12/9/2018 Despite Hype, Blockchain Remains Mostly Theoretical in Precision Medicine | GenomeWeb

Despite Hype, Blockchain Remains Mostly

Theoretical in Precision Medicine
Aug 31, 2017 | Neil Versel
CHICAGO (GenomeWeb) – With all the talk about how blockchain technology might finally represent the
breakthrough in interoperability and security that precision medicine needs, actual usage of blockchain in
life sciences research and clinical practice so far has been hard to find.

"It is more of a potential," said Kamaljit Behera, an industry analyst in the Visionary Healthcare Program at
consulting and research firm Frost & Sullivan. Some pharmaceutical and medical device companies have
completed proof-of-concept studies of blockchain technology, but as far as Behara knows, nothing has
been commercialized yet.

Estonia has applied blockchain to 1 million health records to prevent a recurrence of a cyberattack that
shut down that country's data systems for several days in 2007, according to Dutch blockchain software
company Guardtime.

"Although 100 percent crime prevention is impossible, it is now possible to have 100 percent detection,
accountability, and auditability across highly complex systems," Guardtime CEO Mike Gault wrote recently
in a blog post on the firm's website.

But the Estonia example is an outlier, and it did not involve precision medicine.

When asked if he had seen blockchain-based applications for genomics in true research or clinical
environments, physician Ron Ribitzky, a consultant in precision medicine and health informatics, said he
hadn't, noting that the technology largely represents a lot of potential in healthcare.

One startup called Genecoin promises secure, perpetual backups of DNA sequences across the Bitcoin
cryptocurrency network. If that sounds like a pie-in-the-sky idea, it may be just that. Genecoin actually
suggested on its website that people create their own alternative currencies of sorts to store and share
their own genomic data.

That is similar to the model that purveyors of consumer-controlled personal health records have put forth
for two decades. To this day, not a single PHR brand has gained wide acceptance unless it is tightly linked
to an institution's electronic health record.

"Technology, to date, hasn't been able to support a 'patient-first' approach," noted Emily Vaughn, head of
accounts at enterprise blockchain company Gem.

Genecoin had a bit of a publicity blitz in late 2014. There was plenty of online skepticism then, and the
company has been rather quiet ever since. Nobody from Genecoin responded to an emailed request for an
interview for this article.

Indeed, Ribitzky said to watch Genecoin with a cautious eye. "It's unclear what kind of ecosystem it will
establish," said Ribitzky, who believes that technology to support precision medicine is useless without
suitable ecosystems of genomic information.

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"Genecoin is one of those companies that went out there in the wild," he said. According to Ribitzky, the
startup is on kind of a frontier expedition.

The same might be said of other blockchain developers in life sciences. "[The technology] does exist in the
lab, but it's experimental," Ribitzky said.

A Russian startup called Zenome.io also is looking to put consumers in control of their genomic data,
though cofounder Alexey Gorbachev called his company's nascent platform a "hybrid." The blockchain-
based, peer-to-peer technology will automate collection and sharing of genomic data in part by allowing
individuals to upload their own DNA profiles control which researchers may access and add to each secure
store of information.

"It is for private storage of medical and genetic data," Gorbachev, a microbiologist explained. He called the
system a "platform for buying and selling genomic data" for purposes including drug development and
personalized medicine.

Users "can share it with each other and there will be privacy," added the other cofounder, Nikolay Kulemin,
a bioinformaticist at the Research Institute for Physico-Chemical Medicine in Moscow. Indeed, sharing and
privacy are two basic premises of blockchain.

Another idea being tested now is by Portland, Oregon-based startup Healthcoin, which aims to support
employer and insurer wellness programs by rewarding healthy behaviors through the use of biomarkers
from blood tests — hemoglobin A1c, HDL cholesterol, and blood pressure — rather than adjunct metrics
like steps and other physical activity, with the goal of preventing diabetes.

Healthcoin relies on a blockchain to verify user identities and allow individuals to share their data with any
trusted third party after running their records through an analytics engine.

EncrypGen, a startup from Coral Springs, Florida, launched in May at the annual Bio-IT World conference
in Boston. That company is getting ready to beta test a blockchain-based system to allow patients to store
and share genomic data through what it calls a "gene-chain."

And earlier this month, Insilico Medicine, which makes artificial intelligence software for genomics, entered
into a partnership with blockchain technology developer the Bitfury Group. The companies will co-develop
blockchain- and AI-based products to help academic researchers and drug companies discover and apply
biomarkers for aging and age-related diseases.

"Our long-term goal is to develop a drug to control aging and [find ways to] prevent age-related disease,"
Qingsong Zhu, chief operating officer of Baltimore-based Insilico, said.

Blockchain will help the three-year-old company better secure data to build trust among researchers and
consumers alike, according to Zhu. "We are not an expert in blockchain, but Bitfury is."

In addition to the technology the company provides to academia and pharma, Insilico hosts two consumer-
facing websites, Aging.ai and Young.ai. The former predicts biological age based on an analysis of dozens
of biomarkers, while the latter seeks to prevent age-related disease through behavioral change.

Given that the deal was announced so recently, Bitfury is just getting started moving Insilico's software to a
blockchain platform. "In the future, we want to integrate this technology into patient data" for both clinical
trials and medical practice, Zhu said. In this scenario, blockchain would help with connectivity as well as
security, he noted.

Meanwhile, a San Francisco-based startup named Doc.ai emerged from stealth mode last week by
introducing a natural-language processing platform for quantified biology that relies on blockchain to, as
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the company said, "decentralize" artificial intelligence. To beta test its first module, called Robo-
Hematology, Doc.ai chose Deloitte Life Sciences and Healthcare.

Alas, both Healthcoin and EncrypGen rely on patient control, a model that likely won't succeed unless
EHR, laboratory, and genomic data all easily feed into their systems. And, like Healthcoin, Bitfury talked of
"potential," not concrete results, while Doc.ai simply discussed a vision.

Doc.ai Cofounder and CEO Walter De Brouwer knows that nothing is a sure thing in the world of
healthtech. Late last year, shortly after De Brouwer left his previous startup, Scanadu, that company pulled
the plug on its widely hyped Scout diagnostic device when it became apparent that the US Food and Drug
Administration would not clear the product.

Scanadu invented Scout for the Qualcomm Tricorder X Prize competition, a $10 million challenge to
develop a handheld device to measure vital signs and diagnose common medical conditions, much like the
fictional Tricorder on the original "Star Trek" series. But the abrupt shutdown caused a number of
Indiegogo backers of Scanadu to call the product a "scam" and a "fraud," according to online news site
Stat.

Regardless, some technologies that fail to live up to initial hype do eventually mature. That may be
happening with blockchain in life sciences, but patience is paramount.

After all, a 1991 Institute of Medicine report suggested it could take 10 years for EHRs to become the norm
in US healthcare. It took a quarter century for EHRs to replace most of the paper, though systems still
aren't easy to use or widely interoperable.

For the near term — through 2018 — expect to see "some initial commercialization" of healthcare
blockchain products, according to Frost & Sullivan's Behara. Imminently available applications should
include digital identity verification and management, as well as drug supply-chain management.

In a few years, Behara foresees data exchange and e-consenting for clinical trials, while the longer-term
future of blockchain promises regulatory audit trails, monitoring of adverse events, and management of
universal health records.

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