Medical technology About the entrepreneurs who are developing wearables, home diagnostics, smart products and apps to put patients in the driving seat

Personalised medicine Using DNA analysis and big data to detect diseases and help physicians devise the right treatment for each patient

New paradigms for healthcare Business leaders bringing affordable and accessible treatment to people in emerging markets

Healthy returns Pictet on investing in healthcare stocks

An inspirational leader The Japanese maestro ISSUE EIGHTEEN | WINTER 2015 who brings out the best HEALTH AND TECHNOLOGY in young musicians

FOREWORD

Health matters to all of us: we want to live longer and better lives as our standards of living rise. In this issue of Pictet Report, we take a look at some exciting developments in the diagnosis and treatment of illnesses, and at new models for providing affordable and accessible healthcare. The most significant factor in improving healthcare today is technological innovation – in particular, the falling costs of DNA sequencing and the enormous expansion of computer processing power. So much of this issue is devoted to interviews with exceptional entrepreneurs who are harnessing such developments to analyse data on a large scale, diagnose illnesses and select personalised treatments. Their products include wearable devices, home diagnostic machines, and smart products and apps which can help people take control of their own health. Two physicians told us about new approaches they have devised to treat conditions such as Alzheimer’s and cancer. We spoke to a Swiss company that makes intricate titanium implants used to treat bone diseases such as osteoarthritis. And the Director of Geneva’s new Campus Biotech explained how he is bringing together different disciplines to find cures for diseases that have defeated large drug companies. We also interviewed two entrepreneurs behind different models for providing healthcare in developing countries and emerging markets. And two Pictet analysts told us how innovation in healthcare has made the companies behind it attractive stocks for investors. Finally, the philanthropist profiled in this issue is Seiji Ozawa, the distinguished Japanese conductor who has set up international academies to help talented young musicians realise their potential. We hope that you will find this issue interesting – suggesting, as it does, that we are entering a new era in healthcare.

Rémy Best Managing Partner Pictet Group

Cover image – Microscope slides with tissue specimens, USC Westside Cancer Center & Center for Applied Molecular Medicine Pictet editorial team – Ninja Struye de Swielande Design & editorial consultancy – Forth Studio | Writer – John Willman Photography – Alex Teuscher, Aurélien Bergot, Zakaria Zainal, Roderick Aichinger, Jan Sondergaard, Oliver Oettli, Jean-Marc Falconnet, Carlotta Cardana, Patrick Strattner, Emmanuel Fradin, Wes Sumner, Nicolas Righetti and Christoffer Rudquist Winter 2015 For subscription information please contact: [email protected] PERSONALISED MEDICINE

p15 Dr Richard Isaacson p37 Dr David Agus p41 Sophia Genetics p47 Stefan Roever Reducing the risk of Alzheimer’s Personalised healthcare Data-driven medicine DNA Sequencing

SWISS-MADE PATIENT EMPOWERMENT

p23 Medartis p21 Atonomics p31 Sentrian p45 Withings High-precision bone implants Diagnostic testing for the people Remote disease management Smart products and apps

NEXT GENERATION HEALTHCARE PHILANTHROPY PICTET'S VIEW

p5 Benoît Dubuis p13 Fullerton Healthcare p28 Seven Seas p9 Seiji Ozawa p51 Pictet on Switzerland’s Health Valley Accessible and affordable Technologies The philanthropist healthcare equities treatment for all A new paradigm for Healthy returns in universal healthcare an ageing world

LOCATIONS

1 California 6 Denmark 6 Stefan Roever Atonomics 3 Dr David Agus 7 Kenya 5 4 2 New York Seven Seas 9 Dr Richard Isaacson Technologies 1 2 9 3 United Kingdom 8 Singapore Sentrian Fullerton 4 France Healthcare Withings 9 Japan and 5 Switzerland Switzerland 7 8 Benoît Dubuis Seiji Ozawa Sophia Genetics Malawi Medartis

pictet report | winter 2015 contents health and technology 3 next generation healthcare: pictet report | winter 2015 4 switzerland’s health valley health and technology NEXT GENERATION HEALTHCARE

SWITZERLAND'S HEALTH VALLEY

Benoît Dubuis

The Director of Geneva’s Campus Biotech is creating a new biotechnology and medical technology centre, bringing together different disciplines to find treatments that will save lives and improve the quality of life for patients

Since the beginning of modern pharmaco- meets the needs of an ageing popu- ‘The confluence logy, the treatment of patients has relied on lation, that it can be financed and of innovations advances in medicine and biology to devise that it can respond to new needs such therapies that can cure or alleviate their as chronic diseases which now in computing, conditions. Today, new approaches focus on consume so much of health budgets.’ engineering and specific biological targets, identify predis- The opportunity to create Campus biotechnology will positions to diseases and find personalised Biotech came in 2012 when the revolutionise treatments that use digital technologies to pharmaceutical giant Merck Serono put patients in control. closed its base in a former indus- the treatment of trial area of Geneva, leading to health problems’ Campus Biotech, an ultra-modern the loss of more than a thousand research centre in Geneva, is aiming jobs. To retain their expertise, a to put itself at the forefront of this consortium backed by the canton new approach, bringing together of Geneva and the federal govern- a wide range of skills in biotechnology ment bought most of the build- and medical technology to find cures ing a year later, with plans to open for diseases that have defeated large a new type of research hub. drug companies. Its new approach Two universities are at the centre to research and development will of the project: the University of create opportunities for collabora- Geneva and École Polytechnique Fédé- tion between researchers, technolo- rale de Lausanne (EPFL), Lausanne’s gists, computer specialists and the technical university – both of which drugs industry to bring innovative are moving research groups to the products to market. campus. Two wealthy philanthropists ‘We are at a turning point in also contributed: the Bertarelli family, the history of medicine,’ says Benoît the descendents of Serono’s founder, Dubuis, Executive Director of Campus which has previously endowed neuro- Biotech. ‘The confluence of innova- science programmes at EPFL and tions in computing, engineering and Harvard; and Hansjörg Wyss, founder biotechnology will revolutionise the of a medical devices business, who is treatment of health problems. Our also endowing the Wyss Centre for Bio- goals are to ensure that medicine and Neuro-Engineering at the Campus.

pictet report | winter 2015 next generation healthcare: health and technology switzerland’s health valley 5 With these resources, the new centre will come from the interface between is focusing on neuroscience – The aim is to have these two approaches,’ says Dr Dubuis. a discipline for which both universities platforms open Dr Dubuis believes that the are noted. This leadership position was Campus will be able to find market to anyone to work boosted when the European Union solutions to intractable neurological decided in 2013 to support EPFL’s in – researchers, diseases, especially mental illnesses Human Brain Project, which aims digital experts, and those connected with ageing such to stimulate the brain using comput- engineers, as Alzheimer’s. ‘Most large pharma- ers and has also been relocated ceutical companies have abandoned entrepreneurs to the Campus. many of these fields because they Another reason for this focus and companies see them as too risky. Our collabora- is that the Campus can unite two tion between different disciplines can approaches to treating neurological tackle them.’ conditions: biotech developments of In addition to neuroscience, the pharmaceuticals; and medtech devices Campus has a second focus on digi- such as the brain implants that now tal medicine. Masses of health data treat Parkinson’s disease. ‘We think is generated daily through mobile that the next generation of treatments applications, wearable technologies, computerised records and analytical disciplines such as genomics. Gath- ering and processing this data using digital forms of R&D such as model- ling, simulation and visualisation should provide information that can make treatments smarter. Opened in May 2015, Campus Biotech already has a workforce of 600, which is expected to climb to more than a thousand. The aim is to foster platforms that are open to anyone to work in – researchers, digital experts, engineers, entrepreneurs and compa- nies. ‘Use labs’ are available for non-employees where they can collab- orate on specific projects and return to their normal places of work when they are completed. Dr Dubuis is well-placed to work on such convergence issues. A chemical engineer by training, his doctorate was in biotechnology. He was Dean of the School of Life Sciences at EPFL and has worked with companies such as Ciba- Geigy and Lonza. He also co-founded Eclosion, the first Swiss Life Sciences seed-fund and incubator which helps researchers transform their laboratory findings into commercial products. In addition, he is President of BioAlps, a non-profit association that promotes the life sciences clus- ter of Western Switzerland, notably in biotech and medtech. It has created what is called the Health Valley region, one of the fastest growing life sciences

next generation healthcare: pictet report | winter 2015 6 switzerland’s health valley health and technology Switzerland’s Health Valley

Staff Project investment

CMU

Commissioning in 2015–2016 Staff: Less than 1,000 Project investment: Less than CHF149m NEUCHÂTEL (WCBN)

Commissioned in mid 2014 MICROCITY Staff: 300, the majority remain dependant on their institutions. Project investment: CHF100m over Commissioned in 2013 6 years (operating costs) Staff: Less than 600 Project investment: Less than CHF70m BATLab

Commissioning end 2014 RENENS EPFL VALAIS-WALLIS Staff: Less than 350 LAUSANNE Project investment: Less than CHF65m Commissioned beginning of 2015 CAMPUS BIOTECH Staff: Less than 300 Project investment: CHF115m

Commissioned in 2014 AGORA Staff: Less than 1,000 Project investment: Less than CHF300m Commisioned in 2016 Staff: Less than 400 GENEVA Project investment: Less than CHF70m SION

UNIVERCITÉ

Commissioned in September 2014 4,050 Total staff Staff: Laboratory Community (100) CHF869m Total investment Project investment: voluntary work Source: Messaggio Agency

GENEVA LAUSANNE

CAMPUS BIOTECH THE WYSS CENTER FOR BIO & AGORA With the support of the Bertarelli family NEUTROENGINEERING (WCBN) Located on the site of the CHUV, the future AGORA and the Wyss Foundation, the EPFL and the Made possible by a donation from philanthropist Cancer Centre will be the core of the new Swiss University of Geneva are in the process of Hansjörg Wyss, the WCBN can be considered Cancer centre of Lausanne. transforming the former headquarters as a focal point and ‘translational engine’ of the of Merck Serono into a new centre of excellence Biotech Campus. NEUCHÂTEL dedicated to neuro- and bioengineering. EXTENSION OF CMU MICROCITY BATLab The completion of the CMU meets the needs Microcity lies at the heart of what is expected to become in time one of the largest centres of BATLab is the new building for laboratories of the University of Geneva in the fields of Life Microengineering expertise in Europe. of HUG. At inauguration, 32 laboratories and Sciences, one of its areas of excellence. about 350 specialised employees will move SION into the new building. RENENS EPFL VALAIS-WALLIS CAMPUS

Based in Sion on the site previously occupied by UNIVERCITÉ Espace Création, it will bring together 11 chairs, Based in Renens, UniverCité is an open space two of which will be dedicated to neuroscience which militates in favour of democratised research and two others to biotechnology. where it will be possible to develop breakthrough technologies at the crossroads of various disciplines.

pictet report | winter 2015 next generation healthcare: health and technology switzerland’s health valley 7 clusters in the world, with more than foreigners who can contribute to its ‘We want to 750 biotech and medtech compa- economy and even run some of its innovate in how nies and 500 research laboratories. largest companies. we innovate ’ It also includes some 20 world-famous He says that there is good collabo- research institutions, universities and ration between academia and indus- university hospitals, as well as many try in Switzerland, not always the case bodies supporting innovation such in many other European countries. ‘It as start-up incubators and venture needs a strict framework to define the capital funds. roles of each partner, but there is much ‘The Campus scientists, research- that can be gained from industry – and ers and companies will be able to tap not just financially. Companies have into a huge range of specialisms in many competences lacking in higher the region,’ says Dr Dubuis. ‘Neucha- education, and also terrific knowledge tel’s Microcity, for example, is a centre which should be tapped into.’ of excellence for the micro-engineer- ‘There are two basic principles ing that is essential for many new driving us,’ says Dr Dubuis. ‘The first medtech devices. The region, famous is innovation: we want to not only for its watchmaking expertise, can innovate, but to innovate in how make tiny gadgets that are very reli- we innovate – bringing communi- able over many years.’ ties together to support innovation. Switzerland is an attractive The second is collaboration: we don’t country for such research, he adds: want to compete with any of our part- once a poor country lacking natu- ners – we are simply different. ral resources such as minerals, it has ‘We will spend more time under- developed strengths in creative indus- standing diseases. And we will organ- tries such as engineering and biotech ise ourselves to translate the results to compensate. It has also welcomed of our research into solutions.’

next generation healthcare: pictet report | winter 2015 8 switzerland’s health valley health and technology THE PHILANTHROPIST

Seiji Ozawa

After a distinguished career conducting famous orchestras all over the world, the Japanese maestro has founded international academies that help young instrumentalists develop their potential by playing chamber music

pictet report | winter 2015 health and technology the philanthropist 9 From a young age, Seiji Ozawa was destined It’s fascinating to observe how young ‘Teaching is like a for a career as a classical musician. Born in 1935 artists develop within a short period drug. Once you start, to Japanese parents in China, he made a promi- of time.’ sing start studying piano when his family The Swiss Academy brings you just can’t stop! ’ returned to Japan in 1944. His father had even together 24 young violinists, viola- bought a piano, and his teacher focused on the players and cellists and one double works of Johann Sebastian Bach. bass player for two weeks each summer in Rolle, a town 32 kilometres from But when he graduated from junior Geneva. He oversees the students’ high school in 1950, he developed work with the tutors, renowned artists another passion – for rugby football, with substantial experience in teach- a famously physical ballgame that ing their craft. He also directs them in always carries a risk of injury. Playing public rehearsals open to the residents in the school team in the scrum where of Rolle, and the Academy’s guests. the danger of serious impact is even The instrumentalists are selected higher, he collided with an opponent throughout the year from the best and was trampled on. As a result, he conservatories and international lost consciousness, breaking his nose competitions in Europe, and they are and two fingers. invited to participate free of charge – ‘I had promised not to play a year as with all of Seiji Ozawa’s academies. earlier, but my parents didn’t know I ‘I benefited from the help of was still playing. I had kept it a secret, teachers in my youth,’ he says, ‘so it is so after I cleaned myself up, I travelled important that talented young people the two hours home by train!’ from poor families should be able to Unable to continue playing the attend. I try my best to raise money piano well enough to reach concert so that anybody can come – we had 17 level, he was encouraged by his teacher different nationalities in 2014.’ to think about conducting instead. The program begins with master- However, he had no idea what a classes and rehearsals in Rolle Castle conductor did, having never seen an which overlooks Lake Geneva, and orchestra perform – there was no tele- concludes with concerts in the Castle’s vision in Japan at the time. But when courtyard, Geneva’s famous Victoria his teacher took him to a performance Hall and the Aigues-Vertes Foundation of Beethoven’s Fifth Symphony, he village outside Geneva which cares for realised that conducting was some- people with cognitive impairments. thing wonderful that he wanted to do. In 2015, it concluded with a three-day And so began a distinguished residency at the newly opened Louis career as an orchestral conductor Vuitton Foundation in Paris’s Bois that has taken him all over the world, de Boulogne. and included a remarkable 29 years An unusual aspect of the Academy as musical director of the Boston is that it is devoted to chamber music, Symphony Orchestra. Today at the especially the string quartet. In doing age of 80, he no longer tours, though so, it follows the guidance of his first he still performs as a guest conductor. teacher, Hideo Saito, who focused on But he continues to play a key role in Western music. He believed that the training the next generation of musi- quartet was the basis of all ensemble cians through his inspirational lead- music, to which composers such as ership of academies which he has set Haydn, Mozart and Beethoven gave up, including the Seiji Ozawa Interna- the very best of themselves. tional Academy Switzerland, launched ‘Studying the string quartet leads in 2004. you right to the heart of music,’ says ‘Teaching is like a drug,’ he says. Seiji Ozawa. ‘That is why we urge the ‘Once you start, you just can’t stop! young musicians to focus on them. Working with such top-class young Becoming acquainted with this musicians gives me enormous pleasure. immense and significant repertoire

pictet report | winter 2015 10 the philanthropist health and technology at an early age paves the way towards and then with Leonard Bernstein who He also directs twice a year the Mito being a good musician. invited him to join the New York Phil- Chamber Orchestra, created in 1990 ‘Most young instrumentalists harmonic on a tour of Japan. This was and made up of some 30 top musicians. think like soloists. We must snap them followed by spells as director of the And he has created academies in Japan, out of this: it is only once they have Toronto and San Francisco Symphony including the Seiji Ozawa Ongaku- grasped the miracle of sharing cham- Orchestras, before he was appointed Juku (Music Academy) for Japanese ber music that they will be able to musical director of the Boston and Chinese student musicians with a understand great composers such as Symphony Orchestra in 1973. particular focus on opera, as well as the Mozart, Beethoven and Bruckner. Throughout his professional Ozawa International Chamber Music ‘In a quartet, musicians have career, Seiji Ozawa worked with a Academy in Okushiga. nowhere to hide. There are no frills – limited number of orchestras in cities Today, he is as involved as ever in nothing is purely cosmetic. They must such as Chicago, Berlin, Munich and his academies, inspiring the musi- listen to one another in order to play London, in addition to his direc- cians who have participated in them together, with great intensity. Every- torships in Toronto, San Francisco, and grateful to the sponsors who have thing must be perfect.’ Boston and Vienna. He became made that possible. He sees the young Seiji Ozawa gives much of the known for his expressive conduct- musicians as amazing individuals who credit for his professional success ing style, which he attributes to his deserve the best – to be in contact with to his school teacher, who was very poor command of foreign languages: tutors of the highest calibre who can strict on method and whose lessons ‘I didn’t have good English, so when give them the opportunity to explore included sight-reading for singing and conducting overseas I moved a lot and their abilities. music dictation. And it was those skills used my eyes to convey my instruc- ‘These young people are amaz- that helped his former pupil reach tions to the musicians.’ ing. They have strong personalities public attention in 1959 when he was After leaving the BSO in 2001, he that shared experiences can help to awarded first prize in the Besançon became musical director of the Vienna develop and, at the same time, control. International Competition for Young State Opera, and while in that role he I am happy to take them on such Conductors at the age 24. launched the Swiss Academy. However, an adventure.’ This led to an invitation from the he had not neglected his Japanese French conductor Charles Munch, origins, having founded in 1984 the For more information, visit then musical director of the Boston Saito Kinen Orchestra in honour of his www.ozawa-academy.ch Symphony Orchestra, to conduct the first teacher. Each summer, this brings orchestra at the Tanglewood Music together Japanese musicians from the Festival in the US. Next he studied most prestigious Western orchestras in in Berlin with Herbert von Karajan, a festival in the town of Matsumoto.

pictet report | winter 2015 health and technology the philanthropist 11 12 ********************** NEXT GENERATION HEALTHCARE

FULLERTON HEALTHCARE

Accessible and affordable treatment for all

A Singapore group has become a leading supplier of comprehensive health services to businesses and health insurers in the Asia-Pacific region, helping keep patients out of hospital though preventative healthcare

Providing healthcare for all their citizens is provide cost-efficient healthcare services Rising living a key issue for Asian governments. The popu- and promote healthier lifestyles. standards in lations of countries such as India, China ‘Asia-Pacific governments are and Indonesia are rapidly ageing, placing a spending around 4 per cent of GDP emerging economies growing burden on healthcare budgets which on healthcare, and we expect this to bring the lifestyle are already insufficient to meet the needs of significantly increase over time. But illnesses of more their people. if it goes above 10 per cent – and the affluent societies US is spending well over that – it will This demographic change brings with it become unsustainable. We can help the chronic illnesses and disabilities that develop healthcare systems in sustain- afflict elderly people in developed coun- able ways that will provide accessible tries. And rising living standards are and affordable treatment for all.’ adding pressure by changing consump- Fullerton was founded by Drs tion patterns, leading to the faster onset Michael Tan and Daniel Chan in 2011 of the lifestyle illnesses of more affluent by merging two private healthcare societies. For example, almost one in groups which owned just six clinics in five Indonesians have chronic diabetes, Singapore. The founders had extensive putting additional strain on public and experience in a large Asian healthcare private healthcare systems, and on the company and backgrounds in corpo- care-givers in their families. rate and insurance-backed healthcare, These challenges are forcing govern- and wanted to focus on developing that ments and private enterprises to seek sector for a wider audience. David Sin, help in dealing with the rising demand the Chairman, is chief executive of SIN for healthcare, according to David Sin, Capital Group, a private investment Chairman of Fullerton Healthcare. group which has a majority controlling This integrated enterprise healthcare stake in Fullerton. organisation offers services like those of The company has already expanded US Health Maintenance Organisations into five other Pacific Rim countries: (HMOs) by managing health spending Indonesia, Malaysia, Hong Kong, China for governments, insurance companies and Australia. It now owns close to 200 and multi-national businesses. It uses clinics, and has a global network of its scale across the Asia-Pacific region to more than 8,000 clinics and hospitals

pictet report | winter 2015 health and technology next generation healthcare: fullerton healthcare 13 which can offer a comprehensive service ‘Our doctors and nurses identify the to its patients across the region. And patients most at risk, and we sponsor Fullerton sees part it has close to 10 million lives under the medication for their chronic illnesses of its mission as care, compared with less than 1 million for the rest of their lives. It costs us less in 2011. than 1 per cent in income, but has a keeping patients out ‘Scale is important, and we are the tremendous impact on the community.’ of hospital through only healthcare provider in the region Like HMOs in the US, Fullerton sees preventative that has such scale in terms of patient part of its mission as keeping patients healthcare numbers and countries,’ says David Sin. out of hospital through preventative ‘It helps us to manage costs effectively healthcare. ‘Many healthcare provid- for both the private and public sectors. ers see patients as profit-centres, but And it allows us to extend our reach to we put them at the centre of our care people at risk or below the poverty line model. We aim to empower them to who can’t afford public polyclinics or lead more healthy lives through better the medicines they need.’ knowledge, diets, exercise and moni- In January, Fullerton launched a toring of their own health. If we are first such initiative in collaboration with successful, this will contribute towards the Singapore government to provide managing the cost of healthcare. medical coverage for a large residen- ‘Our long-term aim is to trans- tial area with a high proportion of low- form healthcare across the Asia-Pacific income and elderly people. It runs free region, with the cornerstone tenets mobile clinics every quarter for such of accessibility and affordability for patients who are unable to pay for their those we serve, while making a positive healthcare – many of whom are elderly, impact on all the communities that we disabled or have chronic illnesses. operate in.’

pictet report | winter 2015 14 next generation healthcare: fullerton healthcare health and technology PERSONALISED MEDICINE

THE NEUROLOGY PROFESSOR

Reducing the risk of Alzheimer’s

Dr Richard Isaacson says that the onset of Alzheimer’s Disease can be delayed by changes in diet and lifestyle, including keeping the brain active by learning new skills – but treatment must start long before symptoms emerge

pictet report | winter 2015 health and technology personalised medicine: the neurology professor 15 One of the biggest challenges facing medicine ease their plight. Today, he says, it is as populations age is the cognitive decline possible to talk about interventions associated with Alzheimer’s, the target of for Alzheimer’s and his clinic is treat- considerable investment in research which ing hundreds of people ranging in age has yet to find a cure for patients with this from 27 to 91. distressing condition. But a pioneering ‘We see patients with a family Alzheimer’s prevention clinic at New York- history of Alzheimer’s but no symp- Presbyterian/Weill Cornell Medical Center toms of the condition. It starts in the offers cutting-edge prevention strategies that brain 20–30 years before memory loss can delay its onset. appears: like a heart attack or a stroke, it takes decades to develop. We try to The clinic was founded in 2013 by intervene with nutritional and life- neurologist Richard Isaacson, who was style measures to delay the emergence motivated by the diagnosis of Alzhei- of the symptoms.’ mer’s in four family members at a time There is no ‘one size fits all’ for when there was nothing that could his approach, he says, but the risk of

pictet report | winter 2015 16 **********************personalised medicine: the neurology professor health and technology dementia can be reduced. While some risk factors such as age or genetics cannot be changed, others can. ‘It’s all about treating modifiable risks that can help win the war against genes – genetics are not your destiny. So if there is a gene that increases the risk of Alzheimer’s, the risk can be reduced by taking regular exercise, maintaining muscle mass, doing aero- bic exercise and following a healthy brain diet. ‘To determine what a healthy diet is, we look at the patient’s cholesterol and metabolic markers such as blood sugar and insulin. We then select an appropriate brain-healthy diet which typically involves less carbohy- drates, more lean proteins and lots of green vegetables, and is high in anti- oxidants such as dark cocoa powder.’ Other elements of the treat- ment involve intermittent fasting, specially calibrated doses of vitamins to slow memory loss and shrinkage of memory in the brain, and mindfulness techniques such as yoga and medita- tion to reduce stress. ‘Every four years of work stress equals one extra year of brain ageing.’ cognitive functions are stabilising and Prof Isaacson says that exercise can risk factors are reducing. ‘It starts in the help create a healthy brain. ‘As you age, ‘Including internal staff discus- brain 20–30 years the bigger your belly is, the smaller the sions, it takes more than six hours to before memory memory centre in the brain becomes. prepare each personalised plan. But And it is important to keep the brain we now have a database of 380 patients loss appears’ engaged – by learning a musical instru- that allows us to assess the effective- ment or a new language, for example. ness of our approach. This shows that ‘Sleep is also important: there our patients feel empowered to take are bad proteins in the brain called action, they are less stressed and their amyloids which exercise loosens up, but risk factors are declining. sleep is needed to flush them out. And ‘Overall, global cognitive func- we encourage patients to participate in tions seem to be improving, though clinical trials for products such as vacci- memory loss is proving toughest to nations that could prevent Alzheimer’s.’ deal with. We will be able to find out This personalised approach is very if our treatment delays Alzheimer’s time-consuming, he adds. With a ten- only after ten years, but that doesn’t month waiting list, he encourages mean waiting that long to use it. If we potential patients to use an hour-long can delay the onset for six months, one online prevention course to brief them- year or five years, that will have a huge selves first. Consultations start with a impact on patients and society.’ battery of biometric and cognitive tests lasting an hour and a half, followed by a one-hour review of the results after eight weeks. Hour-long sessions every six months then monitor whether

pictet report | winter 2015 health and technology personalised medicine: the neurology********************** professor 17 pictet report | winter 2015 18 health and technology The custom-made, animated and programmable digital media wall, Belfer Research Building, New York

pictet report | winter 2015 health and technology 19

pictet report | winter 2015 20 **********************patient empowerment: atonomics health and technology

PATIENT EMPOWERMENT

ATONOMICS

Diagnostic testing for the people

A Danish biotech company is using scientific and technical advances to create small and affordable devices that will allow patients to carry out laboratory-quality diagnostic tests quickly and cheaply at home

The diagnosis and monitoring of serious and cally relevant data about your health chronic diseases has long depended on labo- from tests which are as good as those ‘Users can check ratories in hospitals and specialist centres to done by hospital equipment. Users can their health quickly analyse blood samples taken by physicians therefore check their health quickly and pharmacists. However, innovative entre- and simply, and whenever required.’ and simply, and preneurs are exploring new techniques for Atonomics, which is based in whenever required’ bringing diagnostic testing closer to patients Copenhagen, was founded in 2000, that will provide much faster results. at a time when it was believed that diagnostic analysis had to be done Now Atonomics, a Danish biotech- by centralised laboratories. So its nology company, is launching a small first product, developed with a US device that can be used at home to company, was equipment for diagnos- carry out complex tests, empower- ing cardiovascular diseases closer to ing consumers to monitor their own patients, in clinics, pharmacies and health and manage their diseases physicians’ offices. actively. If problems are identified, But Thomas Warthoe’s vision was patients can consult a doctor before to put diagnostic tools in the hands of they become more serious – improv- ordinary people and Trace® is the first ing the quality of their lives and poten- such product. The data it produces is tially saving large amounts of money managed by a smartphone app which in treatment costs. allows users to monitor their health, Trace® is a functional and easy- send the results to their doctor or file to-use device designed to be used in them online to their medical records. a patient’s home – small enough to ‘We have invented ways to analyse sit on a side-table or bedside cabinet. blood samples that, for example, can Users take a small drop of blood from a separate out the plasma without spin- finger stick, and within a few minutes ning them in hospital centrifuges. can measure the level of the biomark- We have solved a lot of such technical ers in their bloodstream which issues, miniaturised the equipment indicate the risk of diabetes and cardi- and simplified the processes so that ovascular diseases. the device can be used at home. ‘This device is not a gadget ‘It is also cheaper than those of like some wearables,’ says Thomas competitors: one larger machine Warthoe, founder and chief executive widely used for diagnostic test- of Atonomics. ‘It produces real, clini- ing costs USD3,000, compared with

pictet report | winter 2015 health and technology patient empowerment:********************** atonomics 21

around USD100 for ours. And in Denmark alone, eliminating the four routine laboratory diabetes tests could save more than EUR500 million a year, and billions more in treatment costs if the disease can be controlled better.’

‘Healthcare should not be about how sick people are, but how healthy they are’

The machines will be manufactured in Israel, but the small cartridges used to hold the blood sample – the brains of the device – will be made in-house. The product will be launched in the UK in 2016, followed by other Euro- pean countries and in Japan in 2017 where the government has ordered companies to do at least 900,000 tests a year in pharmacies by 2020. Atonomics can produce 5,000 devices and 100,000 cartridges a year manually, but automating manufac- turing will raise that to 100,000 devices and five million cartridges within three years. By 2020, the company is aiming for more than 100 million tests a year worldwide. Thomas Warthoe expects that the first users will be reasonably fit people who already have gadgets that meas- ure heart rate, blood pressure and steps taken daily. But he hopes that the device will also be attractive to health- care providers which will encourage their growing numbers of chronically sick patients to use it so that illnesses can be detected and tackled early. ‘We are seeing a new paradigm emerge,’ he says. ‘Our vision is that healthcare should not be about how sick people are, but how healthy they are. This has already started with gadg- ets, but now Trace® can give people access to data about their health before serious problems develop.’

pictet report | winter 2015 22 patient empowerment: atonomics health and technology SWISS-MADE

MEDARTIS

High-precision bone implants

A Basel-based manufacturer of implants and surgical instruments for the fixation of bone fractures and deformities in the head, jaw and face has extended its range to products for orthopaedic surgery for hands, arms and feet

pictet report | winter 2015 health and technology swiss-made: medartis 23 Advances in surgery frequently focus on the elbow and foot. Most of the prod- ‘The rapid growth new techniques which bring relief to people ucts are for fixing broken bones after largely reflects facing life-threatening conditions. But accidents but they are also used for the customers’ many improvements that surgeons bring reconstruction of deformities for skel- to patients’ quality of life rely on high- etal diseases such as osteoarthritis. appreciation of tech products manufactured by innovative Today, Medartis develops and Swiss quality in companies. One of these is Medartis, a Swiss manufactures a wide range of titanium manufacturing’ company that develops and manufactures screws and plates, as well as specialised titanium implants and surgical instru- surgical instruments designed for its ments for a variety of bone surgeries. devices. Having started out with just six employees, it now has a worldwide The company was set up in 1997 to staff of 350 and subsidiaries in five produce titanium implants to fix bone European countries, the US, Australia, fractures in the head, face and jaw by New Zealand and Mexico. joining broken bones and keeping Willi Miesch, its chief executive, them stable during healing. In 2004, it says that this rapid growth largely expanded into implants for the hand reflects customers’ appreciation of and wrist, followed later by those for Swiss quality in manufacturing and

pictet report | winter 2015 24 swiss-made: medartis health and technology technology. ‘Also, everything apart from our subsidiaries is under one roof in Basel – R&D, production, sales and management. When we face a prob- lem, we can look into it with the engi- neers and sales force, find a solution and fix it quickly.’ Innovation is a priority for the company, he adds. When Medartis started out, most implants were rather simple, but they are becoming increas- ingly sophisticated in shape and design. Some of its products for hands are nearly as small as watch parts, but they can be life-changers for older people with osteoarthritis who have been in pain for years. ‘The elbow, which started off as a niche, is a growing segment which is very demanding. We measured a large number of elbows with different anatomies to adapt our implants to the different shapes and sizes. 3D print- ing of implants could make it easier to find the perfect fit in the future, but is likely to be introduced only for diffi- cult cases at first.’ A growing complication as the population ages is the bone quality of elderly patients. This means dealing with all kinds of associated diseases that affect bone quality, such as diabe- tes mellitus and osteoporosis. ‘If you are in a boat and drop the anchor, you need a different technique for sand, mud or gravel – which is what we need for implants in older patients.’ A challenge shared with many other Swiss companies is the currently more employees to comply with them. high value of the Swiss Franc. This ‘For example, we are entering the ‘Everything increases export prices, which has Chinese market and they again have apart from our reduced growth rates at Medartis different requirements and regula- from double digits to one digit. ‘It is a tions that we need to meet.’ distribution popular belief that price is a secondary For the future Miesch believes is under one issue for health products but groups that Medartis can remain independ- roof in Basel’ of hospitals have a lot of purchasing ent, despite consolidation among power. However our employees under- competitors. ‘We are often asked if we stand the pressure and act in a cost- want to sell – and if we had more capi- conscious manner.’ tal, we could grow faster. But we are a A further challenge is the fast- quality-focused company with superb evolving regulatory environment, products, we all enjoy working here, which has become even more difficult we have a clear vision, and we have after scandals such as the one over an excellent relationship with our breast implants in France. Each coun- board. We are aware that this is a very try has its own regulations, requiring precious situation.’

pictet report | winter 2015 health and technology swiss-made: medartis 25 pictet report | winter 2015 26 health and technology Medartis, International Headquarters, Basel

pictet report | winter 2015 health and technology 27 NEXT GENERATION HEALTHCARE Providing healthcare for their poorest citizens is a policy challenge facing African govern- SEVEN SEAS TECHNOLOGIES ments which lack the resources to invest in hospitals, clinics and medical equipment. But Michael Macharia believes that develo- A new paradigm for ping countries can leapfrog over US and Euro- pean healthcare models to provide healthcare universal healthcare for all their people. The founder of Seven Seas Technology (SST) Group, a pan-African business, has teamed up with GE Healthcare Entrepreneur Michael Macharia is using in a Kenyan government partnership to create a nationwide health service for its 40 million- information and communication technology (ICT) plus population. and innovative financing schemes to bring health services to Kenya’s poorest people, even in the His plans have three central elements. remotest parts of the country The first is harnessing the full potential of ICT platforms such as telemedicine and health information management systems in order to widen access to services. The second is collecting data at the centre which can help political leaders – well aware of the importance of healthcare to voters – make deci- sions. And the third is using innovative financing schemes to build the infra- structure for a national health service. ‘I started my company when I was 25, using hardware technology to solve problems for commercial clients,’ he says. ‘They needed to recruit talent, get access to capital, scale their businesses and increase their share of competitive markets. But I decided to focus on apply- ing technology for purpose and impact on the 80 per cent of Kenyans who are at the bottom of the pyramid [those living on less than USD2.50 a day]. ‘I identified three sectors as priori- ties: health, social services and home- land security. If we get those right, it will build a great platform to change lives and transform communities – not just in Kenya, but across Africa. What we build in Kenya can be mapped onto the continent.’ He started by improving access to government services, with a model now adopted by the government nation- wide. In 2013, SST created Huduma Centres, one-stop shops giving access to official documents such as driving licences and national identity cards to tens of thousands of people each day. And in 2015, in partnership with Safa- ricom, Kenya’s leading mobile operator,

next generation heatlhcare: pictet report | winter 2015 28 seven seas technologies health and technology SST launched an online employment information to identify where there is platform called Xaba, linking blue- ‘Health, social insufficient capacity and assist in allo- collar jobseekers and employers. services and security. cating resources. When it comes to healthcare, Kenya Now SST is tackling primary has started to introduce new and inno- If we get those right, healthcare throughout Kenya, using vative delivery models in partnership it will build a great customisable clinics in shipping with some of the world’s biggest busi- platform to change containers – so-called ‘Clinics in a Can’ nesses. ‘Hospitals don’t need to own lives and transform which are already in use in Southern infrastructure such as labs, operat- Sudan and Haiti. The project is in a ing theatres and intensive care units,’ communities’ development phase, but the plan is Macharia says. ‘So the government that specially trained nurses will staff invited multinational companies such them to provide maternal healthcare as GE Healthcare to build the infra- and run vaccination campaigns, as well structure and manage it in partnership as providing triage for admission to with us under a seven-year contract. hospitals. The clinics are connected to ‘SST Group is project-managing the telephone network, giving patients and integrating ICT healthcare solu- remote access to doctors and allowing tions, including a countrywide picture uploads of data. archiving and communication system Macharia hopes that the Seven Seas to enable remote radiology diagnos- approach will be attractive to other tics, and reporting on the roll-out of the African countries such as Ethiopia and project which will introduce new radi- Nigeria. ‘Healthcare is a critical issue for ology diagnostics centres in 98 hospi- any government,’ he says, ‘and if they tals. It will have a landmark impact on get it right, it will play a part in their people for generations to come.’ campaign effort to win re-election. Our The next step was to integrate tech- aim is to replicate this business model, nology into the infrastructure to collect which brings in best-of-breed partners national data about healthcare services. and innovation across Africa and in This provides the health ministry with other emerging markets.’

pictet report | winter 2015 next generation heatlhcare: health and technology seven seas technologies 29 pictet report | winter 2015 30 patient empowerment: sentrian health and technology PATIENT EMPOWERMENT

SENTRIAN

Remote disease management

Jack Kreindler believes that people with chronic diseases can avoid costly hospitalisation by using small medical devices they can wear or have in their homes which detect the need for treatment before the symptoms emerge

The world’s health services face rapidly can analyse the data to get much earlier increasing costs for hospitalising patients, warnings of crises. It can also learn what especially older people with complex chronic works and what does not for people with diseases. Jack Kreindler, a physician and those chronic diseases. technology entrepreneur, believes that as the ‘People who come crashing into population ages further, Western economies hospital cost on average between risk being crushed by the burden of unaffor- USD20,000 and USD30,000 a time, so dable healthcare systems. And he also believes there is a lot that can be saved by avoid- that innovations in medical technology could ing hospitalisations,’ says Dr Kreindler. detect the need to treat such people much ‘It is a USD100 billion a year problem in earlier – reducing avoidable hospital stays. the US and a £20 billion a year problem in the UK. And while there is a reluc- The technologies he is pioneering tance to pay for preventative medicine, include biosensors stuck on patients’ there are organisations and govern- wrists, watches tracking physical ments that want to pay for keeping movements, tiny pulse oximeters people happy and healthy at home.’ monitoring blood oxygen levels and His career began when paying his scales that weigh and monitor the way through medical school in London body’s fluid balance. Apps can report by doing IT consulting. He then worked symptoms, side-effects, exercise levels, for the late Douglas Adams, author of how the patient is feeling and whether The Hitchhiker’s Guide to the Galaxy, carers are providing enough support. a popular comedy science fiction And instead of relying on humans to series which started out on BBC radio. interpret the results of such monitoring, Dr Kreindler worked on Adams’s H2G2 machine intelligence – which he calls project, a collaborative online encyclope- Human Augmented Machine Learning – dia created two years before Wikipedia.

pictet report | winter 2015 health and technology patient empowerment: sentrian 31 ‘I realised that there was an incred- to Cigna, a health insurer that devel- ible amount of knowledge about what ops programmes to keep employees ‘There is an incredible was happening to our bodies through healthy. He put the proceeds into amount of knowledge our lives which we weren’t capturing. setting up the Centre for Health and about what is So I started Vielife which evaluated Human Performance in London’s the current and future risks to healthy Harley Street, which worked with happening to our people who were in large workforces – athletes and celebrities taking on bodies which we are including factors such as workload and extreme challenges, and also on not capturing’ sleeping patterns as well as weight and complex health cases. blood pressure.’ ‘We applied nutritional science, Anticipating the risks could save exercise science, sleep and recovery employers a lot of money lost to poor science, cognitive science and psychol- productivity, sickness and absence and ogy to treat everyone from Olympians the company was sold after six years to very sick people. Ours was a data-

pictet report | winter 2015 32 patient empowerment: sentrian health and technology driven approach – high frequency, continual closed-loop feedback which measures a patient on many dimen- sions, records the outcomes of interven- tions and then varies them as necessary. ‘In 2012, I joined a medical programme run by an organisation in California called Singularity University which brings together brilliant minds at the cutting edge of science and tech- nology. I realised that the kit we were using at CHHP was too big and expen- sive to use outside the lab, and I also learnt about the new wearables that could monitor a person’s health. ‘It was clear that within a few years, we’d be able to do most of what CHHP did in homes by sticking some- thing on patients’ skin, around their necks or even in a light socket. And the brains needed to interpret the data could be emulated – and improved on – by using machine intelligence.’ So he founded Jointly Health, to join together what was going on in the lives and homes of people with the understanding the medi- cal profession had of them. It became Sentrian, and has recruited eminent experts with records in healthcare population analytics and developing wearable technologies. payer a lot more. Our approach is able He expects its work to be attractive to spot that interventions are needed ‘Our approach to organisations that are at risk from two weeks before symptoms appear.’ is able to spot that rising hospitalisation rates – managed Several pilots are under way, and care organisations such as the UK in August 2015, the US Food & Drug interventions National Health Service and those Administration exempted Sentrian are needed two behind disease management plans. In from the normal testing required for weeks before the US, the Government Centers for medical devices – putting them in symptoms appear’ Medicare & Medicaid Services (CMS) a similar position to apps. And new spend a trillion dollars a year looking devices are being developed all the after uninsured patients – many with time, such as one that can measure chronic diseases. And insurers such as several indicators of activity from a wall Anthem, United and Blue Cross also socket at a very low price. need to reduce hospitalisations. ‘We will be publishing some quite ‘Remote disease management extraordinary results from our work programmes have never worked for on the difference between the normal them because the kit has been too approach to triggering alerts and alarms expensive and there has been a high compared to our machine intelligence- false alarm rate that leads to unneces- driven approach. And we are continu- sary call-outs. Outreach and scheduled ing to search for the best devices which calling systems benefit engaged people can generate the right combinations of who respond to them, but they don’t data to predict when people with poly- catch people who are isolated or not chronic diseases need treatment before engaged early enough – costing the they require hospitalisation.’

pictet report | winter 2015 health and technology patient empowerment: sentrian 33 pictet report | winter 2015 34 health and technology Micro fuse tubes with biological cell line samples, USC Westside Cancer Center & Center for Applied Molecular Medicine

pictet report | winter 2015 health and technology 35 pictet report | winter 2015 36 **********************personalised medicine: the professor of medicine health and technology PERSONALISED MEDICINE

THE PROFESSOR OF MEDICINE

Personalised healthcare

Dr David Agus is a leading cancer doctor, pioneering biomedical researcher and best-selling author who sees the human body as a complex system and has developed new approaches to treating diseases and leading a healthier life

Medical science made a wrong turn in the winning physicist. By working with 1920s, according to Dr David Agus. An a physicist and a computer expert, he ‘More movement experiment took a dozen people with signifi- has come to see diseases in bodies as during the day has cant cuts on their legs, and treated half of products of a complex system. them by wrapping bread dipped in water ‘It has radically changed how a dramatic effect around the leg and half by leaving the leg we think about health, wellness and on disease and open to the air. People with the bread on disease. Chemotherapy, radiotherapy life expectancy’ their legs healed twice as fast, and that and drugs can help people live longer, spawned something called germ theory. but there are newer, better ways to prevent and treat diseases. If people ‘Germ theory says that as soon as you come to me with cancer, I can sequence know what you’re up against, you its DNA, know what its on- and know how to fix it. There was mould off-switches are, and identify the right on the bread which made penicillin treatment – such as taking the brakes which attacked the bacteria. But while off their immune system to attack looking through the microscope to see the cancer.’ what you’ve got is right for diseases He has treated many distinguished like bacterial infection, it is not right patients, such as the late Steve Jobs for diseases from within the body – whose life he extended after previous like heart disease, Alzheimer’s and treatments had failed. In his labora- cancer. We have kept looking at the tory, he develops new treatments and diseased cell, but we should be looking diagnostic techniques, which are spun at the whole system.’ off to companies he has founded for And that is the approach that Dr marketing and production. And he Agus takes at the University of South- brings his findings to larger audiences ern California in Los Angeles, where he by writing books and newspaper arti- heads the Norris Westside Cancer Center cles, and through regular appearances and the Center for Applied Molecular on CBS This Morning. Medicine. He has worked closely with His first book, The End of Illness, two non-medics in his researches: Danny became an international bestseller, Hillis, a pioneer in supercomputers; setting out his views on what it means and Murray Gell-Mann, a Nobel prize- to be healthy and how to achieve it.

pictet report | winter 2015 health and technology personalised medicine: the professor********************** of medicine 37 He tells readers not to take vitamins and supplements, to avoid juicing and detoxes, and to eat more fish and fresh food. And he urges them to take more control over their lives, giving them the best data available, and telling them how to use it. ‘There’s a pill that can reduce the death rate of cancer by 30 per cent, of heart diseases by 22 per cent and of strokes by 17 per cent. It’s over 2,400 years old, it costs USD3 a year and it’s called the baby aspirin. Yet most people over 40 have never considered taking this remarkable preventive pill.

‘We should design offices and schools to maximise walking during the day’

‘More movement during the day has a dramatic effect on disease and life expectancy. A study of 26,000 London bus drivers and conductors in the 1950s found that although they weighed the same and lived in simi- lar environments, the conductors who walked up and down the double- decker buses selling tickets had much lower rates of heart disease than the drivers who sat for most of the time. ‘Humans were designed to move, but we have become a nation of bus- drivers. The more important you are at work, the closer your car is to your desk. The richer you are, the more bathrooms you have and you don’t have to walk so far to the bathroom. We should design offices and schools to maximise walking during the day. ‘We live longer every year – clearly by doing good things like smoking less and eating healthily. However, it is not just what we eat that matters, but when we eat – people who graze have 81 per cent more diabetes on a weight- adjusted basis. We were designed by nature to make a kill and eat a meal in the morning and at night. ‘There’s an amazing European study showing that for every year of

pictet report | winter 2015 38 **********************personalised medicine: the professor of medicine health and technology delay in retirement, the incidence ‘At the moment, people go to doctors of Alzheimer’s is reduced by almost who take tests and phone through ‘Keep the brain 3 per cent. If you don’t use it, you lose the results later before making a plan. active – learn a it! We need to redesign the working Measuring blood pressure at home language, take life to keep the brain active – learn a can provide much better data on how language, take up a hobby, give back it rises and falls through the day and up a hobby, give and challenge yourself.’ identify probable causes such as stress back and challenge He is dedicated to finding novel or relaxation. This can help patients yourself’ approaches for personalised health- learn lessons for themselves, and share care that can make people healthier. the data with their doctor for review And he sees a big role for individual and to agree what is needed. involvement, through home machines ‘Personalised medicine needs to that can measure blood pressure and use much more data: the patient’s pulse, and detect irregular heartbeat. DNA profile, their proteome [which There are smartphone devices that reveals biomarkers for diseases in can carry out an electrocardiogram, body fluids], their family history, and and then search a million EKGs on the so on. It is time to throw “one-size- Cloud to see if it is normal. fits-all medicine” out of the window.’

pictet report | winter 2015 health and technology personalised medicine: the professor********************** of medicine 39 pictet report | winter 2015 40 personalised medicine: sophia genetics health and technology PERSONALISED MEDICINE

SOPHIA GENETICS

Data-driven medicine

Jurgi Camblong co-founded a fast-growing company that analyses the data produced by sequencing human DNA, identifying the genetic causes of illnesses for clinicians and recommending personalised treatments

To sequence the first human genome in algorithms using machine learning to 2003 took 13 years, cost USD13 billion and process the information.’ produced information that would have He foresees the company’s tech- filled about 50 metres of books on a shelf. nology being used even before birth, Today, producing the same information to identify chromosome defects that takes one day and costs USD1,000 – and can can lead to conditions such as Down’s identify genetic causes of illness and target syndrome. After birth, it could be used appropriate therapies. According to Jurgi to see whether the individual can use Camblong, the world is entering a new era certain drugs or is intolerant to gluten, of data-driven medicine that can produce lactose or other substances. When a personalised treatments. cancer is developed, it could understand the cancer, indicate how it should be Dr Camblong is chief executive of treated and perhaps learn why the treat- Sophia Genetics, which he co-founded ment has failed if the patient dies. in 2011 to manage and analyse the ‘These technologies will not be used data produced by DNA sequencing to just once in a lifetime, but several times help clinicians diagnose illnesses and – a bit like we now do blood testing.’ prescribe the right treatments. The Dr Camblong’s training was in company’s ‘Software as a Service (SaaS)’ biochemistry and molecular biol- has developed modules that can present ogy. He has a PhD in Life Sciences the results to clinicians more accurately from the University of Geneva and an and much faster than other laboratories. EMBA in Management of Technol- ‘Because the machines used for ogy from Lausanne’s HEC business producing the data have become very school. After directing a personalised affordable, hospitals have been acquir- medicine company in 2010, he founded ing them,’ he says. ‘The problem is no Sophia Genetics with a medical longer sequencing genetic informa- geneticist, and a leading scientist tion but managing and interpreting it. in genomics research. Our technology works with laborato- There are several US and European ries using different protocols, and the competitors in the field, but Dr Camb- data they send helps us build smarter long believes that the winner will be

pictet report | winter 2015 health and technology personalised medicine: sophia genetics 41 Office, Sophia Genetics, St Sulpice, Switzerland

pictet report | winter 2015 42 personalised medicine: sophia genetics health and technology the company that can build the biggest genomics community in the world. That means getting access to the maxi- mum amount of data, which will help the company develop the most power- ful software. ‘The trick is to occupy the space,’ he says. One key part of what Sophia Genetics offers customers is privacy and security. In European law, the owner of the data is always the patient, unlike in the US where companies which offer genetic testing direct to consumers require them to consent to sell it to drug companies and others.

‘The problem is no longer sequencing genetic information but managing and interpreting it’

‘The company that will win in this industry will be the one that can win the trust of professionals, hospitals and patients. In our hands, it’s very simple: we only use the data to constantly improve the service. Nobody else can get access to it.’ Sophia Genetics had contracts with 83 hospitals by mid-2015, handling over 2,000 patients’ data a month. By the end of 2015, it expects to have signed up more than 100 hospitals and be analysing more genomes per month than two listed competitors. ‘In 2015, we should have diagnosed 20,000 patients altogether, up from 4,000 in 2014. Within five years, I think we will be able to help diagnose around a million patients and, with the amount of genetic information we will have gathered, be better at diagnosing them. ‘By that time, I think we will be a public company. When a business is growing at the speed of Sophia Genet- ics, it needs access to a large amount of investment. And because public companies have to be more transpar- ent, it should help us grow by creating more trust in the company.’

pictet report | winter 2015 health and technology personalised medicine: sophia genetics 43

pictet report | winter 2015 44 **********************patient empowerment: withings health and technology

PATIENT EMPOWERMENT

WITHINGS

Smart products and apps

This French manufacturer is using innovation, technology and design to make attractive connected devices that help people monitor key health indicators and change their behaviour to develop a healthier lifestyle

Programmes designed to help people adopt can measure their blood pressure a healthier lifestyle often run out of steam accurately at home, rather than in the ‘The data from long before achieving the desired results. The surgery where they are likely to feel our devices can boom in gym memberships and diet plans stressed. And anonymised data gener- be shared – at the start of every year produces a short- ated by our devices can be aggregated lived surge in activity which quickly declines on a scale never before achieved in providing added under the pressures of everyday life. epidemiological studies and used for motivation health research projects.’ for behavioural Withings, based in Paris, produces a Hutchings studied engineering changes’ range of devices that can monitor and in France and took a Masters at the analyse key health indicators and are Massachusetts Institute of Technol- designed to motivate long-lasting ogy Age Laboratory. The Age-Lab was changes in behaviour. People can track set up to use technology, science and their weight, blood pressure, body knowhow from disciplines such as fat levels, pulse rate, physical activ- aerospace to improve the health of ity and sleep quality, synch the data to ageing populations. their smartphones and use an app to He then joined a French company analyse it and set themselves targets founded by Eric Carreel, which was for improving their health. connecting personal computers, televi- ‘All our devices are connected sions and phones so they could provide which has a lot of value for users,’ multimedia services in the home. With says Cédric Hutchings, co-founder the arrival of the iPhone, the two men and chief executive. ‘The data can realised that every device could be rein- be shared with family members and vented around connectivity, accessed friends involved in activity challenges through apps and analysed using the – providing added motivation for smartphone’s processing power. So in behavioural changes. 2008, they founded Withings – not for ‘The data can also be shared with health purposes but to make products doctors: patients with hypertension for the ‘internet of things’.

pictet report | winter 2015 health and technology patient empowerment:********************** withings 45 By chance, their first device was a left in the bathroom or in cupboards. connected smart scale allowing users to There is a limited market for wearing record their weight and help them lose sensors, but a huge market for attrac- it if they wanted to. ‘Users told us that it tive watches which also have sensors. had changed their lives: the data and the The design should make you want to app’s graphs helped them lose weight use our devices.’ without needing a hard-core diet. The company’s largest market ‘We quickly realised that we had is the US, where the watch is sold by created a device that could change Best Buy which has 1,000 stores. With- behaviour, which led us to change ings has now added other devices to its our mission. We started adding more range, such as a connected blood pres- dimensions to the smart scale which sure monitor and a connected home can now measure body fat, heart rate surveillance system that also monitors and air quality, as well as weight.’ air quality. And its software allows data Next came the Activité Pop wrist- to be loaded onto the platforms of 150 watch which tracks activities such as partners such as diet service compa- walking, running, swimming and nies, Apple Health and Google Fit. sleeping. Attractively designed and ‘If we make attractive, cool and manufactured in Switzerland, it auto- sexy devices which people can use matically synchs the data to a smart- to monitor their health, it will make phone. And it has an eight-month the prevention and management of battery life so it can be worn to moni- diseases more effective. It is still early tor sleep patterns rather than being in the story, but we now have a port- charged overnight. folio of devices and partnerships that ‘Design is very important in chang- can accelerate the developing merger ing behaviour because our devices between self-monitoring and health have to be part of everyday life, not improvement programmes.’

pictet report | winter 2015 46 **********************patient empowerment: withings health and technology PERSONALISED MEDICINE

DNA SEQUENCING

Stefan Roever

The chief executive of Genia Technologies is working with the inventor of a new method of DNA sequencing which could make reading genomes so fast and cheap that it can be used routinely throughout people’s lives

pictet report | winter 2015 health and technology personalised medicine:********************** dna sequencing 47 The next step forward in treating illnesses is tion sequencing technology known ‘The cheaper widely predicted to come from the expansion as nanopore sequencing, and Roche’s sequencing becomes, of DNA sequencing which could lead to new investment has enabled the company medical advances. The cost has plummeted to recruit more staff and accelerate the more ubiquitous since the first human genome was read, but its development. testing will become’ it is still too high and the process too slow to Stefan Roever, Genia’s chief exec- realise its potential. Several companies are utive, believes that faster, cheaper exploring new ways to speed up sequencing sequencing will revolutionise the and radically cut its cost so that doctors and diagnosis and treatment of heredi- clinics can personalise treatment. tary conditions, cancer and infectious diseases such as HIV and ebola. ‘Pre- One of them is Genia Technologies, natal DNA sequencing is already being a company created in 2009 which is used in high-risk pregnancies as a non- based in California’s Silicon Valley invasive test for genetic disorders such and was acquired in June 2014 by as Down’s Syndrome,’ he says. Roche, the Swiss drugs giant. Genia ‘The cheaper sequencing becomes, is in hot pursuit of a fourth genera- the more ubiquitous testing will become – I believe it will eventually become part of annual health checks. Doctors will use it to detect the DNA signatures of viruses and cancers, and to monitor progress in treat- ing them. It will also help diagnose cancers earlier: ovarian and pancreatic cancers are asymptomatic and are only detected now at their late stages when treatment is much harder.’ German-born Roever is a serial entrepreneur, though he came into life sciences only recently. At high school, he had decided that he wanted to start his own technology company. He worked freelance in software development while at Tübingen University, where he studied law and economics to acquire the skills needed for management. While still at university, his soft- ware business took off – provid- ing encryption software for internet banking which was eventually used by 3,500 banks. Brokat went public in Germany in 1998 and on Nasdaq in the US in 2000, achieving a multi-billion dollar market cap and forcing him to commute between the West Coast and his home country. But after his time at Brokat, he decided to settle in Silicon Valley and invest in tech start-ups. It was in 2009 that he stumbled into DNA sequencing: unable to sleep one night, he read an article in Scien- tific American on the origins of life which piqued his interest. The next day, while buying a cappucino in Star- bucks, he met Roger Chen, an elec-

pictet report | winter 2015 48 personalised medicine: dna sequencing health and technology tronic engineer with a masters in development of its technology when biochemistry, who was reading a book Roche’s acquisition brought the much- ‘Roche has focused called The Origins of Life. needed investment. But the Swiss on oncology and ‘We began talking, and it turned company also provided Genia with a diagnostics, and out that he was developing a new missing piece of its jigsaw: the exper- sequencing technology in his garage. tise to use DNA information to diag- is developing the He had no company, business plan, nose and treat illnesses. software needed debt-funding or team, so we founded ‘We can do the reading and primary to interpret the a company together and I helped him analysis of the genome,’ says Roever. DNA data’ raise money from angel investors and ‘But Roche has focused on oncology put a team together. and diagnostics, and is developing the ‘I became interim chief executive software needed to interpret the DNA while we searched for a someone with data. That will make it possible to truly experience in life sciences. But when personalise medicine by using infor- we could not find a suitable candidate, mation derived from sequencing to I became permanent CEO – and I am choose exactly the right treatment for a still here.’ wide range of diseases.’ Genia had been planning to raise more capital in 2014 to accelerate the

pictet report | winter 2015 health and technology personalised medicine: dna sequencing 49 pictet report | winter 2015 50 pictet’s view health and technology PICTET'S VIEW

PICTET ON HEALTHCARE EQUITIES

Healthy returns in an ageing world

Health spending is rising around the world, driven by demographic pressures and economic growth which together create powerful incentives for innovation that boosts the earnings of healthcare companies

NATHALIE FLURY SENIOR INVESTMENT MANAGER PICTET ASSET MANAGEMENT

TAZIO STORNI SENIOR INVESTMENT MANAGER PICTET ASSET MANAGEMENT

Companies in the health sector have proved Another megatrend is the growing ‘Pictet evaluates three to be rewarding long-term investments, focus on health around the world factors when choosing outperforming the market since 1995. which is stimulating the search for Earnings per share on health stocks have treatments to tackle unmet medi- between companies : grown between 10 and 14 per cent annually cal needs. These include Alzhei- the financial over the past five years, with an average mer’s, Parkinson’s, cancer and the fundamentals, quality total return of 19 per cent a year. They are orphan diseases that afflict tens of of the management very profitable, generate a lot of cash and thousands of people in developing pay high dividends – driven as they are by countries. Even when there are treat- and market evaluation’ powerful megatrends. ments, new products may be needed if they are not very effective or have The first of these is demography, with unpleasant side-effects. the global population growing from A third megatrend is economic 6 billion in 2005 to 9 billion by 2050. growth, which is making the world Equally significant is the ageing of the richer and allowing people to spend population: life expectancy around the more on their health. In advanced world has risen 20 per cent on average economies, up to 15 per cent of GDP is since 1980. By 2050, almost a quarter now spent on healthcare, but even in of the world’s population will be 60 poorer countries where expenditure or over, an age-group that uses three is lower, increases in spending boost times more healthcare than 30-year- healthcare revenues because of the olds. The over-60s already consume numbers being treated. almost two-thirds of US health spend- And the rising middle classes in ing, while more than half of all new developing countries and emerging drugs under development are for economies are increasingly afflicted diseases of the elderly. by the diseases of the developed world.

pictet report | winter 2015 health and technology pictet’s view 51 Obesity has become one of the top three government bodies, mutual insurers Nathalie Flury is Senior Investment global social burdens, with an impact or private equity firms. Listed compa- Manager, Global Thematic Equities on the world’s economy of USD2 tril- nies are also diversified, selling their at Pictet Asset Management, manag- ing the Pictet-Health fund. Before lion. Eight out of the ten countries with products worldwide unlike most other joining Pictet in 2014, she worked the highest incidence of diabetes are large producers which often focus on as an analyst and portfolio manager now in the developing world. their domestic markets. for Credit Suisse, Clariden Leu and Global Asset Management. Nathalie Fourth, rising health budgets Pictet evaluates three factors when holds a Masters in biochemistry and are focusing interest on cost contain- choosing between companies. The first molecular biology, and a PhD in on- ment. Top-of-the-range diagnostic is their fundamentals – their assets, cology from the university of Basel. equipment in hospitals is often very markets shares of their products and expensive, though it can still be a good the value they add for the patient. The Tazio Storni is Senior Investment Manager, Global Thematic Equities investment if it improves the effi- second is the quality of their manage- at Pictet Asset Management, manag- ciency of treatment. However, cheaper ment, and the third is their valuation. ing the Pictet-Health fund. He joined versions are now being developed for Finally we carry out bottom-up Pictet in 2014 after working as an an- alyst and portfolio manager for UBS emerging markets and are expanding analysis of each company. For example, Global Asset Management and Belle- sales in richer countries to customers at least 50 per cent of their revenues vue Asset Management. Tazio holds a such as health centres, sports venues must come from healthcare – food Masters in biology and a PhD in im- munology from ETH in Zurich, and and doctors’ surgeries. companies with some health products is a CFA charterholder. Meanwhile IT is making healthcare are too diluted. Whether they are in administration more efficient, whether drugs, equipment or services, we want it be billing payees or making patient to know that they are really innovative data easily available at all points of treat- rather than just improving something ment. The use of apps to pass data from on the margins. And they should add patients to doctors is growing, while value for the payers through greater costs are falling rapidly for new diag- efficacy or efficiency. nostic techniques such as DNA analysis. Because our fund needs liquidity, it These megatrends create powerful is not a small-cap one. We also need to incentives for innovation which is a key see data on the efficacy of a company’s driver for health sector earnings. Mean- products based on human testing. And while, pressure to bring much-needed we talk to doctors and specialists about treatments onto the market is speeding the quality of the products and whether up the work of regulators in approving there are issues such as side effects that new pharmaceuticals – there at least would diminish their attractiveness. 20–30 new approvals a year in the US. Today, we have 50–60 stocks in the We believe that the most attractive fund, and follow closely more than investments in healthcare are compa- another 100. With regular meetings nies that bring value added in at least of a distinguished Advisory Board that one of four ways: brings together leading experts, scien- tists and industry figures from Europe, Innovation: new treatments and North America and Asia, we must processes to address unmet clinical needs; also try to keep pace with new trends Quality of life: solutions that deliver in healthcare. better and faster outcomes for patients;

Efficiency: technologies and systems that improve intensity and time of treatments;

Cost containment: reducing the costs of the healthcare system as its activities expand.

When picking investments for the Pictet fund, we invest only in liquid stocks – mostly listed companies in the US, since European providers are often

pictet report | winter 2015 52 pictet’s view health and technology pictet report | winter 2015 health and technology pictet’s view 53 ACKNOWLEDGEMENTS

We should like to thank the entrepreneurs, physicians and commentators who provided us with insights into their companies, medical practices and strivings for breakthroughs in health and healthcare: Dr David Agus, Jurgi Camblong, Benoît Dubuis, Cédric Hutchings, Dr Richard Isaacson, Dr Jack Kreindler, Michael Macharia, Willi Miesch, Stefan Roever, David Sin and Thomas Warthoe.

We would also like to thank Seiji Ozawa for telling us about his distinguished career as an orchestral conductor and his international academies for bringing through the next generation of musicians.

pictet report | winter 2015 54 acknowledgements health and technology

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