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EXPONENTIAL MEDICINE
Conference Report
San Diego, CA November, 2014C o n t e n t sTable of
San Diego, CA November, 2014
Introduction
Contributors
Observations from the Exponential Medicine event
What is exponential technology?
4 Critical insights for companies to remember in this era of exponential growth
Key take-aways and disruption in the health space
Rise of the patient
A game changer - tech meets neuroscience
Artificial Intelligence (AI) is closer to reality than you think
Where is Pharma?
What will the future of health look like?
Start-ups proliferate: An explosion in the health space
Crime pays…and now it pays exponentially
Now what? Be the disrupters, not the disruptees!
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INTRODUCTION
The exponential growth of technology is redefining the health space.
Through multi-disciplinary events such as Exponential Medicine,
world-class innovators, organizations and start-ups across the
biomedical and technology spectrum are congregating to explore
and leverage the convergence of new technologies in re-inventing the
future of health and medicine.
With innovation being in our company DNA, the groundbreaking
achievements gleaned at the Exponential Medicine 2014 event has
spurred us to put together this report and share the learnings. We
hope you enjoy it and will be inspired to infuse the power of exponential
technology and innovative thinking into your daily lives.
Roberto Ascione President, Razorfish Healthware
A word from our President
Contributors
Kristin is a strategic and innovative thinker whose experience lies at the intersection of health
& technology. She has an insatiable curiosity for “what’s next” and a true passion for figuring
out how to apply new technologies to solve various health and marketing challenges. She’s
been helping clients do just that for 15+ years and is currently a strategic consultant advising
clients in this area.
She can be reached at [email protected].
Kristin Milburn
Brenda is the Business Navigator of Razorfish Healthware in APAC. Through her strategic
thinking and ability to understand clients’ objectives and challenges, she has been putting
together innovative solutions to help them grow their business for 7+ years now. Brenda
envisions a healthcare utopia where all patients are 100% empowered to manage their own
health care, and she is excited to be a part of that health revolution.
She can be reached at [email protected]
Brenda Cheong
Roberto is a digital entrepreneur, pioneering the development of digital technologies in
healthcare. Today Roberto is the President of Razorfish Healthware, a global organization
that includes more than 300 employees working around the world. Passionate for medicine,
computer sciences and human-technology interactions, Roberto believes that technology will
be the most impactful driver of change in the healthcare industry. He has about 20 years of
experience in health-related consulting, media and communications.
He can be reached at [email protected]
Roberto Ascione
Observations from the 2014 Exponential Medicine event
Exponential Medicine is a 4-day conference held
by Singularity University (SU). For those not familiar
with Singularity University, it was founded by Ray
Kurzweil (famed Futurist author of “The Singularity is
Near” and “How to Create a Mind” as well as Director
of Engineering at Google) and Dr. Peter Diamandis
(founder of the x-Prize and author of “Abundance:
The Future is Better Than You Think”).
SU WAS CREATED IN ORDER TO HELP EDUCATE
AND INSPIRE PEOPLE GLOBALLY ON HOW TO
LEVERAGE EXPONENTIAL TECHNOLOGIES TO
SOLVE THE WORLD’S BIGGEST CHALLENGES.
No small feat! They, along with the other SU
faculty members, set their expectations regarding
what is possible very high, and as such it is
headquartered on NASA’s research campus
in Silicon Valley. Exponential Medicine is the
conference SU puts on yearly, which focuses
OBSERVATIONSFROM THE 2014EXPONENTIALMEDICINE EVENT
on the healthcare industry, a 3 to 4 trillion dollar
industry ripe for disruption.
As evidenced by the number of digital health
start-ups and accelerators forming around the
world, along with larger established technology
companies like Apple, Google and Samsung
among others, entering into the “health space”
we can see that disruption beginning already.
There were over 450 participants in attendance,
from all corners of the globe and representing
all sectors of healthcare, scientific advancement
and technology. The attendees were united in
their passion for what’s next, a curiosity of new
Before diving in and trying to provide just a few key
highlights from a 4 day fire-hose of mind blowing
presentations given by some of the smartest
minds and innovative thinkers alive today, let us first
provide a baseline understanding of what we mean
by “exponential technologies”.
technologies and how they can leverage them to
influence and improve the ailing healthcare
system. The curated audience was among the
most hopeful for what the future brings and
excited about how they can contribute to make
in difference in a tangible and proactive way.
THOSE PRESENT, ALONG WITH THE FACULTY
AND SPEAKERS, WERE AMONG THE MOST
ENTHUSIASTIC, PASSIONATE AND CURIOUS
PROFESSIONALS EVER GATHERED AROUND
A SHARED GOAL OF IMPROVING HEALTH
WORLDWIDE.
Figure a 1. Participants of Exponential Medicine 2014 posing for a group shot in front of the Hotel Del Coronado, San Diego. (Source: Exponential Medicine site)
What is Exponential Technology?
WHAT ISE X P O N E N T I A L TECHNOLOGY?
As human beings we think in terms of what
we can relate to personally. Our expectations
being based on what we experience, it is what’s
known as our “cognitive bias”. Life used to be “local +
linear”, that is how our brains are wired.
Local in that until recently we were only influenced
by that which surrounds us geographically and linear
meaning, if I take 10 steps, I will move forward 10
steps. Technology on the other hand is accelerating
at an exponential rate, doubling at every 1.5 to
2 years. Our brains have an extremely hard time
comprehending logical change occurring.
Case in point: A study was done by venture
capitalist Vinod Khosla which analyzed a ten
year time period (2000-2010) and the predictions
made by some of the most well respected strategic
consultancies (Forrester, Gartner, McKinsey etc) to
see how quickly they believed the mobile industry
would grow year over year. They predicted on
average an approximate growth of 16% between
2002 to 2004 (when in fact it grew over 100%),
between 2004 to 2006 they collectively predicted
a 14% increase (it once again grew 100%). In 2006
analysts estimated increased sales of 12% and it
doubled again. As noted in the book ‘Exponential
Organizations: Why New Organizations Are 10
Times better, faster and cheaper than yours
(and what to do about it)’ by Salim Ismail, he notes
“Despite three previous-and notable-failures, in
2008, these very same experts forecast a measly 10
percent growth, only to see the number double yet
again - another 100% leap. It is hard to imagine how
anyone could be more wrong than to be off by 10X -
and yet these were the mobile phone experts upon
whom corporations and governments worldwide
relied for their long-term strategic planning.”
Ray Kurzweil described this rate of technological
change in his seminal book called “The Singularity
is Near” as the “Law of Accelerating Returns” (see
Figure b1) adapted from Moore’s Law.
And indeed, many of the predictions Ray Kurzweil
has made based on that exponential thinking, which
many thought him crazy to even make, have come
true.
Figure b 1. Linear versus Exponential as adapted by Moore’s Law.
Linear vs. Exponential
Exponential
Disruption
Linear
GR
OW
TH
TIME0
1
2
5
4
3
Once you comprehend the concept of exponential
thinking regarding technologies, you can explore how
it is disrupting industry after industry. A framework
called the “6 D’s of Exponential” further explains the
exponential growth processes in technology:
DIGITIZEDAnything that becomes digitized hops onto
the exponential curve (example: photographs).
DECEPTIVEA pattern of growth occurs, which at first
seems deceptive, until it becomes disruptive
(doubling every 1.5 - 2 years).
DISRUPTIVEThis is when it hits the exponential curve
and really starts to make an impact.
DEMATERIALIZEThis happens when a new technology
makes other things obsolete. Think about the
things you no longer carry around with you
that have been dematerialized: GPs devices,
boom boxes, Cd players, record stores,
calculators, cameras, video cameras, 2 way
video conferencing systems - all of these
things have essentially become obsolete
because they are now merely features on
your smart phone.
DEMONETIZEWhen things become dematerialized, they
become essentially free. (i.e. smart phones
demonetized cameras and GPS systems,
FaceTime demonetized video conferencing,
Skype demonetized long distance phone
calls, Craig’s List demonetized classified ads
and the newspapers reliant on them).
6With 3 billion new minds coming online soon, that
means a brand new generation of consumers
and inventors with access to these disruptive
technologies. Peter Diamandis believes that this
represents the greatest era of innovation ever. He
provides the following list of key take aways for
companies (especially their CEOs) to internalize.
DEMOCRATIZEOnce things become dematerialized and
demonetized, they become democratized,
which means many more people will have
access to them. For example, it is expected
that 3 billion new minds will be coming online.
Figure c 1. Here they are! A few of the Exponential Medicine MEDy Award winners this year
4 CRITICAL INSIGHTS FOR COMPANIES TO REMEMBER IN THIS ERA OF EXPONENTIALGROWTH
1
2
4
3
You must have a company culture that
embraces crowdsourcing. No matter
who you are, the smartest people work
someplace else. You must leverage the
wisdom of the crowd in order to compete in
to day’s marketplace.
Only constant is change, and that rate of
change is increasing. This reminds us of a
quote by General Eric Shinseki, “If you don’t
like change, you’re going to like irrelevance
even less.”
You either disrupt your company/products or
someone else will. Standing still = death. As
Daniel Kraft, MD puts it, “We want to become
the disrupters, not the disruptees”.
Your competition is no longer just the
multi-national corporation overseas, it is
the explosion of exponentially empowered
entrepreneurs around the world.
Key take-aways and disruption in the health space
A constant theme throughout the conference
was the importance of and rise of the patient
voice. From e-Patient Dave and his common
sense approach on the importance of the patient
perspective in healthcare, to Dr. Laura Esserman
discussing the importance of the patient voice
in clinical trials, it was noted throughout all 4
days. This focus on the customer experience is
mirroring a trend we see generally taking place
within the marketing industry overall. Long gone
are the days where you can get by selling a cool
new thing, with amazing features at a great price
point. What matters now, is “what’s in it for me
(the customer)?”, and how can we create an
ongoing relationship with the customer. And it’s
not just a new trend in marketing, it is in fact how
KEY TAKE-AWAYS AND DISRUPTION IN THE HEALTH SPACENow that we have a solid understanding of
Exponential Technology, let’s take a look at how it is
affecting the health space.
Rise of the Patient
new companies are born. Often times the most
innovative solutions are borne out of a frustration
for how things are currently done. And when it
affects your health, the very core of your being, it
can be that much more motivating.
“WHO HAS MORE AT STAKE TO ENSURE
POSITIVE RESULTS THAN THE PATIENT?”
asks Lucien Engelen. And when it comes to
getting your vital health information from your
doctors and healthcare systems, why is it so
difficult?
LUCIEN SAID, CAN YOU IMAGINE GOING
TO YOUR BANK AND ASKING FOR YOUR
FINANCIAL INFORMATION, AND HAVING THEM
SAY, “NO, NO, DON’T WORRY, TRUST US, WE’LL
TAKE CARE OF THAT INFO FOR YOU. WE’RE THE
ONLY ONES THAT CAN HAVE ACCESS TO THAT
INFORMATION.” IT WOULD NEVER FLY! WHY DO
WE ALLOW OURSELVES TO BE BULLIED BY THE
HEALTHCARE SYSTEM WHEN ASKING ABOUT
OUR OWN HEALTH INFORMATION?
This is beginning to change.
Lucien Engelen is from the Radboud Reshape
& Innovation Center at the Radboud University
Medical Center (RUNMC) in the Netherlands.
As far as the success of new ventures in the
health space, he put it bluntly saying “ If you
are starting anything new in the health space,
whether that be a start-up or a new project within
an existing company, and aren’t starting from the
perspective of the patient, you will fail. Patients are
the only constant.”Because of new technologies, patients have
much more control over their own health. They
are no longer beholden to their physicians for
health information. Now they can research
information online, tap into the knowledge of
other sufferers, learn first hand what works and
doesn’t work for others, rank doctors on their
bed side manner, and in some cases even
diagnose illnesses before their doctors do via
the wisdom of the crowd on social media.
Technology is indeed democratizing and is one
of the key drivers behind the “consumerization”
of healthcare. But as Dr. Jordan Schlain from
HealthLoop said, and we paraphrase here, “Why
do we call it the “consumerization of healthcare”?
No one wants to “consume” healthcare. We are
participants, not “consumers” of healthcare, an
interesting perspective to think about.
Nowhere was the patient perspective more
poignant than when Nigel Ackland took the
stage with this bionic arm, called the Bebionic
hand.
PEOPLE USED TO LOOK AT HIM WITH PITY
OR SCORN AFTER HE LOST HIS ARM, NOW
THEY ARE FASCINATED, STOPPING HIM ON
THE STREET AND WANT TO SHAKE HIS NEW
“BIONIC” HAND. AS HE SAYS, “NO ONE EVER
ASKED TO SHAKE MY HOOK.”
The technological advances in prosthetics
are starting to have an amazing impact on
amputees world wide.
Figure d 1. Nigel Ackland fascinating the crowd with his “bionic” arm. (Source: Exponential Medicine site)
3D printing is also showing great promise,
particularly for kids, who grow fast. Nigel
advocates for the millions of other amputees
around the world that don’t have access to ANY
sort of prosthetics, and makes sure people
understand how it feels from an amputee’s
perspective to help impart compassion and
understanding and hopefully also to incite even
more innovation and access to a much needed
area of healthcare.
Getting back to Dr. Laura Esserman’s work in
clinical studies for breast cancer, she discussed
how patients are almost an afterthought, the
Figure d 2. Daniel Kraft, MD recent tweet of The New Yorker article on how 3D printing is revolutionizing medicine. (Source: Twitter - Daniel Kraft, MD)
last thing in a long checklist of things to do in
order to establish a clinical trial. Last step, find
clinical trial participants. Why don’t we start
with the patient in mind first, specifically with
their patient journey, and then link it back to
clinical care? A recent article in the Wall Street
Journal entitled “Design Power: Patients Play
Researchers in Drug Trials” outlines some of
the progress in this area, where scientists are
inviting patients in to help them design the trials
from a patient perspective rather than just from
a medical or scientific perspective. It’s hard to
believe it’s never really been designed that way
in the past. But as we see, innovation comes
from the courage of seeing and doing things
differently than they’ve always been done.
Involving patients directly and early in clinical
trial design is positive step in the right
direction.
In addition, ePatient Dave informed us of exciting
progress being made at the prestigious British
Medical Journal, announced this past June
2014. As longstanding advocates for the peer
review process, they now include patients
among those reviewing articles for publication.
And when anyone submits an article for
publication, the editors will ask what the patient
involvement was in their study as well as ask
that they document their patients’ participation
in defining the research question and outcome
measures, the design and implementation of the
study, and the dissemination of its results. They
do not intend this to be a box ticking exercise,
but rather to encourage and properly report on
collaborative research between patients and
investigators. Another step in the right direction to
giving patients a stronger voice.
And finally, in this era of “big data” and patient
centricity, Daniel Kraft, MD posited, “How can
we become not just organ donors, but data
donors too, in order to further health care for
the better of humanity?”It’s an interesting suggestion given the rise of “big
data” coming from devices, sensors, EHRs and
the like. If we’re willing to donate organs, surely
we’d also be willing to donate our data for the
better good of humanity, no? We can imagine
that perhaps one day our driver’s license will not
only have a check box to share our organs when
we are gone, but also to share our medical data.
Something worth thinking about.
Figure d 3. Kristin’s official Singularity shot!
A Game Changer - Tech Meets NeuroscienceOne of the most fascinating sessions was about
the exponential advances occurring at the
intersection of neuroscience and gaming. the
speaker, Dr. Adam Gazzaley, is the founding
director of the Neuroscience Imaging Center at
the UC San Francisco, an Associate Professor
in Neurology, Physiology and Psychiatry, and
Principal Investigator of a cognitive neuroscience
laboratory. A major accomplishment of his
research has been to expand our understanding
of the aging brain that leads to cognitive decline.
His most recent studies explore how we may
enhance our cognitive abilities via engagement
with custom designed video games, neuro-
feedback and TES. His work was recently
profiled in the New York Times in an article titled
“Can Video Games Fend Off Mental Decline?”.
As the article notes, there has been a lot of
skepticism in the area of gaming to improve
cognition and mental health, and not much
science to back up claims made by some.
However, the work Adam Gazzaley has been
doing in his lab in San Francisco has even the
biggest naysayers paying attention.
In “Project: Evo”, Dr. Gazzaley and his team
devised a game that taxes several different
cognitive abilities at once. It is believed that
by using multiple aspects of mental abilities
simultaneously, it may help those over aged
60 fend off the cognitive decline that comes
with aging. And his research has shown that it
does in fact help older brains perform like those
decades younger. Project: Evo has now moved
out of the lab and is part of company called Akili
Labs which is looking to get FDA approval. As
the article states, “ If it gets that government
stamp, it might become a sort of cognitive
Lipitor or Viagra, a game that your doctor
can prescribe for your aging mind.”
Akili is also partnering with Pfizer to leverage
gaming technology in order to test whether
the use of the game can detect a difference
between the healthy group of users and those
that have amyloid in their brains, as seen in
imaging scans—meaning they are at high risk
for Alzheimer’s. They are testing whether the
technology can be used as biomarkers to
detect early signs of Alzheimer’s. Other studies
leveraging the Project: Evo platform include Shire
to test for impact with pediatric ADHD and the
National Institutes of Health which launched a
study leveraging Project: Evo for a depression
intervention study.
Dr. Gazzaley has opened a new lab called the
Neuroscape Lab, the goal of which is to bridge
the gap between technology and neuroscience
and to test as many different data as possible.
They are testing all sorts of games leveraging
sensors, mobile, virtual reality and motion
capture.
The new Body Brain trainer is testing whether
physical activity during cognitive games can help
further increase cognition. By leveraging imaging
technology and virtual reality tools like the Oculus
Rift, researchers hope to be able to potentially
help patients with brain injuries.
Although the projects mentioned above focused
mainly on the effect of brain/mental health, other
speakers, such as Christian Assad believe
that gamification is a missing link in healthcare
overall. We agree that leveraging gaming and
gamification principles can help impact positive
behavior change and is an area that has yet to
be fully exploited by healthcare marketers and an
area that shows great promise for the future.
Figure d 4. Project Evo by Akili Interactive Labs aiming to detect early signs of Alzheimer’s through gaming technology. (Source: Akili site)
Artificial Intelligence (AI) is Closer To Reality Than You Think
AS PETER DIAMANDIS STATED, OUR BRAINS
HAVEN’T HAD A SOFTWARE UPGRADE IN 50
THOUSAND YEARS.
When artificial intelligence is discussed in these
circles, it is with great enthusiasm. As Neil
Jacobstein said in his talk, artificial intelligence
(AI) doesn’t just mean “better, faster, cheaper”
it does things that were never before possible
(given the aforementioned lack of a software
update to our brains in the last 50k years!), it
can augment our intelligence beyond that
which the brain is capable of doing. Jacobstein
knows a thing or two about AI as the former
CEO of Teknowledge Corporation - a pioneering
AI company, an AI consultant to DARPA,
NASA, NIH, Boeing, US Army and Air Force
(among others) and the co-chair of the Artificial
Intelligence and Robotics track at Singularity
University.
AI IS NOT JUST A TECHNOLOGICAL LEVER
OF SORTS, IT IS A FULCRUM WHICH CAN
LEVERAGE OTHER TECHNOLOGIES, LIKE
ROBOTICS. AND AS SUCH A FULCRUM, AI
HAS THE PROMISE TO BE ONE OF THE MOST
DISRUPTIVE EXPONENTIAL TECHNOLOGIES OF
THE DECADE.
Many speakers commented on how AI could
potentially replace most of the mundane tasks
conducted by the primary care physician of
today. As Daniel Kraft, MD puts it, AI in health
is more like IA - Intelligence Augmentation -
augmenting your knowledge to make better
health decisions, providing that software
upgrade to our brains as needed. IBM Watson
technology is being leveraged by Sloan
Kettering to help augment the knowledge of
oncologists. Watson doesn’t replace the final
treatment decision of the oncologists of course,
but it does what no one oncologist could
possibly do individually and that is scour all
clinical studies, treatment protocols and EHRs
for all Sloan Kettering patients treated at the
hospital for the last 30 years and offer up a few
potential treatment paths.
And not only can it provide potential courses of
treatment, it provides the rationale and support
for each of the options recommended. Part of
the allure of AI is that computers aren’t biased
and they don’t make assumptions.
When you combine the power of deep machine
learning with the wisdom of the crowd you can
do things like Merck did in their Molecular Activity
Challenge. They challenged teams via the
Kaggle platform to develop a statistical technique
or algorithm that can predict the likelihood of a
discovered molecule will act on target and the
likelihood of acting “off target” (meaning potential
for side effects.)
Figure d 5. Retweet of article in Wired UK on how IBM’s Watson is better at diagnosing cancer than human doc-tors. (Source: Twitter - Alan Thomas)
Watson is currently only free-text based, but
companies are already thinking about the power
of applying deep machine learning with image
recognition. Baidu, the “Google” of China,
has already incorporated this technology into
its search engine, where you can upload one
picture and it will provide others similar to it.
One can imagine the power machine learning
with image recognition could have in healthcare
by identifying pictures of organs or tumors etc
to help with diagnoses. A new company called
Enlitic launched just a few months ago, led by
famed data scientist (and former President and
Chief Scientist at Kaggle) Jeremy Howard is
actively seeking medical partners to leverage
its technology platform. They believe that
healthcare and medical diagnostics is, by its
nature, a data problem. Sifting through lab tests,
images and patient charts etc and leveraging
deep machine learning, can provide insights and
subtle patterns that man was never able to see
before.
Several companies have cropped up in the AI
space in the past few years and it is an area that
is receiving lots of investment capital (another
sign of the promise expected).
One company mentioned is Viv Labs, which
was started by several engineers from the
original team that created the technology that
became SIRI when it was eventually bought
by Apple. Viv Labs is looking to take the
concept of “virtual assistant” to the next level.
One example shared was to imagine saying,
“Viv, I’m drunk.” Your virtual assistant would
automatically know your location, order you up
your favorite car service and get you home.
Another company called Numenta can analyze
large data sets and detect when there are
anomalies or rogue behaviors detected. Iodine,
a promising new start-up, applies a data driven
approach to medicine that is consumer facing,
asking over a hundred thousand patients
about their experiences with a drug. Therefore
providing real world experience versus what
is only shown in the clinical studies. Deep
machine learning and AI will surely be well
entrenched within the healthcare communities,
and we expect to see many more companies
being born out of this technology in the next
few years to come.
(similar to the Google-X model).
Daniel Kraft, MD asked, “How long before we
have a modern day “pharmaceutical” company
that doesn’t actually sell any medicine, only
digi-ceuticals?” We think it is bound to happen,
and will likely happen sooner than we think.
And given the success of digital therapeutic
companies like Omada, as was heard in a
previous talk by its founder and CEO Sean
Duffy, that reality is in fact here and now. Taking
what works one on one, and scaling that to
many, leveraging technology is what will help
begin to reshape the industry. It will only be a
matter of time before those life-saving platforms
start to displace the traditional pharma space.
Dr. Jeremy Levin, the former CEO of Teva
Pharmaceuticals was one of the favorite keynote
speakers. At the beginning of his talk, he asked
the audience of 450+ attendees how many
were representing pharmaceutical companies.
About 10% of the audience raised their hands.
Therein lies one of the problems, he said, “Why
isn’t pharma here?” Clearly the pharmaceutical
industry will be one of the monoliths of the
coming disruption in healthcare, surely they
should be aware of what’s happening at an
exponential rate. Dr. Levin acknowledged that
pharmaceutical companies aren’t structured
to be as nimble and adaptive as today’s start-
ups and nor could they change overnight. As
Salim Ismail put it, “If you try to innovate in large
organizations, the company’s immune system
will come and attack”. Both he and Dr. Levin
suggested that rather than try to restructure the
entire organization, that pharma should look
to create divisions outside of the day-to-day
business, keeping a pulse on what’s happening
in the start-up space and innovating around
exponential technologies three to five years out
Figure d 6. Kristin’s tweet during Dr Levin’s speech.
Figure d 7. Reflections on the beach: In the early morning of the very last day of the 4-day conference.
Where is Pharma?
Figure d 7. Reflections on the beach: In the early morning of the very last day of the 4-day conference.
A couple of quotes were shared regarding the
performance of Fortune 500 companies (of
which, many are pharmaceutical companies).
“In 10 years, it’s predicted that 40% of the
Fortune 500 companies will no longer exist.”
(Olin School of Business). Put another way
by Richard Foster from Yale University, “The
average lifespan of a company listed in the
S&P 500 has decreased from 67 years in the
1920’s to 15 years today.” As Peter Diamandis
described “The New Kodak Moment”
is that time when a linear thinking
company gets displaced by an exponential
technology. (Referring to Kodak’s demise
in the same year that Instagram, only 18
months old, was bought by Facebook for
billions).
This is a warning to the pharmaceutical
companies not to be too complacent and linear
in its thinking. Pharma can’t continue doing
business how it’s always been done and feel
somehow protected by the regulations driving
the industry and assume they will continue to
grow and prosper.
on where we live. Geo-medicine has yet to
really make its mark, yet when we consider your
zip code is an even more powerful determinant
of your future health than your DNA code, it’s
hard to understand why it’s not part of the
overall health picture for most patients. We
believe that will change as physicians and
patients become more educated around geo-
medicine and have simple tools to use in order
to personalize what it means to them.
As we’ve already summarized above, patients
will be more of a central figure, the CEO of their
health team, it will be more of a collaboration,
more participatory. We already are and will
continue to leverage the crowd, when learning
about ailments and how to cope with them,
what worked for others? This is similar to how
Dr. Alan Greene is the Chief Medical Officer
of Scanadu and the founding President of the
Society for Participatory Medicine, an author of
numerous books and articles among many
other prestigious appointments. Dr. Greene
used an interesting analogy to describe how
the modern day health practice will change and
that was to look to maps. If you think about it,
at its core, health is a navigation issue. How will
I navigate through the healthcare system, what
tools will I need, what will it take to get to where I
need to go?
He believes that the office visit will no longer be
at the center of a practice, connections made
outside the office will be much deeper and
more continuous than it is now. Health will be
contextual, in the same way that Google maps
can now show restaurants and which of them
has availability as you near your destination, we
need to make primary care contextual, leverage
technology to contextualize our health info. We
need to make it comprehensive, our health map
should include environmental exposures based
What will the future of health look like?
Waze redefined maps leveraging the wisdom of
the crowd to make greater meaning from maps.
Finally, there is a belief among some that we
are at the end of the era of a physician being
the one diagnosing your illness. If we play the
map analogy all the way out, we can envision
a Clinical GPS, a health guiding system for
doctors and patients, like an On-star for the
body as Daniel Kraft, MD puts it, leveraging
various sensors throughout our body to provide
warning signs and indicators when we need to
take care of some aspect of our body (as we do
with our car). Imagine if we get into big trouble
or one of our major warning signs start flashing
based on an internal bio-marker it can connect
us automatically with someone on our care team
via telemedicine.
THERE IS NO DOUBT THAT TECHNOLOGY WILL
PLAY A BIG ROLE IN THE DISINTERMEDIATION
OF THE DOCTOR - PATIENT RELATIONSHIP,
THAT SHIFT IS ALREADY UNDERWAY. WE
BELIEVE THAT TECHNOLOGY WILL ALLOW
SOME OF THE MORE MUNDANE TASKS
CURRENTLY DONE BY PRIMARY CARE
DOCTORS TO SHIFT TO NURSES AND OTHER
HEALTHCARE PROVIDERS WHO WILL BE
SUPPORTED BY VARIOUS TECHNOLOGIES TO
HELP IN DIAGNOSIS.
Physicians disagree over how much control will
be given over to AI systems, as some believe
that only a physician can take in the nuances
present in the moment, that machines may be
unable to detect.
MORE CLEARLY THE CONNECTIONS BETWEEN
DECISIONS THEY MAKE AND THE IMPACT ON
THEIR BODY MORE ACUTELY BY TRACKING
VARIOUS BIO-MARKERS. ONE OF THE MAIN
GOALS IN MEDICINE OF THE FUTURE WILL BE
TO DETECT CANCER AND OTHER DISEASES
BEFORE IT MANIFESTS ITSELF, BY FINDING
SUCH BIOMARKERS AND INTERVENING
EARLIER AND EARLIER.
Similar to how Tesla motors can push out
enhancements and upgrades to its software to
all cars as their engineers learn more and tweak
the cars for greatest performance, so too will be
the systems we have navigating our bodies.
Because of the flood of information and data
available on the modern day patient, given
the rise in sensors, EMRs etc, physicians of
the future will need to become data scientists
as well as medical doctors. Making decisions
based not only on what they physically see in
the patient but also via the data presented.
Another example that was shared on the power
of data analytics was a cluster analysis done
on women where the data showed that it could
identify with a great deal of accuracy if a woman
was a victim of domestic abuse – far earlier than
a physician would typically make that diagnosis.
Pilot Captain Sully, who successfully landed his
plane in the Hudson River saving all those on
board, would have died along with the entire
crew and passengers had he followed the
instructions coming from the on-board system
rather than following his own instincts from years
of travel and training. So, the truth likely lies
somewhere in the middle.
NO ONE BELIEVES THAT THE PRIMARY
DOCTOR WILL BE COMPLETELY REPLACED BY
MACHINES. HOWEVER, DOCTORS, WHILE THEY
MAY SHED SOME OF THEIR OLDER TASKS, WILL
NEED TO TAKE ON NEW LEARNINGS AS THEY
ADAPT THEIR PRACTICES. DOCTORS WILL
NEED TO BECOME DATA SCIENTISTS, ABLE
TO READ AND DECIPHER NEW METRICS THAT
WEREN’T TAUGHT TO THEM IN MED SCHOOL,
BECAUSE THEY DIDN’T EXIST.
As mentioned earlier, doctors will be prescribing
digi-ceuticals, digital health tools and platforms
to help their patients monitor their progress and
encourage behavior and life style changes so
critical to managing one’s health.
WITH DASHBOARDS HELPING MAKE SENSE OF
THE DATA COLLECTED, PATIENTS WILL SEE
Medical Scientist at IBM) suggested, physicians
will be given greater clinical decision support and
analytics.
This will allow for more personalized care, and
less waste; help in prevention - the fundamental
goal allow physicians to become better at
prediction of future issues by identifying complex
patterns in data that humans could never see.
Dr. Kohn says that doctors suffer from a “failure
The study did so by leveraging various data from
different sources to “map” what that patient’s
trajectory looked like, in this case, potentially
intervening earlier to get them help and/or
provide a referral to the right organization or
social worker before the violence became fatal.
To summarize, as Doctor Marty Kohn (Chief
Medical Officer at Sentrian and former Chief
of metacognition”, not recognizing their own
limitations. Leveraging the greater empowerment
of the patient in their own healthcare, we
believe technology will support both patients
and physicians in a way that will help overcome
those liabilities. In the end technology will
become a greater enabler, augmenting our
decision making via analysis, and when you roll
outcomes into the mix, you will have a useful
learning system that gets smarter as time goes
on, which is at the core of machine learning and
cognitive computing.
IN THE FUTURE WE ENVISION A “MEDICAL
INTELLIGENCE ORCHESTRA”, WITH THE
COLLECTIVE WISDOM OF ALL DOCTORS
(RATHER THAN BEING LOCKED UP IN
INDIVIDUAL BRAINS) AND OTHER HEALTH CARE
PROVIDERS SHARED, WORKING IN UNISON TO
PROVIDE THE BEST POSSIBLE CARE TO EACH
PATIENT.
Collected wisdom in a medical intelligence
cloud is not far from becoming a reality and
something many are striving towards developing
today.
Start-ups Proliferate: An explosion in the health space
One of the most inspiring speakers during the
entire event was Vinod Khosla (at least for those
of us inspired by entrepreneurs and the start-up
scene). Vinod was the founder of Sun Microsys-
tems and now runs Khosla Ventures where
he provides strategic guidance and capital to
budding entrepreneurs in the technology space
and lately investing heavily into health technolo-
gy start-ups. Vinod has a passion for health and
for breaking out of the mold of doing things the
way they’ve always been done. He believes that
many of the markers we track, like blood pres-
sure, are artifacts of the past and not the best
we can do today. One start-up he is investing
in is tracking over 400 different vital signs via
sensors, biomarkers etc.
Since medical errors currently account for more
deaths each year than those that die of breast
cancer, leveraging technology to help stave
off medical errors would have great immediate
impact. He believes strongly that big companies
don’t innovate, because risk taking is the key to
innovation and big companies avoid risk.
Figure d 8. The inspiring Vinod Khosla speaking at Exponential Medicine 2014.
and insurance (7), workflows (8), genomics
(9), and clinical research (10) round out the
top 10 investment areas. As far as the regional
areas with the most investment, the San
Francisco Bay area tops the list, followed by
New York (2), Los Angeles (3), Washington
DC (4), Boston (5), San Diego (6), Dallas and
Fort Worth (7), Chicago (8), Minneapolis (9)
and Seattle (10). The top 5 VC firms investing
in health technology firms are Qualcomm
Ventures, Khosla Ventures, the Founders’ Fund,
Sequoia Capital, True Ventures and Venrock.
Notable consumer companies that have bought
companies focused on health in 2014 include
Google, Facebook, Intel, Weightwatchers,
United Healthcare and GE.
He believes that change almost never hap-
pens within existing organizations, and if it does
happen, it happens at the fringes. For start-ups,
he believes a 90% chance of failure is ok,
if you have a 10% chance of changing the
world.
As Steven Krein (co-founder and CEO of Start-
up Health) described, there is currently an
explosion of capital investment in healthcare
technology start-ups. As the founder of Box,
Aaron Levie said recently when asked why he
was getting into the health space, he stated
that he looked for an industry that had the
greatest delta between what existed now and
what could be in the future, and he’s not alone
in choosing the healthcare space to innovate
around next. Investment is pouring in - as of
end of Q4 2014, over $6.5 billion has been
invested. The number of deals is trending
lower, but the amount of money VCs are putting
behind ideas they believe in is growing showing
a maturation in the market. As far as what they
are investing in, big data and analytics tops
the list (1), followed by population health (2),
companies aiming to help navigate the health
system (3), diagnostics (4), consumer health
(5), practice management solutions (6), payors
We’ve heard many people use
“Uber” as a descriptor for the kind
of company they want to become;
i.e. the “uber” of retail or the “uber”
of healthcare. What’s important to
remember about the Uber story is
that they didn’t invent mobile phones,
they didn’t invent maps, they didn’t
invent GPS technology and geo-lo-
cation and they certainly didn’t invent
the taxi or limousine systems.
But what they did do was a great
mash-up of all of those things to
create a unique offering which was
truly disruptive and consumer orient-
ed. So, to us, if you say you want to
be the “uber” of healthcare, it implies
a mash-up of multiple existing tech-
nologies, like some of those listed
above, combined with a patient
centered focus to create a unique
offering that is truly disruptive. And
we believe the best is yet to come,
as far as what will have a demonstra-
ble impact on consumers health for
the better.
Innovative Rescue
Innovation is often born out of necessity, particularly in
healthcare. Laurence Aniouz (former Chief Innovation Officer of
Teva Pharmaceuticals and current CEO of a new start-up called
Health:Augmented) is on the board of one such organization
called Hatzalah (which means ‘rescue’ in Hebrew). Hatzalah
is a rescue and emergency care non-profit organization born
in Israel. In emergency care, minutes can literally mean the
difference between life and death. Getting an ambulance out
to the scene of a medical emergency can often take longer
than desired. In fact, in most cities around the world, it takes
an average of 20-40 minutes due to issues related to traffic
congestion, parking etc. With approximately 248 thousand
calls coming in for help, and 45 thousand of them life-or-death
situations (including strokes and heart attacks), Hatzalah knew
they needed to figure out a way to shave off those life-saving
minutes, in order to get to these patients as quick as possible.
To do so, they designed specially outfitted motorcycles with
all the essential life-saving equipment necessary for first
responders, leveraging geo-location services and a large
volunteer force (approximately 2500) of emergency medical
care responders, to get help to those in need of critical care as
soon as possible. Their program has proven to be successful,
as first responders now arrive in less than 90 seconds in all
cities and within 3 minutes in the rest of the country.
Figure d 9. On stage: Laurence Aniouz sharing the Hatzalah story with the audience.
program. They aren’t stopping there, as they are
continuously looking to innovate and integrate other
new technologies as soon as they become available
and upgrade their systems every few months.
Don’t be surprised if you start to see these life-saving
motorcycles in a city near you soon!
They provide the initial critical life saving procedures
whilst waiting for the ambulance to get to a scene
and take that patient to the hospital for further care.
It is estimated that each new motorcycle they add to
their fleet, saves approximately 80 lives! They have
already been in discussions with other major cities
around the world to roll out the program and recently
completed filming a documentary on their innovative
at extreme risk. For one thing, they are typically
older systems that don’t have the latest security
measures in place. In addition, the motivation to
break into those systems are high, because the
pay out is high. The fact is your medical records
are worth more to hackers than your credit card.
Take for example the statistic that Marc shared.
THE AVERAGE IDENTITY THEFT IS WORTH
ABOUT $2K BUT THE AVERAGE MEDICAL
IDENTIFY THEFT YIELDS $20K.
And it is a constant job to maintain the security
of your systems, because as smart as you
believe your coders might be, there are other
coders right now trying to figure out how to
outsmart you. We’ve seen massive security
breaches in the news lately such as the
Community Health System hospital network,
which was hacked recently, and 4.5 million
patient records were exposed. The recent Sony
data breach witnessed not only personal emails
and employee salaries published across the
web – but sensitive health information on dozens
of Sony employees, their children and spouses
as well. According to cybersecurity experts in a
Reuters report, this hack could cost Sony more
than $100 million USD and counting.
Crime Pays… And Now it Pays Exponentially
After 3 days of exponential thinking and a view
into the bright horizons that lie ahead in this era
of new technologies, Marc Goodman (Founder,
Future Crimes Institute and Chair for Policy, Law
& Ethics at Singularity University) brought things
back down to reality when explaining how crime
is also growing exponentially.
CRIME USED TO BE A ONE ON ONE AFFAIR, NOW
ONE PERSON CAN NOW REAP EXPONENTIAL
REWARDS BY HACKING ENTERPRISE WIDE
SYSTEMS AND THEY CAN DO IT FROM
ANYWHERE AROUND THE WORLD.
Given the weightiness of the topic, it was
delivered in a surprisingly humorous way,
without belittling the seriousness of the topic
or minimizing the warning to all of us about the
potential threats to each of us personally as well
as within our organizations.
The healthcare industry and the old mainframe
systems that underlie many of those systems are
used to airlift cell phones and drugs over barbed
wire fences and straight into prisons, they’ve
been used to surveil competitive drug rings and
case joints before potential break-ins and are
expected to be used in many other clever ways
in the future.
Marc is anticipating something next called “bio-
crime”. Your credit card is always changeable,
same with a social security number, but you
can’t change your DNA, therefore it’s at risk
of being stolen. He offered practical advice to
protect yourself such as encrypting your data,
using different passwords across logins and
using VPNs when possible. He has a new
book coming out soon which will provide more
detailed information about what’s at risk and
how we can protect ourselves called “Future
Crimes”, which we look forward to reading.
The same way physicians will need to become
data scientists in the future, what about forensic
pathologists conducting autopsies? What
information might be contained in the medical
device that was imbedded within them? Who
will be responsible for analyzing those devices
as part of an investigation? What about when
the “Internet of You” becomes mainstream,
who will analyze all of those sensors and data
collected to determine clues related to the
cause of death?
And while it may have been exciting to learn
about the positive impact drones are having
in the emergency response area delivering
AEDs in life threatening situations or vaccines
to otherwise unreachable places, rest assured
the criminals are also now leveraging drones
on the dark side of crime. Drones have been
Figure d 10. Kudos to the Singularity University for an inspiring, motivating and intellectually stimulating Exponential Medicine 2014.
Now What? Be the disrupters, not the disruptees!
1
2
5
4
3
6
7
8
GOOGLE’S 8 INNOVATION PRINCIPLES
FOCUS ON THE USER
OPEN WILL WIN
IDEAS COME FROM EVERYWHERE
THINK BIG, START SMALL
NEVER FAIL TO FAIL
LAUNCH EARLY AND ITERATE
BE A PLATFORM, FLOAT ALL BOATS
MAKE IT MATTER
While it’s one thing to take in all of the
amazing technological and scientific
achievements being made over a 4-day
conference, it’s quite another to go back to
your day job and try to apply this thinking.
Peter Diamandis shared in his presentation
Google’s 8 Innovation Principles. We share
them here again, as a nice summary and
a practical framework for everyone to take
back to your organizations and infuse the
power of exponential technologies and
innovative thinking.
NOW WHAT? BE THE DISRUPTERS, NOT THE DISRUPTEES!
Figure e 2. Some Exponential Medicine participants taking part in
a morning meditation on the beach.
TIP: One thing we try to coach our clients on when allocating their budgets is the 70/20/10 rule.
That is, to spend 70 percent on the tried and true tactics, 20 percent on things they’ve never
done before but we have, and 10 percent on things neither of us have ever done and can pilot
together. Those percentages can fluctuate depending on the brand and market dynamics, but
the philosophy remains the same, always set aside at least a portion of your budget to do things
you’ve never done before. It’s the only way to stay ahead of the curve and the only way to
operate in this day and age of exponential technologies.
A recent article in the December 2014 issue of the Harvard Business Review, entitled “Build An
Innovation Engine in 90 Days” provided a nice blueprint for large companies to follow on their
quest to infuse innovative thinking throughout their organization. They borrow a term from the
start-up world called “minimum viable product” or “MVP”, getting a stripped down prototype of
your product ready as soon as possible. Their term is based on setting up a “minimum viable
innovation system” or “MVIS” which outlines the essential building blocks for organizations to
develop a strategically focused innovation system in-house as quickly as possible.
Get Some Head Space!
Given our hectic lives, and the speed at which technology is advancing and changing our lives, perhaps there is never a time better than now, to take some time out for “headspace” and just breathe. Scientific evidence shows that regular meditation can be an effective treatment for stress, worry, lack of focus, relationship problems, addictions and more. It leads to peace of mind and wellbeing, greater focus and creativity and better relationships.
Kristin is currently on day 28 of the 30-day Headspace challenge and trying to enlist Roberto to its virtues.
Check out the headspace meditation app.
communications, leveraging a unique mix of insight, technology, creativity
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