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Hims and Roman target erectile dysfunction, which can signal health issues

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startups young patients erectile dysfunctionErectile dysfunction can be the first sign of troubling health problems like heart disease.Shayanne Gal/Business Insider

  • New telemedicine companies like Hims and Roman have sprung up, offering online prescriptions for Viagra and other erectile dysfunction medications. 
  • That erectile dysfunction can be a sign of other, more worrying health problems, particularly in younger men, is well-established among physicians. 
  • One doctor worries about losing the “window of opportunity” to tackle health problems like heart conditions if men are getting care online rather than in a doctor’s office. 
  • Roman’s CEO, a Hims medical consultant and others say that online medical platforms can play an important role in getting men help. 

Most people associate erectile dysfunction with the silver-haired men in Viagra commercials.

Yet Zachariah Reitano was just 17 years old when he experienced it for the first time. Confused and frustrated, he knew something was wrong.

He was right. It’s well-established among doctors that erectile dysfunction can be the first sign of a more troubling health problem, especially in younger men.

Later diagnosed with a heart condition, Reitano compares erectile dysfunction to “the check engine light in your car going off.” 

“It’s a sign that something is wrong, but you don’t exactly know what,” he wrote in a blog post. Unfortunately, many men ignore that sign because of the embarrassment and stigma that surrounds the condition, he says, and doctors often don’t raise the subject during checkups. 

Reitano’s experience led him to start the men’s health company Roman, which prescribes and delivers medications like Viagra and its lower-cost generic, called sildenafil. Roman is one of a slew of new companies like Hims and others shaking up the traditional model of healthcare by offering this kind of online service targeted specifically at erectile dysfunction. 

These new companies paint erectile dysfunction as a problem among younger, not-yet-greying men, but one for which there is help. 

That raises two key questions. How can these online companies care for patients who could have serious underlying health conditions like Reitano? And are these companies over-hyping how common erectile dysfunction is in younger men?

Read more: Trendy startup Hims wants to shake up men’s health by prescribing generic Viagra online and is nearing a $1 billion valuation. But a move to relax guidelines has raised concerns among some of its doctor partners.

Roman and its telemedicine peers, though, say they can direct patients to get appropriate care, even if it’s not through their own companies. They also say they’re combating the stigma associated with impotence by talking about the condition openly and making care accessible in a discrete, affordable way. 

 

 

A ‘window of opportunity’

At its most basic, an erection happens because of blood flowing to the penis. Trouble getting an erection could mean that something is getting in the way.

Because that part of a man’s body contains very small blood vessels, erection problems could be the first sign of heart disease or other problems with blood circulation. Erectile dysfunction also has plenty of other potential causes, including common medications, psychological factors and health-related behaviors like drinking and not exercising. 

Not every young man with erectile dysfunction is going to have an underlying heart problem, urologist Dr. Hossein Sadeghi-Nejad told Business Insider, “but certainly some of them do.” Sadeghi-Nejad serves as president of the Sexual Medicine Society of North America, which promotes high standards in treating human sexual dysfunction, and co-authored the American Urological Association’s erectile dysfunction guidelines.

The AUA guidelines recommend a physical exam, which can’t be done online. 

“I think to lose that window of opportunity to address the bigger problem would be a pity,” Sadeghi-Nejad said. 

Without an in-person exam, some physical causes of erectile dysfunction could be missed, he said, giving as an example the handful of times in a year when he’s had patients who turn out to have a tumor in their testicles.  

Roman CEO Reitano knows from firsthand experience that a Viagra prescription won’t solve an underlying health problem. But Roman can help patients find out about the connection, including by strongly recommending that patients get in-person tests, and then walking them through the results and next steps for free, Reitano said. 

When Roman began working in erectile dysfunction, it found that many of its members smoked, a risk factor for erectile dysfunction. So the company next expanded into products that help them quit, Reitano said, and now sells the prescription smoking cessation aid bupropion as well as nicotine gum.

“I come to this as a patient,” he told Business Insider. “We treat our patient for life.”

If Roman’s physicians can’t treat a patient, they refer him to nearby health centers and physicians, something that it has done for thousands of patients, Reitano said. 

Read more: A startup aims to help the 18 million US men diagnosed with erectile dysfunction pay attention to their ‘check-engine light’

These online companies all patch patients through to doctors, but they have different approaches and styles. 

Rival Hims’ website reads at first like an e-commerce experience, greeting potential patients with the different categories of medical products they can shop—hair, sex, skin, or vitals—and then glossy product images. After a patient adds Viagra or another prescription product to his online cart, he gets directed to a medical consult. 

See also: We tried to buy generic Viagra online from Hims and failed — here’s how it went down

Online telemedicine services like Hims are a powerful opportunity to “find people who do have medical problems, and get them to doctors that can help them,” according to Dr. Peter Stahl, a Hims medical consultant and the director of male reproductive and sexual medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center. As part of his role at Hims, Stahl came up with advice for Hims’ doctor partners that they can look at if they have questions.

According to those recommendations, one goal of care is to identify health conditions that can underlie erectile dysfunction, he said, which might include diabetes, testosterone deficiency, high cholesterol and vascular disease. Hims’ doctor partners “routinely” recommend patients see a specialist, rather than writing them a prescription, if they decide that is the best course of treatment, the company said in a statement. 

Lemonaid Health is another telemedicine company offering erectile dysfunction medications. The start-up says it is more of an online doctor’s office, and aims to care for the patient as a whole. A patient who clicks on Lemonaid’s various medicines and treatments gets directed to set up a doctor consultation, which might include answering online questions or a live video interaction. 

On a page about erectile dysfunction, the company points out that it can be the first sign of things like heart conditions, cardiovascular disease and diabetes, and says that it offers an optional lab test to look into those possibilities.

Lemonaid also offers a service to quit smoking with the smoking cessation aid Chantix or Zyban, and one to manage patients’ cholesterol, which might include a statin prescription. Both health problems are linked to erectile dysfunction. 

“When we do turn away patients, we think of other opportunities to help,” Dr. Davis Liu, chief clinical officer of Lemonaid, told Business Insider. The company also plans to launch services for depression and anxiety, high blood pressure and diabetes this year. 

40% under age 40

Viagra has been sold for about 20 years, and recently became available as an inexpensive generic drug. In its prime, the brand-name product — brought to market by Pfizer — brought in more than a billion dollars a year for the drug giant.

Back then, the type of older man frequently featured in Pfizer’s ads was a prime demographic, or roughly ages 40 and over, a 2006 article from the peer-reviewed medical journal PLOS Medicine found. 

But new online startups offering erectile dysfunction medications have men under age 40 in their sights, and cite a popular statistic: that erectile dysfunction affects up to 40% of men by that age. 

That statistic comes from one of the most important studies to measure the prevalence of erectile dysfunction, the “Massachusetts Male Aging Study,” which randomly selected men between ages 40 and 70 to participate.

As part of the study, researchers gave men a questionnaire to “characterize erectile potency.” They found that 52% of men reported some level of erectile dysfunction, ranging from minimal to moderate to complete impotence, and that age was strongly connected to the condition. Complete erectile dysfunction was more infrequent, according to the study, ranging from around 5% in the 40-year-old set to 15% by age 70. 

The study found that at age 40, about 40% of men had some level of erectile dysfunction, but didn’t look at younger men. 

Still, that figure isn’t a good estimate for the proportion of men who need erectile dysfunction drugs, urologist Sadeghi-Nejad told Business Insider. While up to 40% of men may have at some point experienced trouble getting or maintaining an erection by age 40, he draws a distinction between chronic erectile dysfunction and occasional experiences with it. 

In other words, not every guy who has experienced erectile dysfunction is bothered enough by it to see a doctor, or to take a medication for it. Online companies offering easier access to generic Viagra and other erectile dysfunction medications could change that, he noted. 

Erectile dysfunction research often excludes younger men, according to a 2017 study by Italian researchers. One exception was a large study published in 2004, which found that erectile dysfunction affected 8% of men in their 20s and 11% of men in their 30s. 

Hims and Lemonaid told Business Insider that the 40% figure is accurate, citing its use in peer-reviewed medical journals and the evidence-based medical resource UpToDate. Roman’s Reitano said in a statement that the “vast majority” of the start-up’s members are older than age 40, with an average age of 46. 

Hims has been dubbed the “millennial erectile dysfunction company” because its splashy advertising appears designed for men in their 20s and 30s, including through use of a color dubbed “millennial pink” and tongue-in-cheek eggplant emojis. The startup treats men starting at age 25 and going up to age 65. 

Hims consultant Stahl calls promoting awareness of erectile dysfunction in this population an important step forward.

Young men are a large part of his in-person practice at Columbia, he said. The condition is less common in men in their 30s and 40s than in older men, but those who do have it are “excellent candidates for treatment,” he said.

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Artificial intelligence pioneers win tech’s ‘Nobel Prize’

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Computers have become so smart during the past 20 years that people don’t think twice about chatting with digital assistants like Alexa and Siri or seeing their friends automatically tagged in Facebook pictures.

But making those quantum leaps from science fiction to reality required hard work from computer scientists like Yoshua Bengio, Geoffrey Hinton and Yann LeCun. The trio tapped into their own brainpower to make it possible for machines to learn like humans, a breakthrough now commonly known as “artificial intelligence,” or AI.

Their insights and persistence were rewarded Wednesday with the Turing Award, an honor that has become known as technology industry’s version of the Nobel Prize. It comes with a $1 million prize funded by Google, a company where AI has become part of its DNA.

The award marks the latest recognition of the instrumental role that artificial intelligence will likely play in redefining the relationship between humanity and technology in the decades ahead.

Artificial intelligence is now one of the fastest-growing areas in all of science and one of the most talked-about topics in society,” said Cherri Pancake, president of the Association for Computing Machinery, the group behind the Turing Award.

Although they have known each other for than 30 years, Bengio, Hinton and LeCun have mostly worked separately on technology known as neural networks. These are the electronic engines that power tasks such as facial and speech recognition, areas where computers have made enormous strides over the past decade. Such neural networks also are a critical component of robotic systems that are automating a wide range of other human activity, including driving.

Their belief in the power of neural networks was once mocked by their peers, Hinton said. No more. He now works at Google as a vice president and senior fellow while LeCun is chief AI scientist at Facebook. Bengio remains immersed in academia as a University of Montreal professor in addition to serving as scientific director at the Artificial Intelligence Institute in Quebec.

“For a long time, people thought what the three of us were doing was nonsense,” Hinton said in an interview with The Associated Press. “They thought we were very misguided and what we were doing was a very surprising thing for apparently intelligent people to waste their time on. My message to young researchers is, don’t be put off if everyone tells you what are doing is silly.” Now, some people are worried that the results of the researchers’ efforts might spiral out of control.

While the AI revolution is raising hopes that computers will make most people’s lives more convenient and enjoyable, it’s also stoking fears that humanity eventually will be living at the mercy of machines.

Bengio, Hinton and LeCun share some of those concerns especially the doomsday scenarios that envision AI technology developed into weapons systems that wipe out humanity.

But they are far more optimistic about the other prospects of AI empowering computers to deliver more accurate warnings about floods and earthquakes, for instance, or detecting health risks, such as cancer and heart attacks, far earlier than human doctors.

“One thing is very clear, the techniques that we developed can be used for an enormous amount of good affecting hundreds of millions of people,” Hinton said.

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Lamborghini’s latest Huracán is a supercar with a supercomputer

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Over the past few decades, technology has made vehicles safer and easier to drive. Anti-lock brakes, traction control, torque vectoring and other bits of tech keep cars on the road instead of flying into a ditch when things get hairy. It’s why newer cars typically handle corners better than older cars.

At Lamborghini, they’ve taken things further with their new Lamborghini Dinamica Veicolo Integrata or LDVI system. The Engine Control Unit (ECU) takes data from the entire car and uses it to adjust how the new Huracán EVO Spyder drives in real time (actually in less than 20 milliseconds. But that’s about as close as you can get to real time). Cars have been doing some form of this for a while but the Italian automaker needs to be able to do this at incredible speeds and in environments your typical sedan or SUV doesn’t encounter.

At Lamborghini, they’ve taken things further with their new Lamborghini Dinamica Veicolo Integrata or LDVI system. The Engine Control Unit (ECU) takes data from the entire car and uses it to adjust how the new Huracán EVO Spyder drives in real time (actually in less than 20 milliseconds. But that’s about as close as you can get to real time). Cars have been doing some form of this for a while but the Italian automaker needs to be able to do this at incredible speeds and in environments your typical sedan or SUV doesn’t encounter.

With this technology, Lamborghini is able to take the raw power of an all-wheel-drive supercar with a V10 engine and 630 horsepower and tame it, just enough, so your average driver (who can shell out $287,400) can enjoy themselves behind the wheel of the all-wheel-steering vehicle without, you know, flying into a ditch.

To achieve this, the LVDI is actually a super fast central processing unit that takes in data about the road surface, the car’s setup, the tires and how the driver is driving the vehicle. It then uses that info to control various aspects of the Huracan.

The system works in concert with the Lamborghini Piattaforma Inerziale (LPI) version 2.0 hardware sensors. This system uses gyroscopes and accelerometers located at the car’s center of gravity. It measures the vehicle’s movements and shares that data with the LVDI computer.

Lamborghini says the system is so in tune with all aspects of a drive that it can actually predict the best driving setup for the next moment. In other words, if you’re behind the wheel flying around corners on a back road, the system will recognize your behavior as you enter a corner and adjust itself.

“Where it’s possible to do a bigger jump in the future is with the intelligent use of four-wheel drive and four-wheel steering and the movement and control of the torque wheel by wheel in a way that can be more predictable and that is what we have with the Huracan EVO,” said Maurizio Reggiani, chief technology officer of Automobili Lamborghini.

Lamborghini is thinking about a world beyond a completely gas-powered engine though — it has a pipeline for hybrid and electric vehicles. But Reggiani notes that Lamborghini will probably be the last automaker to leave behind a large growling power plant.

Putting all that power to the ground in a controllable way requires an incredible amount of technology — that’s where LVDI and other pieces of technology come in. The automaker believes the result is a driving experience that matches exactly what the driver wants, regardless of the mode the car is in. Whether it be Strada, Sport, or the track ready Corsa, the vehicle (in a controlled way) should deliver.

That control allows a driver to do something that typically takes months if not years to master: drifting. It goes against what the car wants to do — lose traction. But in Sport mode it’s possible. To do that, the vehicle has to figure out (in real time and safely) things like what angle it wants to slide. The Huracán EVO Spyder has to understand that you want to drift and not fight that. If it does, it will jerk the car (and driver) back into alignment.

Lamborghini Huracan EVO Spyder

To relive your Fast and Furious dreams, the automaker started where lots of companies start with new technology: In the simulator. But a computer can’t faithfully reproduce the real world. Mostly that has to do with tires, a variable that’s tough to predict because of the density of the rubber’s compound and its wear.

Then, of course, there’s the driver. We all drive differently but the experience must be the same for everyone. It’s important that even with all that technology, it’s still a driving experience. “We don’t want to have something that substitutes the driver. We want to have a car that is able to understand what the driver wants to do,” Reggiani said.

Lamborghini is known for large engines, intense growls, striking design and bank-busting prices. But the reality is all that power would be useless if drivers couldn’t actually control the car. The automaker’s latest system makes that possible for everyone. Sure, only a select few can own a Lamborghini, but everyone can appreciate a system that makes driving safer while simultaneously more fun.

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This device makes it easy for the elderly to stay in touch with their loved ones

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Only 20 percent of over-75s in the UK have a smartphone compared to 95 percent of 16-to-24-year-olds. Digital technologies change fast, become obsolete quickly and usually need you to spend a bit of time learning how to use them.

This helps explain why most older adults tend to use what they know best when it comes to communicating, which usually means a phone call via a landline or basic mobile, instead of a quick text or social media update.

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But it doesn’t have to be this way. My colleague Massimo Micocci and I have recently designed a more modern device we hope will help older people stay in more frequent touch with instant updates, but that has a familiar feel to it. By drawing on smart materials and what we call “design metaphors”, we hope to make new technology more accessible.

When older people don’t have access to instant messaging, a phone call or a visit may be the only way for friends and family to check their loved ones are well. And doing so more than (or even) once a day might not be feasible or wanted.

Similarly, older people might feel that ringing their relatives morning and night just to let them know they’re OK would be an inconvenience. And while you can buy specialized monitoring devices that record people’s movements around their home, these often feel like an invasion of privacy.

With this in mind, we developed something that lets older people broadcast their status to their families like a social media update. Our device (which is designed for research purposes rather than commercial development) looks like an analogue radio. But it lets users transmit information about their activity captured from a wearable heartbeat sensor in a way that is entertaining and intuitive, and only shared with selected group of followers.

The keep-in-touch. Author provided

The information includes how energetic their current activity is, for example whether they are conducting an active task such as gardening, or a relaxing and restful one such as reading a book.

By designing the device to evoke technology with which people will feel instantly familiar, we’re using the principle of design metaphor. Most people find it easier to interact with devices that resemble products they have already used.

In cognitive psychology, this is known as inferential learning, referring to when someone applies established knowledge in their brain to a new context. The design of our “radio” device makes it easier for users to work out how to use it, based on their previous interactions with traditional radios – even though it has a very different function.

Giving users control

There are plenty of systems that enable people to monitor older family members. But usually these are fully passive, where the older adults are observed directly through cameras and sensors around their homes. Or they are fully active, for example mobile phones that require the older adults to stop what they’re doing and respond right away.

Instead, our device lets people choose the level of communication they want. It runs in the background and doesn’t transmit detailed information such as images of people in their homes. This makes it a much less intrusive way of letting someone know you’re OK.

We also wanted to make the device very easy to understand, interpret and remember. So rather than having an information screen that showed text or images, we wanted to create a display that used so-called smart materials to convey what the user was doing.

In this context, smart materials are those that can change color, shape, viscosity or how much light they emit. Our research showed that light-emitting materials were the best way of conveying messages without words for both under and over-60s.

The “radio” is just a research prototype but it has allowed us to understand that the combination of innovative materials and familiar artefacts can be a successful way to encourage aging users to adopt new technologies. In this way, smart materials and design metaphors could help bridge the digital gap and promote innovation among older consumers.

This article is republished from The Conversation by Gabriella Spinelli, Reader in Design Innovation, Brunel University London under a Creative Commons license. Read the original article.

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