Canchid Subscribers

Franklin White has raised interesting questions about the smart phone app
to read blood oxygen levels. I will add a bit more. I posted the front end
of the press release without comment. The rest of the press release does
not answer the questions posed by Franklin White, but I have already
emailed some comment and questions to the LGMedical CEO, comments about how
field trials, pilot projects, or roll-outs will be conducted to produce the
evidence that Franklin calls for. Here is a portion of that query. I will
share whatever I get back from LGMedical.

[Quote] "As rightly wonderful and promising are such devices as this, the
real test is how they take root in their intended setting. The calibration
work and testing of the technical effectiveness of the device can be done
almost anywhere, but the incorporation of the device into human systems use
is more complicated. Poorly executed field trials, pilot projects, or just
plain roll-outs can produce wrong results, by which I mean false negatives
and/or false positives with respect to the suitability of the device in its
hoped for settings. Field trials, pilot projects, or roll-outs require a
careful mutuality with contextual (human systems) factors. Let me give you
an example. 

	Over its 40 years of operation the Comprehensive Rural Health Project
(CRHP) in Jamkhed (India) has trained village health workers, drawn from
the villages and frequently from the lowest (Scheduled) caste women  . I
have been with them as they do blood sugar testing for diabetes. Urine test
strips have been around for decades, and more fancy digital devices,
including smart phone apps, are not all that expensive these days. However,
testing using urine strips, or stand alone/smart phone app devices, is hard
to sustain. Typically the village health worker uses Benedict's Reagent,
and a test tube heated over a burning ball of cotton, and does so in a
communal gathering. This performs the test, while contributing to the
health education of the village. Benedict's Reagent is easy to make. Test
tubes (or substitutes) are easy to obtain, and cotton is grown locally for
various uses, including sanitary pads. Anything beyond that is difficult. I
note in passing that the same project fashions custom fit artificial legs
by hand at a cost of about S75 Canadian, using mainly local resources.    

	In India alone there are three quarter of a billion people living in the
rural areas. Most are poor and supply lines are not good. The Jamkhed use
of trained village health workers, working in their own villages, has
improved the health statistics of those villages significantly and on a
sustainable basis within their resource constraints. I would like to
believe, and certainly do hope, that LGTmedical's blood level analysis
smart phone app can become a tool in the village health worker's arsenal,
and not get stuck as a tool of convenience for more wealthy slices of the
urban population. But, for that to happen LGTmedical will have to pay very
careful attention to how it tests, or rolls out, the device in developing
country settings. A wrongly designed roll out risks giving hope based on a
fall positive result from (for example) a role out in well funded urban
health clinics. Equally, a wrongly designed rural roll out risks giving a
false negative, and the impression that a rural roll out will not work,
when it could. As you refine the technical properties of the device and
calibrate it for excellence in testing, give careful care to how it
integrates into the intended human systems. False positives there will
raise hopes only to dash them, and false negatives would disappoint on all
fronts.   

	As I said above...in case you want to talk, I will be in Vancouver at the
time of the The e-Health 2014 Conference, this June 1-4, 2014..... I am
just in Vancouver for a bit....My home base is Ontario, and until April I
will be in Singapore at ICANN meetings where I am running a panel on how
mobile internet is transforming the area of ICT4Dev, mainly by raising
stakeholder awareness and engagement, and repositioning donors, development
actors, implementing agencies, etc. from being service providers to
becoming collaborating stakeholders." [end of quote] 
	As I say, I will share any updates. This may be a good area for a young
researcher to carry on ongoing due diligence, track what happens, and
produce a useful case study paper from the evidence. 
Sam Lanfranco 
----------------------------------------------
 "It is a disgrace to be rich and honoured
 in an unjust state" -Confucius
 ----------------------------------------------
 Dr Sam Lanfranco (Prof Emeritus & Senior Scholar)
 Econ, York U., Toronto, Ontario, CANADA - M3J 1P3
 email: [log in to unmask] (mailto:[log in to unmask])   Skype: slanfranco
 blog:  http://samlanfranco.blogspot.com (http://samlanfranco.blogspot.com)
 Phone: 613 476-0429 cell: 416-816-2852
---- Original Message ----
From: Franklin White & Debra Nanan 
To: [log in to unmask]
Sent: Mon, Mar 10, 2014, 5:54 PM
Subject: Re: [CANCHID] Smart phone app to read blood oxygen levels

Dear Colleagues, and thanks to Sam Lanfranco for bringing this to our 
 attention:
 Surely this News Release is long on political promotion and short on 
 acceptable public health evidence? While great credit is due to its 
 scientific developers at UBC, and the potential it may hold, the high 
 political profile being given to it at this early stage is surely 
 inappropriate, and possibly misleading at this early stage. I am impressed

 by only one aspect of the release:
 "Longer term medical trials of the mobile application and its preeclampsia

 predictive capability will involve 80,000 women in four countries: India, 
 Pakistan, Mozambique and Nigeria".
 Let us see how this innovation performs against the challenge of improving

 maternal health outcomes in difficult development settings (assuming that 
 this is where the trials will take place, and not only in LDC teaching 
 hospitals in major centres), and whether it will achieve the external 
 validity and population attributable impact required to make a real 
 difference.
 Please let us know when such evidence is at hand, and in the meantime we 
 need to know more from the Minister, the Honourable Christian Paradis,
about 
 how just much Canada's Muskoka commitment is making a real difference on
the 
 ground. May we have objective monitoring and evaluation evidence of a 
 Muskoka initiative impact please?
 Franklin White MD,CM;MSc;FRCPC;FFPH
 Pacific Health & Development Sciences Inc.
 PO Box # 44125 – RPO Gorge,
 Victoria BC Canada V9A7K1
 Website: www.pacificsci.org
 -----Original Message----- 
 From: Sam Lanfranco
 Sent: Monday, March 10, 2014 1:04 PM
 To: [log in to unmask]
 Subject: [CANCHID] Smart phone app to read blood oxygen levels
 News Release: March 9, 2014
 Smartphone app reads blood oxygen levels, capitalized with new S2 million
 Canadian private -public investment, device could save lives of women and
 children in low-resource countries
 Major new investment in LGTmedical’s Phone Oximeter™ will advance it
 towards developing world use Government of Canada S1 million investment,
 part of new S10 million partnership with Grand Challenges Canada to
 accelerate scale up of promising global health innovations. Private and
 public investors are injecting S2 million into a Canadian mobile health
 innovation that offers hope of preventing thousands of deaths and
improving
 the health of expectant mothers, newborns and children throughout the
 developing world.
 LionsGate Technologies (LGTmedical), a Vancouver based social enterprise,
 has secured its first major financial backers to scale up development of
 the Phone Oximeter™, an app and medical sensor that turns a
 non-specialist, community-level health worker’s smartphone, tablet
 computer or laptop into an affordable and simple but sophisticated
 medical-grade diagnostic tool, which is currently typically available in
 the developing world only in some hospitals.
 The device measures blood oxygen levels through a light sensor attached to
 a person's fingertip. This technique is known as pulse oximetry. The Phone
 Oximeter™, using a predictive score, can accurately identify an
estimated
 80% of cases of pregnant women at risk of life-threatening complications
 resulting from high blood pressure. The condition, pre-eclampsia, is one
of
 three leading causes of maternal mortality. an issue of social justice,”
 said Dr. von Dadelszen. The Phone Oximeter™ can also reveal dangerously
 low oxygen levels in patients with pneumonia, which kills more than 1
 million children annually. The S40 target price will make it 80% less
 costly than any other current device capable of meeting high-level medical
 standards.
 For a 4 page pdf news release with links see: http://bit.ly/1gcNan2
 (http://www.linkedin.com/redirect?url=http%3A%2F%2Fbit%2Ely%2F1gcNan2&urlhash=3mzf&_t=tracking_anet)
 Posted by Sam Lanfranco
 Access CANCHID archives at:
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 plus CANCHID subscription management. CANCHID is a joint service of the 
 Canadian Society for International Health < http:www.csih.org > and the 
 Distributed Knowledge Project (York University). Queries to Sam Lanfranco 
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 plus CANCHID subscription management. CANCHID is a joint service of the
Canadian Society for International Health < http:www.csih.org > and the
Distributed Knowledge Project (York University). Queries to Sam Lanfranco 

Access CANCHID archives at: https://listserv.yorku.ca/archives/canchid.html
plus CANCHID subscription management. CANCHID is a joint service of the Canadian Society for International Health < http:www.csih.org > and the Distributed Knowledge Project (York University). Queries to Sam Lanfranco <[log in to unmask]>