Small Door, the OneMedical for pets, launches NYC location

Small Door, a veterinary services membership startup, today announced the grand opening of its NYC location at 15 Seventh Ave. Small Door soft-launched the space in November of 2019.

The vet startup first came onto the scene in April of 2019 with a $3.5 million seed round led by Lerer Hippeau Ventures, with participation from Primary Venture Partners and Brand Foundry Ventures. Flatiron Health founders Nat Turner and Zach Weinberg, Warby Parker cofounders Dave Gilboa and Neil Blumenthal, and Sweetgreen founders on Neman, Nic Jammet, and Nat Ru also invested.

The company is taking a fresh approach to veterinary services by offering a membership program, not unlike One Medical.

Part of the problem with vet services is that veterinary practices are often overworked and underpaid. This can translate to long waits for patients, short visits, and a low quality of professional life for veterinarians themselves. Through a membership model, Small Door believes it can give vets more time with their pet patients and decrease wait times considerably for patients and their owners.

The company has also rethought healthcare space itself. For example, the waiting room is spread out and designed with little nooks to keep animals happy and unthreatened by their fellow patients while waiting.

Different membership tiers get users access to different features. For dogs, the base tier ($12/month) offers same or next-day appointments, priority access to specialists, and 24/7 virtual care. The Premium tier ($75/month) offers two annual exams, core vaccinations, an annual blood panel, and other preventative care like deworming, heartworm screening, etc. The Premium Plus Tier ($89/month) offers everything in the premium package alongside a 12-month supply of both flea and tick preventative treatment as well as a 12-month supply of heartworm preventative treatment.

For cats, plans range from $8/month to $74/month with similar offerings.

Small Door was set up as a Public Benefit Corporation, identifying Small Door vets and pets as key stakeholders in the business. Suicide is a growing problem among vets, who often deal with mounting debt, compassion fatigue, difficult hours and even more difficult customers.

Since its soft launch, 55 percent of Small Door customers are millennials and 70 percent of customers are women, according to founder Josh Guttman.

LocalGlobe partner Julia Hawkins discusses femtech’s risks and rewards

London-based seed fund LocalGlobe is incredibly active at the early-stage end of the startup pipeline with a broad focus across multiple sectors and areas, including health.

We interviewed partner Julia Hawkins about the opportunities and risks related to femtech investing in light of the fund’s early backing for Ferly, a female-founded startup with a subscription app that describes itself as an audio guide to “mindful sex.”

The startup says its mission is to open up conversations around female sexual pleasure and create a place for self-discovery and empowering community — touting “sex-positive” content that it says is “backed by research, written by experts, and personalized to you.”

The interview has been edited for length and clarity.

Codagenix raises $20 million for a new flu vaccine and other therapies

Coadagenix, a company developing vaccines and viral therapies for illnesses ranging from the flu and respiratory viruses to dengue fever has raised $20 million in a new round of financing.

The company’s new investment round was led by Adjuvant Capital with additional participation from Euclidean Capital and Topspin Partners .

Codagenix will use the funds to support clinical development of its general flu vaccine and the first RSV vaccine for elderly patients — who are more at risk to serious consequences from contracting the virus.

The company uses a technology called “codon deoptimization” to make versions of viruses and viral therapies that are rendered relatively harmless by replacing more virulent pathogens with milder strains.

Codagenix said it will use the new financing to bring its RSV and flu vaccines through Phase 1 trials and move its oncology program for a breast cancer treatment into Phase 1 clinical trials. It will also launch two new vaccine development programs for what the company called “neglected public health challenges.”

“With the potential to develop optimized, more affordable versions of existing vaccines, Codagenix is poised to solve persistent public health challenges where existing vaccines have made enormous improvements, but still fall short of desired disease control objectives,” said Glenn Rockman, managing partner at Adjuvant Capital. “Equally exciting, the Codagenix technology has an opportunity to succeed where other immunization attempts have failed. We are proud to be supporting the further clinical development of the company’s RSV and influenza programs.”

Founded as a spinout from Stony Brook University in New York in 2012, Codagenix has received backing from government institutions like the National Institute of Health, the Department of Agriculture and the U.S. Army for its dengue fever, flu, swine flu, RSV, and food and mouth disease virus vaccines.

In all, the company has raised $38 million from private non-profits, venture capital investors and $11 million in federal funding.

 

Kids with lazy eye can be treated just by letting them watch TV on this special screen

Amblyopia, commonly called lazy eye, is a medical condition that adversely affects the eyesight of millions, but if caught early can be cured altogether — unfortunately this usually means months of wearing an eyepatch. NovaSight claims successful treatment with nothing more than an hour a day in front of its special display.

The condition amounts to when the two eyes aren’t synced up in their movements. Normally both eyes will focus the detail-oriented fovea part of the retina on whatever object the person is attending to; In those with amblyopia, one eye won’t target the fovea correctly and as a result the eyes don’t converge properly and vision suffers, and if not treated can lead to serious vision loss.

It can be detected early on in children, and treatment can be as simple as covering the good eye with a patch for most of the day, which forces the other eye to adjust and align itself properly. The problem is of course that this is uncomfortable and embarrassing for the kid, and of course only using one eye isn’t ideal for playing schoolyard games and other everyday things.

And you look cool doing it!

NovaSight’s innovation with CureSight is to let this alignment process happen without the eyepatch, instead selectively blurring content the child watches so that the affected eye has to do the work while the other takes a rest.

It accomplishes this with the same technology that, ironically, gave many of us double vision back in the early days of 3D: glasses with blue and red lenses.

Blue-red stereoscopy presents two slightly different versions of the same image, one tinted red and one tinted blue. Normally it would be used with slightly different parallax to produce a binocular 3D image — that’s what many of us saw in theaters or amusement park rides.

In this case, however, one of the two tinted images just has a blurry circle right where the kid is looking. The screen uses a built-in Tobii eye-tracking sensor so it knows where the circle should be; I got to test it out briefly and the circle quickly caught up with my gaze. This makes it so the other eye, affected by the condition but the only one with access to the details of the image, has to be relied on to point where the kid needs it to.

The best part is that there isn’t some treatment schema or tests — kids can literally just watch YouTube or a movie using the special setup, and they’re getting better, NovaSight claims. And it can be done at home on the kid’s schedule — always a plus.

Graphs from NovaSight website.

The company has already done some limited clinical trials that showed “significant improvement” over a 12-week period. Whether it can be relied on to completely cure the condition or if it should be paired with other established treatments will come out in further trials the company has planned.

In the meantime, however, it’s nice to see a technology like 3D displays applied to improving vision rather than promoting bad films. NovaSight has been developing and promoting its tech over the last year; It also has a product that helps diagnose vision problems using a similar application of 3D display tech. You can learn more or request additional info at its website.

Oscar Health now has 400,000 members and expects to bring in $2 billion by the end of 2020

Oscar Health, the upstart healthcare insurance company and technology developer, expects to have roughly 400,000 members insured under its healthcare plans, who collectively will bring in roughly $2 billion in revenue for the company by the end of 2020, according to slides of a presentation from the JP Morgan Healthcare conference seen by TechCrunch.

Those figures, based on the open-enrollment period that just closed, would represent 50% growth both in membership and revenue for the healthcare provider co-founded by Mario Schlosser and Joshua Kushner, founder of VC firm Thrive Capital and the brother of senior Trump advisor Jared Kushner.

Earlier today, Oscar announced that it was partnering with Cigna to provide services to small business owners. Commercial health insurance is a small but growing proportion of Oscar’s total membership, and it’s one area where the company hopes to expand. Essentially, Oscar can bring its technology-enabled healthcare services to small businesses in concert with the large healthcare networks with which businesses are used to working.

To date, Oscar counts around 375,000 individual members on its insurance plans, with another 20,000 coming through small-group insurance and the balance derived from Medicare Advantage customers, according to a person familiar with the company’s business.

Only three years ago, Oscar was a much smaller business, with only 70,000 members after retrenching its coverage and pulling out of markets in Dallas-Fort Worth and New Jersey. From a footprint that encompassed New York, San Antonio, Los Angeles, Orange County and San Francisco, Oscar now expects to operate in 29 markets by the end of 2020.

Fueling that expansion is prodigious capital infusions the company has received over the past few years. In 2018 alone, Oscar raised $540 million from investors including Alphabet, Founders Fund, Capital G (Alphabet’s later-stage investment firm) and Verily, Alphabet’s investment firm focused on life sciences. In all, Oscar Health has raised $1.3 billion to fulfill its vision of providing better healthcare services through technologies like a mobile app for telemedicine, physician consultations, booking appointments, prescription refills and a more concierge-like healthcare experience for its members.

Initially, the company took advantage of the Affordable Care Act’s creation of new marketplaces for individuals to buy health insurance when it launched in 2012, but is now looking to buoy its growth by adding more deals with insurance providers like Cigna for small businesses.

Ultimately, the company envisions a healthcare industry where employer-defined plans will disappear as more consumers turn to Individual Coverage Health Reimbursement Arrangements. In that environment, Oscar’s bespoke services — like the recent partnership with the startup Capsule Pharmacy to provide same-day prescription delivery for Oscar’s members in New York — or the company’s tight relationship with providers like the Cleveland Clinic, become competitive advantages.

Wear your helmet, concludes new study showing electronic scooter injuries have nearly tripled in the last four years

Taking a ride on an electronic scooter soon? Wear your helmet! According to a recent study published in JAMA Surgery, not wearing headgear or taking other precautions while riding is increasingly sending young people to the hospital — leading to over 40,000 broken bones, head wounds and other injuries.

Unfortunately, less than 5% of riders in the study were found to be wearing their helmet, leading to nearly one-third of patients having a head injury. That’s more than double the rate of head injuries experienced by bicyclists.

The rise is likely due to the increasingly popular adoption of scooters among young people in urban areas. Electronic scooter injuries for those age 18-34 increased overall by 222% and injuries sending riders to the hospital rose by 365% from 2014-2018, with the most dramatic increase in the last year. Close to two-thirds of those with scooter injuries were young men and most were not wearing head protection.

“There was a high proportion of people with head injuries, which can be very dangerous,” said Breyer, an associate professor of urology and chief of urology at UCSF partner hospital Zuckerberg San Francisco General Hospital and Trauma Center. “Altogether, the near doubling of e-scooter trauma from 2017 to 2018 indicates that there should be better rider safety measures and regulation.”

Right now there doesn’t seem to be much in the way of requirements for head gear while scootering in California, thanks to a change in the law that went into effect at the beginning of last year. Those over the age of 18 who want to ride without a helmet are free and legal to do so in California. Several other states also don’t require helmet wearing while on a motorized scooter.

The laws may need an update after recent revelations, but in the meantime perhaps the scooter companies themselves can help ensure safety precautions. We reached out to several electronic scooter companies and only heard back from a few about this issue. Lime tells TechCrunch it is committed to safety by encouraging users to wear a helmet, offering discounts to buy one and giving over 250,000 away as part of a campaign. Bird and others also encourage helmet wearing on their site and some companies offer helmets for rent at another location. But the promise of scooters is their convenience. You don’t have to carry anything. You just click on the app and hop on your ride. It’s too easy to just hop on a scooter without prior planning or helmet in tow.

So what’s the solution? Rider responsibility at this point. You’re free to take your chances but, though inconvenient, wearing your helmet on that scooter ride could prevent a serious accident.

“It’s been shown that helmet use is associated with a lower risk of head injury,” said first author Nikan K. Namiri, medical student at the UCSF School of Medicine. “We strongly believe that helmets should be worn, and e-scooter manufacturers should encourage helmet use by making them more easily accessible.”

 

CES was a snoozefest

At a certain point during the last week, I found myself wandering the halls of CES, looking for the gadget that would fix all of my problems. Maybe it’s the modern condition, or just a sign of having been involved in this industry for far too long.

Technology, of course, has a long and sometimes spotty history of attempting to resolve problems it exacerbated in the first place. Fighting fire with fire, as it were. The Nintendo Wii, for instance, was heralded as fight against a sedentary population to which video games have significantly contributed. Hell, Fitbit helped build an entire industry out of it.

Having utterly matured the world of wearable fitness devices, however, the industry has moved on to the next bit frontier: sleep. There’s about a dozen reasons why sleeping with your smartphone is a bad idea, but I’ve woken up with an iPhone imprint on the side of my face more times than I’d care to admit. We know it’s bad and yet, we still do it. But the depths of our addiction are a topic for another time.

A billion medical images are exposed online, as doctors ignore warnings

Every day, millions of new medical images containing the personal health information of patients are spilling out onto the internet.

Hundreds of hospitals, medical offices and imaging centers are running insecure storage systems, allowing anyone with an internet connection and free-to-download software to access over 1 billion medical images of patients across the world.

About half of all the exposed images, which include X-rays, ultrasounds and CT scans, belong to patients in the United States.

Yet despite warnings from security researchers who have spent weeks alerting hospitals and doctors’ offices to the problem, many have ignored their warnings and continue to expose their patients’ private health information.

“It seems to get worse every day,” said Dirk Schrader, who led the research at Germany-based security firm Greenbone Networks, which has been monitoring the number of exposed servers for the past year.

The problem is well-documented. Greenbone found 24 million patient exams storing more than 720 million medical images in September, which first unearthed the scale of the problem as reported by ProPublica. Two months later, the number of exposed servers had increased by more than half, to 35 million patient exams, exposing 1.19 billion scans and representing a considerable violation of patient privacy.

But the problem shows little sign of abating. “The amount of data exposed is still rising, even considering the amount of data taken offline due to our disclosures,” said Schrader.

If doctors fail to take action, he said the number of exposed medical images will hit a new high “in no time.”

Over a billion medical images remain exposed. Experts say the number is getting worse, not better. (Image: supplied)

Researchers say the problem is caused by a common weakness found on the servers used by hospitals, doctors’ offices and radiology centers to store patient medical images.

A decades-old file format and industry standard known as DICOM was designed to make it easier for medical practitioners to store medical images in a single file and share them with other medical practices. DICOM images can be viewed using any of the free-to-use apps, as would any radiologist. DICOM images are typically stored in a picture archiving and communications system, known as a PACS server, allowing for easy storage and sharing. But many doctors’ offices disregard security best practices and connect their PACS server directly to the internet without a password.

These unprotected servers not only expose medical imaging but also patient personal health information. Many patient scans include cover sheets baked into the DICOM file, including the patient’s name, date of birth and sensitive information about their diagnoses. In some cases, hospitals use a patient’s Social Security number to identify patients in these systems.

Lucas Lundgren, a Sweden-based security researcher, spent part of last year looking at the extent of exposed medical image data. In November, he demonstrated to TechCrunch how easy it was for anyone to view medical data from exposed servers. In just a few minutes, he found one of the largest hospitals in Los Angeles exposing tens of thousands of patients’ scans dating back several years. The server was later secured.

Some of the largest hospitals and imaging centers in the United States are the biggest culprits of exposing medical data. Schrader said the exposed data puts patients at risk of becoming “perfect victims for medical insurance fraud.”

Yet, patients are unaware that their data could be exposed on the internet for anyone to find.

The Mighty, which examined the effect on patients, found exposed medical information puts patients at a greater risk of insurance fraud and identity theft. Exposed data can also erode the relationship between patients and their doctors, leading to patients becoming less willing to share potentially pertinent information.

As part of our investigation, we found a number of U.S. imaging centers storing decades of patient scans.

One patient, whose information was exposed following a visit to an emergency room in Florida last year, described her exposed medical data as “scary” and “uncomfortable.” Another with a chronic illness had regular scans at a hospital in California over a period of 30 years. And one unprotected server at one of the largest military hospitals in the United States exposed the names of military personnel and medical images.

But even in cases of patients with only one or a handful of medical images, the exposed data can be used to infer a picture of a person’s health, including illnesses and injuries.

Many patient scans include cover sheets containing personal health information baked into the file. (Image: supplied)

In an effort to get the servers secured, Greenbone contacted more than a hundred organizations last month about their exposed servers. Many of the smaller organizations subsequently secured their systems, resulting in a small drop in the overall number of exposed images. But when the security company contacted the 10 largest organizations, which accounted for about one-in-five of all exposed medical images, Schrader said there was “no response at all.”

Greenbone privately shared names of the organizations to allow TechCrunch to follow up with each medical office, including a health provider with three hospitals in New York, a radiology company in Florida with a dozen locations and a major California-based hospital. (We’re not naming the affected organizations to limit the risk of exposing patient data.)

Only one organization secured its servers. Northeast Radiology, a partner of Alliance Radiology, had the largest cache of exposed medical data in the U.S., according to Greenbone’s data, with more than 61 million images on about 1.2 million patients across its five offices. The server was secured only after TechCrunch followed up a month after Greenbone first warned the organization of the exposure.

Alliance spokesperson Tracy Weise declined to comment.

Schrader said if the remaining affected organizations took their exposed systems off the internet, almost 600 million images would “disappear” from the internet.

Experts who have warned about exposed servers for years say medical practices have few excuses. Yisroel Mirsky, a security researcher who has studied security vulnerabilities in medical equipment, said last year that security features set out by the standards body that created and maintains the DICOM standard have “largely been ignored” by the device manufacturers.

Schrader did not lay blame on the device manufacturers. Instead, he said it was “pure negligence” that doctor’s offices failed to properly configure and secure their servers.

Lucia Savage, a former senior privacy official at the U.S. Department of Health and Human Services, said more has to be done to improve security across the healthcare industry — especially at the level of smaller organizations that lack resources.

“If the data is personal health information, it is required to be secured from unauthorized access, which includes finding it on the internet,” said Savage. “There is an equal obligation to lock the file room that contains your paper medical records as there is to secure digital health information,” she said.

Medical records and personal health data are highly protected under U.S. law. The Health Insurance Portability and Accountability Act (HIPAA) created the “security rule,” which included technical and physical safeguards designed to protect electronic personal health information by ensuring the data is kept private and secure. The law also holds healthcare providers accountable for any security lapses. Running afoul of the law can lead to severe penalties.

“As Health and Human Services aggressively pushes to permit a wider range of parties to have access to the sensitive health information of American patients without traditional privacy protections attaching to that information, HHS’s inattention to this particular incident becomes even more troubling.”
Sen. Mark Warner (D-VA)

The government last year fined one Tennessee-based medical imaging company $3 million for inadvertently exposing a server containing over 300,000 protected patient data.

Deven McGraw, who was the top privacy official in the Health and Human Services’ enforcement arm — the Office of Civil Rights, said if security assistance was more available to smaller providers, the government could focus its enforcement efforts on providers that willfully ignore their security obligations.

“Government enforcement is important, as is guidance and support for lower resourced providers and easy-to-deploy solutions that are built into the technology,” said McGraw. “It may be too big of a problem for any single law enforcement agency to truly put a dent in.”

Since the scale of exposed medical servers was first revealed in September, Sen. Mark Warner (D-VA) called for answers from Health and Human Services. Warner acknowledged that the number of U.S.-based exposed servers had decreased — 16 servers storing 31 million images — but told TechCrunch that “more needs to be done.”

“To my knowledge, Health and Human Services has done nothing about it,” Warner told TechCrunch. “As Health and Human Services aggressively pushes to permit a wider range of parties to have access to the sensitive health information of American patients without traditional privacy protections attached to that information, HHS’s inattention to this particular incident becomes even more troubling,” he added.

Health and Human Services’ Office for Civil Rights said it does not comment on individual cases but defended its enforcement actions.

“OCR has taken enforcement action in the past to address violations concerning unprotected storage servers, and continues robust enforcement of the HIPAA rules,” said the spokesperson.

“We will continue doing our best to improve the global situation of unprotected systems,” said Schrader. But he said there was not much more he can do beyond warn organizations of their exposed servers.

“Then it’s a question for the regulators,” he said.

A sex tech startup’s triumphant return to CES

When the Lora DiCarlo wagon finally arrives, the rolling glass box’s back door opens and another journalist pops out to get on his way. The sex tech company has a week packed full with 20-minute rolling interviews with a curious tech press. No time to spare; I step up, sit down, and we’re on our way.

Driving down the Las Vegas Strip in a transparent box is a curious, extremely Vegas experience: puzzled tourists and confused CES attendees gawk from the sidewalks. Four of us are sitting in a makeshift living room with fuzzy white carpet: CEO Lora Haddock, Enzo Ferrari Drift DiCarlo (her fuzzy black-and-white Pomeranian), and a colleague, who holds Enzo in their lap. A four-foot-tall faux sex toy sits in a corner, swaying occasionally.

It’s been a hell of a year since the sex tech startup was at the center of a firestorm after the CTA unceremoniously revoked its Innovation Award. By July, the CES organizer found itself eating crow via a press release and agreed to allow sex tech companies to exhibit on a “one-year trial bias,” spreading them out amongst the broader category of health tech at the show’s Eureka Park startup exhibit space.

Zuckerberg ditches annual challenges, but needs cynics to fix 2030

Mark Zuckerberg won’t be spending 2020 focused on wearing ties, learning Mandarin, or just fixing Facebook. “Rather than having year-to-year challenges, I’ve tried to think about what I hope the world and my life will look in 2030” he wrote today on Facebook. As you might have guessed, though, Zuckerberg’s vision for an improved planet involves a lot more of Facebook’s family of apps.

His biggest proclamations in today’s notes include that:

  • AR – Phones will remain the primary computing platform for most of the decade by augmented reality could get devices out from between us so we can be present together — Facebook is building AR glasses
  • VR – Better virtual reality technology could address the housing crisis by letting people work from anywhere — Facebook is building Oculus
  • Privacy – The internet has created a global community where people find it hard to establish themselves as unique, so smaller online groups could make people feel special again – Facebook is building more private groups and messaging options
  • Regulation – That the big questions facing technology are too thorny for private companies to address by themselves, and governments must step in around elections, content moderation, data portability, and privacy — Facebook is trying to self-regulate on these and everywhere else to deter overly onerous lawmaking

Zuckerberg Elections

These are all reasonable predictions and suggestions. However, Zuckerberg’s post does little to address how the broadening of Facebook’s services in the 2010s also contributed to a lot of the problems he presents.

  • Isolation – Constant passive feed scrolling on Facebook and Instagram has created a way to seem like you’re being social without having true back-and-forther interaction with friends
  • Gentrification – Facebook’s shuttled employees have driven up rents in cities around the world, especially the Bay Area
  • Envy – Facebook’s algorithms can make anyone without a glamorous, Instagram-worthy life look less important, while hackers can steal accounts and its moderation systems can accidentally suspend profiles with little recourse for most users
  • Negligence – The growth-first mentality led Facebook’s policies and safety to lag behind its impact, creating the kind of democracy, content, anti-competition, and privacy questions its now asking the government to answer for it

Noticibly absent from Zuckerberg’s post are explicit mentions some of Facebook’s more controversial products and initiatives. He writes about “decentralizing opportunity” by giving small businesses commerce tools, but never mentions cryptocurrency, blockchain, or Libra directly. Instead he seems to suggest that Instagram store fronts, Messenger customer support, and WhatsApp remittance might be sufficient. He also largely leaves out Portal, Facebook’s smart screen that could help distant families stay closer, but that some see as a surveillance and data collection tool.

I’m glad Zuckerberg is taking his role as a public figure and the steward of one of humanity’s fundamental utilities more seriously. His willingness to even think about some of these long-term issues instead of just quarterly-profits is important. Optimism is necessary to create what doesn’t exist.

Still, if Zuckerberg wants 2030 to look better for the world, and for the world to look more kindly on Facebook, he may need to hire more skeptics and cynics that see a dystopic future instead. Their foresight on where societal problems could arise from Facebook’s products could help temper Zuckerberg’s team of idealists to create a company that balances the potential of the future with the risks to the present.

Every new year of the last decade I set a personal challenge. My goal was to grow in new ways outside my day-to-day work…

Posted by Mark Zuckerberg on Thursday, January 9, 2020