Recently I heard an insurance exec speak about innovation opportunities in healthcare. Somehow, he made it through his hour-long talk without once mentioning Trump and his healthcare agenda. He talked about the pressing problem and need for solutions for chronic disease management in an aging population, but somehow never mentioned that these problems can’t improve if people aren’t insured. The soliloquy included a lengthy discussion of the rise in healthcare costs, complete with an alarming graph projecting unsustainable costs in the future. There was much finger-pointing in the direction of pharma, healthcare organizations, and providers (all valid), but little in the direction of the insurance industry or the government (not valid). The re-framing was concerning to me, as it was delivered to a non-healthcare, mostly investment industry, audience.
He went on to talk about opportunities to tackle these risings costs, what kinds of innovation were needed to improve this dismal state of affairs. He lamented that we will never see revolutionary improvement in health like we’ve seen in the past during the vaccine era. I could’ve argued that that statement was not accurate for multiple reasons, but I decided to point out just one.
I raised a hand and said, “Well, I think there would be revolutionary change if we insured everyone.”
He said he was “trying not to go there” and didn’t want to make this a political discussion. Awkward silence.
I know it’s really sexy to talk about innovation in healthcare and digital health and not healthcare policy, and trust me, I love it too, but let’s get real: innovation can’t happen in an utopian bubble. Innovation needs to happen in the real world and the real world needs to have policy that supports innovation. Patients with chronic disease, for example, need to be insured to be able to access innovative therapies. Where is the fun in helping an already healthy person get healthier? I’ve worked in high income areas and low income areas, and hands down I prefer the latter because the difference I can make is so much larger.
Besides access to healthcare, people need a safety net, social support, access to healthy food, jobs, housing, and an education. It would also help if we were better stewards of the environment and protected our air, water, and soil from pollution, and tried to prevent the planet from becoming a giant petri dish for life-threatening infectious diseases.
So, if you wonder why sometimes I drone on about politics so much instead of just staying on message about the cool stuff I say I’m interested in, well, now you know why.
Let’s not do cool things just to do cool things. Can we please do cool things to actually improve the lives of people with real struggles in the real world? It’s our government’s policies that make the difference.
I first heard about cryptocurrency–well, specifically bitcoin–from my then 11-year old 2 years ago. He is a little hacker that enjoys breaking apart and reprogramming every device he can get his hands on. I was worried about his hacking before but he is honestly a good kid and has explained to me the difference between “white hats” and and “black hats” (the good guys vs. the bad guys) in the world of hacking, and assures me he is a white hat hacker. He is just a curious person…yes, kind of like his mom.
“Mom, you should buy bitcoin”, he said, after spending a day trying to “mine” the coin with his weak computer and only accumulating a few cents worth. (More on mining later…) The price of bitcoin was $200-$300 at the time (so it must have been around March 2015), and he was also spending his time playing a silly iPhone game sometime before that called Bitcoin Billionaire, so like any normal parent, I rolled my eyes & said “yeah, no”.
After that, I started hearing about “bitcoin”, “cryptocurrency”, and “altcoins” somewhat regularly. Here I am on Twitter in May 2015 discovering something called “dogecoin”:
Dogecoin has the adorable shiba inu meme (my son’s favorite dog) as their mascot so that didn’t really help me to take cryptocurrency very seriously. I mean, I admire the creativity of folks who come up with this stuff, but c’mon, are people actually using this thing as actual money and not just an arcade token??
Nevertheless, I love new ideas, and I had some Twitter followers talking about it, so naturally I started wondering about it and imagining things. Here I am last year wondering if we could tip people online with bitcoin someday, apparently clueless that people were already doing that:
@mgsiegler@cdixon 1. Culturally, giving needs to be taught alongside earning 2. Make it easier to tip online (e.g. bitcoin "tip jars")
Still, I didn’t think of buying bitcoin until around June of this year when I noticed the price skyrocketed more than 10x from when my son said, “Mom, you should buy some bitcoin”. Here I am in July thinking out loud that maybe I should have taken advice from my little Gen Z’er earlier:
Well I finally thought it was time to actually take this seriously and educate myself. I didn’t want to do anything stupid and end up being a victim of a “black hatter” or a Ponzi scheme or “tulip mania” (as Jamie Dimon recently called it) or God knows what, so before putting my money into any of this, I decided to learn more and read anything I could get my hands on regarding bitcoin and cryptocurrency.
That’s when I learned about Satoshi Nakamoto, the mysterious creator of the first blockchain, the technology that underlies bitcoin. No one knows who he/she is–the name is a pseudonym–and that of course doesn’t help to make it seem any more trustworthy. But the technology is fascinating.
The simplest way to explain what blockchain technology does is to say that it takes care of the problem of trust. In the financial world, for example, in order to give someone money (when you are don’t have cash on hand or need to send it far away), we have to use trusted intermediaries in order to broker these transactions, such as credit card companies and central banks. What blockchain does is replace these third parties with technology.
Here is my explanation of how it works…
The blockchain is a network involving computers (called nodes) that are distributed throughout the world that conducts and records these transactions between people or other entities. Let’s say you are sending money to a someone. Both of you would have verified digital identities on this network and when you choose to send money to this person, a special puzzle is generated to verify the transaction. All the computers on the network try to solve this difficult energy-consuming puzzle. The first one to solve it becomes the winner and gets a small fee in the cryptocurrency used on that blockchain to reward them for the time & energy they used to solve the puzzle and for being first (much smaller than credit card or bank fees, in case you’re wondering). This is what “mining” is. Once someone claims to have solved the puzzle, the other nodes confirm, and if indeed it is correct, the transaction is carried out, added to an audit log. Other transactions are also carried out this way, added to the audit log, which is sealed off when it reaches a certain size or “block”, and it is permanently & securely sealed and a new block is started using a special code that is generated from the previous sealed block (or “hash” which makes all previous transactions harder and harder to hack). This creates a link, or “chain” of blocks that is stored among all computers on the network, not in one central server somewhere. Also, it is harder to hack than typical computer files because if you wanted to go back and change something that happened, say, last year, you’d have to undo all the other things after it on the chain in order to do so, and everything after has the stamp of the previous transactions on it, making it a uniquely permanent record.
So, in short, blockchain is a decentralized, distributed network of computer nodes, that conducts and keeps an immutable and secure log of transactions of all types. (Using all the buzzwords here that are commonly used to describe it…)
As we know, in many part of our lives, technology has replaced many intermediaries. Instead of going to a store and buying from a person, we can now buy online from a tech platform. Instead of going to the bank and asking a teller for money, we can just go to an ATM and withdraw cash. Instead of calling a cab company and asking for a ride, we can just call a car from an app.
So, once I learned about what blockchain is, I finally understood what the big deal was behind bitcoin and other cryptocurrencies. It’s not so much about the bitcoin or the altcoin, the big deal is really the blockchain. That is what can change the world. So, yes, I have bought some bitcoin and other cryptocurrencies, but I have no false assumptions about bitcoin:
Most blockchains have an underlying currency. The ones that will be valuable will be the ones that have the most useful, world-changing underlying blockchains.
What is fascinating to me is that it is not just going to change the financial industry, but IMHO, every industry. I mean, what industry doesn’t have a need for brokers of trust? I hope you’ll start imagining applications of this technology in your own respective industries as I have in healthcare. Maybe you’ll get as excited about blockchain as I have.
Blockchain has captivated my imagination mostly b/c I’m infuriated by the financial services & healthcare industries. /1
One of the things that drives me crazy about healthcare is just how many (possibly unnecessary) third parties (brokers of trust) we have between doctor and patient: insurers, employers, banks, & government. I’m not trying to say all of them should be innovated out, but certainly much can be streamlined, which could greatly help to reduce the excessive cost of healthcare we have in this country, which I see as money that could be better used for providing a safety net for people, taking care of basic needs which we don’t do enough of, and for innovation in preventing and curing disease.
I have so much to say on blockchain + healthcare…this may be a conversation I’m beginning that goes on for a lifetime, so I’m going to defer now to a future post. Stay tuned. 🙂
I took a break from clinical practice as of May of this year. I have been in practice for over 20 years (counting my 4 years in residency training) so it still feels very strange. I am so used to living with the doctor’s paranoid mantra of “I must be missing something” that it’s really hard to shake. There are a lot of other emotions too: guilt, relief, excitement, loss, and (dare I admit?) joy.
I’m having weird dreams, too. Disturbed sleep has been a normal work hazard and my constant companion over the years, so in a way that’s not surprising. Yesterday, though, I actually dreamt that I was flying for the first time in my life. It was a lucid dream and I was even able to choose which directions to travel. It was probably the best dream I’ve ever had. It’s also worth noting that I haven’t had a “falling” dream in a while (which I used to have commonly). That is really something. It doesn’t take a Freud to figure out that maybe I’m feeling freer and lighter than before.
Taking a break from clinical work has been something I’ve been thinking about and struggled with for a few years now. I’m glad that I finally had the courage to just do it. As often seems to be the case, things tend to be scarier in my imagination than when they actually come to pass. (I hope that this is some type of corollary that always holds true because this revelation has encouraged me to be braver lately.) To my surprise, the world around me did not in fact self-destruct as I worried it might, and all seems fine. In fact, maybe things are even better. Funny.
Most people don’t understand, after working so hard to become a doctor and working at it so long to finally become a half-way decent doctor, why I’d then just want to stop. Maybe I should explain.
Like many Indian kids who grew up in households that revere learning and science and believe in karmic goodness, I decided early that I wanted to be a doctor. I think I first started telling people when I was around 10. It was a no brainer: I was fascinated by science and was good at it (my favorite subjects were biology and genetics); doctors are venerated in my culture (second only to priests); my dad in fact had wanted to be a doctor but didn’t get into med school so there was also some inherited, aspirational, existential yearning there; and last but not least, taking care of people matched my soft-hearted personality.
My teenage self–an embarrassing but impressive nerd–took on this mission with zeal. I applied to a science magnet program for high school, I obsessed about getting A’s, I entered science fairs, I was a candy striper, I volunteered to be a lab assistant, and in so doing, got into a competitive undergrad and med school degree program. I tell you all this only to show just how very badly I wanted to be a doctor and how grateful I was when I finally became the very first doctor in my family. It made me proud to make my family proud.
As is my way, I followed my gut when I made the decision to be an ob/gyn. The most moving experience I had had in med school was witnessing a childbirth for the first time, born to a single, too thin, very alone, young black woman. No family member was with her at the birth, until of course, her baby was born, and then they two had each other. I’m a crier, so of course I cried. I don’t know, but in the desolate atmosphere of Newark, NJ at that time, which had too many drugs, HIV, and crime, I was touched by the beauty and hope of that moment. I took it as a sign that this was what I was supposed to do.
The analytical side of me also thought ob/gyn to be an ideal field. It offered the best of all worlds of medicine: a primary care aspect that could grant me the satisfaction of having long-term relationships with patients, a surgical side that could grant me the instant gratification of solving certain problems immediately for patients, and even an emergency medicine aspect to satisfy the adrenaline junkie in me that enjoyed the natural endorphin rush of sometimes having to save the day with quick decision making and action.
I also just admired the women role models I saw in that field. They all seemed like firebrands and lady bosses–kick-ass, bold, honest. (Yes, some would call them bitchy. And that, they would say is a compliment. 🙂 ) They were leaders among women and leaders among doctors. I wanted that to rub off on me. I don’t think I’m at the level yet of my favorites, but I did have a patient tell me last year that she thought I was “tiny but mighty” and that is now how I like to think of myself. It’s motivating to try and live up to that high compliment.
But, I’m not gonna lie: this career has been hard. Really hard. It’s been physically, mentally, emotionally, and spiritually hard. I know I’m not unique among other doctors in my specialty, or even other specialties, or for that matter, even compared to other people working in high stress fields, but I guess I’m just sharing my own personal journey and saying that I’ve struggled a lot with how to cope with the exhaustion, sleep deprivation, mental stress, heartbreak, and yes, even depression, that comes with this work. I could write a book on it, but I try to be a little Buddha about it and live with the knowledge that these are temporary states of pain and move on instead of dwell on it, so I think that this post is all I will say for now, and maybe ever.
I probably sound like a whiner. I know many other people have it much worse. Doctors in general are not a group of people that other people feel too sorry for. That is appropriate. I do know how extremely privileged I’ve been to have this amazing career, which in net has given me much, much more than it has taken from me. And even though many of my lowest lows have been at the hospital, so have many of my highest highs. In all the ways that my medical career has bruised me–physically, mentally, emotionally, and spiritually–it has also burnished me and I feel deep gratitude for that. I’m better as a result.
Medicine has helped to grow my love for humanity. I thought I had a good amount of empathy when I started as an idealistic, young med student, but I really didn’t know the depths I could achieve personally until having heard and felt some of the struggles of my patients over the years. Now, sometimes I even think I can viscerally feel people’s pain, as if it’s my own.
It’s hard to keep being a witness to everyone’s hardship and suffering and feel powerless to do very much, especially in a system that allows you only 15 minutes per patient. I’ve burnt out on that. I’ve always cried easily, but now it’s a little bit ridiculous. I’ll cry during a dumb movie, for example, not so much because I believe the fiction in the movie but because I know these types of things happen to actual people everyday, some of whom I’ve met and I’ll then remember them, and the fiction ends up feeling very real to me. I’ve learned to put myself in little escapist bubbles for short periods of time to re-charge my batteries. Maybe that’s what I’m doing now.
There’s the struggle of the individual patient but also the systemic dysfunctions that bother me, maybe now more than ever in this toxic political climate: how we practice medicine, the design of our healthcare system, and how we as doctors have little influence on socioeconomic problems that are so much at the root of public health. I don’t think it’s right that doctors spend more time with the medical record than with patients, that they are paid on incentives based on quantity of care rather than quality, that we have a structure that encourages quick fixes and overprescribing rather than the time-consuming process of actual care and healing, that patients can’t afford healthcare, that they go into debt over it, that they can’t afford healthy food, that they work too much to have time to take care of themselves, that mental health and prevention are so undervalued and underutilized, and that women seem to be the most screwed-over members in society on multiple, mind-blowing levels and hardly anyone seems to give a shit. I’m tired of all of this and more and I’m also tired of having to be a silent part of it and I guess I needed a break from my participation in it to think about what I can do with myself that will inspire me, make me feel more productive and like I’m making a bigger difference in the world, be able to be more myself and share my opinions freely about what I see without need to censor myself, and also that at the end of the day, will just feel right to me. I need to get back to following my most trusted resource: my gut.
I’m also an intellectually curious person. I’m a learner. I’ve been restless the last few years while in practice. I think it’s hard to do any one single thing for more than a decade, let alone two decades. I think it’s a kind of intellectual death to expect a person to keep being and doing only one thing for their entire lives, especially if they have a personality like this. We accept that kids keep growing and changing. Can we also expect and accept that adults do the same?
Realizing this about myself, I went back to school a few years ago to enroll in a master’s degree program in a thing called “healthcare leadership”. Honestly, I’m embarrassed by the pomposity of the name and I wasn’t even sure what I’d do with such a degree, but I liked the coursework, which was a hybrid of public health and business management courses and I thought it would help build on my background in medicine and that maybe that it would lead me down interesting, gratifying avenues. That has turned out to be true. My mind has bloomed with new ideas, and I’ve discovered a new passion for medical innovation and healthcare technology. It’s lead to some interesting new opportunities that seem to keep growing the more open I am and the more I put myself out there.
I’m excited about the future and where this will lead. It feels like an experiment. I know this could end up being a disaster. But still, I’m excited. It reminds me of what I love about science in the first place: making hypotheses, trying new experiments, discovering something previously unknown before…whether good or bad. Once in a rare while, there is even some magnificent discovery. I wonder what I’ll discover while living life using the scientific method? An experiment, even when the hypothesis is proved wrong, is a success in terms of learning and discovery. I try to remember that these are core things that I live for. (That’s why, for example, I love to travel.)
I’m now trying to think of creative ways to stay clinically engaged but in a more flexible way. I might moonlight, work part-time, in the clinic, or as a hospitalist. I’m not sure yet.
This month I’ll be back to seeing patients in a short-term position as a clinical researcher testing a women’s health device in a trial for a medtech company that is hoping to develop a better treatment for incontinence. I’m excited about that. What if it turns out to be better than surgery? What if it’s a revolution in terms of treatment of this problem? How nice if I can say I helped. Again, if it fails, it was still a worthy experiment.
I am also looking forward to continuing to work with and support startups trying to improve medicine and healthcare and I also hope to get more involved with charitable work, especially in support of women and girls. (Besides these issues, I also deeply care about animals, the environment, and the food system. It probably sounds nuts that I have so many causes!)
Once in a while I think,”What the hell am I doing? What is even my purpose here on Earth?” Am I here for others or for myself? To be the consummate doctor, to serve others? To learn and grow? To just enjoy life & have fun?
These questions used to torture me, but I’ve finally realized that it’s probably a little bit of all of these things, and maybe I should stop analyzing so much and yes…just follow my gut.
This should be an interesting experiment. There is, of course, no clear or guaranteed outcome, but I am taking joy in conducting it.
This article was originally published on Healthegy.
Digital health investments are on track to hit an all-time record in 2016, according to Katya Hancock, director of strategic partnerships at StartUp Health, who spoke at the Digital Healthcare Innovation Summit.
Year-to-date for 2016, digital health companies have raised over $6.5 billion in investments, already surpassing the $6.1 billion that was invested in the space last year.
The sector set a record in the third quarter when companies raised $2.37 billion, the most raised in a single quarter.
Total investments in digital health since 2010 have amounted to $20 billion. According to Hancock, the general consensus at StartUp Health is that digital health is still only in its early stages, and that we are far from a market bubble.
Currently, StartUp Health has 170 companies, across 26 countries, in its portfolio. The firm has an ambitious mission, “to improve the health and well being of everyone in the world,” and aims to do this by supporting and investing in entrepreneurs who hope to reinvent and transform health care.
StartUp has recently outlined 10 major moonshots that it feels will have the greatest impact on health: improving access to health care, decreasing health care costs, curing diseases, cancer, women’s health, children’s health, nutrition, brain health, mental health, and longevity. In addition, StartUp Health actively tracks 7,500 companies outside its portfolio to gain market insights into the digital health space.
Through its market research, the company has identified a number of interesting trends in the digital health market that are worth noting:
US and Global Growth: As mentioned previously, digital health investments are growing with year-over-year increases. In addition, international investments are increasing rapidly. Some of the largest deals are in fact happening abroad, in particular in China. Two of the largest investments, in fact, have been in China, with a seed-stage investment of $500 million in start-up Ping An Good Doctor and $448 million in Baby Tree, both based in China.
Digital Health’s “First Wave”: Digital health is still in its “first wave,” with early investments in sensors and wearables still in early stages and not yet realizing returns. A second wave is expected that may include more sophisticated sensors, which are likely to offer deeper insights and improved solutions.
An Active Investor Ecosystem: The digital health investor ecosystem is extremely diverse, with over 500 unique investors in the space, with over 140 making multiple deals in 2016.
Unique Collaborations: Stakeholders with specialized expertise are coming together for unique partner collaborations. One example is the large $500 million investment by Google and Sanofi into diabetes start-up Onduo. We can expect more of these unique partnerships going forward, aiming to bring together parties with different skillsets to tackle difficult health care challenges.
The Rise of the Rest: Finally, there is a rise of new innovation centers and hubs away from the prominent East and West Coasts to include other sites in the US and internationally. New ecosystems are attracting investors to locales previously underserved by digital health.
Most Active Subsectors
Patient/consumer experience remains the top category for funding in the digital health market, attracting $2.53 billion in investments. The next largest categories were wellness at $918 million, personalized health and quantified-self at $634 million, big data and analytics at $564 million, and medical devices at $478 million. Other categories with less funding included workflow, clinical decision support, and population health.
Most Active Therapeutic Areas
Not surprisingly, the top three therapeutic areas that receive the greatest digital health investment are cancer, mental health, and chronic disease, including diabetes. Other significant areas of funding include: cardiology, dermatology, autism, pulmonology, ophthalmology, immunology, and rare disease.
While the investments are not in drug development per se, according to Hancock, “The lines are getting blurry between digital health and the life sciences. Some companies that we thought we wouldn’t be working with, we now are.”
The largest investment deals were both in the patient/consumer experience category, with a $500 million investment in Ping An Good Doctor (in China) with an undisclosed investor, and $500 million in Onduo, led by Google Ventures. The next largest deals were $448 million in Baby Tree (in China), led by Matrix Partners, and $400 million in Oscar Health, led by Khosla Ventures. Other notable investments include Human Longevity, Inc., which received $220 million, led by StartUp Health; Flatiron Health, which received $175 million, led by Roche Pharma; and Clover, which received $160 million, led by Green Oaks Capital Management.
The most active investors in the space were Khosla Ventures and StartUp Health, both of which made 10 deals in 2016. They were followed by GE Ventures, which made nine deals, and Safeguard Scientifics, which had six deals.
Digital health has high potential for improving health outcomes, and it is expected that investments will continue to grow in the US and internationally going forward. As it is still a young market, only time will tell if returns are realized on this potential.
Last month, the seventh annual Rock Health Women’s Summit was held in San Francisco to promote gender diversity and support more women leaders in Digital Health. According to research from Rock Health, women are the predominant players in the health care marketplace. Women represent 78% of the health care workforce, make 80% of health care decisions in families, and represent 75% of all caregivers in the home. Their influence on health care is profound.
It’s strange, then, that women don’t have equal representation in industry, especially in terms of leadership positions. Women run only 6% of the companies in Digital Health. As it so happens, women also represent only 6% of the venture capital industry. (According to angel investor John Landry, who spoke last month at Capital W’s Boston Women’s Venture Summit, this number is even worse in Boston, with only 3% of VCs being women.)
The gender disparity in venture capital creates a barrier to achieving gender balance in the companies they fund, as VC teams with mostly men are more likely to invest in companies with mostly men. It’s been found that VC teams with women are two times more likely to invest in management teams with women and three times more likely to invest in companies with women CEOs.
Besides being equitable, from a business perspective, it’s also profitable to invest in companies with women on the executive team. According to Rock Health, start-up teams with women on the executive team raise more money than all-male teams during first rounds. Also, companies that have women in board-level leadership positions have been found to produce a greater return on investment.
Gender diverse companies also tend to have greater diversity in general, in terms of race, sexual identity, and sexual orientation. This is important to consider because employees these days – Millennials especially (now the largest generation in the workforce) – prioritize diversity at work. Millennials have a “remarkable lack of allegiance,” according to Lynne Sterrett of Deloitte Consulting, adding, “It’s a serious challenge to us as business leaders.” What has been shown to attract and retain Millennials is having shared personal values and a deep sense of purpose. According to Ali Diab, CEO of Collective Health, a company with a health care benefits platform, “There is a certain meaning, a certain sociological tapestry that Millennials want to feel when they come into the workplace. They want to feel like what they do has that social impact broadly speaking.” Diversity has been cited in numerous studies to be integral to creating a more inclusive work culture and has also been found to result in teams that make better decisions, perform better, and are more successful.
Events like the ones sponsored by Rock Health and Capital W last month help to spotlight success stories that can hopefully inspire others. One Massachusetts firm, Zaffre Investments, the investment arm of Blue Cross and Blue Shield of Massachusetts, and its managing director, Leah O’Donnell, were recognized at the Capital W Summit for being the investment firm with the highest ratio of women-led companies in 2014 and 2015. Six of the firm’s 10 companies are women-led, including Boston-based Ovuline, which has a fertility-tracking app.
Although progress is being made, change has been very slow. Terra Terwilliger from the Clayman Institute, who spoke at the Rock Health meeting, discussed the problem (in both men and women) of unintended bias, sharing an eye-opening study that demonstrated how removing gender from resumes can improve the chances of hiring more women. She challenged the audience to consider before hiring or not hiring an applicant to ask themselves if they, too, may have an unintended bias.
Ali Diab has solved this problem at Collective Health by instituting a 1:1 men to women hiring ratio. He shared that his inspiration for this was his personal experience, having been raised by a mother who worked. “I grew up in a household where my mom was a surgeon but my dad went to grad school, a PhD program, so I got to observe the power of having that sort of a professional female force in the house.” He went on to say, “I also got to observe all of the gender issues she had from her home country, which is in the Middle East … but also here in the US where she dealt with a lot of sexism. So for me it was a very personal thing, I just wanted to make sure we had women well represented because I just feel very passionate about it because of my mom’s experience.” Collective Health has been very successful with this strategy and has even managed to create an engineering team that includes 25% women, which is unheard of – “astronomical” according to Diab – in typical tech companies. Diab also shared that he feels Collective Health has seen the fruits of this hiring policy in the market as well.
Former VC partner Karen Boezi, now an investor with Broadway Angels, urged women to be more confident, speak up, and take more risks. She also encouraged greater investments in women, sharing her thoughts about how successful they can be. “Women, I think, can be very focused on ‘getting it done.’ They have their eye on the ball and they are very good executors, very good managers.” The panel was especially bullish about women with children, calling them “ruthlessly efficient.” In speaking about the positive experience of a small investment firm called Mission Bay Capital, which invested in her biotech company (among others), she said, “They’ve had nine exits so far, all led by women.”
Hopefully, as more people in Digital Health recognize the business advantages of having gender diverse teams in their firms, opportunities for women will continue to increase.
Overall venture capital funding made a sharp decline in the last two quarters amid worries (justifiable or not) of a bear market and a funding bubble in technology investments. In contrast to the tech market, however, digital health funding continues to grow at a record pace. According to Rock Health, $4.5B was invested in digital health in 2015 (an increase from $4.3B from 2014) and $981 million has already been invested in the first quarter of this year. It seems on pace to be another stellar year, which is remarkable considering what is going on in other sectors.
Many are skeptical about the investment potential of healthcare technology investments and have been wary to enter the market (perhaps especially so with all the negative media that companies like Theranos and Zenefits have attracted). Additionally, regulatory barriers and the longer timeline needed with healthcare innovations tend to scare potential investors away. But anyone familiar with the sad state of technology in healthcare can see, even with the record-breaking investments thus far, that there continues to be an enormous untapped opportunity in healthcare–greater, I believe, than in any other sector.
Digital health is vastly underfunded.
Technology is taking over most of our personal and professional lives with indispensable apps, wearables, and other connected devices and software. At home, we have smart appliances, lighting, thermostats, security systems, media systems, and even smart cars. And we have Siri, Cortana, and Alexa doing our bidding. But in healthcare, we’re still in the Stone Ages in terms of technology. Communication via faxes, for example, is still common between hospitals and doctors offices. There are small glimmers of hope, such as patient portals, higher-functionality EMR systems, and telehealth services, but the fact is that we are still a far cry from the ideal vision for healthcare, which includes a seamless cloud-based network of devices and software that can track and record a vast spectrum of patient information, the ultimate goal being the use of computational technology to help prevent, predict, diagnose, and yes, even treat disease. Ultimately, collecting information on large populations of patients could have profound impact through public health measures that can prevent disease and thereby reduce healthcare costs. This can only be accomplished with a wide-spread network of software and devices, that includes electronic health records, wearables, devices based in the hospital, office, and at-home, and with telehealth capabilities. In addition, there are too few companies working to collect, store, manage, and interpret health data.
There is still a lot that needs to be done.
According to MarketResearch.com, the healthcare “internet of things” (IoT) is expected to reach $117B by the year 2020. The fact is, the full potential of digital health won’t be seen until every hospital and doctor’s office and home is connected via cloud-based devices and software and with the development of machine learning platforms that can make sense of the reams of health information.
It is a little challenging to think of all of this in the abstract, so here are a few examples of the potential of the healthcare IoT. Imagine that a spike in certain population health data (like temperature) is detected in a region of the country that alerts public health officials to early to a disease outbreak that can then be contained to prevent an epidemic. Imagine that a change in an individual’s biometric data alerts that person to seek medical care, detecting a life-threatening disease, like cancer, early and improving the chances of cure. Imagine chronic health conditions like diabetes are monitored routinely and continuously with real-time blood glucose levels, with immediate adjustment by doctors of insulin dosages, thereby preventing hospitalizations due to uncontrolled diabetes, and also preventing long-term diabetic complications, such as kidney disease.
These are only a few examples. There are countless other opportunities in healthcare.
In addition to the opportunity to improve healthcare delivery, there is the opportunity to improve the quality of care through tools that provide greater communication and transparency of information with patients and improve care coordination between the providers of those patients. And by changing the focus of medical care to prevention and early diagnosis of disease, there is the opportunity to decrease the outrageous cost of healthcare as well, by decreasing the need for excessive medication, surgery, unnecessary visits, and hospitalizations. According to the Commonwealth Fund, in the US we spend an outsized proportion of our GDP on healthcare versus other countries. Other developed countries spend between 8.8%-11.6% to our 17% of GDP, related in part to better-connected health IT networks.
It’s hard to fathom how much digital health tech is needed to serve a US population of 318 million and a global population of 7 billion, but one thing is certain: the market is huge. We should stay bullish on health tech investments now, and probably for a long while to come.
Recently, I had the opportunity to speak to billionaire surgeon-inventor Dr. Patrick Soon-Shiong about his plans, both private and through the Cancer Moonshot 2020, to cure cancer.
Soon-Shiong, who made his fortune by founding and selling two pharmaceutical companies, has gathered a group of pharmaceutical companies, academic institutions, and insurers to spur cancer research and to attempt to make breakthrough gains by the year 2020. This effort dovetails with the Obama administration’s $1B plan to fund cancer research led by Vice President Joe Biden, whose son, Beau, recently died after a long struggle with brain cancer.
Soon-Shiong’s path to cancer research began while doing research for NASA that involved harnessing stem cells to make insulin. He stumbled upon a paper that reported that the binding of zinc to the blood protein albumin is what transposes it into pancreatic islet cells, enabling the production of insulin. This discovery led to an “aha” moment. “A light bulb went on. In fact you should feed the tumor, not stop the tumor. And if you could take a nanoparticle of albumin and attach Taxol [a common cancer drug] at the core, then it [the tumor] would take up the albumin and kill itself, like rat poison.” This revelation led to his creation of the cancer drug Abraxane, or albumin-bound paclitaxel (Taxol). Abraxane is used currently in a wide variety of cancers, including breast, lung and pancreatic cancer. “To this day, oncologists don’t understand the mechanism of action of Abraxane,” he said, “They think of it as another form of Taxol.” According to Soon-Shiong, Abraxane works so well is because the binding to the blood protein albumin allows it to penetrate cancer tissues better.
Abraxane has had huge clinical and commercial success, but he says the path to getting there wasn’t easy. Initially, after developing Abraxane, he approached large pharmaceutical companies but was unable to gain support despite showing that it had remarkable results in animal models. He was forced to make the painful decision to leave a secure academic career to risk launching his own company. His risk paid off. He ultimately founded both APP Pharma and Abraxis BioScience to support his work. In the end, APP Pharma was sold to Fresenius SE for $4.6B and Abraxis BioScience was sold to Celgene for $4.5B. Then, in 2011, he founded NantWorks, a holding company with a portfolio of firms to pursue his diverse entrepreneurial interests. One of these is NantHealth, a company that has developed a fully integrated digital health platform to collect and analyze genomics and proteomics data on cancer research patients.
Soon-Shiong, a bit of an heretic in the world of oncology, has ideas that veer from the traditional approach to cancer treatment. One example is how he wants to harness patients’ natural immune abilities to treat their cancers. “As we sit here speaking, we are creating 10,000 cancer cells a day. And the natural killer cells in your body are monitoring it and killing it,” he said, “Cancer is a normal evolutionary process. And guess how we’re trained as oncologists? To give you the maximal tolerated dose of drugs to kill those natural killer cells that are protecting you, which makes no sense. This is the dogma in oncology and even in drug development.”
He’d like to see drugs given at lower doses to cause what he calls “cytostress” instead of “cytotoxicity”. The natural killer cells of our bodies look for cells that are under stress (by detecting distinct proteins and enzymes that are released) and then destroy those cells. He suggests that chemotherapy should be administered at what he calls the “lowest effective dose” instead of the much higher “maximal therapeutic dose” typically given in clinical trials for cancer. The lowest effective dose, he argues, won’t completely wipe out patients’ immune systems, and thereby allow patients’ natural killer cells to target “cytostressed” cancer cells. He argues that this approach will revolutionize cancer treatment and lead to more cures and cites numerous personal anecdotes when this approach has worked for his patients.
Unfortunately, for the time being, he’s had a difficult time convincing oncologists and drug companies to move away from what he calls the “schizophrenic dichotomy” of treating with the maximal therapeutic dose that destroys natural immune function.
Another challenge to finding a cure for cancer, according to Soon-Shiong, is developing health IT systems to support cancer research. “Cancer is really a rare disease,” he said, “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer. So you actually need to create a collaborative overarching global connected system.” He continued, “The problem is now you have the other obstacle to the advance of medicine and the cure of cancer…it is going to be bombastic, dogmatic IT.” In order to solve this problem, Soon-Shiong is collaborating with other health IT experts in the Commonwell Alliance to facilitate the development of the digital architecture needed to support the interoperability of electronic medical records.
His critics question the sheer breadth of the projects he’s begun under his NantWorks empire, but Soon-Shiong seems too consumed with making his ideas a reality to worry about critics. At a time when one might expect him to retire, he seems to be only just beginning. “At this point in my career, it’s just: let’s show that there are patients that are alive. Let’s show we’ve created less suffering in cancer patients and then expand it globally.”
Cancer treatment is a frustrating waiting game at the present time. Patients with solid tumors often undergo brutal chemotherapy cycles for weeks to months before they can get an idea (through radiologic examination) of whether their therapy has been working to shrink their tumor. At times, the studies show the therapy is working , but at other times, the studies may show that in fact, treatment may be failing, allowing the cancer to grow. This delay in diagnosis in cancer treatment is what the life sciences startup Blondin Bioscience hopes to correct.
Blondin Bioscience is a company that is currently developing a point-of-care molecular diagnostic assay which they hope will disrupt the traditional current model of care for cancer patients. Their test, which is called FACT (fluorescent analysis of cell-free telomeres), has the ability to detect a nucleic acid biomarker (telomeres) in the blood that is released from dying cancer cells. Blondin Bioscience proposes that this test can be used as an adjunct to cancer treatment, allowing oncologists to monitor the effectiveness of chemotherapy treatment in real-time–days, not weeks or months–and thereby, be able to quickly direct treatments and improve outcomes for patients. Additional benefits are the cheaper cost versus radiologic studies and cost savings from potentially avoiding ineffective treatments, as well as easier access, as this test could be made available in doctors’ offices versus having to make patients travel to centralized, larger hospitals and centers in order to have radiologic studies. Patients would also know sooner whether their treatment is working, thereby decreasing the emotional toll of cancer treatment.
Blondin Bioscience is based in Birmingham, Alabama, and is lead by Chief Executive Officer Brad Spencer, and founders Dr. Katri Selander and Dr. Kevin Harris, who are both Assistant Professors of Medicine at the University of Alabama at Birmingham (UAB) and are members of the UAB Comprehensive Cancer Center. Their leadership team also includes Director of Research Dr. Kate Hayden and Director of Operations Kathleen Hamrick.
Thus far, Blondin Bio has raised $750,000 from an NIH SBIR grant and has been studying their testing method in a clinical trial for prostate cancer, but hopes to scale in order to test other cancer types.
Today I had the opportunity to speak very briefly at a White House-sponsored roundtable called the “Impact of Gender/Sex on Innovation and Novel Technologies (iGIANT)” in Cambridge, MA. Other partners for this event were the American Medical Women’s Association, Boston Scientific, and Medstro. This is what I shared.
What I’ve found while working in the digital health space is that there is a significant lack of women in the healthcare investment industry. Though women make 80% of healthcare decisions in families, and despite women making up 78% of the healthcare workforce, we are sorely underrepresented among investment and corporate leadership. In the digital health space, only 6% of CEOs of startups are women. That, I believe, reflects the fact that only 6% of venture capitalists are women. While we don’t like to admit it, money is power. And if women don’t have access to the purse strings that fund innovations, then of course, innovations that concern women and that can impact women’s health are going to be underfunded and underrepresented.
What I’d like to see is more healthcare and academic institutions, in the public and private sectors, committing to what’s called “gender lens investing”, making it a criteria to invest with gender equity in mind. This may mean making an effort to engage with only those investment and venture capital firms that commit to diversity, have adequate female representation, and make a commitment to try to invest in projects that interest and can benefit women.
I believe that more diverse teams will translate to improved health innovations that can benefit more diverse groups of people. Diverse investors lead to diverse founders and companies; diverse companies lead to diverse innovations; diverse innovations are what serve diverse stakeholders. And that is what will ultimately lead to equity, not just in terms of gender equity, but also racial/ethnic equity.
This cultural change could be facilitated through a policy recommendation, perhaps through a white paper study or policy brief on the matter, and also by all of us here urging individuals and organizations at every level to invest their funds more conscientiously and in a mission-driven manner with gender equity in mind. Thank you.
“The State of Women in Healthcare”, Rock Health, March 2015
“Venture Capital’s Next Venture? Women”, Tech Crunch, June 2015
“Investing for Positive Impact on Women”, Croatan Institute, Nov 2015