White House Precision Medicine Initiative Summit features Tidepool’s Mr. Howard Look in conversation with President Obama – February 25, 2016

This morning, the White House hosted the Precision Medicine Initiative (PMI) Summit – featuring Tidepool’s Mr. Howard Look – to mark the program’s one-year anniversary. Highlights from the two-hour summit included a terrific panel discussion with President Barack Obama, Mr. Look, and several leaders in the biomedical sciences that touched on the potential of improving therapies through the liberation of data. Mr. Look’s comments resonated particularly powerfully with the audience, and one of his statements even prompted roaring applause: "patients with … diabetes shouldn’t have to outsmart the very companies they depend on for these life saving devices."

Notably, today’s panel was not Mr. Look’s first visit to the White House – in July 2015, he was recognized by President Obama as one of nine 2015 “Champions of Change for Precision Medicine,” an honor that acknowledges individuals making a difference in disease management in the US. Today’s event represents yet another major victory for Mr. Look and the Tidepool team who have done a lot since announcing their first integration in January 2014 with Asante – Dexcom G4, Medtronic pumps/CGM (from CareLink), Insulet’s OmniPod, Tandem, and Bayer devices (Animas is coming soon) all currently download to Blip, which launched late last year. We have been fans of Tidepool’s unselfish spirit and commitment to the non-profit path and this was not only an opportunity to make Tidepool’s name more widely known but – even more importantly – to put diabetes more firmly in the public eye. After all, would a diabetes non-profit have been picked for this stage ten years ago? We think not … How far we have come …

More broadly, we’d be remiss not to mention the insights shared by President Obama himself. He did not address diabetes specifically but his insights certainly applied, whether in terms of major barriers (“part of the problem we have right now is that every patient’s data is silo’d”), the importance of population management (“the goal is to create a common database of a million people ... we can then take a disease and see patterns we might not have seen before”), or empowering patients (I would like to think that if someone does a test on me or my genes, then that data is mine.”). Ultimately, we were encouraged to see the President throwing his weight behind the digital health movement, and it was – frankly – inspirational to see just how much he appreciates the opportunity for digital health to facilitate more cost-effective, continuous, and value-based care. We agree – and also wonder what more President Obama can do in his limited remaining time in office. We have our fingers crossed that the next administration will be just as forward thinking (of course, given the bureaucratic red tape and checks and balances it’s hard to know exactly how much say the President actually has).

For more details on today’s Summit, check out the full video, watch the panel discussion featuring Mr. Look and President Obama, or read about some of the commitments made by private-sector organizations and federal agencies to help further the PMI. Below, we have provided background on the PMI, a review of where Tidepool stands with Nutshell, and our top quotable quotes from President Obama and Mr. Look.

• Mr. Look did not share any updates on Tidepool’s activities – not that we were expecting him to, of course. That said, he did note at ATTD that the non-profit hopes to release its novel Nutshell app “within the next quarter,” enabling users to improve mealtime insulin dosing by keeping track of insulin and glycemic data from past meals. By logging and integrating mealtime data (bolus, correction, pre- and postprandial blood glucose values), Nutshell delivers insights that can help users make more informed bolusing decisions for future meals. Nutshell is still in beta testing and will be freely available via open source after its launch.
• Speaking of the D-Data landscape, we learned at ATTD 2016 that Glooko plans to develop two insulin decision support tools: the DreaMed MD Logic pump advisor (funded with $3.4 million from Helmsley Charitable Trust) and a mobile insulin dosing system for type 2 patients to manage long-acting insulin titration. ATTD was the first-ever mention of the latter, which could be very impactful in our view, particularly in the PCP setting. Both systems will help clinicians be more efficient and effective as the software will do analysis and give clinicians crystal clear decision support for changing insulin doses (e.g., for pump users, change basal from 0.95 u/hr -> 0.8 u/hr from 12-8am due to pattern of nighttime hypoglycemia; for MDIs, increase basal insulin dose by two units based on high morning fasting BG). We have long thought insulin titration is one of the biggest challenges in diabetes – particularly for overwhelmed PCPs – and we’re elated to see Glooko prioritizing tools to make it easier. We wonder what Tidepool may have planned along these lines …
• As background, President Obama announced the PMI during last year’s State of the Union address, specifically mentioning diabetes as an area of opportunity. It is a $215 million investment in individualized medicine, and aims to use data from ~100 million participants to customize treatment plans and improve health outcomes. We see precision medicine is an excellent match for diabetes given the immense heterogeneity of the diabetes patient population and the need for diabetes treatments to be compatible with a diverse range of lifestyles. At the same time, we have also been reminded over the past 12 months that genetic links are incredibly complex in all disease states and that understanding them is the first step towards developing targeted therapies. Are we there yet with diabetes? Certainly not. Here’s hoping that with more funding we can get there …  

Quotable Quotes

• “One of the promises of Precision Medicine is not just giving researchers and medical practitioners tools to help cure people, it’s about empowering individuals to monitor and take a more active role in their health.” – President Obama
• "There’s this fear where [device makers and cloud service providers] may say ‘We don’t know what people are going to do with the data, and we’re worried about the liability if that data gets out.’ One thing we can do is just make it very clear that by publishing your data protocols, you’re not accepting any new liability. It is up to the people who take that data downstream to make sure they’re using it in a safe, effective way." – Mr. Look
• “When it comes to gathering and disseminating data – making sure it’s accurate and valid, and that we are communicating it to the patient – sometimes we’re fitting square pegs into round holes. We may have to re-conceptualize this to open up the space.” – President Obama
• “By liberating data from devices, we were able to come up with a much better way to deliver therapy.” – Mr. Look
• “If we do precision medicine well, and we get that data to consumers, it gives them the ability to stay healthy for long periods of time. And that’s hugely promising. It’s good for individuals, it’s good for society.” – President Obama
• [On barriers to sharing] “Another challenge, and this is an easily fixed one, is just making the interfaces available. Devices companies can publish the data and control protocols for their devices. And cloud providers can use very simple, well-known APIs. The President and I are both wearing our Fitbits. There are APIs that let us pull our Fitbit data; there should be APIs just like that that let us pull our diabetes data. These are very solvable problems.” – Mr. Look
• “Part of the problem we have right now is that every patient’s data is silo’d. It’s in a hospital here, a hospital there, a doctor here, and a lab there. The goal is to pool and create a common database of a million people … We can take a disease that may be pretty rare and see patterns we might not have seen before.” – President Obama
• “How do we ensure that if we donate our data to this big pool, it’s not going to be misused or commercialized in some way? We need to set up structures that make me confident that if I’m making contributions to science, I’m not going to end up getting a bunch of spam targeting people who have a particular disease I may have.” – President Obama
•  “When I mentioned researchers earlier, part of the reason people are worried about getting credit is because research dollars and grants flow in the direction of people who get credit. Re-thinking how the NIH designs its grant-making to encourage collaboration rather than siloing is going to be important. There’s going to be a whole range of areas where we may need new safeguards, for example in terms of privacy and security of data being disseminated.” – President Obama
• “Today, we are announcing that 40 more organizations are joining us in the process to create a whole new set of initiatives to drive this even faster. My hope is that this becomes the foundation and we can look back and say we’ve revolutionized medicine in cancer, Alzheimer’s, and other diseases that so many people suffer from. There’s no better place to do it than in the USA where innovation and R&D have driven our economy and improvements in life expectancy and quality of life.” – President Obama

-- by Ava Runge, Varun Iyengar, and Kelly Close