Our Mission | Our Story

Conversations empower patients.

We fulfill our educational mission by sharing video conversations with leading medical experts from different institutions and countries. Experts speak on a topic of their life-long professional interest, they explore crucial aspects of medical conditions from multiple angles.

Our video conversations empower patients in 193 countries to be more confident when they discuss diagnostic and treatment options with their local doctors.

Empowering patients around the world to take better control of their health and to feel stronger during interactions with local medical providers is a significant part of our public health impact. If you don’t know what’s possible, how can you ask for it?

How to stay healthy.

We fulfill our health improvement mission by facilitating precisely-focused remote expert opinions, matching patients with a physician or surgeon who is perfect for their situation, and by helping people to assess and reduce health risks.

Staying healthy mostly does not require going to a large hospital, using sophisticated equipment, or making an appointment with a fancy doctor.

The key to excellent health is paying timely attention to seemingly small yet crucial details: family history, lifestyle, disease screenings, and preventive medicine.

You can build upon this foundation by exploring your personal genetic, lifestyle, and environmental risks to continued health, and reducing such risks before they manifest into a clinical-level illness.

Should your health falter, it can often be restored by getting a timely, precise, complete, and, of course, correct diagnosis.

You will return to health faster by making – on the first try – savvy treatment decisions that perfectly fit your unique situation. Many medical situations are not as bad as they might seem at first. But correct diagnostic and treatment decisions must taken promptly. 

It does not matter where you live. It does not matter what language you speak. Modern medicine transcends borders with the help of communications technology. Most decisions regarding any diagnosis and treatment today can be taken remotely with equal confidence.

Dr. Anton Titov: “My mother had a ‘fibrotic scar’ in her lung for several years. In 2014 this ‘scar’ grew and was re-classified as a lung tumor. This was a sudden and sad new interpretation of diagnostic tests.

I consulted a renowned thoracic surgeon at a top hospital in Boston. I received this gloomy summary:

“Just to be clear, the multiple abnormalities in the lung largely removes it from the realm of surgery. There is no hurry with the biopsy because we don’t have very good options.  I don’t mean to be pessimistic, but her best option is very slow growing tumor.”

I had no reason to challenge this experienced surgeon’s verdict. I had interacted with this senior academic thoracic surgeon during my residency. He is a very competent expert, deeply respected by peers.

So all we could do was… nothing.

Nevertheless, I reviewed dozens of medical research articles on the presumed tumor type. I reached out to many physicians whose contacts I had accumulated since I started working at Harvard’s teaching hospitals in 1994. I discussed the situation with researchers who I knew from the days of working on my PhD in Molecular and Cell Biology in a Nobel Prize-winning laboratory at The Rockefeller University in New York.

Both medical literature review and discussion with my contact network led me to two experts who made this exact type of lung tumor a major focus of their research and clinical work. One of these experts, interestingly, also worked in Boston. In fact, not only he worked in the same hospital system, he was almost next door to the first thoracic surgeon who I consulted about my mother.

After reviewing the case, this other surgeon immediately put my mother on his operating schedule. He proceeded fast with the pre-operative diagnostic tests.

In a few days, he reverted to us with a completely different assessment of my mother’s situation:

“All of the mediastinal and hilar lymph nodes are negative. I think we can proceed to right upper lobectomy on the original date of surgery. The plan would be to remove any extension into the right lower lobe. The other groundglass lesions will be left alone. The remaining lesions will likely pose little risk to her life.”

That was a completely different assessment and treatment strategy for my mother.

While I had no reason to doubt the “we can do nothing” verdict of the first expert, my mother and I certainly preferred action to inaction. Optimism often prevails!

Thus, it took a week of the literature search and discussions with my professional contact network to identify and reach out to this other surgeon who specialized precisely in the treatment of the type of lung tumor my mother had.

In two weeks my mother underwent a minimally invasive operation (VATS) to remove her lung tumor. She was discharged from a hospital to home 6 days later.

I then had this follow-up message from the surgeon:

“Completely resected. It extended in the right lower lobe but we had an adequate margin. All [lymph] nodes were negative. All margins were negative. There is no need for chemotherapy or radiation, just surveillance imaging Q6 months for 2 years and yearly thereafter.”

This was many years ago. My mother still leads an independent life, walks for miles, and continues to have a close and joyous relationship with her granddaughter.

A true revelation for me was not the fact that there I was, plugged into a Harvard medical system for 20 years, getting a pessimistic “nothing to do” verdict from one major surgeon. It was also not the fact that I got a completely different assessment and action plan from another expert who was working next door to the first one, in the same hospital system.

A true revelation for me was the specific reason why the second surgeon preferred to resect the primary tumor. He explained:

“If we do not resect and let the tumor keep growing, however slowly it does grow, the risk of internal transformation of this type of tumor into a more aggressive “classic” lung cancer would become nearly certain. Whereas for other small lesions this risk is very small. So we have to remove the primary tumor.”

This explanation was confirmed by another medical oncologist who studied the behavior of this type of lung tumors. All that convinced us of a need to act quickly and accept risks of surgical operation and general anesthesia.

It is important to emphasize that both surgeons were profoundly knowledgeable in their field. Both surgeons were highly experienced. It was not a question of one doctor being “better” than the other.

For me, the difference between them was the intensity of their professional focus on this specific type of lung tumor. It was the difference in awareness of the changing landscape of treatment for this particular type of tumor.

In other words, the difference between the “do nothing” strategy, proposed by one surgeon, and “resect now” strategy, proposed by another surgeon, can be summed up in two words: “precision medicine“.

No one knows everything. When you encounter any medical challenge, you have to find a specialist who precisely fits the exact issue at hand.

A true expert is the precise key that can open the lock of a patient’s medical issue, and do so without damaging everything around it. That’s how one gets the best possible results of any therapy.”

Helicobacter pylori analogy

Imagine what would happen if you had a stomach ulcer and reached out to the “best” gastroenterologist in the era before the Helicobacter pylori was accepted as the cause of ulcers.

Everywhere you would turn to, you’d get a “classic” advice to “lower your stress and reduce stomach acidity” by taking an anti-acid medication (that pill made $1 billion in annual sales).

But if you were to find Dr. Barry Marshall and Dr. Robin Warren, you’d get a very different advice: take antibiotics.

This advice was dismissed and ridiculed for many years by most medical experts and pharmaceutical company executives, who all had conflicts of interest:

Read this quote from a New York Times article:

Opposition to their radical thesis came from doctors with vested interests in treating ulcers and other stomach disorders as well as from drug companies that had come up with Tagamet, which blocked production of gastric acid and was becoming the first drug with $1 billion annual sales.

Ulcer surgery was lucrative for surgeons who removed large portions of the stomach from patients with life-threatening bleeding and chronic symptoms. Psychiatrists and psychologists treated ulcer patients for stress.

The concept of curing ulcers with antibiotics seemed preposterous to doctors who had long been taught that the stomach was sterile and that no microbes could grow in the corrosive gastric juices.

But Drs. Marshall and Warren could, in fact, cure your ulcer. All other physicians at that time were wrong about the cause and treatment of stomach ulcers (and about the risks of stomach cancer).

A similar situation befalls millions of patients around the world, for many diagnoses.

Yes, we all know that misdiagnosis and suboptimal treatment decisions happen all the time. But when you experience it first hand, in a loved one, it makes a personal impact.

Patients may think they have all corners covered.

They may have an expensive health insurance and they could reach a top doctor in their community or visit a fancy brand-name clinic. But just as my mother and I experienced, being in a top hospital does not guarantee a precise, correct, and complete diagnosis, and a correct interpretation of diagnosis. It certainly does not guarantee the most appropriate treatment, even when it’s available and affordable.

History of medicine is full of examples where new superior treatments were dismissed, ridiculed, and took decades to be accepted widely by medical community.

Colorectal cancer

Prof. Bill Heald developed a superior method of colorectal cancer resection in the early 1980s (TME operation). It reduced colorectal cancer recurrence rates from 20-30% to 5-10%. But his surgical method was not widely accepted “until mid- or even late 1990s”, as a top rectal cancer surgeon from Stockholm discusses in one of our expert video conversations.

Aortic stenosis / TAVI

TAVI, Transvalvular Aortic Valve Implantation (or TAVR, -Replacement) revolutionized minimally invasive therapy for patients with aortic stenosis. Aortic valve stenosis is a debilitating heart condition that is common among elderly patients. They often cannot tolerate open heart surgery.

Dr. Alain Cribier has been developing pioneering TAVI therapy for 20 years. He writes that “many experts declared the project ‘the most stupid I’ve ever heard’.”

First in-human TAVI procedures were performed in 2002 in Rouen, France (not in Boston, not in Texas, not in Paris!)

It took US FDA 10 years to approve TAVI (TAVR) in the US, in 2012. By 2020 TAVI overtook surgical aortic valve replacement in the US. 280,000 TAVI procedures per year are estimated to happen annually by 2025.

Is Rouen on your map of the top medical centers? Likely it is not. But if you needed aortic valve replacement and could not tolerate open heart surgery, Dr. Alain Cribier in Rouen, France, should have been your choice of a heart expert between 2002 and 2012+.

Multiple myeloma / MGUS

Is Pamplona on the list of your top medical centers? Perhaps it is in the mind of most people as a ‘top annual bull run’, but Pamplona does not spring often to mind as a top medical treatment destination.

Yet Pamplona is the place where one of the world’s leading experts in the genomics of multiple myeloma works. Multiple myeloma is a form of blood cancer. Dr. Jesús San Miguel is also an expert in MGUS, a precancerous condition that precedes multiple myeloma. So if you had any of those medical problems, you would benefit greatly from this expert’s view, as some of our clients have benefited.

Epilepsy

In the UK, a scientific review of epilepsy patients concluded that “approximately 55% of the population of adults receiving treatment for epilepsy have never received specialist advice. Reassessment of these patients uncovers diagnostic uncertainty, failure to classify (leading to sub-optimal therapy), and lack of information and advice about all aspects of epilepsy care.”

Another UK medical review found that “as many as 20% to 30% of epileptics may have been misdiagnosed. Many of these patients may have cardiovascular syncope, with abnormal movements due to cerebral hypoxia, which may be difficult to differentiate from epilepsy on clinical grounds.”

Multipel sclerosis, heart attack, ovarian cancer

Whether it’s multiple sclerosis, heart attack (especially in women) or ovarian cancer, a significant percentage of patients are misdiagnosed or their diagnosis is delayed, or it is incomplete. All those problems lead to a delay in getting appropriate therapy.

The right experts could have provided fast, correct, and complete diagnosis and treatment plan, on the first try.

Our goal is to highlight and share an awareness of better diagnostic and treatment options that are often available locally.

Every patient has to explore more options, talk more to local clinicians, dare to challenge the “verdict” of any “grey-haired professor” if something feels ‘off’. Trust your intuition.

It is not easy to convince patients to seek better treatment options. They are under stress and may not have the knowledge to push the medical system to work better. They may not have the energy to explore all options, and fight until the right treatment is found.

We believe that patient education via personal video conversations with leading medical experts around the world is a more effective approach than reciting printed texts and convoluted articles. Most medical texts are the same.

Honest and personal video conversations with physicians from many countries encourage patients and their families to be more active and assertive in seeking better treatment options, first and foremost locally in their communities.

Since the start of this venture, I have become aware of Project ECHO (http://echo.unm.edu/), which indeed pursues a similar patient education goal through technology. Dr. Jason Hwang, co-author of Innovator’s Prescription, a bestseller by Clayton Christensen of Harvard Business School, alerted me to Project Echo. This validates the concept of global interaction between leading medical experts who are precisely matched to patient’s problem, and local doctors who care for the patient.

This is about collaboration, not competition. It is about breaking the silos and aiming for a better flow of knowledge and compassion in medicine.