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Health risks to power plant regulation rollback

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

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Trump’s coal emissions rollbacks will be bad for country’s health, experts say

Chat with us in Facebook Messenger. Find out what’s happening in the world as it unfolds.

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Google Fit is getting redesigned with new health-tracking rings

Today, Google is rolling out a complete redesign of the Google Fit app for Android and the Fit section of the Wear OS app on iPhone. The new design focus is on closing rings, much like Apple (and everybody else). Google says that its rings are informed by health recommendations from the American Heart Association (AHA) and the World Health Organization (WHO). Every day, users will be encouraged to complete two goals: one based on “move minutes” and another based on a new thing called “heart points.”

Those metrics are an attempt to “abstract away the complication” of fitness tracking, says Margaret Hollendoner, senior product manager for Google Fit. “Move minutes” is meant to be a better metric than simple steps because it can capture several different activities since walking “might not be a great option” for some people.

“Heart points” is a little more abstract, but it’s designed to encourage people to engage in activities that will still get their heart rate up but don’t necessarily require a trip to the gym. “It’s as simple as picking up the pace when you’re walking,” Hollendoner says.

With both metrics, Fit will attempt to use as many sensors as are available to it and estimate the rest. If you use a Wear OS watch, it can track your heart rate directly and also automatically detect when you start exercising. Fit won’t require a Wear OS watch, but it definitely works better with one. It can also work with health data from other devices that are compatible with Fit.

As with all tech companies, Google is careful not to cross the line into making actual health claims with Google Fit. Instead, it is saying that it worked with the AHA and WHO to set up Fit so that it can help users track their progress toward achieving the physical activity guidelines the groups recommend.

Those goals are roughly 150 minutes of “moderate” activity per week and 75 minutes of “vigorous” activity. So the move minutes track daily progress to moderate activity. Heart points track toward the vigorous activity goal, but the “points” abstraction means that Fit can award more points for heavy exercise while also still rewarding less strenuous activity. (Fit will still show users more traditional metrics like step counts and estimated calories burned.)

In any case, the Fit app will start every user with goals it thinks are appropriate and move them up as they achieve more. Hollendoner says the system will offer suggestions within the app. For example, it might suggest that you only need another 20 minutes of exercise to hit a weekly goal, even if you missed your rings earlier in the week. In other words: Fit will try to help you alter your behavior, but it might make you feel a little less bad when you take a rest day.

Patrick Wayte, SVP for the center for health tech at AHA, says his organization’s contribution to the new system was more of an “active collaboration” or an “alignment exercise” than a full-on partnership with Google. The AHA’s recommendations will appear directly inside Fit if users go looking to see exactly what these Heart Points are all about. “This gives us an opportunity to get people oriented around the science,” Wayte says. He hopes that Fit’s coaching for users will “increasingly align them to the guidelines” the AHA recommends for physical activity.

Beyond the new metrics, the Fit app has generally been cleaned up, modernized, and simplified. When either the Heart points or Move rings are completed in the app, they’ll turn into an octagon. (Hollendoner calls it a “jewel shape.”) The Wear OS app will be updated as well, including those new rings.

A journal tab can show maps of previous runs and bike rides, track heart rates over time, and more. Users will have a setup process, but Google will take on more of the work to help them set goals over time. A floating “plus” button allows users to set up custom exercise routines.

Google has a lot of work ahead of it now as it fights to gain relevancy in a health tech conversation completely dominated by the Apple Watch and Fitbit. On its own, the new version of Fit seems nice but certainly not enough to pull mindshare away. That will probably require new WearOS smartwatches, and we should be seeing some of those come out later this year.

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RDMD attacks rare diseases with data mined from health records

You wouldn’t expect a medical app to get its start as a Snapchat competitor. Neither did video chat startup TapTalk’s founder Onno Faber. But four years ago he was diagnosed with a rare disease called neurofibromatosis type 2 that caused tumors, leading Onno to lose hearing in one ear. He’s amongst the one in 10 people with an uncommon health condition suffering from the lack of data designed to invent treatments for their ails. And he’s now the co-founder of RDMD.

Emerging from stealth today, RDMD aggregates and analyzes medical records and sells the de-identified data to pharmaceutical companies to help them develop medicines. In exchange for access to the data, patients gets their fragmented medical records organized into an app they can use to track their treatment and get second opinions. It’s like Flatiron Health, the Google-backed cancer data startup that just got bought for $2 billion, but for rare diseases.

Now RDMD is announcing it’s raised a $3 million seed round led by Lux Capital and joined by Village Global, Shasta, Garuda, First Round’s Healthcare Coop and a ton of top healthtech angels, including Flatiron investors and board members. The cash will help RDMD expand to build out its product and address more rare diseases.

RDMD founders (from left): Nancy Yu and Onno Faber

We believe that the traditional way rare disease RD is done needs to change,” RDMD CEO Nancy Yu tells TechCrunch. The former head of corp dev at 23andMe explains that, “There are over 7,000 rare diseases and growing, yet 5% of them have an FDA-approved therapy . . . it’s a massive problem.” 

While data infrastructure supports development of treatments for more common diseases like cancer and diabetes, rare diseases have been ignored because it’s wildly expensive and difficult to collect the high-quality data required to invent new medicines. But “RDMD generates research-grade, regulatory-grade data from patient medical records for use in rare disease drug RD,” says Yu. The more data it can collect, the more pharma companies can do to help patients.

Trading utility for patient data

With RDMD’s app, a patient’s medical data that’s strewn across hospitals and health facilities can be compiled, organized and synthesized. Handwritten physicians’ notes and faxes are digitized with optical character recognition, structuring the data for scientific research. RDMD lays out a patients’ records in a disease-specific timeline that summarizes their data that can be kept updated, delivered to specialists for consultations or shared with their family and caregivers.

If users opt in, that data can be anonymized and provided to research organizations, hospitals and pharma companies that pay RDMD, though these patients can delete their accounts at any time. Because it’s straight from the medical records, the data is reliable enough to be regulation-compliant and research-ready. That allows it to accelerate the drug development process that’s both lucrative and life-saving. “It normally takes millions of dollars over several years to gather this type of data in rare diseases,” Yu notes. “For the first time, we have a centralized and consented set of data for use in translational research, in a fraction of the time and cost.”

So far, RDMD has enrolled 150 patients with neurofibromatosis. But the potential to expand to other rare diseases attracted a previous pre-seed round from Village Global and new funding from angels like Clover Health CEO and Flatiron board member Vivek Garipalli, Flatiron investor and GV (Google Ventures) partner Vineeta Agarwala, Twitter CTO Parag Agrawal, former 23andMe president Andy Page and the husband and wife duo of former Instagram VP of product Kevin Weil and 137 Ventures managing director Elizabeth Weil.

“Onno and Nancy realized there’s an opportunity to do in rare diseases what Flatiron has done in oncology — to aggregate clinical data from patients, and to leverage that data in clinical trials and other use cases for biotech and pharma,” says Shasta partner Nikhil Basu Trivedi. RDMD will be competing against pharma contract research organizations that incur high costs for collecting data the startup gets for free from patients in exchange for its product. Luckily, Flatiron’s exit paved the way for industry acceptance of RDMD’s model.

“The biggest risk for our company is if we lose our focus on providing real, immediate value to rare disease patients and families. Patients are the reason we are all here, and only with their trust can we fundamentally change how rare disease drug research is done,” says Yu. RDMD will have to ensure it can protect the privacy of patients, the security of data and the efficacy of its application to drug development.

Hindering this process is just one more consequence of our fractured medical records. Hopefully if startups like RDMD and Flatiron can demonstrate the massive value created by unifying medical data, it will pressure the healthcare power players to cooperate on a true industry standard.

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Amazon hires star cardiologist as it pushes deeper into health care

Buffett, Bezos  Dimon try to tackle health care

Amazon has hired a top cardiologist as it broadens its involvement in the health care industry.

Maulik Majmudar, who is also associate director of the Healthcare Transformation Lab at Massachusetts General Hospital, announced on Twitter that he is moving to “an exciting and challenging role @amazon.”

Majmudar did not specify what his job at Amazon (AMZN) would be. The tech giant mostly has kept quiet about its foray into health care.

Neither Majmudar nor Amazon immediately returned request for comment.

Amazon announced in June that it is buying the online pharmacy PillPack, which has pharmacy licenses in all 50 states. The company delivers drugs to customers in pre-sorted doses designed to make it easier for people to take multiple medications a day. The move could accelerate Amazon’s long-rumored move into the pharmaceutical business.

Earlier this year, the retail titan teamed up with Berkshire Hathaway (BRKA) and JPMorgan Chase (JPM) to reduce the health care costs of the companies and their employees. The venture, which has yet to be named, hired renowned surgeon and writer Atul Gawande as CEO.

The retailer also has rolled out a line of private label over-the-counter medicines, and is building a business selling a wide array of medical supplies to doctors, dentists and hospitals. The company has a team working on developing employee health clinics, too, according to CNBC.

Majmudar has long worked at the intersection of health care and technology. The Healthcare Transformation Lab says it looks to “improve the experience and value of healthcare for patients and providers through collaborative innovation.” It also focuses on digital health, including mobile and wearable devices and data analytics.

Majmudar, who earned his medical degree at Northwestern University, is also a lecturer and visiting scientist at the Massachusetts Institute of Technology and an assistant professor at Harvard Medical School.

He is also medical adviser at Biofourmis, a start up focusing on monitoring patients remotely, and HiLabs, which focuses on health care data mining. He previously served as founding member and chief clinical officer at Quanttus, which unsuccessfully tried to develop a wrist-based app that monitors blood pressure.

He is leaving all that behind to focus on Amazon, but his tweet suggests the company has big, global plans.

“The one and only reason I am taking on this opportunity is the possibility of making a truly meaningful impact on the health and wellbeing of hundreds of millions of individuals throughout the world,” he tweeted.

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The Exercise That Helps Mental Health Most

We assume exercise improves our mental health. But what kind of exercise works best?

Researchers looking at the link between physical activity and mental health found that team sports fared best, followed by cycling, either on the road or a stationary bike.

The study, published in the journal Lancet Psychiatry this month, is among the first…

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Prolonged sitting: Short bouts of activity reduce health risks

A newly published meta-analysis has discovered that even short breaks from prolonged sitting can reduce some of the adverse metabolic effects associated with it. Short stints of low-level activity can make a real difference.

Sitting for long periods is unhealthful, but a small change in behavior might help.

In Western society, sitting down for long periods of time is now the norm; at the office, watching television, playing video games, our lives are easily filled with physical inactivity.

The negative health consequences of sedentary living are also growing clearer.

As Dr. Meredith Peddie, co-author of the new study, explains, “Most of us spend about 75 percent of our day sitting or being sedentary, and this behavior has been linked to increased rates of diabetes, cardiovascular disease, some cancers, and overall mortality.”

The exact reasons why prolonged sitting is so unhealthful are not fully known, but certain metabolic factors are thought to play a part.

For instance, long periods with little exertion reduce insulin sensitivity and glucose tolerance, while increasing levels of triglycerides — the main constituent of body fat — in the blood.

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Reducing the impact of sitting

Dr. Peddie led a group of researchers at the University of Otago in New Zealand; they were joined in their efforts by scientists from the University of Prince Edward Island and the University of Guelph, both in Canada.

They set out to explore whether small changes in behavior may be effective at minimizing some of the negative acute metabolic and vascular effects of long periods of sedentary behavior.

To investigate, the team assessed 44 existing studies that focused on interrupting prolonged sitting with various amounts and types of movement. Their findings were published recently in the journal Sports Medicine.

More specifically, they were interested in the effect of up to 24 hours of prolonged sitting following a meal. They measured its influence on various factors, including glucose, insulin, and triglyceride levels, blood pressure, and vascular function.

They compared these effects with individuals whose sitting was interrupted with light to moderate activity.

They found that even light-intensity activity every 30 minutes had significant effects.

Physical activity of any intensity was shown to reduce concentrations of glucose and insulin in the blood up to 9 hours after the meal. Similarly, levels of fat in the blood were also reduced, but this only occurred 12–16 hours after activity began.

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A robust and positive effect

Dr. Peddie and colleagues were particularly surprised that the beneficial changes they saw were not affected by the intensity of the activity or the age or weight of each participant. Similarly, the type of meal eaten before the prolonged sitting did not influence the results, either.

We should all be finding ways to avoid sitting for long periods, and to increase the amount of movement we do throughout the entire day.”

Dr. Meredith Peddie

Much more research still needs to be done to understand how to mitigate the impact of prolonged sitting.

Next, the researchers hope to uncover more information about how the timing of breaks impacts the results. They would also like to know which activities are the most effective, and how long active sessions need to be.

However, the studies that the scientists analyzed did not record enough data on blood pressure and vascular measures. They hope that future studies might include more information about cardiovascular effects of sitting with or without short active breaks.

The take-home message, however, is simple: we all need to make an effort to move more.

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Health Briefs:

Wellness day

WHAT: Wellness Health Day

WHEN: 10 a.m. to 2 p.m. Saturday, Aug. 25

WHERE: Mount Pilgrim Baptist Church, 9700 Scenic Highway

DETAILS: Registration starts at 9:30 a.m. Sessions include physical activity, mental health counseling, diabetes management, prescription medication management, healthy cooking demonstrations for weight management, hypertension and diabetes control. Free cholesterol, blood pressure, glucose, vision, hearing, dental, foot health and HIV screening. Door prizes will be awarded and lunch will be served.

Childhood health grants

WHAT: The Blue Cross and Blue Shield of Louisiana Foundation is requesting proposals for grant awards of up to $1 million to address the social and environmental factors that lead to disparities in childhood health.

WHEN: Deadline is Sept. 1


DETAILS: The foundation is seeking projects that use the “collective impact” model — entire communities and multiple agencies working together to solve problems. Most gaps in children’s health and education outcomes fall along racial lines, disproportionately affecting people of color. Data show that when compared to people of other backgrounds, black Louisianans are 1.5 to 4 times more likely to experience poor health outcomes and higher mortality rates, regardless of their income status. A growing body of evidence suggests that attempts to address gaps in health care and education at an early age are especially likely to yield positive results. Furthermore, projects around the country have proven that closing the gaps along racial and socio-economic lines for children leads to better outcomes not just for these children but for the whole community.

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Health insurers are a big winner during long-running bull market

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Young doctors

The bull market, which is about to become the longest running in recent history, has produced healthy returns for investors. The SP 500 is up well over 300 percent over the last nine years, but health insurance stocks have logged even more impressive gains.

The SP Managed Care sector, made up of the largest insurers, has gained more than 1,100 percent during the market’s bull run. That’s more than twice as much as the gains in the biotech sector. The iShares Nasdaq Biotech Index ETF is up about 500 percent during the period.

Yet, in March 2009, when the stock market hit bottom, health insurance stocks hardly seemed like a sure bet. In the lead up to the passage of the Affordable Care Act, the threat of a single-payer plan and new Obamacare regulations weighed on insurers.

“The perception was that the Affordable Care Act was going to be bad for health insurers,” explained Wells Fargo analyst Peter Costa, “and insurance stocks were really very broken.”

“In April of 2009 they were at the deepest discount to the market that they’d been since the 1990s … (trading) at a 50 percent discount to the S P 500 forward price earnings multiple,” said Matt Borsch, health-care analyst at BMO Capital.

Nine years later, two of the biggest health-care winners have seen large growth in part because of Obamacare.

The Medicaid boom

Medicaid expansion under the ACA has resulted in nearly 15 million people gaining coverage under the government health program for the poor and disabled. At the same time, over the last decade, states have increasingly turned to insurers to manage their Medicaid programs.

Medicaid insurer WellCare Health Plan’s shares have gained more than 4,000 percent since March 2009, while its membership has nearly doubled to 4.3 million, and its annual revenues have nearly tripled from $6.9 billion to an estimated $18.7 billion this year.

WellCare shares continue to outperform. The stock is up 46 percent year to date, trading just below analysts’ mean price target of $296 per share. The high analyst target of $325 per share would imply another 10 percent gain over the next 12 months.

Rival Centene’s shares have gained nearly 1,800 percent over the last nine years. Its membership has grown through a series of acquisitions from 1.4 million in 2009 to 12.3 million in its most recent quarter, and annual revenues have ballooned from $3.4 billion to an estimated $59.8 billion this year.

Centene is up 42 percent year to date, trading near record highs; the high analyst price target of $160 on the stock implies another 11 percent gain over the next 12 months.

At the same time that the Medicaid business has expanded, the Medicare has seen big growth over the last decade as more baby boomers have aged into the government health plan for seniors.

For the major health insurers that has meant that their government business has grown faster than the commercial employer and individual insurance plan business. Government plans now account for more than 50 percent of the industry’s insurance revenues.

More diverse businesses

Government plans have been one of the growth drivers for the nation’s largest insurer, UnitedHealth Group, which is up 19 percent year to date, and has seen shares gain nearly 1400 percent over the last nine years.

United’s health plan membership has grown from 32 million to nearly 50 million over the last nine years; its Medicaid and Medicare membership has more than doubled, during the period.

But new business segments outside of health insurance have a played big role in growing the health-care giant’s annual revenues from $87 billion in 2009 to an estimated $225 billion this year. The health services and products under the Optum division have become a key driver of top-line growth.

“They diversified and started gaining non-insurance businesses,” said Deep Banerjee, health-care credit analyst at Standard Poor’s.

United’s Optum unit now accounts for 20 percent of revenues, and includes data analytic services, pharmacy benefit management, physician practices and outpatient surgical centers.

Banerjee notes that revenues from the services businesses are not subject to the ACA regulatory caps, which require insurers to spend at least 80 percent of premium revenues on medical care. That makes them more profitable.

“As the non-regulated cash flows have increased (for insurers) … the investment community has taken a more of a liking to them,” said Banerjee.

United’s success has been part of the impetus behind the increasing number of vertical health insurer deals. More health plans have acquired health-care providers and services in order to have greater control over medical costs in their health plans.

Pharmacy benefit giant CVS Health’s $69 billion deal for Aetna and Cigna’s $54 billion deal to buy pharmacy benefit firm Express Scripts are both predicated on trying to driving cost efficiencies by having greater control over a wider range of members’ care.

For both mergers, diversification of revenues could serve as a bulwark against potential new regulation of pharmacy benefit rules as the Trump administration has pledged new reforms for curbing high drug costs.

New threats of disruption

Beyond government regulation, investors have been focused on the potential threat of health care disruption from tech giants.

This week, Google parent Alphabet took a $375 million stake in Oscar Health to help the 6-year-old health insurer expand its current Obamacare exchange business and develop commercial Medicare Advantage plans by 2020.

This spring, Amazon made a very public entry into health care with the acquisition of online pharmacy Pillpack and its venture to develop a better employee health benefit system with J.P. Morgan and Berkshire Hathaway.

Wells Fargo analyst Peter Costa says right now insurers are well positioned to weather the threat from the upstarts, noting that industry has invested heavily in analytics and data systems.

“I would say they have the technological savvy and they already have the health-care knowledge, whereas companies coming in from the tech side … don’t have the knowledge from the health-care side,” Costa explained.

On the political front, one of the biggest threats over the last 18 months has been the Republican push to cut funding for Medicaid. But the efforts sputtered along with the attempted repeal of Obamacare.

Meantime, Democrats have revived the health reform debate over single-payer Medicare For All, nine years after investors were rattled by the prospect of single-payer health care under the ACA.

If either side gains traction, analysts say the major insurers have positioned themselves to adjust more readily to the shifting landscape over the last decade.

“Even if it’s Medicare for all, it would probably be Medicare Advantage for All,” with the government funding private Medicare plans, said Banerjee.

“Health care today is a public-private partnership … it’s very hard to see a system without a private player meaningfully involved,” he said.

Bertha Coombs

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A Health Chip Is Part of a Broader Move by Apple Into Healthcare

It’s no secret that Apple (NASDAQ:AAPL) has designs on the healthcare market. At the device maker’s annual shareholder meeting earlier this year, Apple CEO Tim Cook signaled a broader interest in the field, saying that the company was in a “great position” to innovate because it wouldn’t be reliant on reimbursements from insurers or federal programs like Medicare and Medicaid. ”The more and more time we spend on this,” Cook said, “the more excited I am that Apple can make a significant contribution here.”

Apple’s latest foray into the field may be its most ambitious yet. Apple’s Health Sensing hardware segment is looking to hire engineers to develop custom chips to process data from “health, wellness, and fitness sensors,” according to a job posting cited by CNBC. This could mark an even deeper move into healthcare by the iPhone maker.

Image source: Apple.

A chip off the old block

The job posting cited a need for “sensor ASIC [application-specific integrated circuit] architects to help develop ASICs for new sensors and sensing systems for future Apple products. We have openings for analog as well as digital ASIC architects.” An ASIC is a processor customized for a specific use or application.

The Apple Watch and iPhone already have a number of sensors, such as those to monitor heart rate and sleep quality, and the company has been working to develop others. Early last year, Apple was said to have a team of biomedical engineers working to create a noninvasive sensor designed to monitor blood sugar levels in those who have diabetes. Cook was reportedly wearing a next-generation watch prototype to monitor his own sugar levels, though a public version with those capabilities might still be years off. 

Developing a customized chip that better interacts with a variety of sensors could advance Apple’s push further into the health field.

A broad interest in heart health

Late last year, Apple showed the first indication of its growing healthcare ambitions when it introduced the Apple Watch Series 3. The new Watch debuted an improved heart rate monitor that provides wearers with more accurate heart measurements during workouts and can detect potentially life-threatening spikes in a user’s heart rate. 

Next, the company partnered with Stanford Hospital in a study to determine if the Apple Watch could accurately identify an irregular heart rhythm, which is often a precursor to a stroke. An earlier study sponsored by app maker Cardiogram showed the Apple Watch could detect atrial fibrillation — a potentially serious heart ailment — with 97% accuracy. 

Apple was also chosen as one of nine companies to participate in a pilot program with the U.S. Food and Drug Administration (FDA) to precertify companies creating software-based medical apps and devices. On the heels of that program, AliveCor’s KardiaBand electrocardiogram (EKG) reader became the first FDA-approved medical device accessory for the Apple Watch.

Image source: AliveCor.

Big tech’s interest in health is growing

Apple isn’t the only technology company expressing an interest in the healthcare field. Earlier this year, Amazon, Berkshire Hathaway, and JPMorgan Chase announced a collaboration with an initial focus of providing employees with more cost-effective healthcare options.

Google parent Alphabet recently announced a sizable investment in start-up insurer Oscar, adding $375 million to an earlier infusion of $165 million. Oscar’s goal is to rely heavily on data in an effort to make healthcare less expensive and more efficient. 

Apple is gradually expanding the health-related capabilities of its devices. With sales of smartphones leveling off, a move into healthcare could provide the company with another potentially lucrative opportunity.

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