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Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
February 2015
Grey Market Cancer Care
5 min reading time

My friend and Wharton classmate, Rice University Adjunct Professor Lin Giralt, is building a new concept.

What if citizens of the “grey market” (Third World) had access to “white market” (First World) healthcare?

Legally registered insurers in Mexico, for example, are selling policies in pesos that entitle cancer patients (through their local oncologist) to send DNA samples to the University of Pennsylvania (a charter hospital).

• Mexican doctors benefit because they get access to the very latest medical research and technologies, plus networking and advisory service support from a Penn Medicine oncologist.

• Mexican patients similarly benefit and get better health care.

• Mexican insurers have an additional “buy-up” product available for customers, and may reduce costs by quickly focusing on therapies with a greater chance of success.

There is a secure IT platform, foreign currency conversions, translation services, and case managers for one-to-one follow up.

See http://medgroup.biz/grey-market-cancer for details.

What do you think of the model?

Are there similar models to build your business outside in the grey market?

++++++

IMPLICATIONS FOR THE MEDICAL DEVICE INDUSTRY

Professor Giralt’s idea decouples the in-person/physical and virtual/intellectual-capital parts of the value chain.

Lin wants to address gaps in handling and transmitting paper medical records and EMRs. He seeks more reliable teleconferencing platforms for international physicians, and better software/mobile apps to enable and track the process.

He believes if Next Generation Sequencing DNA analysis (now done in the US by an Illumina machine or similar) could be deconstructed and modularized (so parts could be done in lab modules overseas), we could reduce the cost and failure rates of the process.

He suggests doing some parts of the DNA-biopsy analysis in the home country.

Lin is starting with oncology, but neurology, cardiology, and others are sure to follow.

Is he on to something? How would you guide his development?

Contact Lin at his http://bit.ly/Lin-Giralt LinkedIn profile.

++++++++++

Discussions this week

New China GMP Code Published
http://bit.ly/China-GMP

What happens if you don’t pay the Medical Device User Fee?
http://bit.ly/you-feelin-lucky

First step to market a bone-conducted hearing aid?
http://bit.ly/first-marketing-step

Best way for single-line company to approach distributors?
http://bit.ly/will-you-carry-me

Suggested best practices for finding angels?
http://bit.ly/find-me-the-money

What to do when your molded plastics vendor repeatedly delays?
http://bit.ly/gimme-my-damn-plastic

++++++++++

Make it a great week.

Joe Hage
Medical Devices Group Leader

P.S. Congratulations to ASCO Numatics’ Michael Dellosso who, with his 27-24 Patriots guess won free admission to 10x! http://MedicalDeviceEvents.com


Jonas Moses
Consulting Translational Research Professional: Sciences and Technology Innovation, Tech Transfer and Acceleration
On the other hand, Mr. Giralt, I can evaluate both “anonymous” commenters’ observations, with my own professional experience and knowledge base. However, I am most concerned with your most recent statement, (sic) “Lets focus on the forest not the trees…” That, sir, is a major problem: indeed, the “forest” — providing quality health care to all who need it, regardless of country or ability to pay — is the ‘brass ring,’ so to speak. Yet, regardless of whether or not those who are offering to provide healthcare services give “quality beyond reproach,” if they are seeking to advise patients (in Mexico, the US or anywhere in the world) on cancer, by forecasting cancer on the basis of genetic markers, there is a serious problem.

Diagnosis and/or predicting future development of cancer, on the basis of markers is an unproven and sketchy methodology, and (at best) an inexact science. Until and unless those engaged in delivering such “services” can demonstrate better-than-90% accuracy (at least as good as the chance that a condom will prevent the transmission of disease or pregnancy), those providing these “services” are merely using human beings as unwitting guinea pigs. As far as I know, the Nuremberg Trials expressly condemned this kind of medical experimentation.

Lin Giralt
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
I cannot evaluate the posters medical comments. I will restate that above genomic or similar testing we are offering remote cancer advisory services from top centers whose quality is beyond reproach. Lets focus on the forest not the trees.

Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
For some reason, this post brought out the “anonymous” among us. Here’s another:

Joe, as a consulting cancer biologist (wrote a ground-breaking book on cancer, predicated on my research at […] University) and former clinician (military surgeon), married to a Mexican physician (currently practicing Medicine in Mexico City), I concur with your other private commenter. It is far more likely that Mexican patients might be “snookered” into paying for insurance — which is very expensive in Mexico — thinking they are going to get critical services from US hospitals. In point of fact, the relationship between genetic markers for cancer and the actual development of various cancers is hazy, at BEST.

It is my expert opinion, having been in the forefront of tumor modeling and the developmental biology of cancer:

Cancer is not a genetic disease, nor are there accurate, direct genetic markers for any cancers. In a classic example, BRCA1, was wholly discredited by a colleague of mine, while at […] University…albeit quite unintentionally. He was planning to build his entire career on the proof-positive and exploration/exploitation of BRCA1 and derivatives. However, after three solid, grinding years of experimentation with this “marker,” he not only shut down his lab and left the University, he actually walked away from a promising career in cancer research. He was a brilliant scientist…who discovered fundamental, catastrophic flaws in the science behind these genetic markers. When he tried to go public with his findings, he was threatened with a lawsuit!

At the risk of sounding ominous, there are some very dangerous and dark goings-on in the cancer diagnosis and treatment industries, Joe. Consider that we announced the “war on cancer” under Nixon, in the 1970’s, when I was a small boy. Forty years later, not only are the vast majority of researchers still using mouse models for experimentation (a completely failed approach), physicians are still treating cancers with radiation and chemotherapy (which are both incredibly toxic to the human body), even though it is well-appreciated that cancer IS a disease process of a damaged immune system. Ergo, why further damage the immune system with radiation and chemo, when the correct approach is to repair and enhance it?

Lin Giralt
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
Major US cancer centers will do diagnostics and LatAm insurance companies will pay for treatment
Best
Lin

Richard Maloney
Owner, Aesthetic Surgery Center
Once they get the data, who will interpret the results coordinated with the clinical staging and can they afford and have access to the treatment options?
The genomic fingerprint is part of the whole.

Lin Giralt
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
Do not forget that half our business is remote cancer advisory services, with or w/o genomic tests…we hope to be profitable I. Year one
Best
Lin

Karl Schulmeisters
Principal and Founder at ExStreamVR
>>
On another note, I believe Lin has to decide which business model he wants to pursue. The first is performing the analyses, while the second, completely different, is providing a platform to facilitate international medical cooperation<< I think this comment is spot on. And given that DNA sequencing is still controversial and the benefits of "personalized medicine" still a long way's out (you need a vast dataset to do valid identification) I'm not sure this is an avenue that is going to be profitable in the near term. Lin Giralt CMC
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
Thanks Shikharesh, very on point and useful.

Shikharesh Das
Medical device market entry strategist at Ontogenix
Cross border insurance coverage is a welcome benefit to many irrespective of which part of the ‘market’ they come from and being offered in some other countries as well (bit.ly/1z4OnWd ). For example the developed regions could see a lower cost if they chose to get treated in a developing region and the emerging countries’ (a term preferred over ‘third world’) population would get access to better care for complicated cases, as in Lin’s model. This in a way already forms the basis for medical tourism in Asia.

The challenges are perhaps more serious than privacy, as the cost of long term chronic disease treatment is out of reach for a large population not covered by medical insurance, even in their own country. As top 20% already has access to comparatively better healthcare, the real benefit to the emerging countries would come when the rest 80% gets covered by Lin’s model in not only sending the samples but inclusive of a full follow up treatment if needed, for a better outcome. He is on the right track to engage the public health officials and may want to study some PPP models. There are some good case studies from E&Y here bit.ly/1LKWEc3

Lin Giralt CMC
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
BRUCE, my thanks to you for your support, it has been a long and lonely road and I appreciate your comment
thanks
LIN

Bruce Dobsch
Independent Medical Devices Professional
Like all good ideas this one needs support as well as critical thinking to assure it reaches full potential. I for one totally support. As with any new way of doing business it will have detractors and abusers but good usually wins. Keep going and my heart is with you.
Bruce

Lin Giralt
Business Development, Growth & Profitability Strategist; Director at Lambda, Mirador Trading and TestAnalytika.
1) Zaffar Hayat – thanks, we heard from dozens of LatAm oncologists that these sessions are adhoc and not structured, very irregular in timing, tho these relations exist, they are not medular to anyone, we are trying to structure and improve the process

2) Dr. Jeff Birkenmeier – not brilliant, the MD’s at MD Anderson told us this was a problem and we simply followed up on ..please lets connect and see if we can do something together

3) Clark Celmayster – we try to see it as win win…not that we are solving all the problems but one link in the chain at a time

4) Leena Pradhan-Nabzdyk – we are encouraging our partner, Foundation Medicine to explore separating and offshoring parts of the process, but it is not technically easy, another issue, privacy and malpractice, we are HIPAA compliant, get patient OK for everything and only act as an MD to MD advisory service, never talk to the patient so do not practice medicine in that respect

5) Gary Rosensteel – Gary, we are firmly in the second group, we do not do any medical or lab work ourselves, we are merely a ‘value added integrator’ or facilitator, bringing all these elements together- insurance, logistics, following up, lab tests and cancer advisory…thanks for your comments, we believe that separating the Intellectual capital transfer from the physical value chain is a big step forward…please stay in touch and lets connect offline or online…

6) Joe Hage, not disagreeing with the anonymous poster, certainly there are many primary issues in third world countries that we are not addressing…we are not God… but this – genomic testing – is a key issue that can be addressed by us and if we can make US level cancer care more accessible everyone is the winner… one step at a time…btw, it is NOT a sell more insurance scheme, were that the idea, we would have gone for many simpler and more commercial initiatives…this has been 2 yrs in development so we are not out for quick bucks! Our initial target is the top 20% of the population with private health insurance, but we are also talking to public health officials in these countries to make versions available to their public health patients…also those in HMO’s will have a program for them as well… we believe that everyone has the right to the best care available with or w/o money….’no person left behind’ …”global care, everywhere” is our motto…

Thanks to all, I am overwhelmed by your response and remain grateful, please keep connected and let me know any other comments or ideas you have

God bless you all

and thanks, JOE!

LIN

Joe Hage
🔥 Find me at MedicalDevicesGroup.net 🔥
I just got a private note from someone who wished to remain anonymous. He wrote, “I suspect Mexico has more pressing needs than tumor genetic testing. To me this seems to be just a tool to sell insurance policies, probably to the unwitting.”

Gary Rosensteel
Business Therapist, NuCoPro
Very interesting approach, which I believe is where ALL patient interaction with the medical community is going. The problem in the US is getting the insurers on board to pay for this type of service. There is a rapidly growing startup, Iagnosis, in my town that provides online dermatology consultations, but patients have to pay themselves. The Medical/Insurance Complex is not in favor of any sort of circumvention of their profitable system.

On another note, I believe Lin has to decide which business model he wants to pursue. The first is performing the analyses, while the second, completely different, is providing a platform to facilitate international medical cooperation. I’ll assume the first has a path to profitability, but I strongly believe the second could be (from an investment standpoint) a home run; if not a grand slam!

Zaffar Hayat
CEO/COO/CIO/CFO – experienced entrepreneurial executive with diverse experience in competitive industries
A brief comment – With regards to privacy and malpractice, the issues are being resolved as teleradiology and telemedince are being adopted. Likewise in the case of radiology, DICOM images can easily be sent from one PACS to another as long there is an internet connection available. As pointed above, a diagnosis can be made on the basis of the image.

Leena Pradhan-Nabzdyk
Life Sciences Leader
What about issues of privacy and malpractice liability? I like the model where the actual analysis is done in home country but the diagnosis can be done in the US. Shipping samples from Mexico will be much easier than say India (DOT issues with hazardous samples, delay in transportation etc.) Maybe Lin can partner with Illumina or any such equipment company to perform the analysis in the home country and have a US practice/hospital as a partner to give the diagnosis or other clinical advice (See Zaffar Hayat’s comment above).

Clark Celmayster
Publisher, Evaluation Engineering / West Coast Sales at Endeavor Business Media
As an associate of mine so aptly opined; very similar to telemedicine, telerad or other. We are sending images to India etc. for their radiologists to read, why not for this?

Bottom line, as long as it isn’t an additional burden on our newly socialized medicine here in the states and that it is being paid for by the Grey Market, it would seem to be a win, win.

Dr. Jeff Birkenmeier
Chief Operating Officer and Healthcare Executive
This certainly is great thinking.

Zaffar Hayat
CEO/COO/CIO/CFO – experienced entrepreneurial executive with diverse experience in competitive industries
In some of the grey markets, medical institutions have already established contacts with leading medical institutions in a specific area of medicine in the white market regions. Say, oncology or cardiology. They physicians from the grey markets consult with physicians abroad in the white markets.

These types of consults also provide a potential source of international patients for the white market regions.i.e. patients that require specific treatments only available in these regions. The grey markets become a referral source.

I think what is key in this regard, is the utilization of Tele-medicine/EMRs that will play a major role in making this process seem-less and easy to use by both sides. Patient records and test results can be easily transmitted. Live consults between physicians, utilizing various tele-medicine tools make the process efficient and cost effective.

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