Hospital of the future: breakthrough or manilovshchina?

How viable is "electronic medicine"

Matthew Herper, Forbes.uaBillionaire Patrick Soon-shon is working on an IT system that, according to his plan, will help doctors defeat most diseases.

Skeptics consider the project almost a scam. Adherents – a grand breakthrough in medicine

It's a fine summer day in Los Angeles, but the richest doctor in the world, Patrick Soon-shon, is not up to walking. The billionaire is sitting in the headquarters of his company. The building is hidden behind the entrance gate, so inconspicuous that taxis always skip past the entrance. Patrick is waiting for a like–minded person - Tee Danny Sanford, who earned $2.8 billion by issuing MasterCard credit cards with high interest rates. Today, Sanford is not averse to fork out for charity: he donates most of his fortune to children's aid funds and hospitals. Sanford goes to Soon-shon to see what the advertisement presents as "the future of medicine."

62-year-old Soon-shon has something to show. First, he leads the guest to a full-size model of a futuristic hospital ward and demonstrates a cuff that measures the patient's pulse, temperature and blood pressure. Nearby is a small device called Hbox, with which all medical equipment is connected to a computer network. Soon-shon shows a dim room filled with monitors.

This is a control center where a handful of doctors can monitor the condition of hundreds of patients – even those who are treated on an outpatient basis. Finally, Soon-shon launches several computer programs. Their task is to provide the latest information (up to the latest articles in scientific journals) about effective methods of treatment. All this accumulation of high–tech toys is the fruit of secretive corporate acquisitions worth a total of $1.3 billion. Sun-shon paid almost the entire amount out of his own funds.

Sanford is delighted with the tour. "I think this is exactly what the world needs. We have a department for working with medical institutions. We help 40 hospitals and 150 clinics, but the costs are growing at a crazy pace. Medical institutions do not exchange information. This needs to be fixed first." "Hospitals lack organization,– Sun-shon echoes him. – They lack money and qualified employees to create a communication infrastructure. To be honest, this should be handled by the government."

Sanford believes the doctor implicitly. They enthusiastically shake hands: the Sun-shona technology will be introduced at the Children's Hospital in Phoenix, Arizona. However, even after the tour, it is not entirely clear what exactly Sanford is buying. Sun-shon's demonstration looks fantastic. But there was no one from the outside with whom I communicated who would try out all the components of this technology in action. Sun-shon has neither a real business plan nor a pricing model. Everything the client gets is Sun-shon's word of honor. The businessman is undoubtedly smart. And, of course, he likes to brag: in medical circles, many people note this quality of his. "Its marketing is three years ahead of real developments," says John Halamka, IT director at Beth Israel Deaconess Medical Center in Boston. – What works on paper and in the laboratory will not necessarily work in a large medical center. Patrick is a showman in a way. It costs him nothing to say: I have solved the problems that others have been struggling with for 20 years and have achieved nothing..."

Such statements cannot but be alarming. From its glittering headquarters - a futuristic glass and steel building – Soon–shon coordinates the work of 800 employees. The office is located in Culver City - a suburb of Los Angeles – next door to the studios of the MGM film company. This place has given birth to dozens of Hollywood fantasy films, including The Wizard of Oz.

I have spent the last 10 months trying to lift the veil of secrecy surrounding Sun-shon's firm. The businessman gave me a unique opportunity to get acquainted with his project in detail. At that moment, he himself was engaged in concluding a deal with a non-profit organization Providence Health & Services, which finances 34 hospitals in the states of Oregon, California, Alaska, Washington and Montana. Providence Health & Services will be the first to introduce Sun-shon technologies. In addition, I talked to a dozen experts.

The first thing that everyone I've talked to pays attention to is the scope of Sun–shon's project. "When we found out what he was up to, we were amazed," recalls Gillis McKenna, head of the Department of Oncology at Oxford University. "If he succeeds in completing what he started – and it won't be easy, then the amount of data on the basis of which we can make decisions will increase exponentially." Sun-shon explains: "Every day we will have more information at hand than humanity has produced in its entire history. We will receive them not once a month or a week, but every day. Thanks to full awareness, we will abandon the vicious practice of prioritizing the treatment process instead of the result. Because of it, the annual cost of medicine in America has already exceeded $ 3 trillion. Information will help to defeat most diseases, even cancer."

Soon-shon is used to being treated with skepticism. He grew up in apartheid-era South Africa, in a family of Chinese immigrants. At the age of 16, the future scientist graduated from school, and at 22 – medical college. His first patient was afraid to let doctors near him. But after Soon-shon drained his inflamed sinus, he began to advise his friends: "Go to the Chinese. Just let him treat you."

Soon-shon left South Africa in the late 1970s, and in 1980 entered the University of California, Los Angeles (UCLA). Hematologist Stephen Nimer, who later joined the board of directors of one of Sun-shon's companies, considers him "an amazing surgeon." Patrick always took on the most difficult operations. "The desire to help people is in his blood," says Nimer. The same can be said about the scientist's craving for bragging and talent to anger colleagues and investors. When Soon-shon worked as a surgeon at UCLA, his name made headlines after an operation to transplant insulin-producing cells to a diabetic. The president of the American Diabetes Association considered the hype in the press inappropriate. "It's too early to consider a transplant as getting rid of diabetes or even as a way of therapy," he was indignant.

In 1990, Soon-shon created a company that was supposed to put his diabetes treatment method on commercial rails. He made a deal with the pharmaceutical company Mylan – he wanted to do research on transplanting internal organs of pigs to humans. Later, the scientist rejected this idea, considering it unsafe. The case ended in legal disputes in which his brother was involved.

Then, in 1991, Soon-shon invented abraxane, a medicine that brought him a huge fortune. In fact, it is a well-known antitumor drug taxol, "packed" in albumin protein. According to Sun-shon's plan, by consuming albumin, cancer cells were supposed to receive a portion of taxol and die.

Leading oncologists have dubbed abraxane "old wine in a new bottle." But Soon-shon was sure that he had made an important discovery. He decided to take an innovative and risky step for himself. Typically, biotech companies finance research by selling their shares to venture capitalists. Instead, the scientist took out a loan and bought a small public company for the production of generic drugs. The company was renamed American Pharmaceutical Partners (APR) and moved the production of abraxane there. Doctors who joined a group for the wholesale purchase of medicines invested in the company. The group purchased medicines from APP, so they saw a conflict of interest in the investment. Sun-shon, on the contrary, believes that this investment helped prevent the shortage of abraxane. As soon as the APP went public, the group's shares were sold. But Soon-shon's reputation has suffered again.

In 2005, the scientist won a major victory: the American FDA approved abraxane. APP shares soared 47%. But Soon-shon found himself at the center of a scandal again when, a few months later, he merged the APP with a private company owned by him. On the day the deal was announced, APP securities fell by 18%. But in 2007 they went up again. The company turned out to be the only manufacturer of the anticoagulant heparin, whose products did not need to be recalled from hospitals because of the impurity that killed 81 patients.

Soon-shon divided the APP into two parts and sold them. The business of producing generics, including heparin, was transferred to Fresenius in 2008 for $4.6 billion. The abraxane division was bought by biotech giant Celgene for $4.5 billion. At the time of the sale, Soon-shon owned 80% in each business. Then – another unexpected piece of luck. By 2011, sales of abraxane brought in only $386 million, which is a fairly modest figure for a thriving biotech sector. But last year, studies showed that the drug prolongs the life of patients with pancreatic cancer by 1.8 months. Sales soared by 90%, and by 2017, it is expected to reach $2 billion. Shares of Celgene, in which Soon-shon remains the largest individual shareholder, have steadily gone up.

Thanks to his intelligence, determination and a bit of luck, Soon-shon turned out to be the owner of a huge fortune: Forbes estimates him at $ 12 billion. However, he gained a reputation not as a scientist, but as a businessman. And this, according to friends, offends the researcher. "He is respected as a businessman," says Michael Crowe, president of Arizona State University, with whom Soon–shon works, "But this is not the fame that the creator of a drug that increases the survival rate for cancer to 80% deserves."

Sun-shon's new large-scale project is akin to science fiction. In theory, his technology should work like this. A cancer patient comes to the clinic for examination. He is given an instant comprehensive analysis – from decoding DNA to determining the composition of blood. The results are transmitted in real time via an ultra-fast network based on proprietary technology. No fountain pens, paper and folders for documents. After a few minutes, computers recommend which drugs should be tried. When the patient returns home, doctors continue to monitor his condition using the same technology. Meanwhile, the clinic administrator evaluates the effectiveness and cost of various procedures and medications by comparing data from hospitals across the country.

This concept was born in 2005, during the approval process of abraxane. One of the studies showed that doctors incorrectly prescribed treatment to every two out of three patients with pancreatic cancer. Soon-shon realized that computers alone could not solve the problem. We need to connect them with a high-tech "nervous system". "How could one hope to win, relying on new knowledge in molecular biology in the fight against a disease that is constantly changing?" – asks the scientist.

Like an auto mechanic scouring for spare parts, Sun-shun began buying up companies and building his new "car" out of them. Among them is Philadelphia–based Eviti, which offered insurers services to verify the correctness of treatment prescribed to cancer patients. Three dozen oncologists and nurses of Eviti carefully study medical journals. The goal is to make sure that doctors use only the latest information.

Another purchase is the iSirona company from Panama City, Florida. Its specialists are engaged in connecting medical equipment to electronic medical records management systems. Soon-shon claims that he can now connect 6,000 different devices with a computer network, including pulse oximeters (blood oxygen saturation sensors), blood pressure monitoring devices and floor scales. Hundreds of different medical and financial computer programs from major manufacturers are also connected to the system.

Other technologies are also used. Using the Qi Imaging program, for example, you can view CT and MRI scans on mobile devices. A GlowCap pill bottle with a smart cap for $80 reminds the patient by flashing an indicator that it's time to take medicine, and then tells the doctor whether the patient has opened the vial. In addition, Soon-shon bought for $100 million and upgraded the high-speed government computer network National LambdaRail. According to it, he plans to transmit medical data. "In order for the treatment to be of high quality, it is necessary to track the result in real time," the billionaire explains. – The same should be done with costs. Then the patient will be able to receive the highest quality medical services at the lowest price."

All of these companies (and dozens of others that Soon-shon bought or founded) are combined into a corporate structure as convoluted as its final product. About 800 employees of Sun-shon are scattered across offices in 14 cities. Parent holding company NantWorks has nine divisions. Everyone has their own group of investors. All divisions were created so that they could be brought to the stock exchange separately. The first IPO is planned for next year – it will be held for the NantHealth division, which develops information technologies for medicine. Investors include Verizon, Celgene, BlackBerry and the Kuwait Investment Authority. Forbes estimates NantHealth at $1.6 billion, and all the holding companies at $7.7 billion.

The potential advantages and disadvantages of Sun-shon's medical project fit into a single indicator: 47 seconds. That's how much, according to the entrepreneur's doctor, his most complex supercomputer needs for genetic analysis. Accuracy – up to the identification of individual proteins susceptible to a particular drug. "Usually such an analysis takes 11 weeks," smiles Sun-shon. This is an incredibly bold statement. And like many other statements of the businessman – unconfirmed.

For the first time, Soon-shon presented his platform to the general public in October 2013, at the Forbes Healthcare Summit conference in New York. The presentation turned out to be surprisingly interesting and emotional. The participants – outstanding doctors, scientists and heads of medical institutions – recognized Sun-shon as the best speaker (95% of the audience rated his performance as good or excellent). But many participants reacted to the billionaire's report skeptically – precisely because of his statement about "47 seconds".

Last year, I spent a lot of time trying to figure out whether Sun-shon's words about "47 seconds" can be trusted – the billionaire repeats them too often. It turned out that his statement was fundamentally wrong. 47 seconds is the average value of the interval with which the results are given, and not the analysis time for one patient. You might as well say that a McDonald's restaurant is able to instantly give you 800 boxes of "Happy Meal", based on the fact that the company sells 800 boxes per second worldwide. How long does the analysis of the patient's genome actually take? Soon-shon admits that he aims to speed it up to 24 hours.

It's incredibly fast anyway. David Feinberg, president of the UCLA Health System division, confirms that he received analysis data for cancer patients in a couple of days. Randy Axelrod, executive vice president of Providence, where the Nant system will soon be implemented, said that he was given DNA sequencing data from several patients in a few hours.

Why then is this unnecessary, if not harmful, exaggeration about 47 seconds? Can't we just say: we use incredibly fast equipment and data networks? In the end, it doesn't matter how long the analysis takes: 47 seconds, an hour or five hours. Accuracy and cheapness are important.

Sun-shon is annoyed by such questions: "When you go beyond the usual framework, some people feel threatened and attack," he says. – And if you also have a public firm, then stock speculators playing for a fall add fuel to the fire. Fortunately, strong people (I don't mean only myself) persistently continue their work. If they had given up, we would never have seen many breakthroughs in healthcare, science and technology."

Soon soon-shon will have a chance to silence the skeptics. "He has brilliant ideas and fantastic employees," says Jim Davis, director of technology at Genomics England. "It's just about the introduction of technology."

At the Los Angeles St. John's Hospital. Joanna, to whom Soon-shon donated $85 million, is already working on a prototype of the system created by Nant. It tracks the progress of patient treatment and its cost in real time. Providence Health & Services, which bought the hospital, has planned a full-scale implementation of the system. When Soon-shon made a deal with Providence, he met with its CEO Rod Hochman. The businessmen agreed to use Providence as a testing ground not only for NantHealth software, but also for its genetic analysis technology. 25,000 cancer patients will undergo this procedure.

Cancer is a genetic disease. It develops when a genetic defect, or more often a combination of them, leads to uncontrolled cell growth. By identifying genetic defects and selecting medications to eliminate them, doctors will be able to fight oncological diseases that cannot be cured in any other way.

Sun-shon has an example of successful use of Nant technology. A woman with cervical cancer underwent a DNA sequencing procedure. When the data was uploaded to Nant computers, it turned out that the human papillomavirus that causes cancer had embedded itself in a gene called HER2. This gene is blocked by the drug herceptin, which is used to treat breast cancer and is usually not given to patients with cervical cancer. After treatment with herceptin, the tumor shrank.

The story is good, but the advertising hype around it, again, only harms. The Nant system has shown excellent results. But it can hardly be called a medical breakthrough or even a unique case. For example, the startup Foundation Medicine, which is funded by Bill Gates and Google Ventures, published information about a case when a cancer drug helped fight a colon tumor.

What makes the Nant system unique is its scale. If Foundation Medicine checks 343 cancer cell genes for mutations, Sun-shon plans to test 260 times more. The company will sequence the entire genome of the patient, the genome of cancer formations (it differs from the genome of healthy cells), as well as RNA chains created by cancer. Even with the use of sequencers, decoding the patient's genome will cost $3,000 and take three days plus a day for analysis. Providence plans to partially pay for the procedure at the expense of insurers.

Perhaps the most eloquent phrase about Sun-sean was uttered by Susan Desmond-Hellman, CEO of the Bill and Melinda Gates Charitable Foundation. She followed the progress of the scientist when she led clinical research at Genentech, then as rector of the University of California at San Francisco. At the Forbes Healthcare Summit, Susan said, "Don't underestimate him."

Portal "Eternal youth" http://vechnayamolodost.ru12.11.2014