The future of neurology will be in patients’ pockets.
In this episode of Bite the Orange, Charisse Litchman, Chief Medical Officer at BeCare Link, talks about developing free neurology apps that offer remote exams and calculate disability scores using artificial intelligence, increasing accessibility and empowering patients with their neurological health. Clinical trials, providers, and patients can now register and monitor signs of possible neurological problems from very early stages, preventing significant side effects and increasing safety. Currently, BeCareLink has an existing MS app and is working on two more: one focused on Alzheimer’s disease and the other that runs a general neuro exam. Charisse explains how this app can help patients worldwide by enabling them with remote options and shares how its adoption has been widely successful so far, thanks to word-of-mouth spread.
Tune in and learn how BeCare Link approaches access to neurology with gamified, complex apps!
FULL EPISODE
BTO_Charisse Litchman: Audio automatically transcribed by Sonix
BTO_Charisse Litchman: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today, we have another very, very smart lady, by the name of Dr. Charisse Litchman, who is a neurologist, I just found out, and the chief medical officer of BeCare.net. Welcome to the show, Charisse.
Charisse Litchman:
Thank you, thank you for having me.
Emmanuel Fombu:
It looks like you have a French name. Is your name French, Charisse?
Charisse Litchman:
I was named after Sid Charisse because she was tall. My mother thought that would give me some height, it didn't work.
Emmanuel Fombu:
Look at that.
Charisse Litchman:
She was a dancer in the 30s.
Emmanuel Fombu:
Fascinating, it's good to know the story behind the name. So tell us about yourself, Charisse.
Charisse Litchman:
So I live in Connecticut. I have three children. I've been a neurologist for over 30 years. I was in private practice for part of that. I was at Yale as faculty for part of that. I also have worked with the CROs running clinical trials on neurology products, and I created the health, the migraine service for a telehealth company to help give access and treat patients remotely. So I've seen all sides of healthcare.
Emmanuel Fombu:
Well, with that being said, I spent some time in Connecticut, and actually, everyone's, Connecticut innovation. I spent some time in New Haven, and there is a lot of brilliant people in the state of Connecticut. It is like big on investing in innovation, bringing people down to New York, and it's a very great community. Are you originally from Connecticut?
Charisse Litchman:
No, I'm originally from Baltimore, and I went up to Wesleyan in Middletown, Connecticut, and then didn't make it far. I went to Yale Med School, trained at Cornell, and I've been in Connecticut ever since.
Emmanuel Fombu:
Go Big Red, ... Cornelian, by the way. I'm, have my mom who lives in Rockville, Maryland, so it's great to hear from the ... area, 410 area code, so it's great. With that being said, as a clinician, how did you get involved with BeCare.net? Not necessarily just picking one particular company, but it looks like you are someone that is innovative, right? And if you read the book Crossing the Chasm, is that early innovators, early adopters in that particular space. Especially you being in practice for 30 years, you mentioned, over 30 years, because I had this idea that only young clinicians were innovative for adapting technology. That's beautiful to hear from you, so tell us.
Charisse Litchman:
I'm glad I don't have to give my birth date. That's, thank you very much.
Emmanuel Fombu:
But age is just a number, right? But it's great to find leaders and clinicians like yourself, and I'm sure the challenge that you face in pushing this through makes it look easy today. So what makes you actually adopt this technology?
Charisse Litchman:
So basically, this came out of a story of tragedy. We, my brother-in-law and I, Larry Rubin, who was the CEO, lost his wife and my sister back in 2015, and it was because she had an undetected disorder. And when she went to complain that something was different, they weren't able to listen to her. Staffing, shortages, paperwork, whatever it was, not good monitoring. And when we got past our grieving a little bit, we decided we had to do something about that. We chose the field of neurology because neurologic examination is the most difficult part of medicine. In fact, most people consider it like a black box. They just refer out to neurologists. The problem is that the number of neurologists is shrinking, down 20% in the next ten years by prediction, and over half the patients who are seen who have neurologic problems are not even seen by neurologists. Even when you have two very talented neurologists doing the same examination, it's all subjective outcomes. How bad is the weakness? How normal was the speech? There are no quantitative measures. And so when you go to track a patient who has MS you missed the relapsing-remitting component to it because if you only see them twice and they happen to be doing well on the days they come in, then you miss the fact that they had flare two months ago. But, and so what we wanted to do was, we created a gamified app that has activities that the patient does that mimics what's done in an MS clinic. The difference is not only can they do it remotely, and we did start this before the pandemic, but it's even more poignant now, it's quantitative. So we can not only measure all of the neurologic function that is measured in a very similar way to a neurologist, but we can also use our artificial intelligence to calculate the disability scores. And when we did testing, we showed that our disability scores were within one point out of a ten scale of a clinician doing it. And in the literature, two clinicians are two points apart. And as we get smarter, as we have more and more patients, we're going to rival the neurologic exam. But for the primary care doctor, we are the neurologic exam because they're not trained to do that. And so we can say, okay, you can see that their score was five, now it's four, or now it's six, you need to change medication whether you're going to do it yourself or whether you're going to refer on, but also, this empowers patients. So patients can go on, do their activities, see their own scores, see if they're improving, see if they're worsening, if they're in the middle of an acute flare, they can call their doctor and say, hey, I need steroids tonight. And the MS Group is a real empowered group of patients. We're moving on, not that we're leaving it, but we have several thousand users who have found us organically online on the app store, but we have a general neuro exam that's coming out in the next two months, and if you can think about that, let's suppose that your mother had Alzheimer's and you thought you were going to have it. If you can go on and do a general neuro exam and get this screening to show you that, yeah, there's something coming on, it may be preclinical, maybe before you're aware of it, then you can get one of the newer treatments started because the newer treatments only work if you use them early. So the general neuro exam will be available to patients, to primary care doctors, and then we've put in a grant to create an app for Alzheimer's, because we do believe that we will be able to diagnose the preclinical phase of Alzheimer's as well as track clinical trials.
Emmanuel Fombu:
I like the fact that you talked about Alzheimer's, something very interesting. I actually support a group called We Are HFC, which is Hilarity for Charity with Seth Rogen and Lauren Miller, and Dan Miller, a good friend of mine. And for a very long time, I've thought about Alzheimer's in a very interesting way, right, for basic biology, that cells of the central nervous system do not regrow. So the concept that we do all these studies looking at amyloid and tau proteins, for example, right? When it's already accumulated, then you have dementia. At that point, it doesn't really improve quality of life per se. So from an idea of catching disease early, especially if you have like the eight-point age, for example, with high risk for Alzheimer's or Trisomy 21, for example, remember from Down syndrome, right, had effects on this, on the chromosome that we know about. I would think that the best idea would be to find a way to catch this way early on, if we have the amyloid plaques and tau which is forming? What do you think about this?
Charisse Litchman:
Absolutely. So you prevent the deposition, you prevent the massive side effects, at least with the current one that was, current medication that was recently released, but you also prevent disability, you prevent brain atrophy. And what's different about BeCare than the other cognitive apps out there is they're doing traditional cognitive testing, but there have been many articles showing that it's not just cognitive testing that will predict whether or not you're preclinical for Alzheimer's. There are subtle gait changes, there's changes in your motor function, there are different changes in your speech. We capture all of that. So when we're looking for Alzheimer's, it won't only be with cognitive testing, it will be with testing of the entire neurologic system and as well as incorporating the gold standard questionnaires. So we're going to advance the field once we get that going.
Emmanuel Fombu:
So my expertise is in cardiovascular medicine, and I've looked at several studies that have shown that, in animal models, if you look at like the ... Inhibitors, for example, right? You give this to people that have hypertension, everyone is taking this drug, right, that is to increase amyloid concentrations in the CSF, there's certain studies that show that. I'm wondering if there's a correlation between this and humans in the real world, right? And you can actually track people, like your app, for example. I think that's where it's very important to have such platforms. You collect data sets to answer this question because right now, we don't know. What do you think about that?
Charisse Litchman:
Right, we don't know what side effects they cause, and many medications that are going out there for a different indication, we'll have neurologic side effects, especially the ones that are in the psychiatric field. And so if a psychiatrist can follow our movements, facial movements which are affected with the antipsychotics, they can know when they're going to get into trouble well before it happens and change therapy, same way that we could be used to run a clinical trial, so we can be used for safety measures even if it's a non-neurologic drug. And I think about the amount of money that would save in terms of running these clinical trials, and the. so the healthcare cost savings is potentially huge.
Emmanuel Fombu:
I particularly love innovations that come out of the clinic from clinicians because clearly, there's a need for you because you need this, right? That's why you're doing it, because there's a gap. If there was something else available, I'm sure you would use that. So I think that validates the need for this particular product in the market. So with that being said, so tell us, how does the app work? How does someone sign up for the app?
Charisse Litchman:
So actually, I just want to say the approach is exactly what you just said. So when we went to develop the MS app, we got a couple of MS specialists. In developing the Alzheimer's app, we brought on some Alzheimer's specialists and some psychiatrists. So we start with our key opinion leaders and find out what's needed and how can we replicate what's done in the field. And so right now, BeCare MS Link is up, and it's on the Google store, the Apple store, and the Android store for free to patients. And so all they have to do is look up, BeCare MS Link, download it, and sign in, and they can start using it. There are very strong HIPAA and encrypted security systems so that this data doesn't get shared.
Emmanuel Fombu:
You know what's interesting? On that data that you mentioned, every time I talk to someone, it helps make it a point to mention that the HIPAA, right? And every time I get in a conversation about innovation, lawyers, and compliance, people always pop up the name, HIPAA, HIPAA, HIPPA. And it's a very sensitive moment where we are seeing classified documents, even at homes of our leaders. If you can, you can walk in it from a psychological perspective, right, where they target you with ads, right? Or things like ChatGPT and all this new technology they show up. They don't ask us for privacy, you understand? So when it comes to the point, why do we anchor this particular point as if someone knows what happens with your brain cells, that somehow the privacy has been completely violated and you'll be turned into robot? So my point being, the safety should be there, that's secondary, and we just move on and focus on innovation part. What do you think?
Charisse Litchman:
I agree with you, except think about if somebody is using as a screening tool for Alzheimer's, and somehow that information gets out there, and then it affects their ability to get long-term life care, etc, etc, or it's used in a political campaign somehow. I do think it's important, and we've dotted those I's and crossed those T's.
Emmanuel Fombu:
But it's particularly scary when you have companies like ... and ... Are connected to Google and the Alphabets of the world. It's quite scary, and I think that they could still find out even without your consent if, anyone right? If you give a sample of a tissue, and someone could find out, they could find out. So I don't think that's necessarily a rate-limiting step. If we make prices transparent and we make it transparent so we know what happens, people cannot be discriminated against in that sense. And I have friends, for example, that have parents with Alzheimer's, and they all have the genes right now, and they're young. So they're trying to fight in a sense, and they want to share, ... to me, right, I get all the datasets, and there are different things that they could do. I understand the disease on a platform such as yours and answer those questions without being scared, right? It would make it transparent, right? So I think we need to be bolder in our space where clinicians have to engage with the policymakers, and they will make this transparent and educate patients. So today, how do patients find out about your app?
Charisse Litchman:
Through podcasts like this, and thank you for having me. We have a website BeCare Link, and we have running studies at Yale and at Cornell, and we are trying to get physicians to get their patients to use it, but a lot of this is patient-driven, so we need patients to try it. We get some very good feedback, there's nothing like it on the market, and then we need them to get their fellow patients to try it out. We need to get the word out there. When there are enough patients that have used it, then the healthcare systems and pharma will begin to use it in their trials. I've spoken to primary care doctors who said they want to adopt this as soon as the general neuro app is out, and they're going to have patients fill it out in their waiting room along with their demographics.
Emmanuel Fombu:
Selling technology to clinicians is a complete waste of energy. I've called clinicians personally, I'll be honest with you, I've called primary care clinicians, and I told them that they have remote patient monitoring solutions that exist today, that they could be reimbursed for it. And then they say, I don't have time. I will talk about this in the next year, like in December, I want to hear about that now. Because they don't have time to do things like this and be engaged with this, and the thing is an extra burden of something. So what about if specialists like yourself, we had a fun event that is not just about disease, where clinicians get to meet patients and talk to them about their disease and patients get to meet each other, right? And they have a sporting event and like something more lively and more joyous in that particular space. We get to talk to other clinicians and it makes it more fun. I think people want to join this platform so they meet next year and you see how they progress in certain things. So we make this more exciting in our field and I'm telling you, this will say, I'll support you to do this. Let's find the best way to do this, let's bring people on board, and let's make something out of this. Because the patients that are suffering from this and they're concerned about this.
Charisse Litchman:
That would be terrific. We really want to have this patient-driven and get this out there and then the patients will show it to their doctors and insist that they use it because it's an amazing communications tool. You're exactly right.
Emmanuel Fombu:
So who are your customers right now? Or how do you make money from the app right now, or how do you do it?
Charisse Litchman:
Right now we are making money, we're largely pre-revenue and we are ready to deploy now because the MS app is perfected and it's FDA class-one cleared, so we're out there. We are running a couple of trials for pharma companies and right now it's that, and it's financed by hedge funds.
Emmanuel Fombu:
Well, how do you go about ensuring that there's diversity in your studies? For example, you mentioned, you mentioned Yale, you mentioned Cornell. These are big institutions which are fantastic. We have people mostly in rural areas in different parts of the world, it's an app. And I would love to hear your expertise, your second opinion, you're a US-trained clinician, expert in 30 years. I'm from Cameroon, for example, where we probably have probably one neurologist in the entire place, where second opinion from you, for example, would be something fantastic. Have you had any ideas about scaling this beyond the borders of the States and countries?
Charisse Litchman:
I mean, that's exactly where we come in, right? So if you have somebody who's in a different country and doesn't have access, they can do the app, have the remote exam, have their disability score done, and make a remote appointment with somebody at the different institutions. We're working with a group at Hopkins who are very much interested in delivering neurologic care by increasing access to other countries. This would be a way for them to benefit from the US expertise because there won't be starting from anywhere. People do travel across the country to get care, but there are people who can't do that and even within our own country. But if they can send objective data to the doctors at the finest institutions, they can get the right care.
Emmanuel Fombu:
This is quite fascinating and I'm very supportive of clinicians coming up with these innovative ideas, and I think there's a lot we can do to help support you and what you're doing and your efforts. And anyone listening, I think we should spread the word. It's an app, it's on the app store. You could download the app, share it. You have to have the disease to download the app, or can anyone?
Charisse Litchman:
No, you do, anyone can download the app, BeCare MS Link. It's interesting that you asked that, and it was really what spurred us to go on to develop the general neuro exam, is that when we look down, we asked people their diagnoses and about 70% had MS, but we had a good number of people with Parkinson's, a good number of people with Alzheimer's, with migraines, who wanted a neurologic exam, and they could get that neurologic exam from our app even though they didn't have MS. When we have the general neuro app, it'll be more in tune with exactly what's done in a general neurologist's office, but this one is a little bit more specialized to MS, but it serves that purpose.
Emmanuel Fombu:
So I'm a commitment piece that, on behalf of the podcast and Marche Health, as you see, we have hospital members and that's the point of the podcast. It's about innovation, adopting innovation. And so I think anyone listening, please download the app. Please reach out to Charisse. We'll have her contact information below the notes here. Help us spread the word, let's make this app a big thing and I would love to have you back on the show. Thank you, Charisse, for joining us today, and keep pushing forward.
Charisse Litchman:
Thank you, Manny. Really appreciate it.
Emmanuel Fombu:
Thank you.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Charisse Litchman:
Trained at Yale School of Medicine and Cornell-New York Hospital, Charisse had a successful neurology private practice for 25 years, was on the faculty of Yale School of Medicine, worked with a Contract Research Organization monitoring pharmaceutical trials, and created a migraine service at a Telehealth company.
Things You’ll Learn:
The number of neurologists available is decreasing, predicted to drop by 20% in the next ten years.
Over half the patients with neurologic problems have not been seen by a neurologist.
BeCare Link can measure traditional neurologic functions and use artificial intelligence to calculate disability scores.
BeCare Link is preparing a general neurological exam that's coming out in the next two months.
The cells of the central nervous system do not regrow.
The app has the potential to be scaled globally, as patients in different countries can use it and have remote appointments with institutions for further diagnosis and treatment.
Resources:
Connect with and follow Charisse on LinkedIn.
Follow BeCare Link on LinkedIn.
Visit the BeCare Link website.
Download the BeCare MS Link from the App Store or the Google Play Store.