Peleton’s stock sinks 7% as the ad saga continues to weigh on the company

Shares of popular home exercise company Peloton are off 7% in regular trading today as the company continues to reel in the wake of an advertisement it released that went viral for the wrong reasons.

The ad is to blame for Peloton being in the public eye for the wrong reasons, but can’t be framed for causing all the company’s recent stock price declines. Having a brand-centric company’s name drawn into controversy can have a larger impact on a momentum-focused stock than on, say, an industrials concern whose brand isn’t in the consumer eye. But it isn’t enough, on its own, to explain Peloton’s recent value erosion.

Still, it does matter that Peloton is shedding value after it helped an already fit woman become slightly more fit while her husband slept in. That other brands have picked up on the ad segment (which also got a mention on Saturday Night Live) has helped keep the episode alive far longer than it might have on its own.

History

Peloton, a heavily backed company that raised nearly $1 billion while private, went public earlier this year worth $29 per share. Its post-IPO life was initially fraught, as the company’s losses were rising sharply alongside its revenue leading to investor unrest.

For context, Peloton lost about four times as much in its fiscal year ending June 30, 2019 (a net loss of $195.6 million) compared to the preceding fiscal year ($47.9 million). As the market rejected the WeWork IPO and SmileDirectClub’s own losses seemed to push investors away from high-growth, high-loss companies, Peloton’s debut quickly slipped underwater as its shares closed under its IPO price.

Then things got better. After Peloton reported its first earnings as a public company in early November, its share price recovered, cresting its IPO price and reaching $37 per share. Today the company is worth just a little over $30 per share, a sharp retread from its return to form.

Why

If the ad isn’t entirely to blame, why is Peloton losing value? Short interest is helping spook investors about the company’s future prospects recently, and, I would add, the company’s churn rate is rising.

Regarding the short interest, you can read the report in question here, but it deals mainly with the possible challenge of lower-priced, third-party hardware being paired with Peloton’s lower-cost media option. This would undercut Peloton’s revenue twice, though consumers would still add to the company’s subscription revenue category in the scenario. The same group also points out that Peloton’s valuation per subscriber is higher than some market comps; how to weigh those concerns we leave to you.

Turning to churn, observe the following data from Peloton’s recent earnings report:

The table shows Peloton’s average churn rising from 0.50% to 0.90%. That’s up 80% in a single year. If that trend continues, some of the money that Peloton spent on sales and marketing in the calendar year 2019 will look a bit more expensive than it did at first; rising churn lowers the lifetime value of a subscriber, making marketing spend less efficient.

Peloton shares are down, but remain far above its recent lows, and the company is still worth far more today ($8.5 billion) than it was as a private company ($4.1 billion). The ad, of course, hasn’t helped.

Healthcare-focused venture firms are forming a best practices group for securing health data

Some of the nation’s top healthcare-focused venture capital firms are banding together to form an advisory council with the technology security certification provider, Hitrust, to create best practices for data security for startups developing digital health technologies.

The conversations, spearheaded by the Nashville-based, healthcare-focused investment fund, Frist-Cressey, were designed to accelerate the adoption of digital technologies throughout the healthcare industry by creating best-practices around data security that large healthcare organizations demand before adopting a new service.

“Our service or our software want to be taken nationwide and everybody gets excited and thats’ when you get in front of the Chief security officer’s office and they ask if you’re HiTrust certified,” says Frist-Cressey partner Chris Booker. 

“It makes [startups] more marketable or more viable,” says Daniel Nutkis, the chief executive of Hitrust. “Organizations tend to be reluctant to work with startups… [Our certification] gave venture capital firms a level of comfort and we saw it as an opportunity.. Chris approached us to better develop a program more targeted at early stage companies… so that this becomes an easier program and can make it more wide-scale.”

So far investors including Ascension Ventures, Bain Capital . Ventures, Echo Health Ventures, Frist Cressey Ventures, Andreessen Horowitz, Blue Cross Blue Shield Ventures, Heritage Group, New Enterprise Associates and 7wire Ventures have all signed on to the venture capital advisory council.

For the firms, it’s simply a matter of protecting what is an increasing percentage of capital commitments. Investors have poured $50 billion into healthcare startups, according to data pulled from CB Insights, and nearly $16 billion of those investments were in digital health companies. Meanwhile, early stage startups are increasingly vulnerable to data breaches and lax security practices — failures of oversight that can mean the difference between life and death for early stage startups.

“Data breaches and privacy violations… these things can destroy a company,” says Booker.

Mindstrong Health hires leadership team with all-star tech product experience

Mindstrong Health is tackling one of the most difficult challenges in healthcare: Severe mental illness, commonly referred to as SMI in the healthcare industry. The startup, founded in 2013 by Paul Dagum, Richard Klausner and Thomas Insel, recently brought on former Uber VP of Product Daniel Graf as CEO, and is now announcing a number of new hires to its senior product leadership team as it moves to turn into an even more compelling and user-friendly product the technology and research it has developed over the past six years.

As mentioned, Graf was Mindstrong Health‘s first high-profile hire this year, when the former Uber, Twitter and Google product leader joined in October. Graf’s turn as the company’s chief executive is his return to the operational side after spending some time away from building product as an investor. He and Mindstrong have brought in four new C-suite execs to lead the company, including a new CPO, COO and CTO, as well as a new VP of Data Science and new VP of Marketing.

The CPO role is the only one Mindstrong can’t yet disclose, but the incoming person has been a product leader at large tech companies, Graf told me in an interview. Meanwhile, the company is revealing that Brandon Trew (ex Uber, Google) will join as COO, Erik Albair (ex Google Maps, DeepMind) will join as CTO, Kane Sweeney (ex Uber, StubHub) comes in as VP of Data Science and Dena Olyaie (ex Facebook, Oscar Health) joins as VP of Marketing.

“The inflection point we’re going through now is really building out the whole foundation,” Graf told me. “If you look at our [current] app, it’s not an app, I would describe us as a consumer and from an experience point of view – it’s a science app. We basically have to build this whole foundation and platform, so for a technology person, for a product person, for a data scientist, for a marketing person, it’s kind of a dream. When you look at the planning stage, you look at the mission, with amazing investors, we don’t really have to worry about investments, and we can build this now. We can build this amazing platform and that’s why all these folks are joining.”

Mindstrong Health’s primary product is a platform that provides remote care on-demand for patients dealing with SMI. This group in particular faces challenges with current healthcare options, because they often face long wait times for appointments with qualified medical professionals, but their issues are pressing, hard to predict and often immediate in nature. Traditional care is also very expensive, and Mindstrong’s model has been shown to drive better results for patients, and to lower cost for insurance companies and other payers. Backed by ARCH Venture Partners, General Catalyst, Bezos Expeditions and more, the company has a number of ongoing trials with healthcare providers and patients, and based on the positive outcomes they’ve seen from this work, the goal now is to refine and prepare the product for commercial use.

Graf’s new leadership team also shares a lot of experience building products that benefit from optimization based on interpretation of large data sets, and that’s also not a coincidence. Part of Mindstrong’s unique approach has been developing a way to quantify SMI issues in a way that makes it possible to anticipate problems based on signals from how a user is interacting with the app, including typing speed an other cues, as compared to an established personal baseline. It’s a big data problem, but instead of solving something like routing on-demand transportation, it’s tackling the issue of delivering reliable, quality care to individuals who are most in need.

Lucence raises $20 million Series A for its non-invasive cancer screening technology

Lucence Diagnostics, a genomic medicine startup that develops non-invasive tests for cancer screening, announced today that it has raised a $20 million Series A led by IHH Healthcare, one of the world’s largest integrated private healthcare groups. Other participants included SGInnovate and returning investors Heliconia Capital (a subsidiary of Temasek Holdings), Lim Kaling and Koh Boon Hwee.

The round will be used for scaling Lucence’s labs, hiring and making its products commercially available to more patients in Asia and North America.

The funding will also support two prospective clinical trials. One will focus on its technology’s sensitivity to actionable variables in late-stage cancer patients, while the other will evaluate its use for early-stage detection in several types of cancer, including lung, colorectal, breast and pancreatic. Lucence is currently designing a study that will involve 100,000 participants to validate its early-stage detection test. It will recruit its first patient in the middle of next year and launch in the United States and Asia.

Together with its seed funding, this round brings Lucence’s total raised so far to $29.2 million.

Lucence’s tests are currently used by physicians in Southeast Asia and Hong Kong, and it plans to expand further in North America and East Asia. Its lab in Singapore has received both CLIA certification and CAP accreditation, which means its tests can be used by doctors and patients in the United States. It is also currently building a lab in the Bay Area to decrease turnaround times for patients.

Headquartered in Singapore, with offices in San Francisco, Hong Kong and Suzhou, China, Lucence was founded by CEO Dr. Min-Han Tan, an oncologist, and spun out from Singapore’s Agency of Science, Technology and Research (A*STAR) in 2016. Two years later, it launched LiquidHALLMARK, which the company describes as “the first and only clinical sequencing blood test that detects both cancer-related genetic mutations and cancer-causing viruses with a single assay” and looks for signs of fourteen types of cancer. The company says LiquidHALLMARK has been used by oncologists for 1,000 patients in Asia so far.

Other genomic sequencing startups that have developed tests that screen for cancer risks and signs include Sanomics, Prenetics, Guardant and Grail. Lucence’s differentiators include its proprietary amplicon-sequencing, which examines specific genomic regions for variations, including mutations linked to cancer. The company describes its tests as a “Swiss Army knife,” because it can be used for cancer screening, diagnoses, treatment selections and monitoring.

In a statement, Dr. Kelvin Loh, the CEO-designate of IHH Healthcare, said “liquid biopsy is a game-changer in our endeavor to provide cancer treatments with better, value-driven outcomes through precise treatment selections and more affordable care. Our investment in Lucence will provide IHH patients with better access to this advanced technology.”

Fertility startup Mojo wants to take the trial and error out of IVF

Fertility tech startup Mojo is coming out of stealth to announce a €1.7 million (~$1.8M) seed round of funding led by Nordic seed fund Inventure. Also participating are Doberman and Privilege Ventures (an investor in Ava), plus a number of angel investors including Josefin Landgard (founder and ex-CEO of Kry) and Hampus Jakobsson (partner at BlueYard, BA in Clue & Kind.app).

Mojo’s mission, says co-founder and CEO Mohamed Taha, is to make access to fertility treatment more affordable and accessible by using AI and robotics technology to assist in sperm and egg quality analysis, selection and fertilization to reduce costs for clinics. Only by reducing clinics’ costs will the price fall for couples, he suggests.

“What the AI does in our technology stack from now until our roadmap is completed, product wise, is to look at sperm, look at eggs, look at data and ensure that the woman or the couple get precise treatment or the precise embryo that yields healthy baby,” he tells TechCrunch. “The role of robotics is to ensure that the manipulations/procedures are done precisely and at reduced time compared to nowadays, and also accurately.”

The idea for the business came to Taha after he was misdiagnosed with a kidney condition while still a student. His doctor suggested freezing his sperm as a precaution against deterioration in case he wanted to father a child in the future, so he started having regular sperm tests. “I was super annoyed with one particular fact,” he says of this. “Every time I do a sperm test I get a different result.”

After speaking to doctors the consensus view of male fertility he heard was “I shouldn’t care about my fertility — worst case scenario all that they need from me is one sperm”. He was told it would be his future partner who would be put on IVF to “take the treatment for me”. Doctors also told him there was little research into male fertility, and therefore into sperm quality — such as which sperm might yield a healthy baby or could result in a miscarriage. And after learning about what IVF entailed, Taha says it struck him as a “tough” deal for the woman.

“It’s completely blackbox,” he says of male fertility. “I also learned that in terms of IVF or ART [assisted reproductive technologies] everything, pretty much, is done manually. And everything, pretty much, also is done at random — you select a random sperm, they fertilize it with a random egg. Hopefully the technician who’s doing it manually knows his or her job. And in the end there’s going to be an embryo that will be implanted.”

He says he was also struck by the fact the ‘trial and error’ process only works 25% of the time in high end laboratories, yet can prospective parents between €40,000-€100,000 for each round of treatment. “This is where the idea of the company came from,” he adds. Mojo’s expectation for their technology is that it will be able to increase IVF success rates to 75% by 2030.

The team started work in 2016 as a weekend project during their PhDs. Taha initially trained as an electrical engineer before going on to do a PhD in nanotechnology, investigating new and affordable materials for use as biosensors. It was the microscopes and robotic arms that he and his co-founders, Fanny Chesa, Tobias Boecker, Daniel Thomas, were using in the labs to examine nanoparticles and select specific particles for insertion into other media that led them to think why not adapt this type of technology for use in fertility clinics — as an alternative to purely manual selection and fertilization.

“We just completely automate everything to ensure that the procedure is done faster, better and at the same time more reliably,” Taha says of the concept for Mojo. “No randomness. Understand the good from the bad.”

That — at least — is the theory. To be clear, they don’t yet have their proposition robustly proved out nor productized at this stage. Their intended first product, called Mojo Pro, is still pending certification as a medical device in the EU, for example. But the plan, should everything go to plan, is to get it to market next summer, starting in the UK.

This product, a combination of microscopy hardware and AI software, will be sold to fertility clinics (under a subscription model) to offer an analysis service consisting of a sperm count and quality check — as a first service for couples to determine whether or not the man has a fertility problem.

Initially, Mojo’s computer vision analysis system is focused on sperm counts, automating what Taha says is currently a manual process, as well as assessing some basic quality signals — such as the speed and morphology of the sperm. For example, a sperm with two heads or two tails would be an easy initial judgement call to weed out as “bad”, he suggests.

“The first product is to look at the sperm and say if this man experiences infertility or not. So we have a smart microscopy — built custom in-house. And this is where the element of the robotics comes in,” he explains. “At the same time we put on it an AI that looks at a moving sperm sample. Then, through looking at this, the system on Mojo Pro will tell us what is the sperm count, what is the sperm mobility (how fast they move) and what is the predominant shape of the sperm.

“The second part is the selection of the sperm [i.e. if the sample is needed for IVF]. Now we ensure that good sperm is being selected. This microscopy will look at the same and visually will guide the embryologist to pick the good sperm — that’s highlighted around, for example, by a green box. Good sperm have green boxes around them, bad sperm have red boxes around them so they can pick up through their current techniques the sperm that are highlighted green.”

Mojo

Based on internal testing of Mojo Pro the system has achieved 97% of the accuracy of a manual sperm count so far, per Taha, who says further optimization is planned.

Though he admits there’s no standardization of sperm counts in the fertility industry — which means such comparative metrics offer limited utility, given the lack of robust benchmarks.

“The way we are going with this is we’re really choosing the best of the best practitioners and we are just comparing our work against them for now,” is the claim. (Mojo’s lab partner for developing the product is TDL.)

“We will try to introduce new standards for ourselves,” he adds.

The current research focus is: “What are the visuals to make sure the sperm is good or bad; how to actually measure the sperm sample, the sperm count; in terms of morphology… how we can incorporate a protocol that can be the gold standard of computer vision or AI looking at sperm?”

The wider goal for the business is to understand much more about the role that individual sperm and eggs play in yielding a healthy (or otherwise) embryo and baby.

Taha says the team’s ultimate goal is “automating the fertilization process”, again with the help of applied AI and robotics (and likely also incorporating genetic testing to screen for diseases).

He points out that in many markets couples are choosing to conceive later in life. The big vision, therefore, is to develop new assisted reproductive technologies that can support older couples to conceive healthy babies.

“Generally speaking we leave our fertility to chance — which is sex… So there’s a little bit of randomness in the process. This doesn’t necessarily mean it’s bad — it’s how the body functions. But when you hit later ages, 30 or 40, we face biological deficiencies which means the quality of the eggs are not good any more, the quality of the sperm might not be good any more, if fertilization happens with old gametes… you are not sure there is a healthy baby. So we need technology to play a role here.

“Imagine a couple at the age of 40 who want to conceive a baby ten, twelve years from now. What happens if this couple have the possibility of the sperm of the man to be shipped somewhere, the egg of the woman to be shipped somewhere and they get fertilized using high end technology, and they get informed once the embryo is ready to be implanted. This is where we believe the consumer game will be in the future,” he says.

“We envisage ourselves going from just working with clinics in the coming ten years… making our AI and our robotics really flawless at manipulation, and then we are envisaging of having as consumer-facing way where we ensure people have healthy babies. Not necessarily this will be a clinic but it will be somehow where fertilization will happen in our facilities.”

“I’m not speaking about super humans or designer babies,” he adds. “I’m speaking about ensuring at a later stage of the conception journey to have a healthy baby. And this is where we see ART can actually be the way to procreate at later stages in order to ensure that the baby is healthy then there should be new technologies that just give you a healthy baby — and not mess up with your body.”

Of course this is pure concept right now. And Taja concedes that Mojo doesn’t even have data to determine “good” sperm from “bad” — beyond some basic signifiers.

But once samples start flowing via customers of the first product they expect to be able to start gathering data (with permission) to support further research into the role played by individual sperm and eggs in reproduction — looking at the whole journey from sperm and egg selection through to embryo and baby.

Though getting permission for all elements of the research they hope to do may be one potential barrier.

“Once the first module is in the market we will be collecting data,” he says. “And this data that we’ll be collecting will go and be associated with the live births or the treatment outcome. And with that we’ll understand more and more what is a good sperm, what is a bad sperm.

“But we need to start from somewhere. And this somewhere right now what we’re relying on is the knowledge that good practitioners have in the field.”

Taha says he and his co-founders actively started building the company in January 2018, taking in some angel investment, along with government grants from France and the EU’s Horizon 2020 research pot.

They’ve been building the startup out of Lyon, France but the commercial team will shortly be moving to the UK ahead of launching Mojo Pro.

In the short term the hope is to attract clinics to adopt the Mojo Pro subscription service as a way for them to serve more customers, while potentially helping couples reduce the number of IVF cycles they have to go. Longer term the bet is that changing lifestyles will only see demand for data-fuelled technology-assisted reproduction grow.

“Now we help streamline laboratory processes in order to help the 180M people who have fertility problems have access to fertility at an affordable price and reliable manner but also we have an eye on the future — what happens when genetic testing… [plays] an important role in the procreation and people will opt for this,” he adds.

TriNet sent remote workers an email that some thought was a phishing attack

It was the one of the best phishing emails we’ve seen… that wasn’t.

Phishing remains one of the most popular attack choices for scammers. Phishing emails are designed to impersonate companies or executives to trick users into turning over sensitive information, typically usernames and passwords, so that scammers can log into online services and steal money or data. But detecting and preventing phishing isn’t just a user problem — it’s a corporate problem too, especially when companies don’t take basic cybersecurity precautions and best practices to hinder scammers from ever getting into a user’s inbox.

Enter TriNet, a human resources giant, which this week became the poster child for how how to make a genuine email to its customers look inadvertently as suspicious as it gets.

Remote employees at companies across the U.S. who rely on TriNet for access to outsourced human resources, like their healthcare benefits and workplace policies, were sent an email this week as part of an effort to keep employees “informed and up-to-date on the labor and employment laws that affect you.”

Workers at one Los Angeles-based health startup that manages its employee benefits through TriNet all got the email at the same time. But one employee wasn’t convinced it was a real email, and forwarded it — and its source code — to TechCrunch.

TriNet is one of the largest outsourced human resources providers in the United States, primarily for small-to-medium-sized businesses that may not have the funding to hire dedicated human resources staff. And this time of year is critical for companies that rely on TriNet, since health insurance plans are entering open enrollment and tax season is only a few weeks away. With benefit changes to consider, it’s not unusual for employees to receive a rash of TriNet-related emails towards the end of the year.

But this email didn’t look right. In fact when we looked under the hood of the email, everything about it looked suspicious.

This is the email that remote workers received. TriNet said the use of an Imgur-hosted image in the email was “mistakenly” used. (Image: TechCrunch/supplied)

We looked at the source code of the email, including its headers. These email headers are like an envelope — they say where an email came from, who it’s addressed to, how it was routed, and if there were any complications along the way, such as being marked as spam.

There were more red flags than we could count.

Chief among the issues were that the TriNet logo in the email was hosted on Imgur, a free image-hosting and meme-sharing site, and not the company’s own website. That’s a common technique among phishing attackers — they use Imgur to host images they use in their spam emails to avoid detection. Since the image was uploaded in July, that logo was viewed more than 70,000 times until we reached out to TriNet, which removed the image, suggesting thousands of TriNet customers had received one of these emails. And, although the email contained a link to a TriNet website, the page that loaded had an entirely different domain with nothing on it to suggest it was a real TriNet-authorized site besides a logo, which if it were a phishing site could’ve been easily spoofed.

Fearing that somehow scammers had sent out a phishing email to potentially thousands of TriNet customers, we reached out to security researcher John Wethington, founder of security firm Condition:Black, to examine the email.

It turns out he was just as convinced as us that the email may have been fake.

“As hackers and self-proclaimed social engineers, we often think that spotting a phishing email is ‘easy’,” said Wethington. “The truth is it’s hard.”

“When we first examined the email every alarm bell was going off. The deeper we dug into it the more confusing things became. We looked at the domain name records, the site’s source code, and even the webpage hashes,” he said.

There was nothing, he said, that gave us “100% confidence” that the site was genuine until we contacted TriNet.

TriNet spokesperson Renee Brotherton confirmed to TechCrunch that the email campaign was legitimate, and that it uses the third-party site “for our compliance ePoster service offering. She added: “The Imgur image you reference is an image of the TriNet logo that Poster Elite mistakenly pointed to and it has since been removed.”

“The email you referenced was sent to all employees who do not go into an employer’s physical workspace to ensure their access to required notices,” said TriNet’s spokesperson.

When reached, Poster Elite also confirmed the email was legitimate.

This is not a phishing site, but it sure looks like one. (Image: TechCrunch)

How did TriNet get this so wrong? This culmination of errors had some who received the email worried that their information might have been breached.

“When companies communicate with customers in ways that are similar to the way scammers communicate, it can weaken their customer’s ability over time to spot and shut down security threats in future communications,” said Rachel Tobac, a hacker, social engineer, and founder of SocialProof Security.

Tobac pointed to two examples of where TriNet got it wrong. First, it’s easy for hackers to send spoofed emails to TriNet’s workers because TriNet’s DMARC policy on its domain name is not enforced.

Second, the inconsistent use of domain names is confusing for the user. TriNet confirmed that it pointed the link in the email — posters.trinet.com — to eposterservice.com, which hosts the company’s compliance posters for remote workers. TriNet thought that forwarding the domain would suffice, but instead we thought someone had hijacked TriNet’s domain name settings — a type of attack that’s on the increase, though primarily carried out by state actors. TriNet is a huge target — it stores workers’ benefits, pay details, tax information and more. We had assumed the worst.

“This is similar to an issue we see with banking fraud phone communications,” said Tobac. “Spammers call bank customers, spoof the bank’s number, and pose as the bank to get customers to give account details to ‘verify their account’ before ‘hearing about the fraud the bank noticed on their account — which, of course, is an attack,” she said.

“This is surprisingly exactly what the legitimate phone call sounds like when the bank is truly calling to verify fraudulent transactions,” Tobac said.

Wethington noted that other suspicious indicators were all techniques used by scammers in phishing attacks. The posters.trinet.com subdomain used in the email was only set up a few weeks ago, and the eposterservice.com domain it pointed to used an HTTPS certificate that wasn’t associated with either TriNet or Poster Elite.

These all point to one overarching problem. TriNet may have sent out a legitimate email but everything about it looked problematic.

On one hand, being vigilant about incoming emails is a good thing. And while it’s a cat-and-mouse game to evade phishing attacks, there are things that companies can do to proactively protect themselves and their customers from scams and phishing attacks. And yet TriNet failed in almost every way by opening itself up to attacks by not employing these basic security measures.

“It’s hard to distinguish the good from the bad even with proper training, and when in doubt I recommend you throw it out,” said Wethington.

UCLA now has the first zero-emission, all-electric mobile surgical instrument lab

Electrification in the automotive industry isn’t just about consumer cars: There are plenty of commercial and specialist vehicles that are prime candidates for EVs, including in the healthcare industry. Take the new UCLA mobile surgical lab developed by Winnebago, for instance — it’s a zero-emission, all-electric vehicle that will move back and forth between two UCLA campuses, collecting, sterilizing and repairing surgical instruments for the medical staff there.

Why is that even needed? The usual process is sending out surgical instruments for this kind of service by a third-party, and it’s handled in a dedicated facility at a significant annual cost. UCLA Health Center estimates that it can save as much as $750,000 per year using the EV lab from Winnebago instead.

The traveling lab can operate for around eight hours, including round-trips between the two hospital campuses, or for a total distance traveled of between 85 and 125 miles on a single charge of its battery, depending on usage. It also offers “the same level of performance, productivity and compliance” as a lab in a fixed-location building, according to Winnebago.

Aside from annual savings on operating costs, UCLA also got some discounts toward the purchase of the lab from a few grant programs, including the Hybrid and Zero-Emission Truck and and Bus Voucher Incentive Project (an admitted mouthful, but it does have its own acronym luckily — HVIP). These programs all encourage the adoption of electric vehicles through financial incentives that help defray the upfront costs, which is yet another good reason for industries like healthcare to look at EVs as a way to not only reduce costs long term, but upfront as well.

No one knows how effective digital therapies are, but a new tool from Elektra Labs aims to change that

Depending on which study you believe, the wearable and digital health market could be worth anywhere from $30 billion to nearly $90 billion in the next six years.

If the numbers around the size of the market are a moving target, just think about how to gauge the validity and efficacy of the products that are behind all of those billions of dollars in spending.

Andy Coravos, the co-founder of Elektra Labs, certainly has.

Coravos, whose parents were a dentist and a nurse practitioner, has been thinking about healthcare for a long time. After a stint in private equity and consulting, she took a coding bootcamp and returned to the world she was raised in by taking an internship with the digital therapeutics company, Akili Interactive.

Coravos always thought she wanted to be in healthcare, but there was one thing holding her back, she says. “I’m really bad with blood.”

That’s why digital therapeutics made sense. The stint at Akili led to a position at the U.S. Food and Drug Administration as an entrepreneur in residence, which led to the creation of Elektra Labs roughly two years ago.

Now the company is launching Atlas, which aims to catalog the biometric monitoring technologies that are flooding the consumer health market.

These monitoring technologies, and the applications layered on top of them, have profound implications for consumer health, but there’s been no single place to gauge how effective they are, or whether the suggestions they’re making about how their tools can be used are even valid. Atlas and Elektra are out to change that. 

The FDA has been accelerating its clearances for software-driven products like the atrial fibrillation detection algorithm on the Apple Watch and the ActiGraph activity monitors. And big pharma companies like Roche, Pfizer and Novartis have been investing in these technologies to collect digital biomarker data and improve clinical trials.

Connected technologies could provide better care, but the technologies aren’t without risks. Specifically the accuracy of data and the potential for bias inherent in algorithms which were created using flawed datasets mean that there’s a lot of oversight that still needs to be done, and consumers and pharmaceutical companies need to have a source of easily accessible data about the industry.

”The increase in FDA clearances for digital health products coupled with heavy investment in technology has led to accelerated adoption of connected tools in both clinical trials and routine care. However, this adoption has not come without controversy,” said Coravos, co-founder and CEO of Elektra Labs, in a statement. “During my time as an Entrepreneur in Residence in the FDA’s Digital Health Unit, it became clear to me that like pharmacies which review, prepare, and dispense drug components, our healthcare system needs infrastructure to review, prepare, and dispense connected technologies components.

The analogy to a pharmacy isn’t an exact fit, because Elektra Labs currently doesn’t prepare or dispense any of the treatments that it reviews. But Atlas is clearly the first pillar that the digital therapeutics industry needs as it looks to supplant pharmaceuticals as treatments for some of the largest and most expensive chronic conditions (like diabetes).

Coravos and here team interviewed more than 300 professionals as they built the Atlas toolkit for pharmaceutical companies and other healthcare stakeholders seeking a one-stop-shop for all of their digital healthcare data needs. Like a drug label, or nutrition label, Atlas publishes labels that highlight issues around the usability, validation, utility, security and data governance of a product.

In an article in Quartz earlier this year, Coravos made her pitch for Elektra Labs and the types of things it would monitor for the nascent digital therapeutics industry. It includes the ability to handle adverse events involving digital therapies by providing a single source where problems could be reported; a basic description for consumers of how the products work; an assessment of who should actually receive digital therapies, based on the assessment of how well certain digital products perform with certain users; a description of a digital therapy’s provenance and how it was developed; a database of the potential risks associated with the product; and a record of the product’s security and privacy features.

As the projections on market size show, the problem isn’t going to get any smaller. As Google’s recent acquisition bid for FitBit and the company’s reported partnership with Ascension on “Project Nightingale” to collect and digitize more patient data shows, the intersection of technology and healthcare is a huge opportunity for technology companies.

“Google is investing more. Apple is investing more… More and more of these devices are getting FDA cleared and they’re becoming not just wellness tools but healthcare tools,” says Coravos of the explosion of digital devices pitching potential health and wellness benefits.

Elektra Labs is already working with undisclosed pharmaceutical companies to map out the digital therapeutic environment and identify companies that might be appropriate partners for clinical trials or acquisition targets in the digital market.

“The FDA is thinking about these digital technologies, but there were a lot of gaps,” says Coravos. And those gaps are what Elektra Labs is designed to fill. 

At its core, the company is developing a catalog of the digital biomarkers that modern sensing technologies can track and how effective different products are at providing those measurements. The company is also on the lookout for peer-reviewed published research or any clinical trial data about how effective various digital products are.

Backing Coravos and her vision for the digital pharmacy of the future are venture capital investors including Maverick Ventures, Arkitekt Ventures, Boost VC, Founder Collective, Lux Capital, SV Angel, and Village Global.

Alongside several angel investors, including the founders and chief executives from companies including: PillPack, Flatiron Health, National Vision, Shippo, Revel and Verge Genomics, the venture investors pitched in for a total of $2.9 million in seed funding for Coravos’ latest venture.

“Timing seems right for what Elektra is building,” wrote Brandon Reeves, an investor at Lux Capital, which was . one of the first institutional investors in the company. “We have seen the zeitgeist around privacy data in applications on mobile phones and now starting to have the convo in the public domain about our most sensitive data (health).” 

If the validation of efficacy is one key tenet of the Atlas platform, then security is the other big emphasis of the company’s digital therapeutic assessment.  Indeed, Coravos believes that the two go hand-in-hand. As privacy issues proliferate across the internet, Coravos believes that the same troubles are exponentially compounded by internet-connected devices that are monitoring the most sensitive information that a person has — their own health records.

In an article for Wired, Koravos wrote:

Our healthcare system has strong protections for patients’ biospecimens, like blood or genomic data, but what about our digital specimens? Due to an increase in biometric surveillance from digital tools—which can recognize our face, gait, speech, and behavioral patterns—data rights and governance become critical. Terms of service that gain user consent one time, upon sign-up, are no longer sufficient. We need better social contracts that have informed consent baked into the products themselves and can be adjusted as user preferences change over time.

We need to ensure that the industry has strong ethical underpinning as it brings these monitoring and surveillance tools into the mainstream. Inspired by the Hippocratic Oath—a symbolic promise to provide care in the best interest of patients—a number of security researchers have drafted a new version for Connected Medical Devices.

With more effective regulations, increased commercial activity, and strong governance, software-driven medical products are poised to change healthcare delivery. At this rate, apps and algorithms have the opportunity to augment doctors and complement—or even replace—drugs sooner than we think.

Facebook finally lets you banish nav bar tabs & red dots

Are those red notification dots on your Facebook home screen driving you crazy? Sick of Facebook Marketplace wasting your screen space? Now you can control what appears in the Facebook app’s navigation bar thanks to a new option called Shortcuts Bar Settings.

Over the weekend TechCrunch spotted the option to remove certain tabs like Marketplace, Watch, Groups, Events, Profile, Friend Requests, News, Today In, Gaming and Dating or just silence their notification dots. In response to our inquiry, Facebook confirms that Shortcut Bar Settings is now rolling out to everyone, with most iOS users already equipped and the rest of Android owners getting it in the next few weeks.

The move could save the sanity and improve the well-being of people who don’t want their Facebook cluttered with distractions. Users already get important alerts that they could actually control via their Notifications tab. Constant red notification counts on the homescreen are an insidious growth hack, trying to pull in people’s attention to random Group feeds, Event wall posts, and Marketplace.

“We are rolling out navigation bar controls to make it easier for people to connect with the things they like and control the notifications they get within the Facebook app” a Facebook spokesperson tells me.

Back in July 2018, Facebook said it would start personalizing the navigation bar based on what utilities you use most. But the navigation bar seemed more intent on promoting features Facebook wanted to be popular like its Craigslist competitor Marketplace, which I rarely use, rather than its long-standing Events feature I access daily.

To use the Shortcuts Bar Settings options, tap and hold on any of the shortcuts in your navigation bar that’s at the bottom of the Facebook homescreen on iOS and the top on Android. You’ll see a menu pop up letting you remove that tab entirely, or leave it but disable the red notification count overlays. That clears space in your nav bar for a more peaceful experience.

You’ll also now find in the three-line More tab -> Settings & Privacy -> Settings -> Shortcuts menu the ability to toggle any of the Marketplace, Groups, Events, and Pages tabs on or off. Eagle-eyed reverse engineering specialist Jane Manchun Wong had spotted that Facebook was prototyping this menu and the Notification Dots settings menu that’s now available too

A Facebook spokesperson admits people should have the ability to take a break from notifications within the app. They tell me Facebook wanted to give users more control so they can have access to what’s relevant to them.

For all of Facebook’s talk about well-being, with it trying out hiding Like counts in its app and Instagram (this week starting in the US), there’s still plenty of low-hanging fruit. Better batching of Facebook notifications would be a great step, allowing users to get a daily digest of Groups or Events posts rather than a constant flurry. Its Time Well Spent dashboard that counts your minutes on Facebook should also say how many notifications you get of each type, how many you actually open, and let you disable the most common but useless ones right from there.

If Facebook wants to survive long-term, it can’t piss off users by trapping them in an anxiety-inducing hellscape of growth hacks that benefit the company. The app has become bloated and cramped with extra features over the last 15 years. Facebook could get away with more aggressive cross-promotion of some of these forgotten features as long as it empowers us to hide what we hate.

Microsoft uses AI to diagnose cervical cancer faster in India

More women in India die from cervical cancer than in any other country. This preventable disease kills around 67,000 women in India every year, more than 25% of the 260,000 deaths worldwide.

Effective screening and early detection can help reduce its incidence, but part of the challenge — and there are several parts — today is that the testing process to detect the onset of the disease is unbearably time-consuming.

This is because the existing methodology that cytopathologists use is time consuming to begin with, but also because there are very few of them in the nation. Could AI speed this up?

At SRL Diagnostics, the largest chain to offer diagnostic services in pathology and radiology in India, we are getting an early look of this. Last year, Microsoft partnered with SRL Diagnostics to co-create an AI Network for Pathology to ease the burden of cytopathologists and histopathologists.

SRL Diagnostics receives more than 100,000 Pap smear samples every year. About 98% of these samples are typically normal and only the remaining 2% samples require intervention. “We were looking for ways to ensure our cytopathologists were able to find those 2% abnormal samples faster,” explained Dr. Arnab Roy, Technical Lead for New Initiatives & Knowledge Management at SRL Diagnostics.

Cytopathologists at SRL Diagnostics studied digitally scanned versions of Whole Slide Imaging (WSI) slides, each comprising about 300-400 cells, manually and marked their observations, which were used as training data for Cervical Cancer Image Detection API.

A digitally scanned version of a Whole Slide Imaging (WSI) slide, which is used to train the AI model

Then there was the challenge of subjectivity. “Different cytopathologists examine different elements in a smear slide in a unique manner even if the overall diagnosis is the same. This is the subjectivity element in the whole process, which many a time is linked to the experience of the expert,” reveals Dr. Roy.

Manish Gupta, Principal Applied Researcher at Microsoft Azure Global Engineering, who worked closely with the team at SRL Diagnostics, said the idea was to create an AI algorithm that could identify areas that everybody was looking at and “create a consensus on the areas assessed.”

Cytopathologists across multiple labs and locations annotated thousands of tile images of cervical smear. They created discordant and concordant notes on each sample image.

“The images for which annotations were found to be discordant — that is if they were viewed differently by three team members — were sent to senior cytopathologists for final analysis,” Microsoft wrote in a blog post.

This week, the two revealed that their collaboration has started to show results. SRL Diagnostics has started an internal preview to use Cervical Cancer Image Detection API. The Cervical Cancer Image Detection API, which runs on Microsoft’s Azure, can quickly screen liquid-based cytology slide images for detection of cervical cancer in the early stages and return insights to pathologists in labs, the two said.

The AI model can now differentiate between normal and abnormal smear slides with accuracy and is currently under validation in labs for a period of three to six months. It can also classify smear slides based on the seven-subtypes of cervical cytopathological scale, the two wrote in a blog post.

During the internal preview period, the exercise will use more than half-a-million anonymized digital tile images. Following internal validation, the API will be previewed in external cervical cancer diagnostic workflows, including hospitals and other diagnostic centers.

“Cytopathologists now have to review fewer areas, 20 as of now, on a whole slide liquid-based cytology image and validate the positive cases thus bringing in greater efficiency and speeding up the initial screening process,” Microsoft wrote.

“The API has the potential of increasing the productivity of a cytopathology section by about four times. In a future scenario of automated slide preparation with assistance from AI, cytopathologists can do a job in two hours what would earlier take about eight hours!” Dr. Roy said.

SRL Diagnostics-Microsoft consortium said they are hopeful their APIs could find application in other fields of pathology such as diagnosis of kidney pathologies and in oral, pancreatic and liver cancers. The consortium also aims to expand its reach with tie-ups with private players and governments and expand the reach of the model even in remote geographies where the availability of histopathologists is a challenge.

The announcement this week is the latest example of Microsoft’s ongoing research work in India. The world’s second most populous nation has become a test bed for many American technology companies to build new products and services that solve local challenges as they look for their next billion users worldwide.

Last week, Microsoft announced its AI project was helping improve the way driving tests are conducted in India. The company has unveiled a score of tools for the Indian market in the last two years. Microsoft has previously developed tools to help farmers in India increase their crop yields and worked with hospitals to prevent avoidable blindness. Last year, the company partnered with Apollo Hospitals to create an AI-powered API customized to predict risk of heart diseases in India.

Also last year, the company also worked with cricket legend Anil Kumble to develop a tracking device that helps youngsters analyze their batting performance. Microsoft has also tied up with insurance firm ICICI Lombard to help it process customers’ repair claims and renew lapsed policies using an AI system.