Stanford Dropout Says Blood Startup Won't Be Another Theranos | Hacker News Reader

Stanford Dropout Says Blood Startup Won't Be Another Theranos

bloomberg.com

65 pointsmcone67 comments

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.)

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

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.

That struck me as odd. I haven't had a blood draw at the doctor's office in at least a decade. In my area doctors order all the testing from a third party.

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.

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.

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

You guys definitely seem to be on the right track - especially with being open about your results in light of the whole Theranos debacle. I remember an article a few months ago describing your CV/ML based approach and think it's a great use case. Good luck.

Can one device be shared by multiple people?

What are the details behind $20/month? E.g. is the machine "rented"? Or is the $20 for consumables?

Is it connected to the cloud? (In other words, is the machine-learning algorithm's "counting" happening in the device or are you uploading image data to a server for analysis?)

The $20/mo is for the device and the test strips per month, as such the device is rented. Each subscription comes with 10 test strips a month usable between different users!

Isn't "athelas" Tolkien-inspired? The Tolkien estate isn't super friendly with regards to this kind of reference. Try to find out how much Palantîr paid for an agreement with them (my understanding is that it's a very large number), and ask if that really makes sense...

The Tolkien estate is full of shit, they have no leg to stand on. Names aren't copyrightable and the book certainly doesn't give them a trademark over these industries.

Did you submit a 513(g) to get classified as (apparently) Class I Non-Exempt?

We're working under the 510k Class 1 and Class 2 framework

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?

Wow great to have a Pathologist in the Room.

I think this device is super awesome and I was trying to come up with something similar a few years back.

The primary concerns is that one of the first things I learnt in Med School is that capillary blood is way less reliable in compare to venous blood for something as important as CBC.

Not sure how they are accounting for the issue that the sample they have isn't the best one to get started with.

ps: killjoywashere how do I get in touch with you ? Am at Asingh [at] healthenclave.com

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.

As a former anemia patient and deep learning practitioner, I'm really rooting for you guys. This is a great approach.

Thank you!

did you purposely pick a name that sounds kind of like Theranos just to mess with people?

What are false-positive and false negative rates for Circulating Tumor Cells with your tech?

Do you control for age and other bio-factors and how?

CTCs are a very early application in our tech and one that we're excited to continue working on. We have some strong sample share relationships with Stanford and sensitivity/stage/specificity testing is in its early stages right now. Will publish on the data page when more information

Look at CU-Anschutz as well, CCTSI is very active in CTCs.

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?

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?

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.

>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.

automated diff counters are relatively new compared to chemistry analyzers (diabetes, heart disease). Cancer is a whole 'nother league.

And perhaps already accomplished? (with FDA approval)

https://www.medonic.se/products/

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

"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.

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.

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 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.

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?

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.

Requestatest.com also offers Quest (& LabCorp in some states) DTC orders, and Everlywell does the sample-collection-by-mail thing in the US as well.

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?

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

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).

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.

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.

Implying disruption can only be done by 20-year-olds with little knowledge of the industry being disrupted? I don't think that's even remotely true.

SV ageism is a blight that spreads globally fast.

I've seen some very bright minded people in just their mid 20s think they're too old already to find their calling.

not if you replaced "easily" with "considerable thought and effort". Musk definitely didn't disrupt rocketry by assuming everything Boeing was doing was dumb. They had some good ideas and some bad existing habits like any established community.

What are your favorite things that have been positively disrupted? I'm not sure there are very many.

VisiCalc was disruptive, but I don't think putting a company's FileMaker screens on the web is. YouTube? Sure. YouTube recommendations? Not so much. Uber/Lyft/etc. only leapfrogged the taxi industry by automating dispatch, not much else about the business is seismic compared the past (medallions aside). Adtech doesn't seem to be any more effective than print/broadcast strategies were a generation ago.

Someone has to be the first-mover. I'm happy to outsource that responsibility to a bunch of 'kids' in the Valley, because I certainly don't have the guts.

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.

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

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

entire headline reads like it came from the onion

Its actually pretty great.

The not-Pets.com of pet consumer products.

One thing that I'd point out is that this comes entirely from the press rather than the startup - we see ourselves in a totally different sub-industry from Theranos (Athelas is a single type of blood test, at-home device, specifically for oncology patients, and a totally different technology). Really the only common word is "blood", but unfortunately I think that often gets drowned out in the media

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.

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.

> 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.

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.

> 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.

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.

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

I think that would have happened regardless of who was leading the company, because a lot of people stood to make a lot of money from their success.

agreed! checkout our data (including 3rd party run studies): https://athelas.com/publications.

we also ran a live demo with sarah from TC here: https://techcrunch.com/2017/08/28/athelas-launches-its-amazo...

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?

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...

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.

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.

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.

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/

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

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".

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