The Harry Glorikian Show Harry Glorikian

When your doctor prescribes a new medicine, there's a pretty good chance that some snafu will crop up before you get it filled. Either your pharmacy doesn't carry it, or your insurance provider won't cover it, or they'll say you need "prior authorization," or your out-of-pocket cost will be sky-high. The basic problem is that the electronic health record systems and e-prescribing systems at your doctor’s office don’t include price and benefit information for prescription drugs. All of that  information that lives on separate systems at your insurance company and your health plan’s pharmacy benefit manager, or PBM. And that’s the gap that a company called RxRevu is trying to fix. Harry's guest on today’s show RxRevu CEO Kyle Kiser, who explains the work the company has done to bring EHR makers, insurers, and PBMs together to make drug cost and coverage information available at the point of care, so doctors and patients can shop together for the best drug at the best price.

Harry's guest Eric Daimler, a serial software entrepreneur and a former Presidential Innovation Fellow in the Obama Administration, has co-founded a company called Conexus that uses category theory to tackle the problem of data interoperability. Longtime listeners know that data interoperability in healthcare—or more often the lack of interoperability—is a repeating theme of the show. In fields from drug development to frontline medical care, we’ve got petabytes of data to work with, in the form of electronic medical records, genomic and proteomic data, and clinical trial data. That data could be the fuel for machine learning and other kinds of computation that could help us make develop drugs faster and make smarter decisions about care. The problem is, it’s all stored in different databases and formats that can’t be safely merged without a nightmarish amount of work. So when a company like Conexus says they have a way to use math to bring heterogeneous data together without compromising that data’s integrity – well, it's time to pay attention. That's why on today’s show, we’re all going back to school for an introductory class in category theory.

Harry's guest this week is Rohit Nambisan, CEO of Lokavant, a company that helps drug developers get a better picture of how their clinical trials are progressing. He explains the need for the company's services with an interesting analogy: these days, Nambisan points out, you can use an app like GrubHub to order a pizza for $20 or $25, and the app will give you a real-time, minute by minute accounting of where the pizza is and when it’s going to arrive at your door. But f you’re a pharmaceutical company running a clinical trial for a new drug, you can spend anywhere from $3 million to $300 million—and still have absolutely no idea when the trial will finish or whether your drug will turn out to be effective. Because there's little infrastructure for analyzing clinical trial data in midstream or spotting trouble before it arrives, some studies continue long after they should have been canceled, and positive data sometimes gets thrown out because of minor procedural flaws; in the end, 20 to 30 percent of the money drug makers spend on clinical trials goes down the drain, Nambisan says. Lokavant's platform allows drug makers and clinical research organizations to harmonize the results coming in from study sites, compare it to data from other trials, and discover important signals in the data before it’s too late. For example, a company might discover that it’s not enrolling patients fast enough to complete a trial on schedule, or that the researchers administering the study aren’t following the exact protocols laid out in advance. Such headaches might sound abstract and remote, but poor data management slows down the whole drug development process, which means fewer beneficial new drugs make it to market ever year; that's the ultimate problem Lokavant is trying to fix.

This week Harry continues to explore advances in "digital therapeutics" in a conversation with Paolo Pirjanian, the founder and CEO of the robotics company Embodied. They’ve created an 8-pound, 16-inch-high robot called Moxie that’s intended as a kind of substitute therapist that can help kids with their social-emotional learning. Moxie draws on some of the same voice-recognition and voice-synthesis technologies found in digital assistants like Siri, Alexa, and Google Home, but it also has an expressive body and face designed to make it more engaging for kids. The device hit the market in 2020, and parents are already saying the robot helps kids learn how to talk themselves down when they’re feeling angry or frustrated, and how to be more confident in their conversations with adults or other kids. But Moxie isn’t inexpensive; it has a purchase price comparable to a high-end cell phone, and on top of that there’s a required monthly subscription that costs as much as some cellular plans. So it feels like there are some interesting questions to work out about who’s going to pay for this new wave of digital therapeutics, and whether they’ll be accessible to everyone who needs them. Pirjanian discussed that with Harry, along with a bunch of other topics, from the product design choices that went into Moxie to the company’s larger ambitions to build social robots for many other applications like entertainment or elder care.

Can a video game help improve attention skills in kids with ADHD? According to Akili Interactive in Boston, the answer is yes. They’ve created an action game called EndeavorRx that runs on a tablet and uses adaptive AI  to help improve focus, attentional control, and multitasking skills in kids aged 8 to 12. And it’s not just Akili saying that: In 2020 the U.S. Food and Drug Administration agrees cleared EndeavorRx as a prescription treatment for ADHD, based on positive data from a randomized, controlled study of more than 600 children with the disorder. It was the first video game ever approved as a prescription treatment for any medical problem, and Harry's guest this week, Akili co-founder and CEO Eddie Martucci, says it opens the way for a new wave of so-called digital therapeutics. Even as Akili works to tell the world about EndeavorRx and get more doctors to prescribe the game for kids with ADHD (and more insurance companies to pay for it), it's testing whether its approach can help to treat other forms of cognitive dysfunction, including depression, the cognitive side effects of multiple sclerosis, and even Covid-19 brain fog.

Why is hibernation something that bears and squirrels do, but humans don’t? Even more interesting, what’s going on inside a hibernating animal, on a physiological and genetic level, that allows them to survive the winter in a near-comatose state without freezing to death and without ingesting any food or water? And what can we learn about that process that might inform human medicine? Those are the big questions being investigated right now by a four-year-old startup in California called Fauna Bio. And Harry's guests today are two of Fauna Bio’s three founding scientists: Ashley Zehnder and Linda Goodman. They explain how they got interested in hibernation as a possible model for how humans could protect themselves from disease, and how progress in comparative genomics over the last few years has made it possible to start to answer that question at the level of gene and protein interactions. The work is shedding light on a previously neglected area of animal behavior that could yield new insights for treating everything from neurodegenerative diseases to cancer.