Salvatore Viscomi, M.D. is CEO of Carna Health, a digital platform that is making it easier for patients with chronic conditions to do tests at home that would normally have to be done in the hospital.
Highlights:
Sal Daher Introduces Salvatore Viscomi
What Carna Health is Solving
"... We connect the device to our platform, we collect the data, we stage the disease, and then we share that information with the patient-provider..."
"... The solution is really to bring the testing to the community, identify the 90% of people that don't know they have it, let them know they have it..."
"... The devices on their own without connectivity and without a platform are really not a scalable solution for the type of programs that are needed to make an impact on these diseases ... The doctors are connected through a physician portal, and we identify all the people that are being screened..."
Carna Health's Business Model
"... We don't want our patients, necessarily, who are not feeling well, have medical conditions, to be exposed to other patients and potentially get infected..."
"... One of the ways that Carna Health enables hospital home, is that it provides some of that testing in real-time, so patients don't need to go into a laboratory or phlebotomist..."
Digital Twins: What Are They?
Salvatore's Entrepreneurial Journey
Advice to the Audience
"... I think our system has been based on being very reactive to disease as opposed to prevention. The truth is that about 80% of longevity is determined by you and your environment and 20% by your genetics..."
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Transcript of, “The Hospital at Home”
Guest: Salvatore Viscomi, MD
Sal Daher: I'm really proud to say that the Angel Invest Boston podcast is sponsored by Purdue University entrepreneurship, and Peter Fasse, patent attorney at Fish & Richardson. Purdue is exceptional in its support of its faculty, faculty of its top five engineering school in helping them get their technology from the lab out to the market, out to industry, out to the clinic. Peter Fasse is also a great support to entrepreneurs.
He is a patent attorney specializing in microfluidics and has been tremendously helpful to some of the startups in which I'm involved, including a startup that came out of Purdue, Savran Technologies. I'm proud to have these two sponsors for my podcast.
Sal Daher Introduces Salvatore Viscomi
Welcome to Angel Invest Boston, conversations with Boston's most interesting founders and angels. I'm Sal Daher, an angel who's really curious about how to better build technology startups. Today we are very happy to welcome back Sal Viscomi, MD. Welcome back, Salvatore Viscomi.
Salvatore Viscomi: Sal, great to be back again.
Sal Daher: Sal is a physician who founded two companies and is now working on a third startup. The company is called Carna Health. We had an interview earlier with Greg Geehan about Carna health. Greg is doing some preliminary work and initial building of the company. Sal is now CEO and in charge. We're going to revisit what Carna is doing because they've made quite a bit of headway. Sal, tell me what problem Carna Health is solving.
What Carna Health is Solving
Salvatore Viscomi: Carna, Sal, is a digital platform that really enables for traditional care that's normally done in the hospital or in the laboratory setting to happen in the community or at home. Through remote patient monitoring using special devices that are clinical grade that collect important data from a drop of blood or urine, and are recorded instantaneously within 20, 30 seconds for the patient to see but also for the providing doctor to see as well.
Sal Daher: What is Carna building? Is it building a software platform that integrates all of this? Is it also building the devices? Is it building medicine here? Is it creating diagnostics? Where's most of the work that you're doing going?
Salvatore Viscomi: Most of the work is on the digital platform. We have exclusivity around some really unique devices that measure special biomarkers that are needed to manage certain diseases. For example, creatinine is the single most important biomarker to manage kidney health, and so we connect to the only clinical-grade creatinine meter in the market.
Sal Daher: Now, let me just back up a little bit. Biomarkers, these are biological indicators, the things that we look for in the body that give us a sense of how something is functioning. Creatinine is just a little bit of what it is and how it signals the stress in the kidney.
"... We connect the device to our platform, we collect the data, we stage the disease, and then we share that information with the patient-provider..."
Salvatore Viscomi: We connect the device to our platform, we collect the data, we stage the disease, and then we share that information with the patient-provider. It could be a Ministry of Health, it could be a pharmacy, it could be a physician. We aggregate data not only from that device but several other devices that are important for managing that disease.
Sal Daher: Basically it allows remote monitoring, a really essential indicators of health. In this case, you're focusing on kidney health, right?
Salvatore Viscomi: That's right. Initially.
Sal Daher: Is that the sort of low-hanging fruit? Yes.
Salvatore Viscomi: A couple diseases we're focused on. On the kidney health, we help manage both acute and chronic kidney conditions.
Sal Daher: Let's just unpack. Acute is an emergency situation. Chronic for our lay people is something which is ongoing, that's kind of like an ongoing thing. Sorry for doing this, but we're trying to reach a broad audience.
Salvatore Viscomi: No.
Sal Daher: I'm not a physician. There are a few physicians in our audience, but yes, please continue.
Salvatore Viscomi: For example, after a kidney transplant a patient gets monitored up to three times a week where they have to leave their home to go back into the hospital to get their creatinine levels tested. We can replace those visits with them being monitored at home. That information is shared with their doctor. They don't have to miss work. They don't have to miss school. They can test more frequently. They can test any time of day. In addition to a convenience factor, there's also higher compliance and there's also the ability to test. If you're not feeling well you can do a test instantaneously, you don't have to leave your home. From the doctor perspective, they get a lot of permission.
Sal Daher: That is extremely powerful what you're saying here. The idea that a patient has agency, the technical term is compliance. It's being shifted to adherence now, to sticking to the therapy, sticking to the procedures for monitoring your health to know that your very valuable kidney transplant. The kidney transplant is an extremely expensive thing to do. It's very hard to get the right kidney. You want to make sure you do everything possible to make your kidney work. A big part of that is just monitoring the creatinine levels in the kidney, and so making it doable at home and giving the patient control over that is really powerful. Please continue.
Salvatore Viscomi: Our goal as a platform is not just to provide data, but also to empower patients. There are reminders, there's education to let them know why they're testing, when they should test, the benefits of testing. We find that they really enjoy, they're more likely to test, they're more likely to be engaged with their disease and their doctor when they're doing it at home by themselves.
The chronic kidney disease it's a disease that needs to be monitored not only with blood testing at home but also blood pressure and glucose for people that have diabetes. Chronic kidney disease is something that we don't speak a lot about. It's about 900 million people in the world, 40 million Americans have it. 90% of people that have it don't know they have it. As a healthcare system, we've really failed in this disease. It's one of the few non-communicable diseases that's actually getting worse in mortality.
Sal Daher: Wow.
"... The solution is really to bring the testing to the community, identify the 90% of people that don't know they have it, let them know they have it..."
Salvatore Viscomi: We have a solution. The solution is really to bring the testing to the community, identify the 90% of people that don't know they have it, let them know they have it. Stage them because chronic kidney disease is something you can go from very mild to very severe, and when it's very severe you end up at dialysis or kidney transplant. We don't want that. We want to find people early. We want to empower them. We want them to monitor more frequently and intervene so to prevent the really unpleasant sequelae of chronic kidney disease.
Sal Daher: I have someone in the family who had a kidney transplant because of a viral infection. Very healthy person, but the bad luck had a viral infection and messed up the kidneys. Just like a very healthy person who is just struggling to get back to normal with this thing. If you have working kidneys, you don't want to mess them up. It's pretty, pretty straightforward stuff that you have to do to keep from screwing it up unless you have the bad luck of a virus or something, but blood pressure plays a big role in that. The marker that you're looking for in this chronic, which is ongoing, not an emergency situation, but an ongoing situation is also creatinine. Is that what you're measuring?
Salvatore Viscomi: Yes. It's the same biomarker. In chronic disease, it changes slowly over time, but first, you have to be aware that you have it, and you have to know where your starting point is. The great thing about 2023 is now there are several drugs on the market that are FDA-approved that stop or slow the progression of chronic kidney disease if you give it at the right time. Why our solution works well is that we are finding the 90% of people that don't know they have it, and we're telling them what they need to do. When are they a candidate for a drug?
Sal Daher: How are you finding them? Is this something that a bell goes off when they have an annual physical and their blood test comes back with high creatinine?
Salvatore Viscomi: Yes. We've partnered with several ministries of health around the world where we have screening days where there are people in the population that are at higher risk. Age, diabetes, high blood pressure, family history, other comorbid conditions, and we have them come in for screening. At that time, they'll get an immediate result while they're being screened to let them know you don't have it, or you're stage two, you're stage three or stage four.
Depending on which bucket they sit in, they're put in a bucket, come back next year for your screening, or you're a candidate to have testing at home. We want you to monitor yourself every month, every quarter, and we want to connect you with a nephrologist or a doctor that has expertise in this area. That's our solution. We have these programs in multiple continents currently.
Sal Daher: I think we should mention at this point that in the interview with Greg Geehan, we mentioned the strategy that Carna Health has, which is not starting out in developed countries, but starting out in developing countries where there is a very, very massive need for a lightweight and digital solution. The existing system isn't well-developed enough to provide care. In some of the places where-- do you want to mention countries where you're [crosstalk]?
Salvatore Viscomi: Sure. Yes, I can mention both developed and developing. We have Cameroon and DRC. We also have Serbia and Bermuda.
Sal Daher: DRC, Democratic Republic of Congo, Cameroon, Serbian, and--
Salvatore Viscomi: Bermuda.
Sal Daher: Bermuda. Bermuda is a highly developed country, but still, it reminds me a little bit of-- I remember we were sitting down having coffee at Roust, talked about telephony how in Africa the seller telephony leapfrogged over wire telephony. A lot of countries never installed a wire system. It is possible that some of these places like in Cameroon and so forth that this digital monitoring becomes much more standardized way ahead of regular doctor's visits and so forth.
Patients go to screening clinics and then they're monitored remotely, you're creating a completely different workflow that can be much more efficient in those situations. Then maybe in the future, this is going to come back to more developed countries. As for example, some of the payment systems that were developed in Africa very early on using mobile telephony became an example for payment systems that we use here in the US and other places in Europe. Please continue. Your focus is really on licensing cutting-edge devices. You're not building the device yourself.
From an investor's point of view, you're always thinking devices are really hard to build. What you're doing is you're creating an integration for these. You're creating a medical integration, one that works in a medical setting. That's where all the work is going in, and that's what separates you from any competitor that might be out there is that you're offering this solution with state-of-the-art remote devices that can be used.
"... The devices on their own without connectivity and without a platform are really not a scalable solution for the type of programs that are needed to make an impact on these diseases ... The doctors are connected through a physician portal, and we identify all the people that are being screened..."
Salvatore Viscomi: That's right. The devices are built by an experienced manufacturer, they're clinical grade. They go through all the regulatory processes. They have a lot of experience and know-how and IT. The devices on their own without connectivity and without a platform are really not a scalable solution for the type of programs that are needed to make an impact on these diseases. For example, in Africa, we have programs in the Democratic Republic of Congo and in Cameroon.
We take the devices in the community to do screening programs. The people being screened are connected through their phone app. The doctors are connected through a physician portal, and we identify all the people that are being screened. We identify who has chronic kidney disease, at what level do they have it, and what needs to happen next. Who do they need to see next? When they need to come back? Who needs to go home with a meter for more frequent testing?
Whose fine and we want just routine testing? Places like Cameroon and DRC, not only is chronic kidney disease a common problem, up to 14.5% of the population, they're finding that it's occurring at younger. They're finding that it's happening in people in their '30s and '40s and it's a bit unexplained. The typical risk factors we know about diabetes, hypertension, we know about those, but heat stress seems to be an important one as well.
There's something else because many people are trying to figure out why in parts of Africa, why people in their '30s and '40s are arriving in clinic with stage five chronic kidney disease. At a point where the only thing you can offer them is dialysis or transplant, which are difficult and expensive. Our goal in that population is identify people early on and start at a younger age.
Sal Daher: Mysterious, because the usual problem in first world countries is people getting older associated with hypertension. That's the usual progression. There are other factors, but the most common one is just hypertension and destroying the function of a kidney.
Salvatore Viscomi: That's correct.
Sal Daher: Very interesting. What is the business model of Carna Health? How are you expecting to make money from serving this population?
Carna Health's Business Model
Salvatore Viscomi: There's a couple of different models from the transplant perspective because we offer a higher compliance rate, a convenience factor, more frequent testing decompressing the hospital systems. We expect the payers to realize that our solution is more cost-effective and allows for a lower rate of kidney transplant failure. On the chronic kidney disease side, some of the governments that we have worked with are paying for these programs. There's also the model for the people that require routine testing at home. In addition to the disposable of the strips there's a SaaS platform.
There's a monthly subscription that allows for all the testing to have to be captured and transferred to the EHR system. We also are speaking with large pharmaceutical companies that have drugs for chronic kidney disease that are looking to identify who are the candidates for their drugs, so they're interested in sponsoring programs as well. For example, there's an opportunity for drugs that stop CKD. They're just not getting in the hands of most of the people that need them.
Sal Daher: Chronic kidney disease, CKD. Once again, for the audience, the term compliance does not mean that they're forcing things on patients. What they mean is complying with the therapy, complying with the treatment schedule, or monitoring schedule. Perhaps a better word that should be used as adherence or sticking to the program. Please continue. We talked about monitor creatinine. Is there anything else that you're monitoring remotely?
Salvatore Viscomi: Sure. We have a FDA-approved device for uric acid. Uric acid is important for gout. There are 10 million Americans that have gout. This is a disease that causes arthritis in various joints of the body. It's related to diet. It's related to how your body is able to clear uric acid. Measuring this at home allows people to understand how their medication is working, how their diet is affecting their uric acid levels. Ordinarily, they'd be going into the hospital once a week to get this measured. They can do this at home. We know what happens if you have a weekly appointment, things happen. You're not feeling well, your child's not feeling well. A lot-
Sal Daher: There's a lot of data to be disaggregated in a week. If someone can test midday, person knows what they ate in the morning, they know what they did in the morning. It can guess that they test in the evening, they know what they did the rest of the day, they have more actionable information it's more immediate. The week it could be, what did I do? I don't know. A lot can happen in the week. It makes a lot of sense. This also reminds me, we discussed a company that's been on the podcast as well called Leuko.
They're monitoring the level of white blood cells as a proxy for whether someone has become immunocompromised. Their immune system is depressed by chemotherapy. The idea here is to make sure that patients who are undergoing chemotherapy are not getting to the point where they get an infection or something because their immune system is so compromised, so depressed by the chemotherapy. The idea is to allow people to test at home.
They just put their finger in a device and it tells them you are okay to go, continue your chemotherapy. Stop, your white cell count is fallen, so your immune system is weakened. You have to see your doctor right away and get checked, and see if you can continue your chemotherapy because you might get some opportunistic infection that might be a complication. This finer reading allows people to adhere better with more confidence to their chemotherapy, which is the key for success in cancer therapy. It decreases adverse events.
"... We don't want our patients, necessarily, who are not feeling well, have medical conditions, to be exposed to other patients and potentially get infected..."
Salvatore Viscomi: That's the future. We don't want our patients, necessarily, who are not feeling well, have medical conditions, to be exposed to other patients and potentially get infected. The other thing is to be respectful of people's time. We have a colleague in the UK who did a study for a patient that needed to go in three times a week for creatinine measurements.
From when they left their home, parked their car, went to the laboratory, got their blood drawn, saw their doctor for two seconds, got back into their car, and went back home, it is a five-hour journey. They're doing that three times a week. That's 15 hours that they're not spending doing something else which they prefer to do. The convenience factor is not to be overlooked.
Sal Daher: You're absolutely correct to point out that this is patient-centric. You have a patient-centric system. People say that and people throw it away. This is where it comes in. Patient-centric is the center that's doing the testing spends 15 minutes doing the testing. The patient spends 15 hours getting there. That's not patient-centric. That's medical system-centric.
Salvatore Viscomi: That's time that they could be working.
Sal Daher: They could be working, they could be seeing grandchildren, they could be doing gazillion things.
Salvatore Viscomi: For kids, they're missing school. There are kids that are missing school, because they're spending time, they're missing play dates. They're missing other things that are really important for their mental and physical wellbeing. The part of this that we're creating is the patient experience and how we are saving them time, but also that they feel like they're more in control of their health.
They're getting the information firsthand in collaboration with their doctors, but they're the ones doing the testing. That's something powerful about that. It really gives them some ownership over things. We are finding that feedback for most patients is that they're more likely to take their medication. They're more likely to be careful about their diet. There are many wins here besides the medical ones.
Sal Daher: People having agency, being able to make a difference with their own actions. They take ownership instead of saying, "Well, I don't know, I was told to do this." Seems kind of distant. If the thing is in your hand, and it's saying, hey, let's check, once a day or whatever. This is really powerful. Another example of this is founder that I interviewed here, Chrissy Glover of Imago Rehab. What Imago Rehab is doing is just basically bringing rehab to the home. They have this robotic glove which helps stroke patients open and close their hands.
Before they could even manufacture enough of the robotic glove, that connected health element of it was having results go through the roof in terms of people's improvement. Simply because the model that they had before was the patient that has a stroke-- imagine a person who has a stroke has to get herself to the physical therapist office. That person's probably not driving, someone has to drive her. They get to the physical therapists office.
They're doing orders of magnitude more repetitions, which is just key in opening and closing your hand, that's key to recovery. They repetitions of the movement going through the roof, just with the clinical health even before they have enough with the gloves coming in. Of course, when they have the gloves, they'll have a lot more data, it'll be much better. This is the beautiful side of virtual connections between humans. You and I like to get together in person, in the real world.
There's a massive value in that. There is no value for a stroke victim to get driven to the physical therapists office. The physical therapist should be able to go to the stroke victim's house, help out a little bit in the beginning and then do virtual visits. We have a massive shortage of physical therapists, massive shortage of physicians, massive shortage of every type of caregiver and health professional, so this is really great. For social things, let's meet in person.
"... One of the ways that Carna Health enables hospital home, is that it provides some of that testing in real-time, so patients don't need to go into a laboratory or phlebotomist..."
Salvatore Discomi: That's right. This reminds me, one of the directions that healthcare is going is this hospital-at-home concept, is that patients are either discharged sooner and going to a home setting which has the devices and the monitoring that you would have in a hospital. People that would ordinarily go into hospital, get to stay home and care comes to them. One of the ways that Carna Health enables hospital home, is that it provides some of that testing in real-time, so patients don't need to go into a laboratory or phlebotomist.
Doesn't need to go into the home, draw the blood, which is also unpleasant right to do finger puncture where you take-- find the vein, draw a large amount of blood and then send it to a laboratory wait for the results. It's that you can take a drop of blood while somebody's at home, get an instantaneous result and act on it. We're going to see more of that. These hospital-at-home programs are growing.
Sal Daher: When people are taking a drop of blood for the device, taking it themselves. They get used to it and they know how to do it in a way that's minimally painful to them. When a phlebotomist, someone who draws blood shows up, it's always discovery. That person's highly practiced, but they're taking a lot of blood and is it the right arm? Is it the left arm? The drop of blood solution is a big step in the right direction. Eventually, we're going to be completely non-invasive as we're already doing glucose monitoring I think. For now, that's a big step in the right direction. A drop of blood, which is what is implied right now. A state-of-the-art for measuring creatinine is a finger stick, right?
Salvatore Viscomi: That's correct.
Sal Daher: The uric acid as well?
Salvatore Viscomi: Uric acid, yes. The future product will be an electrolyte meter that would include sodium, potassium, which are really critical minerals that tell you about your heart health, your hydration status. Until now you would have to go to the hospital and get your blood drawn and wait for those results. In the near future, we're going to be able to tell you that in real time at home.
Sal Daher: This is really exciting. Sal, is there anything else that you want to say about Carna Health right now to our patients? Because what I thought I would do, is do a brief promo for the podcast. Then the second half, let's get into your entrepreneurial career, the companies you started, why you got into being an entrepreneur after being a physician. We talked a bit about this, about the first interview, but let's review that in the context of what's going on with Carna Health. Perhaps you could put Carna Health in that setting. First, is there anything you want to say to wrap up the Carna Health business aspects of what's going on right now?
Salvatore Viscomi: Yes, I think we're revolutionizing care by taking the laboratory and bringing it to the home. I think it's putting the patient first. I think the data that we're collecting is incredibly valuable. It's real-time data multiple times a day in addition to what's going on in the home, temperature, humidity that data is really interesting to a lot of different stakeholders, potentially even pharmaceutical companies. We're a patient-centered application that enables care, but also is collecting unique data that's going to lend itself to algorithms for managing patients, digital twins. We see ourselves as a data company as well.
Sal Daher: Excellent, excellent. You mentioned digital twins. Would you unpack digital twins for the audience who's not specialized in this area?
Digital Twins: What Are They?
Salvatore Viscomi: Sure. If you have lots of data points, you can create models, a sort of a twin of yourself of a disease. You can use that model to practice the therapy on saying, what if we took all these data points, and this is a patient-- not a real patient, but a digital patient that has all these characteristics and we were to try this new therapy. Would it work or not? Instead of experimenting on a human being, trial and error, you would say, "Under these circumstances, we know that this works better than something else." This forecasting will be helpful because a patient will more likely have success if the therapy was tested on something that was the most similar to their scenario.
Sal Daher: If you have enough data to help people respond to therapy and enough data about an individual, you can create a digital model that will predict outcomes reliably for a certain intervention, a certain therapy that you might be trying. Very interesting, very interesting. Sal, we're having this really interesting conversation here, and a few thousands of people routinely they listen, but that could be brought to many, many more thousands of people. If listeners take the trouble to first follow us on whatever app they're using, so the future podcasts come up in their feed every week because we launch every week.
They could also leave a rating, five star rating is great, and a short written review. Just saying that this is interesting. I like what they're doing in Cameroon. I love Cameroon soccer and I love the fact that Cameroon is the cutting edge of developing patient-centric healthcare. Then leave us a rating there to help us get found. I'd be very grateful of that. Then let's go second part of the podcast. Let's get into your entrepreneurial journey. How is it that you went from being a physician at Mass General Hospital to now founding your third company? Tell me that story. What got you to put down your lab coat or your stethoscope and start a company?
Salvatore's Entrepreneurial Journey
Salvatore Viscomi: It wasn't really planned. It happened spontaneously. I was a third-year resident at Brigham and Women's applying for a fellowship in neurointerventional radiology where I'd be treating aneurysms and putting wires and coils to treat neurovascular disease. I was having a conversation with a co-resident in the reading room, and the idea came about of wouldn't it be great to have a job where we could read images from anywhere in the world and images came to us. It was the idea of teleradiology. Then we discovered there was one place that was doing it in Australia during their daytime, but no one was doing it in the United States to cover evenings for doctors.
We did it in a way to create what we thought was an ideal job for ourselves. We'd work a night on and two weeks off provide a service that we thought we needed. We pitched this to our mentors at Harvard, at Brigham, and they thought it was a silly idea. They said no one's going to outsource imaging and we thought differently. We knew a new generation of doctors. They didn't want to lose sleep, they didn't want to be on call, didn't want to go to the office fresh the next day. We convinced the Brigham to do this as a joint venture with us. That was my first idea that turned into a business and spent the rest of my residency really learning business as much as learning my specialty.
That experience was important for me because it made me realize as much as I like clinical medicine I truly enjoy taking my ideas or other people's ideas and trying to make them work. Try to implement them and also create businesses around them. I've been fortunate enough to do things outside of after that idea. Everything else in the entrepreneurial world even while I stayed on staff at the Brigham for 14 years I've done medical devices through FDA approval. I joined a Harvard Stem Cell company as Chief Medical Officer building a platform of novel genetic testing.
It's been interesting for me to take on different specialties on this business journey. Digital health with Carna it's a new journey for me. I'm not a kidney specialist, but we brought in kidney specialists. It's understanding things that when you dive into something you realize these are really big problems in the world that are unsolved. I love solving problems and I love bringing teams together. We're able to bring a world-class team of doctors, venture capitalists, entrepreneurs onto the team.
It's been pretty amazing. That's probably the most special part is really bringing in all the people, sharing the mission and vision, and then seeing it to fruition. Seeing that the application in the hands of doctors, the hands of patients, and seeing that it makes a difference. I think Carna of all the things that I've started is the most special because I think it has the biggest impact.
Sal Daher: It is definitely. We talked about good cell technologies in our first interview, and that is providing something really valuable. I use it, but it is probably a small-- we put it this way, it's something which can be extremely valuable to someone if a person is very sick and needs a treatment in the end of life and so forth. With Carna health you're picking off a lot of low-hanging fruit. Preventing kidney disease in 25-year-olds in Congo, in Cameroon is massively, massively valuable. You have entities that will pay you for that because they realize that the cost of having these patients with this kidney disease is just much, much higher than a little bit of monitoring.
Salvatore Viscomi: It's a worldwide problem. The United States, despite our advanced care, we have close to 40 million Americans with chronic kidney disease. Also, 90% they don’t know they have it. It's one of the areas where the developed world-
Sal Daher: Sal, but even with annual checkups, they don't know that they have chronic kidney disease?
Salvatore Viscomi: Well, only one in four Americans is getting annual checkups.
Sal Daher: Wow.
Salvatore Viscomi: That's part of the problem. It's one of these things that was surprising to me as well when I looked at the data. When you look at the article in Lancet from a few years ago that said that by 2050 it's going to be number five cause of mortality. It's number 12 today, it was number 40 maybe 30 years ago. It's really getting worse and worse and worse, for many reasons that are explained and unexplained.
The explained reasons, diabetes is getting worse, obesity is getting worse, high blood pressure is getting worse, heat stress is getting worse in many parts of the world. There's some unexplained factors. Certainly, whatever interventions we've done to date have not helped. It's nice for us to have a solution that's not only intuitive, but it's on the ground right now and it's changing people's lives.
Sal Daher: These things are correlated. Somebody with a body mass index of 35 in a warm country is going to have a lot more heat stress than somebody with a body mass index of 23. As the populations get fatter, you're likely to have more heat stress in these warmer countries. The challenge though is how to get-- I like the idea that doing screenings, some of the countries where you're working.
The idea of having people just being screened for it because it confronts them with the problem. I guess there's potential for that here as well in the US just to do free public health screenings. You think you're okay but you're somebody who's jumped out of a 10-story building and you're passing the 9th floor right now. Do something about it. Grab onto something because you don't want to wait until you hit the sidewalk.
Salvatore Viscomi: The other solution here in the United States is not having patients come to you, but coming to them. We're in conversations with a lot of pharmacies, customers prefer to get their medical care at pharmacies. We know this. There's been surveys done. Being present at the pharmacies where they could be shopping for something like household item and then they can say, "Oh, I can get my kidney check here instantaneously." That's the wave of the future too.
Sal Daher: Is there anybody doing that right now?
Salvatore Viscomi: In Europe, actually, there are a couple of programs where the devices have been used in pharmacies to determine whether a certain drug is a good idea or not because they might have toxicity in somebody that has Kidney issues. We are in conversation with some major pharmacy chains in the United States that have clinics to provide that service in the clinic.
The patient's customers, in this case, want to find out if they have kidney disease, and if they do, what happens next? We think that's a great solution because of the role of pharmacists is becoming more important everywhere in the world, including the United States. They touch many lives that otherwise we wouldn't know about. Us going into the community is important as opposed to us trying to wait for patients to come to us.
Sal Daher: I interviewed two founders of MIT, Natalie Park and Saumya Rawat about their company, Pharmesol and they're doing exactly that. They've created an expert system to provide answers. They're using pharmacists to program this expert system. Very primitive, it's not AI yet. It's just a little bit of automation just to provide a chat with patients to help them adhere to their therapy. If they're prescribed some medication, let's say for blood pressure or whatever. The chat would ask them they take medication, they're supposed to take them at certain time of the day.
Do they take it? What's your blood pressure doing? Measure it and so forth. They could communicate with that. Also in the future, they're looking for ways to actually bring the pharmacists into the equation. Right now they're using pharmacists to basically program the expert system. Eventually, they want to be able to create a way of extending the skill of the pharmacists having it be used more effectively. An underappreciated resource that we have. Very good. Sal, is there anything else that you want to touch on at this point as we think about wrapping up our conversation here?
Advice to the Audience
Salvatore Viscomi: I think just if you are a consumer or patient to know that there are solutions that are happening that are going to make your life easier and better. Healthcare has been stagnant for a while and I think there's some revolutionary things that are happening that are going to improve our quality of lives. I'm optimistic.
Sal Daher: I'm very optimistic too, but the thing that could happen right now without massive developments of technology is just for people to understand that they can do a lot more to have a healthy old age than they think they can do. I'm a little bit of a bore on this whole fitness thing since I've lost 100 pounds. I go on like crazy. It's hard to reorganize your life, to prioritize your health long term. If you've ever been sick-- I had open heart surgery to replace a heart valve that had become calcified because-- it was supposed to have three flaps and it had only two.
It eventually became calcified. I have a artificial heart valve. Let me tell you, I had never been sick in my life before, very healthy, but recovering from that surgery, there was times I felt so sick. I was just miserable. Being sick stinks. For people who are healthy, they have no clue what it's like not to be perfectly healthy. You get up every day just go, oh, a hangover. Doesn't compare what my thing is. I've never had a hangover in my life. I don't drink to excess.
Even then, I don't think it compares to how miserable you feel after you have something like that. For most people, especially for young people, wake up and smell the coffee, it's later than you think. Go out and do something about your health right now. If your blood pressure is creeping up, if your blood lipids are not where they should be, get out there. You can do something about it one step at a time because sooner or later this stuff catches up with you and it is crummy.
"... I think our system has been based on being very reactive to disease as opposed to prevention. The truth is that about 80% of longevity is determined by you and your environment and 20% by your genetics..."
Salvatore Viscomi: I couldn't agree more. I think our system has been based on being very reactive to disease as opposed to prevention. The truth is that about 80% of longevity is determined by you and your environment and 20% by your genetics. Stop being predetermined, you have a big impact on your own health. You need to take that initiative and you also need the tools, and we have to make the tools convenient.
This is why we're bringing care to the home before people are sick before people are too far along or need some therapies that have their own problems and side effects. The goal is to identify early or before something happens and it never becomes a problem. It sounds so logical and simple but it is doable. There hasn't been the type of support you would expect for these types of programs.
Sal Daher: For younger listeners, while you still can do great things for your health, before things get messed up, start listening to the Peter Attia podcast, Peter Attia, MD Drive. Listen to the early podcast. Talk about-- you have to start worrying about blood lipids way earlier in your life than you think. It's not something for preventing 45-year-olds from getting heart attacks. It's about preventing 25-year-olds from getting plaque on their arteries, to begin with.
It is possible for you not to have plaque in your arteries if you address it early enough. Don't wait until you have heart disease for you to do something about heart disease. I really encourage people to exercise more, to control their eating, and to be at a good body weight and do it sooner than I did. Don't wait until you're 67 years old to really do that.
Salvatore Viscomi: Couldn't agree more.
Sal Daher: Excellent. Sal, very good. Thank you very much for making time for this, and let me know if I can be of help in any way with supporting the work of Carna Health. What's the big thing for you? What's the next step that you're trying to achieve with Carna Health?
Salvatore Viscomi: We are on the ground in several different continents, and we are launching pilots that we want to become national programs that impact the entire population. Right now we're doing smaller segments of the population. I think relationships with pharmacies and pharma companies to be able to be on the ground in the United States as well, and then tackling some other diseases in addition to chronic kidney disease, those are all in the pipeline.
Sal Daher: Listeners, if you're connected with these players that could be of help to what Sal is doing, reach out because this is extremely valuable stuff. Saving a 25-year-old in Cameroon from getting kidney disease is a really worthwhile pursuit. Thanks a lot, Sal.
Salvatore Viscomi: Thanks for having me. It's been wonderful and I'm looking forward to our next coffee date, Sal.
Sal Daher: [laughs] Me too. Tremendous. This is Angel Invest Boston. I'm Sal Daher. Thanks for listening.
I'm glad you were able to join us. Our engineer is Raul Rosa. Our theme was composed by John McKusick. Our graphic design is by Katharine Woodman-Maynard. Our host is coached by Grace Daher.