What does colon cancer screening have to do with self-driving cars? [PODCAST]

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“We can clearly see that exponential technologies are disrupting cars and phones. So why wouldn’t these technologies find their way into health care and gastroenterology?

What do stool tests have to do with self-driving cars? We’ll soon find out. But let’s first go back to the discussion we had earlier on the shift to digital. Screening for cancer through colonoscopy, while a gold standard, reminds me of a field that’s at the crossroads of disruption—much like music or photography was before iTunes or smartphones.

If you consider the argument for a moment, a colonoscopy is largely limited to one doctor and one patient at a time. When a doctor performs a colonoscopy, he or she can’t scale beyond the procedure. With each procedure, the learning happens within the capacity of that one doctor. To put that into context, only a very small percentage of doctors become endoscopists. And an even smaller percentage achieve mastery in endoscopy. Statistically speaking, we are talking of a very few highly qualified individuals who can reliably screen for cancer using sophisticated methods.

Ask yourself what could make the field of cancer screening go digital? Something that can accelerate cancer screening and give control to the nonexperts. I’m sure you might have arrived at DNA testing or artificial intelligence.”

Praveen Suthrum is president and co-founder, NextServices and blogs at redo | healthcare.

He shares his story and discusses his KevinMD article, “What does colon cancer screening have to do with self-driving cars?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Praveen Suthrum. He is a health care entrepreneur, and he wrote the KevinMD article “What does colon cancer screening have to do with self-driving cars?” That’s an excerpt from his book, Scope Forward: The Future of Gastroenterology Is Now in Your Hands. Praveen, welcome to the show.

Praveen Suthrum: Thank you so much, Kevin. I’ve long admired your work, so it’s great to be here. Thanks for having me.

Kevin Pho: So we’ll get into your book and article in a little bit, but first off, can you just share your story and your journey to where you are today?

Praveen Suthrum: Yeah, absolutely. I’m at the intersection of business, technology, and health care, and as you mentioned, I am a health care entrepreneur. I’m actually the co-founder and president of NextServices. Now, if you take the context of GI, or any private practice system in the U.S. or elsewhere, it’s plagued with administrative hassles, technology hassles, and regulatory burden. What we do is, we have a system that takes care of all of this for physicians, and in particular gastroenterologists. So that is the perspective that I’m coming from, and that set the context for Scope Forward. It helped me see where the future is, and write about, especially from a business and technology standpoint, where the future of GI is going.

Kevin Pho: Let’s get into that article, “What does colon cancer screening have to do with self-driving cars?” Now, for those who haven’t read your article, can you just walk my audience through it and share the story of why you decided to share it?

Praveen Suthrum: So, Kevin, back in 2012, I sat in a strange-looking Lexus. It had a gray-colored scanner, a lidar scanner, on top of the roof, and it was rotating all around. Inside there was a laptop, and there were wires running behind the steering wheel and elsewhere. As you might imagine, it was a self-driving car, and it was one of Google’s initial forays into autonomous vehicles. Back then, most of the auto companies dismissed the project, and they said it wouldn’t be practical. Now, fast forward to today: There is not even one major auto manufacturer that doesn’t have a plan for self-driving cars.

So how did this happen? It happened because technology keeps improving in performance every few years, and the costs keep coming down, making this possible. And GI, or gastroenterology, and many aspects of health care are exactly in that place right now. In this particular article, I touched upon colon cancer screening and DNA testing associated with colon cancer screening. So if you ask a gastroenterologist today, they would tell you that traditional colonoscopy is the gold standard for colon cancer screening, and they’re absolutely right. They would also tell you that any of the tests which are out there do not have the right level of sensitivity, or that there would be many false positives and false negatives, and one must be careful. And again, they’re absolutely right.

But if you go back and correlate and connect the dots with the self-driving cars example, you know that with data, technology gets better, and this is digital biology. So just as with self-driving cars, even DNA testing would get better. And not only that, it wouldn’t stop there. In writing Scope Forward, I’ve had plenty of conversations in the industry, and it’s moving towards liquid biopsy. Now, with liquid biopsy, you’re not only going to test for one cancer, colon cancer; you’re going to test for 50. A blood sample would tell you the results for 15 different types of cancers. Now, how would a gastroenterologist compete with something like that? So that is the premise of the article.

Kevin Pho: Tell me a little bit more about liquid biopsy. Is this a blood test, and what other cancers would it screen for?

Praveen Suthrum: So it would screen for all kinds of cancers, including colon cancer, but liquid biopsy is a blood test. Again, this is the holy grail of where the digital biopsy is going. There are several companies, and these are all biotechnology companies, including public limited ones, that are working in this direction. We don’t have it yet, but the whole idea would be to take a blood sample and be able to find, to spot, cancer in a blood sample.

Kevin Pho: And I could imagine that something like this would have far-reaching impacts beyond gastroenterology. It could certainly affect pretty much every area of medicine as well.

Praveen Suthrum: Yeah, absolutely. It will cut into multiple specialties. And imagine: Right now, during the COVID period, one of the companies that does stool DNA testing, for example, started doing telemedicine too, just like the physician community. They were already sending kits home to patients, but now they were promoting, “Hey, you can just stay at home, and you can get your screening for cancer just at home.”

Now imagine the possibility when the sensitivity of these tests improves, and companies like them are able to tell patients, “Look, don’t worry. You don’t even have to visit a doctor’s office. We will test for 15 different types of cancers, and you don’t even have to drink a liquid, or go through the pain of a colonoscopy, or the inconvenience of a colonoscopy. You will know the results at home, and it will come to you on an app.” There are lots of people and companies working on this, and the money, the technology, the energy, and the number of heads working in the space is huge. So we are going to see solutions.

And the same with AI. Now, when you combine digital biology and artificial intelligence and some of the other exponential technologies, then you have great momentum. It will be hard to stop this tsunami. It’s not about fighting it or resisting it, but about how to take advantage of this wave, to do better for patient care, help more patients, and reach more people out there.

Kevin Pho: Now, a lot of your KevinMD articles have focused specifically on gastroenterology. Tell me, what are some other technological advances that may be in the pipeline that gastroenterologists can expect in the next, say, five to 10 years?

Praveen Suthrum: If you take the field of advanced endoscopy, a lot of surgery is now happening through advanced endoscopy. If you think back and ask why that might be the case, the reason is because of more sophisticated robotics. Now, on the face of it, you may think that there’s no correlation between robotics and gastroenterology, but they are actually very closely interrelated. With the greater sophistication that we have in robotics, the manufacturers, so the industry, are able to make more sophisticated endoscopy equipment. And when you combine that with the kind of procedures that you’re able to do, then you can perform procedures without making incisions in the body.

So what does that mean for patient care? They get to go back home sooner, because the recovery rates are faster. At an earlier time, that would have been a general surgery procedure, for example, but right now maybe an advanced endoscopist can do it. For the book Scope Forward, I interviewed an advanced endoscopist who specializes in removing dead pancreas from the body, and he’s a master at that. It’s fascinating, but his ability would have only come about if the equipment exists, if that level of sophistication exists in technology.

Now combine that with the advances in imaging. If you look at what got released at CES last year, you see that we have all these 8K and 4K TVs, or beyond. So there are 8K TVs, and at some point the eye cannot tell the difference between what’s real and what’s virtual, once the imaging equipment gets more and more sophisticated. Now combine that in the endoscopy room, combine that with sophisticated robotics, AI, and digital biology. Each of these technologies would interplay and multiply, creating an exponential wave and opening up completely new possibilities for patient care as well as for endoscopists.

Kevin Pho: A lot of these innovations, are they happening in the United States, or are they happening elsewhere in the world?

Praveen Suthrum: A lot of it happens in the U.S., but it happens globally. Especially, I’ve come across a lot of advances related to AI in gastroenterology in Japan. So it’s a collective momentum, but a lot of it happens in the U.S.

Kevin Pho: We’re talking to Praveen Suthrum. He’s a health care entrepreneur, and he wrote the KevinMD article “What does colon cancer screening have to do with self-driving cars?” It’s an excerpt from his book, Scope Forward: The Future of Gastroenterology Is Now in Your Hands. Now, for the gastroenterologists that you consult with, what do you think are some of the biggest challenges that they face in the foreseeable future?

Praveen Suthrum: Kevin, I could talk to you about all the technology disruptions: the disruption from private equity-led consolidation, the disruption from health systems consolidating, big insurance companies, big technology companies from Google to Microsoft and Amazon, and big retailers like Walmart, all coming into health care. I could tell you that these are the big disruptors and they must watch out for this.

But what I’d actually like to leave gastroenterologists with is that the biggest challenge that they’re going to hit is their mindset, their own mindset towards change. If they’re able to actually work on the organ between their two ears, all of us, if we can use this phase of disruption and use the very things that are disrupting the field, use them as a tool to disrupt and propel ourselves forward. So that’s what I would tell them.

Kevin Pho: Now, what’s a common thing that a gastroenterologist currently does that you think is going to be disrupted first?

Praveen Suthrum: Screening colonoscopy, and they see it. If you look at Medicaid data for the last 10 years, the payments, or the reimbursements, for screening colonoscopy have not gone up, and they’re steadily on the decline. But it contributes a reasonable portion of their income right now. And yes, if that gets disrupted, then you have other business issues that would come up. A lot of the private equity deals are based on physician productivity in the future. Now, my question to a lot of private equity companies that are in the GI field is, “You’re basing it on future productivity, but what if that productivity itself gets disrupted? Then what happens to the financial assumptions that are made today?”

Another example, Kevin, is artificial intelligence in the endoscopy room. If the AI is going to spot the polyps and classify them, and the technology is available today, it’s out there, a lot of it is going through FDA approvals. So if that is out there, then it is going to set a new baseline for performance for endoscopists. That again becomes a big disruptor.

Kevin Pho: And other than changing their mindset, what could gastroenterologists do that could help them best adapt to these coming changes?

Praveen Suthrum: They must first educate themselves and develop a point of view, an independent point of view, of the future. They must understand the big trends that are coming their way, and they must take practical next steps on what they must do. I’m currently working on a tool called the Scope Forward growth tool. We will be releasing it soon. What that helps gastroenterologists do is identify what level of practice they are at, from level one, two, three, four, or five, across six different categories. So they identify where they are right now and what the next level looks like.

So that becomes a very practical tool and guide for them to know, “OK, I need to improve on my finances. I need to improve on my operations. I need to improve on the technology area.” And then get into growth orientation, which would involve starting different ancillaries, or getting into digital health, or developing a robust plan of action for consolidation in their region. So that’s what I would say.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Praveen Suthrum: To the KevinMD audience, I would say that when you look around right now, things seem very, very disruptive. There’s widespread death, there’s widespread infection from forward, there’s economic disruption, there’s all kinds of disruption, and it may seem very bleak. But the situation is going to turn around. All that COVID has done is accelerate trends that were already underway. A lot of things that are happening now are really not new. It’s just that this wave, this tsunami, has come at us closer and faster. So I would tell you to use these same disruptive forces to propel yourself forward, and you will come out stronger from the space. That is the message that I would like to leave you with.

Kevin Pho: Thank you so much for sharing your insight and time, and thanks again for being on the show.

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