The Kids Are Alright – With Just a Little Help from the Innovators

I was in Austin last week for South By Southwest (SXSW), a sort of conference/meetup/party/experiential mash-up which is really like no other event that touches healthcare.  At SXSW you can see a healthcare startup pitch, experience the latest and greatest in weird automotive or robotics engineering, see a movie and take in a concert, all while doing yoga and eating a taco.  It’s some sort of funky combination of Health 2.0, CES, the Cannes Film Festival, Lollapalooza and Joe’s Taco Lounge.  It’s hard not to like.  Especially if you like tacos.  Tacos are everywhere.  In San Francisco, every third store is a coffee shop.  In Austin, you can get tacos for breakfast, lunch and dinner.  And snacks.  You could probably rename SXSW something like Blockchain Tacos with a Hollywood Beat (BTHB) and it would work.

It used to be that the healthcare programming at SXSW was sort of short and meh.  But it has become quite robust under the auspices of Energizing Health, Novartis, and numerous others who have invested heavily in creating great programming.  This year there was a particular focus on health disparities and underserved communities.  Good stuff.

One of my primary tasks in coming here was to emcee the Impact Pediatric Health Innovation (IPH) event, which has been running for 5 years at SXSW. True story: I was supposed to emcee the first IPH event but couldn’t do it, so they got Mark Cuban instead.  Guess they had to settle….

Be that as it may, IPH is a forum for the audience to see targeted and innovative digital health and medical technology solutions that address the unique challenges of children’s health, from babies to teens. It’s also a forum for entrepreneurs to compete not just for recognition, but for cash and support from supporting organizations. Those supporting organizations are the Cambia Health Foundation, the Southwest National Pediatric Device Consortium, plus 8 top-ranked pediatric hospitals that come together for this in an unprecedented show of cooperation, collaboration and collegiality that you rarely see in the adult health world.  The hospitals include Boston Children’s, Cincinnati Children’s, Texas Children’s, Seattle Children’s, Children’s Healthcare of Atlanta, and Stanford/Lucille Packard Children’s Hospital.  These places all send their best and brightest to share, learn and also judge the presenting startups.  Everyone’s goal is to find solutions to real problems that face babies and kids and to recognize and provide exposure, counsel, and potential financial support (from prizes or hospital product evaluation) to accelerate the concept to clinical use and patient impact.  A secondary goal is to foster excitement and action around innovation in the pediatric space, helping providers, payers, patients, and families get involved and move the process of care forward.

Pediatrics is one of the most grossly underfunded areas of healthcare when you look at the venture capital world.  It’s ironic, as the response from venture capitalists is always “the market is too small.”  In fact, an estimated 43 percent of U.S. children, some 32 million, currently experience at least one in 20 key chronic health conditions. This number increases to 54 percent if we include children who are overweight, obese, or at higher risk for social or emotional developmental delays. Notably, per capita spending on adults in Medicare exceeds Medicaid spending on children by a factor of 4 to 1. Yet Medicaid covers over 45 million kids.  That is a legitimate market.

Considering that everyone I know was a kid at one point or another, this small market excuse just doesn’t hold up for me.  What it should mean is that we seek capital-efficient solutions that need lower amounts of investment to pay-off well for all involved.  But considering that many of us end up not just as investors, but also as parents, I think the venture field should open its mind a little more to this population, who are not just miniature adults and who have significant clinical and access problems.

Today’s kids are tomorrow’s chronically ill patients if we aren’t careful.   Given that the United States is one of the world’s wealthiest nations, there are big gaps in our healthcare system when it comes to prevention and treatment.   Worse than that, only half of U.S. children meet basic criteria for flourishing. Similar high proportions of children experience Adverse Childhood Experiences (ACEs), which have demonstrable impact on early brain and social development and subsequent adult health.  Children exposed to ACEs are over twice as likely to have chronic health problems, even after taking into account all other contributors to health, such as adult lifestyle and nutrition.  I have written about this topic before in the context of cardiovascular risk, which you can read HERE.  But for now, I’m back to SXSW (BTHB?) for actual opportunities to solve these problems.

This year at IPH, there were 12 finalists, drawn from an applicant pool of 100 companies, that got to present to and be grilled by the panel of judges drawn from the health systems and other supporting companies, including Microsoft, J&J, Cambia, AT&T and the American Nurses Association.  Finalists included:

• Smileyscope, Cambridge, MA, transforms scary pediatric procedures with virtual reality, @smileyscope
• Bardy Diagnostics, Seattle, WA, digital health and remote cardiac patient monitoring innovation @bardydx
• InfraScan, Philadelphia, PA, developed an easy to use, handheld brain scanner to identify brain bleeds
• Prapela, Boston, MA, helps newborns breathe, relax and sleep with SVS – a breakthrough technology @Prapelainfo
• Gravitas Medical, San Francisco, CA, developed a ‘smart’ nasogastric feeding system
• PolyVascular, Houston, TX, created pediatric polymeric transcatheter pulmonary valves @PolyVascular
• Vifant, LLC, Philadelphia, PA, vision screening test preverbal and nonverbal children
• Sound Scouts, Sydney, Australia, provides accessible hearing checks for school-aged children @SoundScoutsGame
• BabyNoggin, San Francisco, CA, whole child population platform to screen and test for developmental delays @BabyNogginApp
• KinChip Systems, Perth, Australia, link health, education and social services for better care outcomes @KinChipSystems
• Better Living Technologies, Austin, TX, hardware enabled software driving patient behavior changes and outcomes with data @BetterLivingPBC
• Elemeno Health, Oakland, CA, B2B SaaS ‘virtual coach’ for frontline teams to improve quality and safety @elemenohealth

It’s a challenging pitch competition because entrepreneurs get a grand total of 3 minutes to present the most important thing they do, and then they get to be pummeled with questions about how they do it and why pediatric hospitals and others in the field should care.  It’s pretty intense and I am always amazed that people can cram their life’s work into this condensed box of time.  The winners this year were PolyVascular (in the Medical Device and Health Disparities competition) and Sound Scouts (in the digital health category).

Some of the pitching companies are still quite early stage, pre-revenue, pre-FDA approval.  Others are in the market already.  All are pretty early in their development.  I was struck by how many of them were in the diagnostics and screening field this year: 5 of the 12.  Screening and diagnostics are always tough, particularly when you have to link them to treatment, payment and distribution models.  But there are some known pathways, aka through the schools, for some of these capabilities.  Clearly we need to do a better job identifying kids early for hearing loss, vision problems and developmental disabilities – all areas where early identification and intervention can make a material difference in clinical outcome.

Two companies that particularly stuck out as interesting to me were Gravitas Medical and Prapela.  First of all, they are quite different than some of the other things I have seen.  Second of all, they are addressing serious and immediate problems for which there are few other solutions (and maybe no good ones).

Gravitas is solving the problem of nasogastric tube misplacement in babies.  Let me break this down for you non medical people:  More than 1 million babies per year need feeding tubes placed due to a variety of other medical conditions.  In about 43% of these patients, the tube is accidentally and traumatically placed into the LUNGS or other places it is not supposed to be (aka, esophagus) – so we are talking about nearly half a million cases of medical error.  As you may remember from high school biology, the lungs are not part of the process of eating, so this is a major freaking mistake.  Babies die every year from this mistake and, today, tubes are generally placed blindly into kids.  Sometimes Xrays are used but they don’t always tell the story, and are not always used when available in an effort to avoid radiating the baby.  More often than should be the case, evidence-based practices for placement are ignored or unknown.

Gravitas Medical has invented a smart feeding tube that automatically aids in placement and immediately informs the clinician if the tube is in the right or wrong place.  This enables faster time to feeding, of course, but also prevents a potentially tragic never event.  It also gives continuous feedback about whether the baby is experiencing gastric reflux, an important thing to know.

I honestly do not have enough knowledge of the company to verify whether their data is robust enough yet, but they have some very smart and experienced people involved.  This seems like the kind of innovation that will be a no-brainer at most children’s hospitals or units when they get their FDA approval in 2020, as expected.

The other company that really struck me was Prapela. The company has licensed and created technology that treats babies born with neonatal abstinence syndrome – aka born into an immediate experience of opiate withdrawal.  The company relies on a technology called “stochastic vibrational stimulation” which for us political scientists is also known as random vibrational patterns, emitted by an insert to the baby’s mattress.  This isn’t like those rocking/vibrating things you find at Baby’s R Us.  Rather, these products were developed for clinical use and, due to their approach, reduces the baby’s pain, soothes most almost immediately to enable sleep, and does not create a dependence on the vibration itself.  According to Prapela’s website, “Prapela’s SVS is a random vibration that stabilizes the  brain’s pacemaker neurons supporting cardiorespiratory function. Stabilizing the neurons can enhance healthy, rhythmic breathing and heart rate. Rhythmic breathing helps babies relax.” 

Basically, this is a form of external, non-invasive neurostimulation that reduces the many horrific side effects of an infant’s opioid withdrawal, all without a drug. The company is in the process of getting FDA approval for an in-hospital product but sells an at-home product now (presumably with a less medical label).  They cite several clinical studies on their website and have a highly professional clinical pedigree.  Again, I am not an expert on this company and can’t verify it’s claims, but I was impressed – solving this awful problem in a simple and non-invasive manner is one of those holy grail challenges.   Some babies may come into the world with a miserably monkey on their back, but if we can tame it quickly and get them on the right track, that is what healthcare is supposed to be about.  I hope they are incredibly successful.

There were many other interesting product entries in the IPH, but one comment particularly caught my attention and is worthy of remembrance by all of us in the healthcare field.  Peggy Macguire, President of the Cambia Health Foundation, made a comment about how innovation does not always have to be about technology.  Rather, innovation advances can be simple and still make a major difference for patients. Peggy told a story about a young child with a terminal illness who had been discharged to be with her family at home.  In her first several days at home, the child refused to sleep.  Doctors could not figure out a solutions short of sleep aid drugs.  Eventually, after several days of trying to tell the little girl to sleep, one of the nurses asked her what was keeping her awake.  And get your tissue ready people…the little girl told the nurse that she was afraid that if she fell asleep she would not go to heaven – that she had to be ready and alert for when the time came.  Well the nurses took that patient input and high-tailed it to a neighborhood craft store where they bought the kind of angel wings you get for a Halloween costume or ballet recital.  They brought them to the little girl, put them on her, and she promptly fell asleep, knowing that the angels would recognize she was ready to go, even with her eyes closed.  I’ll pause while you pretend you’re not choked up.

Bottom line:  engage the patient, think about the circumstances, use technology when you must, use love when it’s enough. I’ll leave you with that for today.  And I recommend you take a look at the Innovation in Pediatric Innovation website HERE and attend with me next year.  One thing I know for sure: there will be tacos.