What Silicon Valley Doesn’t Understand About Medicine
Posted on June 22nd, 2011
Wheres Silicon Valley when we need it? The inexorable rise of healthcare costs has created not only a crisis waiting to happen, but also an urgent need for innovation–exactly the sort of thing for which Silicon Valley is justly famous. So where is it?
While entrepreneurs in the Valley and elsewhere have achieved remarkable success (at least historically) developing new drugs and devices, more fundamental innovation in healthcare delivery–particularly the sort designed to take costs out of the system–has proved far more elusive.
Its not for lack of trying. Almost every legendary Silicon Valley entrepreneur (see here; also here) has recognized the opportunity: our healthcare system is legendary for its inefficiencies, complexity, and opacity–all areas that seem utterly amenable to a technology-driven solution. Yet, to date, the results have been middling at best. Why hasnt there been a Google or a Facebook in the healthcare space?
One reason may be that existing stakeholders are more entrenched than generally appreciated; we may also be more reluctant to tinker with our health than we are to try out the latest app. Its also likely that at least until recently, entrepreneurs were more incentivized to create expensive solutions than to engineer cost-effective ones (as this McKinsey report suggests).
Yet Id argue that the most significant disconnect Ive found here in Silicon Valley is a failure to understand the nature of the problem to be solved. Most engineers and computers scientists with whom Ive spoken conceptualize medicine as primarily a rational, evidence-based, problem-solving enterprise focused on well-defined conditions, rather than a discipline that in my experience owes more to scientism than science, is far more ambiguous than most engineers tend to recognize, and is founded on relationships, connectedness, trusted advice, reassurance, and frequently the off-loading of significant responsibilities from patient to doctor. Perhaps the physicians greatest responsibility is helping to compassionately mediate the patients experience of illness.
Simply put, medicine is so much more than simply a diagnosis and treatment (although regrettably in todays world of rapid-fire outpatient medicine, it occasionally seems to be reduced to this cartoon), and patients — especially those with chronic illnesses–value more than just the rigid outcome measures traditional metrics tend to capture. A novel technology platform that overlooks the integrated needs of patients or underestimates or fails to account for the complexity and messiness of illness as it actually occurs and is experienced by patients (and those closest to them) will inevitably fall short.
Former Google CEO Eric Schmidt represents the pervasive Silicon Valley perspective in this dialog with surgeon and author Atul Gawande. Stanford Medical School professor (and author) Abraham Verghese presents a contrasting perspective in this recent NYT Op-Ed.
This disconnect between the reality of medicine and its Silicon Valley conceptualization is especially important because technological innovation–the sort of ideas the valley was founded upon–is urgently needed in medicine, and offers the potential to radically disrupt the way we think about health and disease, and can make it easier for us to stay healthy and understand what may be ailing us when were sick. Theres also an urgent need for improved communication between providers so that successful approaches can be shared, and less effective approaches identified and called-out (highlighted in this BCG white paper). Theres also a growing need to adopt what might be called a network or systems view of medicine, and develop ways of integrating complex data over multiple domains to uncover new patterns and suggest new approaches to diagnosis or treatment.
An especially useful starting point for an aspiring healthcare company would be to think about ways to deliver a “positive good.” Most contemporary medicine is generally regarded, economically, as a negative good–something we use or engage in because we have to, not because we especially want to. While this creates a ready market, its also results in a tense and uncomfortable relationship between the “producers” of healthcare–who have often invested a significant amount of resources with the intention of making a profit–and consumers, who have little choice but to pay (or co-pay) for expensive care, and consequently tend to resent it.
Back when I was in the clinic, I remember feeling confused by patients who would complain about the cost of care while seeming to have few qualms about the going on pricey vacations or buying expensive gadgets. On reflection, however, I think the key difference is that patients at least felt they had a choice about buying a gadget, and liked selecting something they thought they might enjoy. The opportunity here for technologies companies is to develop an attractive and engaging platform that will warmly incentivize positive behaviors, and help patients nudge themselves in healthier directions. The business case hinges upon its voluntary adoption, rather than obligatory usage.
Consequently, Id argue theres a significant opportunity for a platform focused relentlessly (think Jeff Bezos) on the patient, providing patients with significant value and benefits from engagement that are both immediate and accretive. Jamie Heywoods PatientsLikeMe has achieved much deserved recognition for the ALS patient community it has developed, and may be one model to consider; the question at this point is whether theres its possible to achieve this level of community benefit and participation for less devastating diseases, especially considering that most patients want to live life, not spend their days fixated on their particular medical condition.
It will also be important to ensure that even as we recognize–and seek to capture, leverage, and ultimately monetize — the value associated with the collection of an ever-increasing amount of data, we also recognize that most people dont want to be perpetually monitored (at least not intrusively). While theres a much-discussed movement called quantified self, focused on capturing and sharing vast quantities of physiological data using sensors and other devices, this sort of excessive monitoring is almost certainly not something most of us want. One challenge will be figuring out how to capture useful physiological information in a way that offers benefit while also remaining unobtrusive and respecting privacy concerns.
Steve Jobs famously recruited Pepsis John Sculley by asking him, “Do you want sell sugar water for the rest of your life or come with me and change the world?” Perhaps its time for the next generation of technology entrepreneurs to revisit this challenge, and discover that there are some things in the world even more rewarding than the latest iPad–though I suspect my two year old daughter would emphatically disagree.
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Tags: Silicon Valley, Valley
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