
Stanford Dropout Says Blood Startup Won't Be Another Theranos - mcone
https://www.bloomberg.com/news/articles/2017-08-28/no-turtlenecks-this-time-stanford-dropout-pitches-blood-startup
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skybrian
Re: "My business manager would be upset because we can’t charge the patient
for that visit."

I appreciate the honesty, but here's the problem with the US medical system in
a nutshell. Saving patients a trip to the doctor is not trivial. (Particularly
people who need frequent visits or have trouble getting around.)

~~~
vonmoltke
Replace "patient" with "government" in that quote and I don't see how the
rationale changes or the problem is specific to the US.

~~~
skybrian
It's not entirely US specific, but incentives do vary depending on how the
system works. In some, doctors are on salary so there isn't any particular
incentive to increase office visits.

Incentives are tricky though; systems can break down in other ways.

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rdlecler1
This is a very narrow use case. Theranos was trying to be an all purpose
replacement for blood sample. The problem with Theranos is that a pin prick
sample is too small to account for the heterogeneity in blood for many use
cases. Only a larger draw gives you a large enough sample. It should be fairly
simple to determine how much heterogeneity is present for this use case. With
Sequoia behind this I'd be pretty confident that they consulted the necessary
experts.

~~~
killjoywashere
CBC is not a narrow use case. The CBC encompasses a huge variety of issues.
The hematology bench is one of the larger chunks of any lab, and
hematopathology (the things that can go wrong) is the largest chunk of my
library, by a wide margin.

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ttandon
one of the founders (Tanay) here - happy to answer any questions. we also put
out a new trove of data here:
[https://athelas.com/publications](https://athelas.com/publications)

~~~
killjoywashere
Hi, pathologist here.

* How do you account for interstitial fluid expressed into the droplet?

* Do you use the same flags as a CBC analyzer?

* Have you tested blasts?

* Have you tested leukostatic samples (very high white count: over 100k)?

* Have you validated against platelet clumping?

* Have you validated for basic sources of interference (lipemia, hemolysis, icterus).

* Have you engaged Cerner? Epic? DrChrono? AllScripts? Other EMR providers?

* Have you engaged a pathologist?

~~~
ttandon
Great questions

-The first line of defense against interstitial fluid is wiping away the first drop (commonly used protocol in most drop test). The inevitable remaining interstitial fluid chunk is then classified out by our image processing models, which have been trained to recognize differences in images based on debris/cell concentration.

-We currently report the WBC, WBC Differential, Platelets, and RBC indices. The flags we're missing are secondary RBC metrics like MCH and RDW estimates but we have plans to roll these out soon as well.

-Yes, we've run both bench and clinical testing on patients with north of 100k white blood cells - the image processing can segment out cell chunks in these crowded samples better than traditional flow cytometry. Not in the currently published studies, but some good data coming out about this soon.

-We've run basic initial tests on platelet clumping (artificially induced in certain diluted samples), and present in clinical samples. Since our model looks at the boundaries of these platelet cells, we have a lot less trouble with this than flow cytometry/beckman and even human pathologists. Still, we're working to find more samples with clumping to define the limits of detection on this front.

-We've done interference studies with Hemolysis, EDTA, not with lipemia and icetrus. These are on our list of clinical samples to source as well.

-We've begun working with some of these EMR providers, the good thing is many of them have sandboxes to get setup in relatively quickly. The larger ones do have long, long-term engagement timelines.

-We work with dozens of pathologists to help review results, train the system further, and in general go over good morphology practice. Has definitely been a core part of our strategy.

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altotrees
This is pretty interesting and sounds promising. I found it kind of odd the
emphasis on "dropping out" of Stanford and USC respectively. These guys have
clearly been busting their tails to get things done, why even mention that? Am
I missing something?

~~~
Swizec
It’s the “Entrepreneur drops out of expensive university to change world”
trope. It’s what it takes to be a successful entrepreneur didn’t ya know?

~~~
altotrees
I kind of thought that, but then second guessed myself thinking that is such
an old and tired trope that there is no way that could be what they were
aiming for. I guess some tropes never die.

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jasode
_> can run a complete blood-cell count_

I'm not a biologist but getting a "count" seems way easier and more realistic
than Theranos' claims of reliably detecting diabetes, heart disease, cancer
from a single prick of blood. Therefore, I'm not surprised that Sequoia backed
them even though Theranos may have poisoned the well for other bio-tech
startups.

~~~
EpicEng
And perhaps already accomplished? (with FDA approval)

[https://www.medonic.se/products/](https://www.medonic.se/products/)

Don't know if they're going beyond the capabilities there, I'd have to assume
they are.

~~~
jforman
"Not available for sales in the USA"

And these are point-of-care devices, not DTC devices. There are a lot of POC
diagnostics devices out there and very few DTC diagnostic devices.

~~~
EpicEng
Huh. Well, my company performs cancer diagnostics using blood samples and we
use a Medonic to get a WBC count prior to processing and image analysis.

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petra
They will probably have a hard time with marketing to consumers , because of
the alternatives, and the fact that this is limited to a single diagnostic
type:

1\. Walmart is working with Quest on offering blood testing services on site.

2\. This Australian
site:[https://www.myhealthtest.com](https://www.myhealthtest.com) is offering
mail-order testing services, for some things(for many you need a phlebotomist
to draw blood, but maybe that will change[a])

[a]Startups are working on lab-on-test diagnostics, which require small
volume, but there's still scientific debate whether sampling blood via finger-
prick is pure enough for testing.

~~~
QAPereo
It's crazy to me that these products are going to be marketed while there is
still debate to be had. This is medicine not software development, and
efficacy should be the first thing on the table, then safety and
reproducibility. Without that what exactly is being invested in here?

~~~
petra
I don't think that without serious research proving to doctors that this works
in this case, they'll have a chance.

The diagnosis they are going after is cancer, so people do what their doctors
tell them.

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kolbe
Can tech VC put their hubris aside for a minute and stop thinking that other
well-established industries are filled with idiots who are easily disrupted by
20 year olds?

~~~
asdfologist
Sorry that's terrible advice. If everyone had that attitude, nothing would
ever get disrupted.

~~~
kolbe
There's a pretty clear realm in which tech VC has been successful over the
past couple decades: utilizing large digital networks (which is the new object
that SV understands how to work with) to either improve existing businesses
(reservation booking, media viewing) or create new ones (social networks, ride
sharing). And when they do break out of that mold, it's with very experienced
entrepreneurs that have a thorough understanding of what the industry is, and
how it can be improved.

The model of hurling "20 year old dropouts" at industries with well-
established practices like medicine is a bad model. That doesn't mean that
there isn't room for very knowledgeable and experienced entrepreneurs to
disrupt medicine, but it'll probably be thanks to someone with two PhDs, an
MD, and a decade of research experience. It's not the same thing as some kids
molding a new industry from scratch with few prior entrants (e.g.
Gates/Jobs/Zuck).

~~~
jedberg
In this particular case, they are applying a very digital solution (machine
learning and vision processing) to an old industry (medicine). So it makes a
lot of sense.

And also, there are plenty of cases in the past of 20-somethings disrupting
established industries. Einstein developed his first disruptive theories in
his 20s, for example.

~~~
mikeash
Einstein was already highly knowledgeable in physics and part of the broader
physics community, though. Certainly young people can disrupt established
industries, but young outsiders doing so with little knowledge of the industry
in question is a lot less common.

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technologia
Aside from the snub about dropping out and comparing them to Theranos, the
quotes from Brawley showed a greater problem of potential adoption as most
folks wouldn't buy this without their doctor ok'ing/recommending it. The lack
of enthusiasm for this product makes it seem that even if Athelas makes it
through the FDA approval and insurance hurdles, it won't hit that critical
mass necessary for it to be successful.

Personally I'd like to see this succeed but I'm skeptical about how hospitals
and insurance companies will react to it.

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frandroid
After "Uber for..." startups, we now get "Not-Theranos for..." startups :D

~~~
wellboy
Thank you all for being part of the tech community, Sequoia, Google, Amazon,
Dropbox, Not-Theranos, Airbnb!

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Sangermaine
To avoid being another Theranos they simply have to be able to publicly
demonstrate their products work and do what they claim. When they start making
excuses and withholding that, run.

~~~
quoquoquo
I think we will see something like that. Theranos was blatant fraud by an
individual who came from a family of money, and felt the need to protect the
"fragile, young vulnerable women of tech".

Even as Theranos, there were lot of people defending Holmes, and attacking
people who were calling her a scammer.

I definitely don't think we are going to see any of that this time.

~~~
cowsandmilk
> felt the need to protect the "fragile, young vulnerable women of tech".

I've seen plenty of men with similar frauds in the healthcare space. Theranos
just got a lot more attention because it was a young female CEO. So, lots of
attention on the upswing, which led to a huge fall. Reading Adam Feuerstein
will show you plenty of white men in their 50's pushing similar BS while
leading publicly traded companies. And the reporters exposing the BS get
attacked constantly by duped investors on Twitter.

~~~
quoquoquo
It got a lot of attention because of the size of the scam and she came from a
place of money which she used to further her goals.

Imagine if this was a non-white male CEO, could you imagine how different
public opinions would've been? She got some sort of soft landing because she
was white, gender and her family wealth.

~~~
cowsandmilk
> Imagine if this was a non-white male CEO

Sure, I can imagine. Look at the "Bridge" detox device which is being pushed
by a Filipino American male. No randomized, blind clinical trials showing it
works, but it is being used all over America in clinics where it is not
covered by insurance. I'm guessing you've never heard of this scam, so I would
say that public opinion about it is indifference rather than outrage.

~~~
dragonwriter
Yeah, but public attitudes toward substance abuse treatment vs. “real”
medicine are substantially different, in part because the former is widely
seen as only needed by moral reprobates.

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sk5t
From the article:

"Beyond the matter of convenience, if Athelas doesn’t integrate seamlessly
into existing electronic medical-record systems, most doctors would reject it
because they don’t want to deal with separate software[...]"

Devices, FDA, and insurance reimbursement aside, is $3.7MM enough capital to
try to start addressing even this task?

~~~
jdmichal
I'm pretty sure that's in "definitely not" territory. I would expect that
initial funding to go towards productizing the actual blood tests -- I'm
assuming they're at more or less proof-of-concept level at this point. That
would be enough to get some sales to individual offices without large records
systems and maybe even some overseas and doctors-without-borders types. I
would expect larger rounds of follow-on funding to enable those larger
integrations, which would then open up the large practices and hospitals.

Also, more pessimistically, I don't think less than $4m is even enough to
start courting all the admins that would need to be greased to get large
hospital sales, even if all the tech existed...

~~~
sk5t
Thanks--I actually posted to try to verify or reject my own biases: as
software lead for a startup focusing on LDTs, I've been ruthless about
shooting down any suggestion to veer towards EMR/EHR integration as very
likely lethal to a fledgling business.

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reallymental
I was about to colour the company all sorts of sceptical until I read about
these two founders. A lot of work + very young.

Very well done indeed.

~~~
naturalgradient
I don't understand.

Why is being young a good reason not to be sceptical?

Wouldn't being young in a healthcare startup be all the more reason to be
sceptical?

Assuming that there is a distribution wherein some industries and products are
simply better tackled by founders with substantial experience, e.g. by
conducting research in the area, practising medicine, consulting on
healthcare, ..

That is not to say you cannot successful being young in healthcare, I just
don't see any prior reason why being young would be an advantage here, unlike
in e.g. social media.

~~~
rhizome
See Tom Nichols' "The Death of Expertise"[1] (now also a book) for more on
your sentiment.

1\. [http://thefederalist.com/2014/01/17/the-death-of-
expertise/](http://thefederalist.com/2014/01/17/the-death-of-expertise/)

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cryptozeus
When the article starts with "blah dropout says blah...." sigh

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logandavis
Technische Universität München dropout says new zeppelin "won't be another
Hindenburg"

Well, yes, I'd certainly hope this startup won't be another Theranos, one of
the most high-profile disasters in recent memory. Best of luck to the founders
in clearing that rather ignominious bar, and here's hoping at some point
another biotech startup can once again craft a public image other than "we're
not a complete trainwreck".

