37 Quotes on Health Care and Health Tech from 2016

I have always been drawn to quotes, those little snippets of wisdom that distill the thoughts we have in a perfect manner. Great quotes can give us goosebumps as they connect us with some larger truth. Geoffrey O’Brien may have said it best in his love letter to quotes, “Quotes are the actual fabric with which the mind weaves: internalizing them, but also turning them inside out, quarreling with them, adding to them, wandering through their architecture as if a single sentence were an expansible labyrinthine space.”

(Almost) every week when I send out the round up of health tech news for Startup Digest, I include a quote from one of the articles that I was drawn to. My hope is that the collection of these quotes tells us something about the state of digital health, and how the movers and shakers within digital health are making sense of the many transformations the industry is going through. Below are the quotes I included with my digests this year — they are certainly not all encompassing — but I think they are a good start. To make it a bit easier to digest, I broke up the quotes into a few larger themes: Advice for Entrepreneurs, Health Care and Silicon Valley, Change in Health Care, Quantified Self, and Grab Bag. If you have any additions, do let me know!

Here’s to a fruitful and productive 2017.

Advice for Entrepreneurs

“It seems to me we’re at a point where a lot of interesting ideas remain interesting, but they were never meant to be companies. They were meant to be products, or parts of products, or parts of companies. And as valuations are coming down, which they are, and as access to capital is becoming a little more challenging and there’s more need for evidence and proof that what you have is a legitimate solution big enough to be a company, you’re going to see more and more of this type of M&A. Of small good ideas that were never meant to be standalone, rolled up into bigger projects, into bigger companies.”

• Lisa Suennen, Managing Director, Cardeation Capital Management

“If your product is regulated, do not hide from the FDA. Talk to them early and find supporters in the agency. The FDA is more diverse than you might think and people in leadership are often more capable of collaborating with you. If you are able to share your insights into health tech and communicate new ways of doing things, you do have a chance to shape their thinking — and they are open to that.”

• George Savage, Proteus Digital Health

“So we frequently see entrepreneurs who come in, wanting to do a B2C approach, and then a year later, understanding that, to really get true volume of patients and consumers and providers on the system, you really have to go to a more B2B2C approach.”

• Lynne Chou, Partner, Kleiner Perkins

Health Care and Silicon Valley

“Silicon Valley’s failures are often linked to illiteracy about how clinicians and patients interact, and how individuals think about their health: lack of communication, cooperation or respect for the clinical community, underestimating the depth of regulatory hurdles, over-estimating healthy individuals’ willingness — or need — to actively use IT in maintaining their health, and impatience in understanding how IT needs to function within the patient-clinician relationship.”

• Carla Smith, Executive Vice President, HIMSS

“Entrepreneurs in Silicon Valley have this kind of hubris about being able to lean into problems and move the world, and in a lot of technology scaling you can just do that. But this is a big industry, we are taking the approach that you want to show better and better every day, but we know that we’re not going to wake up one morning and realize that we’ve completely changed the hearts and minds of everybody”

• Owen Tripp, CEO, Grand Rounds

“The future is not about eliminating physicians, it’s about leveraging physicians. Leveraging [physicians] by providing digital and other tools that work like they do in virtually all other industries — making our environments more supportive, providing the data we actually need in an organized, efficient way, and saving time so we can spend more of it with our patients.”

• James Madara, MD, Executive Vice President & CEO, AMA

‘At most digital health “pitchfests,” it’s pretty much white millennials hawking their technology to potential investors. “It’s about the shiny new object that really is targeted at solving problems for wealthy individuals, the ‘quantified-self’ people who already track their health,” Aulakh said. “Yet ….What if we could harness the energy of the larger innovation sector for some of these really critical issues facing vulnerable populations in this country?”’

• Barbara Feder Ostrov

“In fact, however, Silicon Valley’s most experienced investors in start-ups saw red flags at Theranos before anyone else. The Theranos saga shows just how well Silicon Valley does its homework, especially when considering medical technology, in which the risks of doing real harm to people are higher than those posed by the next photo-sharing app.”

• Randall Stross, NYT

“With the Affordable Care Act, and the transition to value based payments, there is more incentive in health care systems then there has ever been to innovate. So, now is a really good time to be an entrepreneur in health care technology, and I think people have been saying that for a long time, but I think deal flow right now is very strong, venture capital and a lot of generalist VCs are moving more and more of their assets to health care, so things are happening faster.”

• Matt Kozlov, Managing Director, Techstars

Change in Health Care

“Digital health is likely to have a strong Hype Cycle because healthcare is such a difficult market in which to make change happen on a large scale. Regulation, patent protection, and regional concentration of suppliers resist change. Most patients don’t know how to act as consumers, and many don’t want to do so.”

• Todd Hixon

“Change is hard, in my view, because the fruit is harder to pick than we thought. The fruit is hard to pick in part because delivering health care is not much like making a car. Auto manufacturing involves highly standardized and intensively automated workflows. Changing how work gets done may require a lot of capital investment. Nevertheless, a numerically-controlled lathe will change what it does when you reprogram it. And you don’t need to worry about the expectations of the steel that the lathe shapes. Medical work is much less standardized. No two patients are the same, biologically, psychologically, or in their social circumstances. Unlike steel, patients have agency that the care system should and must accommodate. All this makes caregiving a matter of craft skills, and care ‘algorithms’ are often more like suggestions. Above all, because they are craftsmen and craftswomen, and not robots, caregivers can be nudged, but they can’t be programmed.”

• Bill Gardner

“For whatever success health tech companies did have during this era, it amounted to a rounding error relative to the incumbents. Looking back, it is clear that the existing value chain of the industry — where dollars flow from households, corporations, and the government through the pipes of medical and drug payers, ultimately depositing in the sinks of the suppliers (providers and life sciences companies) — was the real winner, by a long shot.”

• Malay Ghandi, Ensemble Labs

“There are few sectors as resistant to change as government and health care. We count on their stability. But I have seen those two millstones grind a great idea down to powder. I’ve also seen initiatives flourish and grow, nurtured on the strong platform that this agency provides.

Innovators need sustained, courageous commitment from the top. We need a culture of experimentation that embraces risk and recognizes that failure is not only an option, but is likely within the safe setting of a lab like ours. And we need to ensure that anyone who sees a problem can research, prototype, and test a solution.”

• Susannah Fox, CTO, HHS

“If our society can seize this moment to unleash the power of innovators to create better models, which allow them to profit from removing waste and finding new efficiencies, we can put ourselves on the path to a satisfying and sustainable health care system.”

• Jonathan Bush & Michael Chernew, PhD

“All of this begs the question why — why is our system so sloppy? The answer: because it can be. Because the costs of medical errors are hidden. No senior hospital administrator or Washington policymaker heard about Mr. Jones’s death. Even when the errors are more obvious, the financial consequences to institutions are small. And until we fundamentally shift the incentive structure of the system so that the most careful and safe systems get rewarded handsomely (and the poor performers get punished), none of the sloppiness goes away.”

• Ashish Jha, MD

“For 10 years I’ve heard people talk about consumerism in health care, but I don’t think as health care providers we’ve felt that until the last two years. In talking to folks that register patients, the folks that are physicians, and nurses, and pharmacists, what I hear consistently from them is that our patients are asking better and different questions than they asked a few years ago.”

• Nick Turkal, MD, CEO of Aurora Health Care

“I don’t think it’s fair to say that digital health hasn’t made a difference […] because I think that part of the problem is the time horizon at which you look at things [ …] 5 years in healthcare is like 5 minutes in other industries, really I think we’re going to have to look out 20 years from now and look at what the impact of technology has been on how the healthcare system operates in order to measure efficacy.”

• Lisa Suennen, Cardeation Capital Management

“While the U.S. health care system is shifting from fee for service to total cost of care, this is a very slow change. Right now, primary health care providers are being asked to do one thing while they’re still getting paid to do another. This means leadership at all levels is required to create the space for innovation.”

• Alex Ryan, Systemic Designer, Government of Alberta

“Having just returned from Japan, I have been struck by the number of obvious, often simple, low-cost ‘low-tech’ measures that societies can adopt to improve health and indeed overall quality of life. These measures compare markedly with the ‘high-tech’ digital healthcare world that is my usual professional environment, yet one that is often prone to carte-blanche enthusiasm for any technological innovation, particularly from the start-up scene.”

• Len Sternes

Quantified Self

“The problem is getting these exabytes of genetic data. Turns out you can’t just walk up to people, millions of them, and say, “Your data, please.” You must first persuade them that you’ll only do good things with it and won’t let it fall into the wrong hands. (We do like our privacy.) You must then convince the medical centers and genetic companies that collect this data that, rather than hoard it for their own profit, they should share it so the entire research community can attain the economies of scale — the critical mass of data, individual sets eventually numbering in the millions — that Schadt and many others believe is necessary to understand the causes of diseases and engineer new treatments and cures.”

• Lola Dupre, Wired

“Data on the significant health benefits of fitness trackers is lacking. Furthermore, if fitness tracking technology can lead to such notable behavior modifications, why isn’t the market advertising simple solutions like pedometers? I wonder if it might have to do with the cost of a pedometer being as low at $2–3.”

• Jorge Rodriguez, MD & Internal Medicine Resident @ MGH

“Even if it’s “free,” as was the case with both the Microsoft and Google offerings, most people find tracking their health to be, in some sense, an admission of frailty, imperfection and mortality. Except for occasional blips related more to vanity (weight loss is the prime example), when it comes to our health most of us are in denial. So when people talk about technology for patient engagement, I tend to pause and wonder: Should we be building apps and services just for patients, or for the people who care about them too?”

• Dr. Alan Pitt, The Health Care Blog

“By working with the game maker to engineer member-specific engagement toward physical activity (fitness club incentives on steroids, pun intended) that relies on fractional payment, similar to online music sales for single tracks vs. albums, Niantic Labs can behave as a de facto wellness company without changing its business model while massively differentiating its revenue potential.”

• Taqee Khaled

“Mobile applications, or apps, have the potential to help patients with diabetes and other chronic conditions manage their health better. But as currently designed, health apps can present challenges to the vulnerable populations who would likely benefit the most, including the poor and patients with low levels of health literacy. An observational study of adults using apps to manage their chronic conditions found that patients could complete only a minority of tasks without any assistance.”

• The Commonwealth Fund

Grab Bag

“And so, we find ourselves in 2016 using the very latest stopwatches and journals to figure out just how bad our technology problem is. The very idea that we’re measuring 21st century technological performance with 19th century technology — the clipboard and stopwatch — is a nightmare of the absurd that only health care (or possibly Terry Gilliam) could conjure up.”

• Jonathan Bush, CEO, athenahealth

“ But with nearly [every hospital] getting a passing grade on website that is difficult to navigate and doesn’t differentiate between measures that matter and those that don’t, improvement just isn’t happening. We are being transparent so we can say we are being transparent. So, the bottom line is this — if transparency is worth doing, why not do it right? Who knows, it might even make care better and create greater trust in the healthcare system. And wouldn’t that be worth the extra effort?”

• Ashish Jha, MD

“Health care probably stands out as one of the great issues in our society from an access point of view, from a cost point of view, from an efficiency point of view, from a waste point of view. And if you think about technology as simply being able to do more with less, health care is a great place to apply those skills.”

• Steve Krupa, CEO, Psilos Group

“The increased costs of prescription drugs are one of the most critical items for American families. The development of high-value prescription drugs has improved the health and well-being of millions of Medicare and Medicaid beneficiaries. The continued investment in innovation is critical to unlock the treatments for many diseases such as cancer and Alzheimer’s, and help us better manage our chronic conditions like diabetes, heart disease and depression, providing significant benefits to patients across the country.

However, in order to have the maximum impact on these innovations, medications must also be affordable and accessible. In the last several months, we have heard about rapidly increasing prices for Epi-Pen, the rising lockstep cost of insulin medications, and the practice of some companies hiking prices by combining two cheaper products into one, higher-priced drug.”

• Andy Slavitt

“Doctors aren’t technophobic they are money losing and time losing phobic”

• Dr. Jordan Schlain

“Doctors will save more lives using the time they have on patients proven to be unhealthy by clinical-grade and approved devices than by studying the immense volume of non-standard data from gadgets worn by a healthier-than-average population.”

• Ahwaz Chagani and Philippe L. Michaud, Dion Strategic Consulting Group

“Clinicians do not distinguish between the sectors that we think about. They think, ‘I have a problem, my patient has congestive heart failure, what are all the tools that I need to manage that patient. Maybe it’s a medical device, maybe I need some diagnostic sensor to understand how their heart failure is progressing, maybe it’s tech enabled software because I need to put sensors in their house to understand whether they’re gaining weight and fluid and whether I need to manage them more aggressively.’ They’re not thinking I need a health IT answer and a device answer and a diagnostic answer, they’re just thinking, ‘I need to manage this patient.’”

• Dr. Garheng Kong, Managing Director, HealthQuest Capital

“[The view that collaborations between pharma and acadamia are bad], however, not only fails to capture the urgent need for effective, new therapies, it overlooks entirely the vital role played by companies in translating fragile but promising scientific ideas into robust medicines for patients.

• David Shaywitz, Forbes

“Finally, we find that the strongest predictor of higher prices is the market power of hospitals. In particular, monopoly hospitals (hospitals without competitors within a 15 mile radius) negotiate prices with insurers that are 15% higher on average when compared to those with three or more competitors. We also find that clinical quality plays a very small role in determining price.”

• Stuart Craig, UPenn

“There is a compelling superficial logic to value-based pricing. Why shouldn’t manufacturers charge the full value of the products they produce? Why shouldn’t consumers have to pay it? That logic begins to fray, however, when you think about how other markets work in our capitalist system.”

• David Blumenthal, M.D.

“Doctors ‘are the experts on the medical side,’ says Yale’s Dr. Krumholz. ‘Patients are experts on themselves.’ While they need coaching to make major medical decisions, he adds, ‘it’s up to us to give them permission to make a decision that’s not like ours.’”

• Medicare Requires Some Heart Patients to See a Second Doctor, WSJ

“These shenanigans aren’t just evidence of a failure in what drug companies are here to do, make medicines, they also reinforce all the bad things the public already thinks about the drug industry.”

• Meg Tirrell and Luke Timmerman, Signal Podcast

“How come as a patient, we’re always last in line to the data? How come my doctors and the university researchers can see my tumor genome and I can’t? Why are there so many barriers for getting access to my own data? No one really sees the problems with getting access to your own data, until you’re in the hot seat.”

• Steven Keating, The Open Patient