Snakes on a Phone!

“Every great story seems to begin with a snake” – Nicholas Cage

 

I am approached every day by digital health companies looking to introduce me to their new products. 98% of them seem to be virtually the same: the new, new population health program, the next greatest re-admission avoidance product, yet another approach to managing behavioral health online. It takes a lot to discern how these products differ from each other and, even if they are great, the number of products seeking the exact same market makes one understand exactly why it’s so damaging to have so many political candidates from one party – they split the vote so only the loudest can win. With 37,942 population health apps targeting the same few hundred buyers, it’s very hard to get to critical mass.

But every once in a while something entirely different shows up and that is when the fun starts. I bet none of you have seen a digital health product targeted to treating snakebites, but I have. And thus I couldn’t help myself but write about it to prove that someone holding an Apple product actually did “Think Different.” We are talking “beyond the pill” at a whole different level here, but it is a great example of how a pharmaceutical company is matching a treatment with a digital health tool to make it more useful.

Apparently there are actually 7200 people bitten by rattlesnakes and similarly creepy and dangerous North American pit vipers every year in the U.S. Most of these bites happen from March to August, so it’s time to start looking where you walk. Rumor has it that the strength of this year’s El Nino storm system will make this worse in 2016. And lest you think you are safe, if you are not one of those people who likes to hike the back country think again. The spread of human habitat into snake habitat is further increasing the snake-on-human dating opportunities in a way not seen since the time of Adam and Eve. Weekend gardeners beware.

Remarkably there is a lack of knowledge about what to do when this nightmare happens, not just by the unlikely lunch target, but also by emergency responders and emergency physicians. One too many movies has over-fictionalized what to do when facing a snakebite and I’m sure that most clinicians don’t brush up on this topic each year when they get their CMEs. But to fill that void, welcome to SnakeBite911, a new digital health app for the iPhone that helps all of these stakeholders (snakeholders?) know what to do once they have stopped screaming. And even better, this is actually tied to a therapeutic, an anti-venom drug, so what we have here is an integrated digital health app/service/therapeutic targeted at a specific problem. Can I get a hallelujah?

Ok, you ask, what is the real market size for this? Is the total addressable market (TAM for all you Silicon Valley dorks) big enough to turn a rattlesnake into a unicorn? Probably not. But how refreshing to see something different for a change and not even a whiff of buzzword about population health. And even better, the story of how the therapeutic is made is the stuff of People Magazine articles – so wild to contemplate.

So here’s what SnakeBite911 actually does. It gives consumers, aka those who might be put themselves in harm’s way, information on snake sightings in their area. Kind of like Open Table for people to find snakes, the app includes geolocation as to recent sightings, what the critters look like and background about these little beasties. It gives consumers information about what to do if bitten (Do not try to catch the snake! Do not try to cut out the venom!), starts a clock ticking so the time elapsed since the bite is known (this is important to treatment outcome) and provides a direct line to the Poison Control Center and 911 with a telemedicine feature to photograph the bite site in order to transmit early medical info to First Responders. I know you don’t think you need this, but if you are one of the unlucky 7200 outdoorsy types who actually does, you will be relieved to know it’s there.

The First Responder version of the app also tells paramedics and their teams which hospital carries the anti-venom drug, generally believed to be one of the best ways to effectively treat rattlesnake and similar bites. Since there are 6000 hospitals in the U.S. and only around 1900 that stock the drug, this really matters. It’s one thing to run all over town to find your favorite shampoo, another when the clock is ticking on your life. Time is of the essence with snakebites and choosing the wrong treatment locale can mean the difference between a good recovery and a bad one. Instructions for First Responders in the app help ensure they follow best practices during the transport and not to do what they see on TV, like apply a tourniquet, which is a no-no in this instance.

For the Emergency Room personnel, there is a companion part of the app which includes algorithms for proper anti-venom dosing given bite age and patient specifics. There is also safety information about the drug, as well as guidance for the physician who probably doesn’t see a lot of snakebites and may not have thought about this problem since medical school or viewing Raiders of the Lost Ark.

The drug itself has a wild route to market. The company that makes it, BTGplc, is a UK-based pharmaceutical and medical device company that actually owns a snake farm. They also employ snake wranglers who catch wild snakes in a few different locales so they can mix the venom of the domesticated and wild snakes together and ensure there is an adequate cocktail based on type, age, sex, and perhaps horoscopes and whatever else the snake version of eHarmony might suggest. For some reason I can’t help but imagine a bunch of guys in straw hats sitting on stools and singing songs from Oklahoma! while milking snakes, but I’m sure they have a better way to extract the venom.

Once liberated from the snakes, the venom is then shipped to BTG’s other farm in Australia and, get this, injected into sheep so that the blood antibodies needed to make the anti-venom can be produced. Think of the sheep like wine barrels where the anti-venom is aging, but where the barrels are covered in wooly hair, say “Baa!” and have a close affinity to a woman named Mary. The antibodies are recovered by drawing blood from the sheep, which aren’t getting paid enough if you ask me. The antibodies are refined into the doses of anti-venom at another facility in Wales. So your California Diamondback is getting treated by a drug distilled from American snakes, via Australian sheep and Welsh scientists. Globalization at its finest.

So there you have it: a digital health product that serves patient and provider, uses data to help prevent the problem (“Watch out, a snake!”) and gives information for when it happens anyway (“Oh damn, a snake!). It uses geographic and clinical algorithms to find the optimal treatment and to allow for personalization of that treatment. And it has a crazy sheep backstory. While SnakeBite911 may not be the cure for the broadest of our health system’s woes (we need a good Heart911 or Lung911), it is a great example of broad thinking about how to create a combined digital prevention and therapeutic product that actually does something useful and creates a closed loop around a condition. If there were iPhones back in Indiana Jones’ day, you know he would have downloaded it. If you want to download it, you can do so HERE.