Blindly Investing in Healthcare: Diagnosing Depression Via Voice

The great thing about Silicon Valley is the diverse group of people that you meet everyday or the people that you may meet. Sitting at Starbucks reading my subscribed copy of Pharmacology Today, I was approached by an investor who shall remain unnamed.

Investor: Are you in the healthcare field? I notice you’re reading that magazine.

Me: Um yes, you can say that. I am into pharmaceuticals and technology

Investor: Oh, so you must know a lot about drugs and diseases

Me: Yes..my Doctorate degree is in it

Investor: Do you have a minute to talk? I’d love to hear your opinion about a product that my firm is thinking about funding

Me: Sure thing

Investor: This great idea is ran by some really brilliant guys from M.I.T. It’s a way to diagnose depression from someone’s voice.

Me: Excuse me? Can you repeat that again? Diagnosing depression from voice?

Investor: Yes. Finding out if someone is depressed from their voice. I wanted to know what you thought of that

Me: (Thinking how to phrase it politely that he’s nuts). Well…that is definitely…new. I’d have to see the clinical data done with this hypothesis before I can make a suggestion but I can tell you now that depression is a very difficult thing to diagnose. It’s a condition that is often misdiagnosed by doctors. To use voice technology and link it to depression seems to have so many variabilities associated with vocal pattern recognition.

This is when the investor attempts to explain to me that the technology is supposed to help with depression diagnosing and that the two physicians on their health investment team thought it was a good idea. When I asked this enthusiastic investor why the two physicians voted for the green light on this project, he replied “It’s going to change medicine and help with diagnosing depression.” And hence begun the 1 and 1/2 hour discussion of my opinion on the matter.

Lack of supporting clinical data

Mood disorders is currently diagnosed by doctors using the DSM-IV criteria. Even with the criteria set forth by the medical community, depression is already being misdiagnosed. The argument made by the physicians on the health investment team is that this voice technology system is going to make diagnosing depression easier and reduce misdiagnoses. In health, before any practitioner even considers using a new discovery, clinical studies are looked at first and scrutinized. I couldn’t find a clinical trial that used more than 10 patients in the experiment of linking depression to voice. Would I base a disease diagnosis on a case study of 10 patients? No. Would I have invested X million dollars into this idea based on these clinical trials? No. Anyone who has done years of research has learned the art of reading clinical trials and determining whether or not the study is pure crap. The things to look for when shown clinical trials: population size, statistical analysis used, funding source, experimental method, among others must be considered. With that said, you’re probably wondering why the MDs on the investment team didn’t see that viewpoint. Most healthcare professionals such as physicians, nurses, and pharmacists receive an education focused solely on clinical aspects. The ability to analyze research papers require one or two more courses that are often elective. So not every clinician is an expert at clinical data analysis. A very old and wise Judge once told me, “You would never ask a corporate lawyer to advise you on your divorce.” In the same way, you would never ask a physician on a topic he was not specifically trained in. Would you ask a cardiologist how to diagnose depression?

Too many variabilities

There are too many reasons a patient’s voice may change: illness, drugs, screaming to loud, and other conditions such as anemia. How would one go about in filtering a diagnosis of depression among such a vast amount of other reasons?

Health Economics Barrier
Lets assume that the voice technology actually works and may accurately diagnose depression by following a user’s voice pattern. Would the medical community and your insurance company accept this?

My answer is no. What a lot of health innovators and investors forget is that health is about money. I wish I could say that health was about patient care but then I’d be lying.

Any sort of technology that requires a physician to spend their income on will not be accepted by him. For instance, e-prescribing was a really big investment for a lot of firms. It was the main topic at all medical conferences. There were news that e-prescribing would reduce medication errors by over 60% and medical conferences were boasting about how great it would be to have a centralized medication database. This led to companies putting millions into e-prescribing and investors throwing their money into funding anything that was as part of e-prescribing. For instance, Wellpoint put over $42 million dollars into a project that gave away physicians free PC and handheld devices with e-prescribing software on it. Despite the free giveaway, Wellpoint’s vice president of technology, Charles Kennedy said that the free giveaways wasn’t causing a large number of physicians to use it.

Why would physicians want to implement a technology that would cost them money instead of save or make them money?
E-prescribing would have cost physicians about $27,000 for the first year to implement and this is without any financial help. Investors were putting money into e-prescribing without considering all the players in the healthcare community: nurses, pharmacists, patients, and doctors. E-prescribing would have increased revenue for retail chains and increase patient safety but they failed to recognize the lack of benefits for doctors.

This example applies to the voice-depression technology. Depression is often diagnosed at a primary physician’s office. Primary physicians with over 3 years experience, make about $150,000 a year. So along with over $300,000 debt from medical school loans, the voice-depression technology investors expect these primary care physicians to fork out x thousand dollars to implement this technology for “easier depression diagnosing.” Is this realistic? I don’t think so.

Healthcare Investment and Innovation

Warren Buffet always said “invest in what you know.” Healthcare investment isn’t just about clinical but also health politics. Holding a degree in healthcare may provide you with the needed clinical knowledge but unfortunately, there’s more to healthcare investments than clinical.

Before investing in a healthcare related investment, think about the feasibility, competitors and most importantly, health politics – how will the community accept or reject it? If done right, healthcare may lead to a very lucrative investment but if a mistake is made, it may lead to millions being loss in an instant.