Page 51 - Forbes Magazine-September 30, 2018

Technology HEALTHTECH

to a deeper question: How eff ective are stents for stents. “It’s very scary to know you have coro-
treating heart disease, and do you even need to nary artery disease, knowing it played out with PROTOTYPE
know whether an artery is open or not? other family members,” Plain says. “It’s good to
HeartFlow was started by Charles Taylor, who be back, focused on life.”
as a Ph.D. student in the 1990s was studying how An open question is when stents are worth
wind coursed over the wings of fi ghter jets. Could their cost and risk. Th ey save lives when placed
the same mathematics explain blood moving during a heart attack and ease chest pain. But a
through the heart? He hooked up with Christo- 2,287-patient study a decade ago and a more re-
pher Zarins, the chief of vascular surgery at Stan- cent comparison to a sham procedure raised
ford’s School of Medicine, earning a Ph.D. for doubts that they are better than medication. So
the cardiology work and becoming a professor at does using HeartFlow prevent unnecessary proce-
Stanford himself. Together, they founded Heart- dures or cause them?
Flow in 2007. For every $1,450 test, HeartFlow says, it pre- WEIGHTLESS
Taylor, HeartFlow’s chief technology offi cer, did vents $4,000 in costs. But “do patients live longer
a study of his early soft ware on a dozen patients in and have fewer heart attacks when you do this ap- Pumping iron has
Latvia and raised $2 million in venture capital. Ste- proach, as opposed to something more routine?,” always entailed stacking
vens had been inspired to become a surgeon as a asks Venkatesh Murthy, a cardiologist at the Uni- metal discs the size of
manhole covers (or,
boy, aft er a pitchfork went through his toe, but quit versity of Michigan. Indeed, do patients need a um, salad plates) until
his job doing heart operations for the startup life cardiac fl ow measurement at all? the resistance seems
two decades ago. He joined Taylor in 2010. “I don’t wake up in the middle of the night right, then adding and
subtracting to fi nd the
thinking can we do an FFR in more peo- Goldilocks zone. Tonal
ple,” says Ethan J. Weiss, a cardiologist at ($2,995; tonal.com)
HOW TO PLAY IT BY WILLIAM BALDWIN UC San Francisco. wants to change that.
“Weights have never
The prudent way to invest in medicine: Own the Th en there are technical doubts. been digitized,” says
Vanguard Health Care ETF, a portfolio of 375 HeartFlow calculates fl ow by looking founder Aly Orady.
stocks available at a modest 0.1% annual fee. The at the shape of a blood vessel, as one They’re hard to lift,
more daring way: Take a fl ier on a device compa- thanks to gravitational
might guess the speed of a stream from
ny, hoping to hit on the next Stryker Corp. (Shares pull, so Tonal replicated
the shape of its banks. “Trying to mea-
of that implant maker are up 131,000% since 1979.) that sensation with a
sure FFR from a CT scan is like trying to cable system that drags
Some intriguing candidates: LivaNova, which makes instruments
for heart surgery and implants to combat epilepsy; Insulet Corp., run a marathon on one leg,” says Darrel magnets through an
which makes insulin pumps for diabetics; and NuVasive, which Francis, a professor of cardiology at the electromagnetic fi eld,
providing resistance
makes products for spine surgery. Be forewarned, though, that National Heart & Lung Institute in the minus the bulky barbell
speculative fervor has made the entire category richly priced. U.K. According to a report in JAMA Car- capable of crushing
William Baldwin is Forbes’ Investment Strategies columnist. diology, analyses that used CT scans to your rib cage. Tonal’s
measure fl ow, including but not limited cables make almost
any strength-training
to HeartFlow, were much less accurate in workout possible, and
In a 2014 study, HeartFlow’s soft ware ana- sicker patients. HeartFlow says the report is “fun- once you’re done,
lyzed the CT scans of 254 patients, matching damentally fl awed.” fold them up into the
Tonal machine, which
FFR 84% of the time in detecting a clog and Th ere are also many believers, like Robert resembles a 50-inch
86% when blood was fl owing freely. Later that D. Safi an, a cardiologist at Beaumont Health in wall-mounted HDTV
year the FDA approved HeartFlow’s soft ware as Royal Oak, Michigan, who has received $3,000 tipped on its end.
The $49-a-month
a medical device to evaluate the symptoms of from HeartFlow for travel. “Initially, I was one of subscription (mandatory
coronary artery disease. the worst skeptics, but now I’m completely con- the fi rst year) gets you
Experts use the HeartFlow test mainly in verted and I think it’s amazing technology,” he workout coaching and
ambiguous cases. Hank Plain, 60, a healthcare says. He’s used HeartFlow for the past three years how-to classes. One
extra benefi t: Tonal can
investor who focuses on medical devices, got a on 2,000 patients. feel when you’re slowing
CT scan that showed calcifi ed plaque in his coro- Most large U.S. insurers pay for HeartFlow’s down and adjust so you
nary arteries, but a stress test (a walk on a tread- test, as does the ever-skeptical U.K. National fi nish your workout, at
mill with electrodes on his chest) indicated no Health Service. Medicare is paying for it except in appropriate resistance,
every time. Inevitable,
problems. Th en a CT scan was put through the western U.S. Says Stevens, the chief executive, we guess: The digital
HeartFlow’s soft ware, which revealed two par- “At the end of the day, the data will win.” revolution has fi nally
tial block ages. His doctor decided to insert two Matthew Herper contributed to this story. produced the smart
dumbbell.
PROTOTYPE BY BIZ CARSON
FINAL THOUGHT
“Life is short, science is so long to learn, opportunity is elusive,
experience is dangerous, judgment is diffi cult.” —HIPPOCRATES

46 | FORBES SEPTEMBER 30, 2018