interaction with the physician becomes actionable because the testing is at the time and frequency it matters, so clinicians and individuals can understand where they are and where they are headed.   The typical clinical visit goes from today:  I see my doctor, first in a year, he sends me for a test, do a routine set of labs, doc calls me, your hemoglobin was low, here's a therapy, we'll come back in and do more labs, to figure out the initial test.  And they need more tubes of blood.  

So I do that second set of labs. On my third visit, he takes me off the Rx, puts me on a new one, and the three office visit, two lab, unnecessary prescription process, can be consolidated into one lab before I see my clinician.  Because any test can be run from a tiny sample for less cost than any one, before.

We see a world where people get access to lab information late at night, on a weekend, and in rural areas.

With a decentralized framework, decentralized care becomes possible, in developing economies.

This future is beginning now.  

But engagement begins with the individual.  If I had one wish.  Standing here.  With all of you.  Today, just for a minute, you think about the fact that we have this "right" - a human right - to engage with information about ourselves, our bodies.   And for those that we love.  To engage with information about themselves.  When we do that, we will change our lives.  And the lives of those we love.  And we begin to change our healthcare system.  

And our world.


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