Thanks for shedding some light on this incredibly relevant topic Kelly! I think that the trend in healthcare is indeed towards leveraging technology more and more to connect patients with providers. Like the commenters above me though, I have some concerns around Teladoc’s operating model. The inability to collect vitals and perform a physical exam is concerning to me from a provider perspective. To run with Lindsey’s example of strep throat, current best practice guidelines recommend that physicians calculate a score to determine the likelihood of strep, and 3/5 parts of that score require a physical exam. If the patient’s score suggested that they are likely to have strep, the provider would then administer a rapid strep test before giving antibiotics – so really none of this could be done through Teladoc (at least in accordance with current guidelines). I would also be concerned that Teladoc’s operating model lends itself to physicians overprescribing antibiotics, which is harmful from a societal standpoint as it contributes to the rise of multi-drug resistant bacteria. Most of the diagnoses mentioned in the video would from my perspective be best addressed in an urgent care setting, so I think the solution is to make urgent care more affordable, in part by leveraging lower cost health providers such as NPs and PAs who are more than qualified to treat colds, allergies, etc.
Thanks for a really fascinating article! I think this is a really exciting product in many ways – I like that it allows for holter, event, or mobile telemetry monitoring all in one device. I’m also very optimistic about the idea of generating an arrhythmia database (assuming patient consent) and think this is a great space in medicine where machine learning can be applied – ECG interpretation particularly in the setting of arrhythmias is a difficult skill and requires a lot of experience and nuance. I have some concerns about the pricing, which seems to be justified relative to the cost of mobile cardiac telemetry. In my experience I’ve never seen mobile cardiac telemetry used; there are very few instances in which a patient is healthy enough to avoid hospitalization but requires real time ECG interpretation. As a practice manager I’d like to see a pricing tier that doesn’t charge me for 24/7 data analysis. I’d also push back against the assertion that this device would be able to identify triggers, as in many cases arrhythmias are triggered by health conditions external to the heart, which wouldn’t be captured by ECG data.
Extremely interesting article! I agree with you that genome sequencing and personalized medicine are the future of healthcare, and Illumina holds a very valuable position as the market leader in NGS technology. I just want to point out one risk in shifting focus away from academic/clinical customers in favor of commercial customers as you suggest. Our ability to generate genomic data is moving at a much faster pace than our ability to interpret it (when is a genetic mutation actually significant clinically?) as well as to do something about it, as Paul points out above. This discrepancy has made many stakeholders in the healthcare field, including regulators, hesitant about placing a large amount of difficult to interpret data in the hands of consumers. For example, 23andme recently struggled with FDA approval, was forced to shut down for a period, and ultimately was allowed to return to market but with a product that was much more limited in scope.
Thanks for a fascinating article! I’m personally very excited about the digitization of the clinical trial process and think that there is a lot to be gained in terms of both increased efficacy and higher quality data. I’m a bit more skeptical about the digitization of medical devices such as inhalers. While I think with certain disease states and patient populations the development of smart medical devices (e.g, the artificial pancreas) will be a huge win, I worry in other settings that we are using technology to solve a problem that doesn’t really exist while ignoring the real issue, which in this case is patient motivation and engagement. I also question who is going to pay for a device like this. It seems like the device is targeting patients with poor adherence who are unlikely to pay themselves out of pocket; payers (meaning insurers) are also unlikely to pay until there is robust data demonstrating use of this device significantly decreases hospitalizations for COPD exacerbations compared to non-digital inhalers.
Thought-provoking article! While I have a lot of respect for PepsiCo’s aggressive sustainability goals and recent success in achieving its 2015 50-in-5 goal, I can’t help but wonder whether PepsiCo can be doing more. Specifically, I find it hard to get behind PepsiCo’s stated vision of “Performance with Purpose,” one key pillar of which is environmental sustainability, while knowing that PepsiCo is the producer of the second largest bottled still water brand in the US. Initiatives such as more eco-friendly packaging, which Lindsey perfectly describes above, seem to pale in comparison to how much environmental harm is done through the energy required to produce and ship bottles and the added volume of plastic that ultimately ends up in landfills. A cynical response we hear a lot is: even if Pepsi stopped doing it, somebody else would – but I really believe that if one of the world leaders in beverages stood up and said ‘we’re going to stop doing this because it goes against our values,’ it would send an incredibly powerful message that Coca Cola and other competitors would have to respond to.
Incredible article! This topic is so fascinating because, exactly as Maria and Kelly describe above, we must be skeptical of BP’s commitment to sustainability when the trend towards sustainability threatens to put them out of business. However, I see BP’s investments in renewables not as a PR ploy, but as a means to mitigate business risk and move towards sectors of energy that represent the future of the industry. As a global leader in energy, it seems that BP can either keep doing the status quo, or step up and become one of the first movers in sustainable energy on a large scale. I also thought it was interesting how they are taking a multi-pronged approach – first, by trying to reduce the environmental impact of their processes, and second, by moving albeit slowly towards more sustainable products. Ultimately I think the regulation has to come from above, but I am optimistic that if governments are able to put the right incentives in place (a big if), today’s leaders in traditional energy can play a role in the innovation necessary to get to a more sustainable future.
Really fascinating post about a critical topic, as for many of us consumers (and particularly those of us without cars) air travel is our single greatest contribution to greenhouse gas emissions. While I think many of the innovations that Airbus is investing in are exciting and seem very promising, I have to wonder how much of an impact Airbus will have without committing to a target percentage by which to reduce emissions from its planes or similar type of goal. In the absence of such a goal, it seems to me that many of these projects are ultimately aimed at improving Airbus’s bottom line (decreased fuel usage translates into significant cost savings for Airbus’s customers), and could quickly be abandoned if the business case doesn’t pan out. Ultimately, though, Airbus will operate in its best interests as a for-profit corporation and can’t be faulted for that – regulation and enforcement must come from national and international aviation organizations.
As a loyal Nutella consumer, this article really resonated with me! I agree that from a business perspective Ferrero could be doing more to ensure the future of its superstar product, particularly in terms of forecasting the impact of climate change on all its key raw materials and developing plans to specifically address these climate-related risks. As a citizen of the world though, I’m more concerned about how Ferrero is changing its practices to become more environmentally sustainable, so that I can continue to coat everything I eat with Nutella without feeling terrible about the environmental impact I’m having. It is extremely discouraging that Ferrero has not made any sustainability pledges in terms of its hazelnut sourcing, especially as the company purchases around ¼ of the world’s hazelnut crop. I was additionally concerned about figures like the water footprint of hazelnuts. Per this Huffington post article from 2014 (http://www.huffingtonpost.com/2014/10/13/food-water-footprint_n_5952862.html), hazelnuts have the most favorable water footprint out of all the nuts at 1,260 gallons of water required to produce 1 pound – but that number is still astoundingly large, especially when compared to other categories of food (e.g., potatoes at 34 gallons/lb, rice at 222 gallons/lb, chicken at 518 gallons/pound). I wonder if Ferrero can invest in research to develop more water-efficient hazelnut production.
Completely fascinating company! As a scientist I am a strong believer that GMOs are a critical instrument in our toolbox for leveraging technology to achieve sustainable agriculture, and that we as a society would be remiss if we did not explore the opportunities offered by recent advances in synthetic biology such as CRISPR technology. Despite how much I want this to work though, as an investor I would have several concerns about the viability of this business model. First, I agree with the above poster that consumer receptivity to GMOs is a significant risk (though I disagree with the concerns raised about the nutritional value of genetically modified salmon, as it seems like the growth advantage to the AquaAdvantage salmon is due to higher levels of growth hormone which mechanistically should not affect nutritional content; the analogy to two types of cows fed different types diets is not really a fair one, and grain-fed animals are not necessarily genetically engineered.) Second, the AquaAdvantage salmon was first submitted to the FDA in 1995 and did not gain approval until 2015 (source: https://www.wired.com/2015/07/eating-genetically-modified-animals/). My hope would be that the FDA becomes more receptive to genetically modified animals and shortens the approval process, but I wonder how viable a business can be if the current regulatory environment demands a two decade long process. Third, I think the point you raise about potential impact on the ecosystem is an important one – we need to be cautious about potential unintended consequences of our actions. Nevertheless I think this industry is extremely exciting and I hope that it brings about some of the solutions we so critically need. Humans have been breeding organisms for desired qualities for thousands of years – isn’t it only natural that we leverage modern technology to help us improve the process?