| | DECEMBER 20209UTLOOKHealthcare Tech The goal of diagnostics should ultimately be to limit the overuse of therapeutics by requiring more strict diagnostic criteria before prescribing treatmentleukemia or lymphoma) has become 80 separate conditions each requiring a different management, treatment, and probable outcome. The International Classification of Disease demonstrates this trend clearly with ICD 10 containing five times the number of diagnostic codes as ICD 9. This trend has been paralleled by an influx of new therapeutics. While drug companies are more likely to focus on medications for diseases with large markets of potential patients, progress in medical science has led to a greater need of treatments for more narrowly defined conditions with limited markets. To maintain revenues and to justify the investment expense, costs per treatment skyrocket. To avoid this unsustainable trend, diagnostics must become equally specific and such diagnostic testing must be mandated prior to treatment. This trend creates an increasingly critical requirement on diagnostic technologies that we look for in our investments. In the past, the fear of failing to detect something that could be fatal took precedence over treating someone who would've been better off left untreated. Research has shown, however, that the risk of treating something that is unlikely to produce harm is often much greater than the potential risks of the disease itself. Diagnostic technology that is high in sensitivity but low in specificity has largely exacerbated this issue, driving up the number of over-diagnosed individuals. While it is impossible to quantify the scale of such an issue, estimates suggest that around 35% of treatments are wasted, unnecessary, or even dangerous to patients. This is a massive financial burden to our healthcare system, as well as to our health. This brings us to the heart of our investment thesis. We can no longer justify overspending on useless or harmful treatments. Advancements in diagnostics will not only allow us to differentiate disease and correctly prescribe therapeutic treatments but also better determine whether or not a patient will be a responder to a typical drug. The goal of diagnostics should ultimately be to limit the overuse of therapeutics by requiring more strict diagnostic criteria before prescribing treatment. As to the handling of pandemics... While writing this article, the Governor of Ohio announced that the visit of President Trump had to be cancelled as he had tested positive for the coronavirus. Hours later, following a more specific PCR test, the Governor was told he was negative. The sensitivity and specificity of testing is clearly critical to managing a pandemic. It is easy to imagine the disastrous consequences that a false negative result (infecting others) or a false positive result (belief in subsequent immunity) can have. It is why GreyBird has, prior to the COVID-19 pandemic, invested in one company that is commercializing a fast and inexpensive, but highly sensitive and specific testing technology for SARS-CoV-2 (GNA Biosolutions) as well as a second company with a platform virus capture technology that has shown to improve the limit of detection for the coronavirus testing by up to a factor of ten (Ceres Nanosciences). As the COVID-19 pandemic brought to light, the availability of precise diagnostic testing is one of the basic inadequacies of American healthcare and is chronically under-reimbursed. Ironically, it offers perhaps the most critical tool to repair our failing healthcare system. The time to invest in precision diagnostic technologies as a means to reduce costs, prevent harm, and save not only lives but our economy, has clearly arrived. HTTom Miller
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