A theme has been, how do we think differently
about health, medicine, and technology and
the convergence?
How might we reimagine the near future and
the distant future of healthcare?
Daniel Kraft is a physician and an inventor
who wants to transform healthcare.
Well, the term "exponential" is usually referred
to think about the pace of change.
Most of us know linear thinking: one, two,
three, four five.
Exponential thinking is when you double every
step: 2, 4, 8, 16, 32, 64, et cetera.
By 15 steps, you're about 32,000 but, by your
30th exponential step, you're at a billion.
That would be, if you were taking a step,
by a meter, that's 26 times around the planet.
That's usually something hard for our brains
to kind of grok how quickly technologies can
accelerate.
The one most folks are familiar with is Moore's
law, which is why our supercomputers in our
pocket are pretty incredible in terms of what
they're able to do.
They're better than a Cray supercomputer by
many orders of magnitude.
This is my antique iPhone 2 from 11 years
ago when, 11 years ago, it seemed amazing
and now it still works.
It feels slow and clunky and a low-resolution
camera.
In 10 years, my iPhone 11 will feel slow and
clunky or be embedded in my Apple AR glasses.
Part of the theme of exponential medicine,
in general, is not about any one technology
accelerating from not just digital and Moore's
law and computation, but what's happening
in synthetic biology and low-cost genomics
to big data, AI, nanotech, and virtual reality.
Some of them are just moving quickly.
Some of them are moving exponentially.
The most exciting part, which I love to kind
of curate, is the convergence.
When you mash things up that are getting faster,
cheaper, better, how do you use those to reformat
how we do virtualized care, cancer diagnostics,
or contact tracing?
That's a bit of the theme.
It's not just about pure exponentials but
getting people to think a couple of clicks
of Moore's law forward because that has huge
implications about how we want to set up our
healthcare systems for today and what's coming
next.
You mention the term "convergence," so I'm
assuming that an important part of this—and
correct me if I'm wrong—is the bringing
together of folks from different medical disciplines.
Would that be an accurate way of describing
it?
Yeah, absolutely.
I found out when we were starting Exponential
Medicine ten years ago.
I'm trained as an oncologist, hematology/oncology,
I'll go to the ASH, American Society of Hematology,
meetings and the cardiologists go to the American
Cardiology and the gastro folks go and the
pharma folks go.
Things get very, very siloed and it's very
rare that you bring clinicians, researchers,
technologists, investors, patients, nurses,
and healthcare administrators together to
kind of go, "Wow, what really is cutting edge?
What's happening now?"
Many folks have no clue what's already here
let alone what's coming and, again, that sort
of blending.
Also, at Exponential Medicine, we had, I think,
last year, 45 countries, so a lot of things
happen asynchronously in different parts of
the world and we can learn from things that
are happening in the NHS, Israel, China, or
even Latin America and vice versa and cross-catalyze.
To open up the thinking and mindsets as well.
It's not often about the technology.
It's how we blend those with incentives and
the often misaligned incentives in the healthcare
systems around the planet.
If we go to a hospital today, the bastions
of traditional medicine, a patient comes in
is seen by the oncologist and then various
specialties.
It seems to me that we already have that blending,
so how is what you're describing different
from what's taking place now, everywhere?
What takes place today, most everywhere, is
not really health care or the care side.
It's really the sick side of the equation,
sick care.
That's based on our traditional model where
you go to see the oncologist or your doctor
in the primary care clinic or, God forbid,
the emergency room or intensive care unit.
That's where care happens.
That's where your data is collected, whether
it's your vital signs or your labs.
We end up with very intermittent, reactive,
sick care.
We get the data in a siloed way.
The 0.0001% of the time you happen to be seeing
a clinician of some sort, and that leads to
our reactive system where we wait for the
patient to show up with a heart attack, stroke,
or late-stage cancer, or the pandemic to arrive.
Where that hopefully is starting to shift
is now starting to leverage some of the more
Internet of medical things, the connected
data, the continuous healthcare exhaust that
can be picked up from our wearables and our
environments to then being much more proactive,
to identify problems early, to optimize your
health and wellness, to diagnose something
early or then to manage a disease if you have
it, whether it's diabetes, hypertension, or
cancer.
There's been a shift, I think.
There's amazing technology in individuals
and systems, but they're very disparate and
the data often is disconnected.
Even though we're in this exponential age,
the data doesn't talk to each other.
It's still stuck on fax machines as a bottleneck.
I went to have a cardiac study a few months
ago.
The only way I could get my results at home
was on a CD-ROM.
I don't even own a CD-ROM player anymore,
so we have a lot of old technologies, whether
it's a fax machine or CD-ROM and paper forms
still in the cogs of our sick care model.
Why are we stuck using fax machines and CD-ROMs?
Well, there's a big layer.
Again, some incredible things are happening
but often our regulatory and reimbursement
rules are stuck in our analog age and are
just starting to catch up to our digital.
How many of us had to fax and sign a medical
release, get it to the medical records, get
them to fax it to another hospital?
That might be very time-sensitive.
There's always HIPAA laws that are well-meaning
that are supposed for portability, but they've
become overly layered and encumbrance in privacy.
I would argue the patient would rather be
alive than with their privacy intact.
I've seen many examples where the fear and
the inability to transmit data and information
has had dire outcomes or hindered smart innovation.
We definitely need to focus on smart privacy
but sometimes there's an over-fear element
in that regard and the regulations often haven't
kept up.
That's why we're still stuck on fax machines
because that's the old regs and some of that,
again, is international standards and some
are even state-to-state in the United States.
Lots of challenges to do what we call often
interoperability from one medical record system
to talk to another or for your ability to
get your chest x-ray or your labs to you in
a sharable way where you own your data, can
be much more empowered to make sense of that,
and can be more of a copilot in your care
if you're a patient.
If you're a clinician, to use this new connected
world to gather not just the data but the
actual information so you can use that and
even get paid for it, aligning the incentives
to use some of these new technologies to really
amplify and improve what's called "value-based
outcomes" where you pay for outcomes when
they're better.
The drug, the app, the digiceutical, the gene
therapy are increasingly only going to get
paid for when they work.
It's about the technology, also aligning incentives;
that means follow the money, in most cases.
You have this conference that you've been
running for a number of years now entitled
"Exponential Medicine" and you bring together
a very interesting cast of participants.
What's the underlying set of decisions that
you're making in terms of how you bring these
folks together and how does this relate to
what you were just describing?
I think I'm fortunate I live here in Silicon
Valley, despite our current fires and earthquake
risk, to see a lot of things hopefully a little
bit early, whether that's next-generation
VR or 3D printing, or in travels around the
world, when we used to travel, bump into very
interesting people, technologies, and ideas.
My favorite thing in terms of curating exponential
medicine and, if you go to exponentialmedicine.com/videos,
you can see a tremendous array of amazing
thought leaders, technologies, and ideas.
But often, it's finding not the obvious folks,
not the folks who are famous scientists, investors,
or technologists, but to find things that
are a little bit early.
One example of a technology that's at the
convergence of exponential—and I have it
over here—is virtual and augmented reality.
I've got my Oculus Quest here that some of
you might have at home now.
Incredible amounts of technology for $300,
$400.
That starts as a gaming platform and it's
wonderful for gaming.
I've done 100 days straight of VR-based exercise,
as an aside.
A few years ago, I met a young surgeon who
had built the first VR training platform for
orthopedic surgeons.
You go into the VR headset and you're now
in the operating room with the actual instruments
from Stryker or a different company.
You can practice a procedure, whether you're
an orthopedic surgeon or not, and learn how
to do that.
Just like a flight simulator for pilots—I'm
a pilot as well—you can drain for very difficult
circumstances, bad weather, bad outcomes,
and you're seeing that early and bringing
that to the stage, you know, four years ago.
Now, it becomes sort of obvious.
That company is advanced, called Osso VR,
to the point where they've now done randomized
trials showing physicians training on VR getting
much better, much faster with their outcomes.
It's finding things a bit early and then also
showing examples that are not always traditional
medicine, things that are outside of the norm
to some degree, like psychedelics being used
for treating PTSD or end of life care, and
that's going through MAPS, going through phase
3 clinical trials with dramatic input, so
those are fun.
We also blend in music and art, and everything
from mindfulness, which relates to neuroscience,
to music, to chakra shaman ceremonies.
We get people a little bit out of their usual
headspace, and that's where some of the interesting
blending and connections happen outside of
your usual button-down kind of conference.
As I was looking at the attendee list from
some of the past years.
I found it striking that you have, among those
folks, senior executives from traditional
healthcare as well as senior execs from major
pharma companies.
Given the state of healthcare today, how can
we start to integrate the things you're describing
into our healthcare system?
It seems like an enormous gap and pretty hard
to do.
Particularly in the United States, there's
no one healthcare system.
There are thousands of types of systems, many
of which are designed differently, and some
are sort of aligned as a payor player.
I mean Kaiser, Geisinger, or VA, the clinicians
there or the system is not paid per procedure
or per admission.
They're aligned with, hopefully, being proactive
and preventative.
Big healthcare systems, just like big companies,
often have trouble innovating, innovating
at scale.
One of the nice things about coming to Exponential
Medicine or getting in the mix is, it opens
your mind to what's here or what's coming.
Often, again, it's not about the technology
but how you integrate it in.
Design thinking, how you might redesign your
clinic so the waiting rooms, the patient stays
in one room; the medical team comes to them.
How you think about the design elements of
how you communicate differently to a baby
boomer versus a millennial and learning from
others.
When you're coming from big pharma, especially,
those are big ships and slow to move.
No one wants to be the disruptee.
You want to be the disruptor.
No one wants to be the next Kodak or Blockbuster.
We always overuse the phrase, "You want to
Uber yourself before you get Kodaked."
We hopefully open the eyes and sometimes scare
folks a bit, like, "Wow.
If we don't get ahead of the curve here or
start thinking a little more proactively and
innovatively, we're going to be left in the
dusk by the next generation payment models
or virtualized care systems, et cetera."
It's often a challenge for people to get out
of their silos and that's what we try and
do is break open the silos and connect the
dots.
When you're speaking with, again, senior folks,
decision-makers, innovators from traditional
medicine and healthcare and pharma, what's
the reception that they have to the things
that you're describing?
Sometimes, it's a bit of shock and awe, like,
"Oh, my gosh.
We're behind the curve."
Others are trying to do things like a chief
innovation officer or someone who is very
forward-thinking inside of a larger organization
and it's hard to bring their folks along.
Back to the Kodak example, Kodak invented
digital photography.
It was invented there, but they didn't want
to cut into their film sales because maybe
the VP of film was blocking things out.
Sometimes, it's a matter of sparking leadership
inside of a traditional organization and getting
them to think about how do you accelerate
some of these things internally with their
five- or ten-year plan because, if you're
doing your ten-year plan with the mindset
of 2020 and not thinking about where AI, robotics,
3D printing, nanotech, genomics, and crowdsourcing
are going to be, you're not going to be making
a very good plan.
Plans change, but you need to be somewhat,
again, not on the linear track but the exponential.
I think sometimes it spurs some new thinking.
A lot of the cross-fertilization that happens,
we've had the head of innovation from National
Health Service come for several years.
He got spooled up and built a young entrepreneur
physician or clinician program in the U.K.
and that started a bunch of their docs and
clinicians starting to go, "Wow!
Here's a problem.
I might be able to solve that and then role
that out at the scale of the NHS."
Part of what I love about Exponential Medicine
is it's catalyzed a lot of next-generation
innovations that I don't even know about all
of them.
Part of it, again, is about understanding
technology, where it's heading, their convergence,
what's possible today, and what's coming next,
and how to see a pain point and solve for
that not just with what's in your pocket today
but what you'll be able to do with next-gen
systems, and those next-generation systems
are coming quickly.
Are we talking then about healthcare, technology,
or business disruption?
I think it's a bit of all of it, right?
It's also psychology.
Again, moving the cheese is sometimes hard.
If you create a new app, service, or platform
that a good example might be virtualized angiograms
where you can now do a 30-second CT scan,
send the data to the cloud, it'll reconstruct
your coronary blood vessels.
It's gone through the FDA, et cetera.
A company called HeartFlow.
But is that going to be exciting to the interventional
cardiologist who gets paid to do those procedures
or the hospital itself that makes a lot of
money from doing diagnostics in the cath lab?
That's a business model meets technology meets
mindset.
I think it's a blend of all those.
Frankly, the old models of healthcare were
medical devices and drugs.
Now, in the last decade or so, we have AI-based
drug discovery.
We have robotic surgery.
We have digiceuticals.
We have virtualized care.
We have fields that have built at the interface
that didn't even exist, in some cases, 10
or 20 years ago, and so it's business models
meets innovation.
Then where the money hits the road, how do
you pay for these things?
There are a lot of great apps, devices, platforms,
gene therapies that just don't ever get out
of the gate because of misaligned incentives.
From that standpoint, this is really not much
different than any other business innovation
problem where you're looking at disruptive
technologies and trying to figure out how
do we bring those into the market.
Except that you've now got the added layers
of lives are at stake and it's not like you
can just ship a new software version or print
a new widget.
You've got to go through regulatory.
To their credit, the FDA has now been getting
out of their linear mindset.
We've had Bakul Patel, Head of Digital for
FDA, come to Exponential Medicine several
times and, through workshops and other outside
elements, go, "Well, what's coming and how
do they now build a software and medical device
platform for speeding up how you might think
about the app controlling your insulin pump
using AI machine learning?" or a precheck
platform.
If you're a well-established startup or company,
you don't have to go through every hoop every
single time and send in PDF books of your
trials.
I think it's about bringing all these folks
together, including the patient population.
My friend Lucien Engelen calls it Patients
Included or Nurses Included.
You need to bring often the caregivers and
the patients who are the need-knowers when
you're solving a problem.
When I was a fellow at Stanford in hematology,
oncology, and bone marrow transplant, I was
part of the very first year of a program called
Stanford Biodesign, which brings together
medical folks, engineering, and law.
In the first third of the year, you're just
looking for problems to solve and really understanding
them because many folks will build it and
no one is going to come because it doesn't
work with a nurse or fit into the medical
records system or the payment model.
For anybody out there, many of you are nonmedical,
you've got incredible skills in platforms
and blockchain, gaming, design, IT, or apps
that may have never been applied to healthcare.
But if you find a pain point, particularly
when you collaborate with clinicians, patients,
and caregivers, a lot of things can move quickly.
But you also have to understand and engage
the regulatory process at the same time.
It's bringing together of the technology,
addressing the economic aspects, addressing
the patient experience, the regulatory aspects,
the business model aspects, and these are
the kind of building blocks, could we say,
who are driving healthcare change, essentially.
Right, and all those are moving parts.
Now we're in the setting over COVID.
We're speaking now in August of 2020.
A lot of things have been catalyzed in sometimes
good ways by the COVID pandemic.
Virtualized care is an obvious one.
I think, in April of 2020, the number of virtual
visits when up by 1000% and maybe have come
down a bit.
Now, because HIPAA got relaxed so you could
do Zoom-based virtualized calls that weren't
against the law and reimbursement models matched
so you could get paid to do a virtual visit,
those have exploded and the genie is out of
the bottle and I don't think it's ever going
to go completely back in because now we're
able to see the value of not just a Zoom call
for business but, in many cases, for a clinical
encounter because you don't often need to
lay on hands for every follow-up visit.
The ability to add connected devices is the
future of virtual visits so it's not just
the doctor or nurse on the screen.
You can look at your Fitbit or your Apple
Watch data or you're connected to a stethoscope
or home ultrasound and use that as part of
your care.
Asynchronous chatbots, which can do early
triage.
Is that cough related to COVID or the flu?
Bring in-home diagnostic platforms that could
do labs or use your voice to diagnose conditions.
Lots of things are converging and being accelerated
is a bit of the silver lining, as well as
the speed and pace of taking all this data
and moving it from data to information, actionable
information.
Then narrowing the gap from knowing that actual
information the clinic, like, how do you manage
a sick COVID patient in the intensive care
unit?
Lessons from Wuhan, China, and from Italy,
and from the ICUs in New York City are now
distributed across the U.S. and the world.
There is an acceleration of collaboration
as well because it often is a long journey
between something becoming known and being
standard of care.
The other day, I was party to a conversation
between two physicians discussing a patient
and one physician said to the other, "Oh,
yes.
I have to get this information."
A question was asked.
"I have to get this information," and he was
looking through the chart and couldn't really
find it.
The other physician said, "Oh, yeah.
I also prefer the paper records."
The first physician said, "Yeah, you know,
well, that's what I'm used to using."
That's a great example.
I'm sort of that digital, bridging the digital
divide.
I got my first mobile phone when I was a medical
resident.
When I grew up, we didn't have Twitter or
Facebook, or email when I was an undergraduate.
Now you have folks graduating medical school
who completely grew up on all these platforms.
Yes, there are some benefits to just looking
through a paper chart.
I started in paper charts.
Then you go to digital and that has pluses
and minuses.
A great example, Dr. Bob Wachter, who chairs
medicine at UCSF, gives a great example of
when I trained.
You go to radiology rounds.
You go to the radiologist with the whole team
and you look at the actual physical x-rays.
You put them on the light board, you look
at them, and you have a discussion.
Now, in the digital age, you can look at your
x-rays on your mobile phone or a computer
and you miss that sort of interaction piece.
There's something that changes in this element
of interaction and sometimes solving problems.
Then there's the issue of, you can digitize
a medical record.
Unfortunately, that's what the problem is
with our EMRs, things like Epic, Cerner, Allscripts.
They've become basically digital versions
of a long list of what used to be written
by hand and they don't really add to your
cognition.
They can get in the way.
Too many clicks.
There's burnout from trying to just enter
data.
I'm hopeful, whatever solution, a lot of these
exponential solutions need to be integrated
into the workflow of the doctor, the nurse,
the pharmacist because there's so much friction,
whether it's fax machines or CD-ROMs, just
to be able to synthesize.
My favorite example that most people kind
of get is, 15 years ago, we all used to drive
with paper maps and now you couldn't imagine
driving without Google Maps or Waze where
we're crowdsourcing our data.
Our private speed and location build the driving
map that's hyperlocal.
Imagine our electronic medical record systems
and our personal record systems are building
a bit of our own personal Google Map or Waze
to take us on our healthcare journey, whether
it's for our patients or for ourselves, that
is gleaning knowledge from other patients
like me or patients like mine on the genomic
level, on the sociome level, on the digital
exhaust level.
There are a lot of challenges to make the
technology integrate with actual clinical
care that goes all the way down to your medical
record and eventually using AI, machine learning,
et cetera to really upskill the doctor, the
nurse, or the community health worker to use
that at the point of care in much more impactful
ways.
One of the points of exponential medicine
in general is, how do we democratize healthcare
and improve health equity?
There's a lot of disparity and that can be
definitely improved using something as common
as a smartphone.
We have a question from Twitter.
Exponential medicine isn't just about technology
and science, but it's about ways of working.
Sometimes people tell us at the conference,
which we have at the Hotel del Coronado in
San Diego, when we're in real life, on the
beach, it's sort of like Burning Man meets
a medical conference.
Sometimes it's, how do you work together out
of the usual silos of title and rank all the
way to how do you interact at a conference
at a silent disco or doing an unconference
where people are sharing things in new ways?
I think we do need new ways of working together.
Part of that can be facilitated by the connection
digital, virtual layer.
In the cancer world, we can now think about
doing virtual tumor boards where might bring
the oncologist, the radiologist, the pathologist
together, and then also look at the data from
their digitized slide and using AI machine
learning.
Have a thousand experts around the table virtually
in terms of learned information.
New ways of doing asynchronous care.
We just did a series with UCSF called "Hospital
to Home."
I like to call it hospital to homespital.
All these new ways of doing remote patient
monitoring, so whether it's an Internet of
Things type medical device or sensor in your
underwear band that can track your respiratory
rate and your steps and shows you if you're
getting into trouble from a pneumonia or COVID.
How do you connect the dots on that for managing
folks outside of the clinical realm?
Something else that's been obviously catalyzed
by COVID and that means we need new definitions
of who does what where and when.
We have another question from Arsalan Khan.
"Doctors can benefit greatly from learning
technology during their education not only
as an end-user but perhaps even as developers.
Why hasn't the education system emphasized
this enough?"
He is raising the broader question of medical
education, which seems like a really important
part of this.
Medical education has not changed dramatically
maybe a hundred or so years.
Things were set up in the early 1900s to hopefully
make medical education much more regulated,
which makes some sense.
But we're still picking medical students based
on their ability to do well at organic chemistry
and physics and not maybe on their ability
to have engagement, empathy, decision-making,
and maybe even manage apps and services because
you need your memorization muscles less now
than synthesis, potentially, going forward.
Part of this is who do we select for, let's
say, medical school and how do you train them,
not just for 2020, but they're going to be
working into 2040, 2050?
What skills do you need?
How do you use some of these new platforms
like virtual reality and augmented reality
to vastly accelerate your ability to have
a virtual patient in front of you?
There are several apps where you can pull
up a virtual heart and play with it, learn
its anatomy, walk through it, and add a heart
attack, add a valve problem, or add a drug
to treat it or a medical device.
You can dramatically learn in new forums and
even do that collaboratively.
The opportunity reinvent continued medical
education all the way back to how do we educate
clinicians and, again, the ability, I think,
to democratize and upskill folks.
If you're a nurse in a rural village in Rwanda,
you can use one of the little tools, the Eko
Stethoscope.
It's a general stethoscope with an EKG.
You can listen to heart sounds and potentially
diagnose a heart murmur as good as a highly
trained cardiologist.
Blend in, again, the virtual coach that can
come on your iPad and help you through sewing
up a tough laceration or be inside the robotic
surgeon surgery with you.
There are lots of ways we can do real-time,
crowd-sourced, not just if you talk about
a Waze or Google Maps for patients, but for
clinicians as well to be always sort of virtually
coached and seeing the map to a path forward
clinically.
Do clinicians even have the time and anything
beyond a very broad, abstract interest in
patient experience?
Even to go further, if it's true that the
body is essentially a set of mechanistic equations
and chemical reactions, then why do you have
this focus on design thinking, patient-centeredness,
and everything else?
Why don't you just train people and force
them to learn better?
That'll lead us to better healthcare and life
will become simpler.
We don't have to worry about all of this other
stuff you're talking about.
We can always try and learn better and even
how you can flip classroom education to gamifying
education.
There are now video games where you can learn,
as a nonmedical person, do a full operation
and do a heart transplant.
I think now there is just so much data.
You have your digitone from your wearable
devices like an Apple Watch or a Fitbit.
Remember, Fitbit has only been out for 11
years.
It's pretty new to the point we can measure
almost every element of physiology and behavior
from our wearables or insideables or our invisibles.
Wi-fi can measure our data now.
That creates exponential data sets, including
our genomics, our microbiome, our sociome,
and the challenge in terms of learning is
we can't learn it all.
You can't read every paper.
The amount of medical information is going
up fast, so we need to leverage—it's over
buzzwordy—AI, machine learning, and big
data because AI is not going to be replace
a doctor but the doctor using AI will replace
those who don't – or the healthcare system.
Pick your favorite specialty or any field.
It's when you blend those together to give
us the best insights.
A simple example would be: Okay, Michael.
Let's say you have high cholesterol.
Normally, I would just pick the standard dose
of Lipitor.
Hopefully, I could look at your microbiome
because that might impact how you absorb Lipitor.
I could look at your genomics from something
as simple as 23 and Me to look at your pharmacogenomics
to know that Lipitor is not the best drug
for you because you're at high risk of muscle
myopathy or inflammation.
We need to skip to Simvastatin.
How do we then combine that with your blood
pressure medicines that are personalized to
you?
What if we could 3D print those in a single
medication so that, every morning, you take
your combined blood pressure med, your statin,
and the right amount of aspirin for you and
even print that every morning, which is something
I'm doing with a new startup called IntelliMedicine?
We need to start to pull this together in
ways that isn't just learning but is continually
learning and, hopefully, surfacing the best
information at the point of care to the patient
and the system around them.
Dr. Rasu Shrestha makes this comment.
He says, "Policy has always been a big catalyst
for tectonic shifts in healthcare in the United
States.
With the elections around the corner, do you
see opportunities to exponentially move forward
with the right policy catalysts?"
Yeah, you can't get a lot of this out of the
gate.
We can just look at our current predicament
in COVID.
A lot of our challenges in testing, et cetera,
were based on bad regulatory or policy decisions
that slowed up testing or other elements.
Exponentially changing things might be always
difficult in healthcare, but I'm hopeful.
I'll show my biases that we have a new administration
come January that's much more forward-thinking,
can align what we need to do next in policy
to reward not just healthcare, but sick care.
We're paying for prevention, for public health,
thinking about new models.
I like the idea I came up with a colleague
of mine of a global public health corps where
you could volunteer, just like an EMT or fireman,
to be your local public health servant and
use all these technologies to do contact tracing
and address social disparities.
A lot of that does come from the policy level
and how we pay for things at the NIH level,
the NSF level, and beyond.
We need smart, exponential mindsets to shift
policies so that these exponential technologies
can come together and really shift things
because we have so much room to go.
We spend more per capita in the United States
for an individual that have 20th in terms
of lifespan, so we have a long way to go to
align our technologies and our capabilities,
and that requires leadership and smart policy.
We have another question from Twitter.
You can see I prioritize the questions from
Twitter over my own.
Very often, the questions from Twitter are
better than the ones that I have because they
are from practitioners in the field such as
Shawna Butler, RN.
Shawna says, "How is exponential medicine
catalyzing cross-disciplinary teams and making
health innovation a team sport that has a
variety of new and unexpected players?"
She also is asking, "How are we innovating
for the "bottom billion" that don't have access
to high-tech healthcare?"
Two questions, the cross-disciplinary teams
and innovating to help the remainder of the
world that doesn't have access to all of this
high-tech.
It's not just about the traditional doctor
or health administrator.
We need to, as Shawna has proposed, accelerate
nurses being involved, physical therapists,
the team element so that we're all upskilling
the nurse practitioner to do what a primary
care doctor did and was assured to primary
care docs, to being part of innovation.
There are several examples.
It started as MakerNurse where nurses see
challenges in the clinic and they solved them
with macgyvered systems and now can scale
them through 3D printing and democratized
platforms, which also leads to democratizing
healthcare.
There are good examples now.
A community health worker with a $50 or $25
smart tablet can collect data, can do diagnostics,
might have a pocket ultrasound or other device
that are coming to market, and can give them
the ability to interact with the community
and do smart diagnosis and triage.
Then when they need care, may not need to
send them 100 miles walking to the city or
central village.
They can mediate some of that with an AI assist
or with telemedicine type visits.
Tremendous ability to democratize healthcare
and I think that's one of the great potentials
of the fact that we all now have smart apps
that can integrate our data, show us when
we're off track, and make us, each as individuals,
empowered to be on top of our health, not
waiting for the problem to happen.
That can be globalized and can play a key
role in preventing the next pandemic as well.
That means it's patients included, nurses
included, doctors included.
All of us can be helping create the future
of healthcare.
What about things like COVID testing?
The word that came to mind starts with cluster
and ends with something that we probably shouldn't
say, although why not?
I will say it.
You know it's been such a clusterfuck.
What can be done about that?
I bring that up because it's just such a practical
problem that affects every person who is listening.
Absolutely.
The key thing to getting ahead of a pandemic
or stopping one is to have smart identification,
isolation, and quarantine.
Contact tracing is the key term, but that's
driven by testing.
Some of our regulations have slowed down.
Better tests, the ones we have now that often
take several days to come back, are over $100.
I've been chairing the XPRIZE Pandemic Alliance
Task Force and have worked with Jeff Huber,
who is the founder of GRAIL, and started OpenCovidScreen.
With XPRIZE, we've now launched an XPRIZE
for rapid or fast, frequent, cheap, and easy,
FFCE.
Fast, frequent, cheap, and easy, that's the
hashtag #FFCE.
To be apprised to make tests under $5 in an
hour or less that can be done multiple times
a week at a school or workplace to get us
back to normal life and to identify cases
when you're asymptomatic.
That's an example of leveraging an innovation
prize to get things to move and scale faster.
There are some pretty exciting, fast, frequent,
cheap, and easy tests that are coming to market
now as well.
That blends with our regulatory needs.
To get out of our cluster, we need to have
the ability to do fast, frequent, cheap, and
easy testing.
You can go to xprize.org/testing to learn
more about the prize.
We've had over 450 teams already enter the
preliminary registration and we're going to
hopefully then find, test the tests, and scale
the winners very quickly.
That might play a role for this pandemic but,
hopefully, if we need it in the next ones,
to have those sorts of tests, molecular or
otherwise, spit in a tube, have the result
fast and easy.
That's critical as part of our cluster.
Part of it, again, is going to be smart public
policy, funding, and mindset.
There has been so much attention and resources
paid to the problem of testing by so many
different companies and governments without
a lot of, as far as I can see as a layman,
a lot of apparent success given how screwed
up everything is right now.
Why will your approach with the XPRIZE produce
results that are better and faster than just
what's going on in out there in the marketplace
today?
Well, prizes can often help speed things up.
One of the early prizes was to cross the Atlantic,
which Lindbergh won.
That incentivized steam.
That opened up transatlantic travel.
The first XPRIZE, the Ansari XPRIZE, was the
first rocket to space that was privately done.
That's catalyzed SpaceX and many other endeavors.
Part of what it does is sets some rules out
there for fast, frequent, cheap, and easy
testing.
It gets people to compete and then often collaborate.
Then we help support the teams from the regulatory
perspective, from the scale perspective, from
the funding perspective so that the best tests
that meet the criteria can accelerate into
market and get the attention and funding they
deserve.
If we move up the ability to get 50 million
tests in the United States every day up by
a month, that will definitely save lives,
shorten the pandemic, and have economic impact.
Sometimes, it's about aligning.
It's $5 million of prizes.
It's not a lot in the big picture, but it
gets a lot of people really thinking and motivated.
Again, often teams combine.
I helped come up with the medical Tricorder
XPRIZE a few years ago that was won.
A lot of teams converged and now we have,
coming to market soon, the equivalent of a
medical tricorder to do home-based diagnostics
and triage.
It's often about setting audacious but achievable
goals and helping speed them up when the market
could use a little bit of a nudge.
We have another question from Arsalan Khan
who asks, "We talked about connected healthcare
but the change has been so difficult since
connected means across borders and tech is
not the same across different countries.
How do we develop some type of baseline healthcare
technology that's available more broadly?"
We have challenges even state-to-state let
alone hospital-to-hospital.
Telehealth is required usually to be licensed
in every state you're practicing in.
That's hopefully going to get shifted in the
United States, let alone different countries.
I think we need a baseline.
I like to call it moving from quantified self
where you can collect your heart rate data
in your sleep, which is all great to know
and can change your personal habits.
Quantified self to quantified health where
connected data can start to flow to your clinician
in meaningful ways that aren't overwhelming
and integrate with their workflow.
I've just been building out a new platform
called Digital.Health.
That's the website.
It's still very early.
A place for, eventually, clinicians to find
and prescribe connected health technologies,
whether it's a connected blood pressure or
an app to quit smoking or a mindfulness app
or a diabetes prevention program.
But I think we can democratize some of these
around the planet and learn.
We don't need to keep building lots of widgets.
It's a matter of building the ones that work
and having a data flow, closing the loop because
most clinicians—we talked about this a bit—don't
want to see your heart rate data or every
little hiccup or sleep information.
They want to see the actionable information
in a way that integrates in.
"Oh, I've got a thousand patients in my panel.
There are the three that the blood pressure
or blood sugar are out of whack.
We need to call them proactively."
That needs a lot of smart not just technology
but policy and folks like Russ, Sue, and others
building that into their healthcare systems
for the nurses, the doctors, and patients
together.
The other day, I had a test denied by my health
insurance provider and I pay these guys.
I won't say how much, but it's literally over
a few tens of thousands of dollars a year.
I mean it's insane.
I said to them that I will pursue this to
the ends of the earth until the day I die,
because I felt I needed this test.
I did and it took me a long time and they
finally agreed.
How is it that this is happening and what
can we do about that?
I realize you're not a healthcare economist,
but what do we do?
Oh, it's so crazy.
Even in my own personal and family health,
the smallest things, it's just so hard to
even understand your medical bill let alone
your insurance plan, gold versus blue, and
what's reimbursed and not.
We need health education as well as financial
education.
I think part of what we need to almost think
about is—it's overused—the uberization
of healthcare, which is starting to happen.
It used to be a hassle to get a taxi and then
flag them down and have a paper receipt.
Now it's connecting the dots between things
that these companies didn't invent: mobile,
GPS, online payments.
Some of the winners that are coming to market
are redesigning that experience for you as
an insurance member, so it makes it more streamlined
that you're not stuck on the phone or looking
at fax reports and battling.
I don't know.
Your particular challenge of getting something
approved is very, very common and it's so
hard to get through all those phone numbers
and emails to get an answer.
I think we need to uberize that platform.
That means smarter chatbots better designed
to match you and your personality and education
rather than one size fits all, but a huge
conundrum.
I think the more we can streamline the rails
and get rid of the friction in healthcare,
the better we can spend time on the actual
care part.
A lot of that is not from future technologies
but what we have now.
Just putting them together in ways that are
smart, engaging, and value-driving, and not
crazy-making.
Getting rid of the friction and that would
require then aligning financial incentives
in a way that is completely out of whack today.
Well, there's this payments chart of the number
of doctors, let's say, doubling over the last
couple decades but the number of administrators
going up like this.
You get rid of that friction; you're taking
away someone's paycheck because that's how
a lot of the money is made.
Companies like Amazon, they're famously getting
into healthcare.
Still with their challenges, are able to sometimes
get rid of the middlemen.
That's threatening to a lot of providers.
We're seeing the CVSs and Walmarts and others
build healthcare hubs at their local pharmacies.
That's disruptive because you can get care
done at lower prices.
People are going to go where it's easy and
where it feels connected and it feels that
it's entered the Fourth Industrial Age.
You know, how we get our banking done and
get our movies feels pretty natural.
Healthcare, again, is still stuck on waiting
on hold.
I even had my own tele-visit follow-up for
a primary care visit but I still had to get
four phone calls from my local healthcare
team to set up the voice call.
Those little layers will get improved.
It's starting to happen and it's all about,
again, not being stuck in our old mindsets,
thinking at least accelerating things, not
just always exponentially, and solving for
the actual pain points, not just first shiny
new object, app, device, or wearable.
I love that, solving for the actual pain point.
Combine that with patient experience all across
the board throughout the patient lifecycle
and, boy, that would sure revolutionize our
healthcare system.
We're just out of time.
Any final thoughts, Daniel, that we haven't
spoken about?
There's been so much.
I wish we did have a few more hours.
Any final thoughts?
Maybe back to your pain point.
All experienced pain points, whether it's
challenges getting a test approved or tracking
your mother's health or medication adherence,
to better forms of detecting cancer.
Many folks listening out there have built
incredible technologies and platforms and
see their own personal or other problems,
whether it's in their own life or friends,
family, or business members.
I think we can all start to work collaboratively.
Platforms like Exponential Medicine are open
to everybody, so it's a team sport.
Again, we have a lot of power in our hands
to reshape things if we align the incentives,
the technology, the people, the design, the
workflow to kind of talk healthcare and advance
it to where it can be and where it should
be.
Daniel, if people want to look you up, what's
the best URL or the best place to find you
and learn about your work?
I try and put everything at danielkraftmd.net.
You can follow me on Twitter, @daniel_kraft.
If you go to exponentialmedicine.com, sign
up for the newsletter, or exponentialmedicine.com/videos
for lots of great content from a prior year.
We're hoping to have a virtual ExMed, Exponential
Medicine, later this fall, so keep your eye
out for that.
We've always live-streamed those and made
those open to everybody because we don't want
to have different tiers of access.
We want to have a big tent for healthcare
catalyzation and improvement.
All right.
I would like to thank Daniel Kraft.
Daniel, thank you so much for being here today.
Thank you.
Okay.
Everybody watching, thank you for watching
and particularly to those folks who asked
questions.
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Bye-bye.
