I had the pleasure of interviewing Michael Abramoff, MD, PhD, president and director of IDx. We are the first-ever system to get FDA approval that makes a clinical decision without physician oversight. To date that is our major accomplishment.
Thank you so much for doing this with us! What is your “backstory”?
I am physician, an ophthalmologist, retinal specialist and surgeon with deep experience in IT, machine learning and artificial intelligence. Twenty-two years ago, I was a resident and I noticed that many patients had diabetic retinopathy. They often came in too late and had irreversible damage that we couldn’t treat. I decided there had to be a better way to diagnose them. That began a 22-year journey that involved moving to Iowa and founding IDx and realizing that autonomous AI is the best way to reduce the cost of healthcare.
DR was the lowest-hanging fruit because it is the most preventable cause of blindness with the most agreement in the scientific and medical communities in terms of how to treat it. We then focused on how to make autonomous AI safe and effective. It took a long time including a big clinical trial last year, and from there it’s moved very, very rapidly because many people realize the great potential for AI in healthcare.
Can you share the funniest or most interesting story that happened to you since you began leading your company?
It’s the same story, really. I thought I could change the world by doing a scientific study that an algorithmic can detect DR. Then nothing happened. I thought I needed to publish many more studies so I did about 150 of them. Nothing changed. I thought maybe if I had a patent it would help, so I started inventing things related to autonomous AI and now I have about 16 issued patents, 22 if you count patents pending. I kept hammering on this and maybe a few more people were listening but nothing was changing for patients, and that’s why I do this: I want to change the lives of patients.
Next, I started a company because I thought I understood what to do. The same year I was targeted in an editorial by the chair of ophthalmology at Johns Hopkins, who called me the “Retinator” — referring to the Terminator — saying that I was going to destroy patients and ophthalmologists’ jobs. I had this continuous struggle with getting this to patients and people being somewhat resistant to it, and then suddenly a year ago everyone was talking about AI. The biggest company in the world said they were going to do it, but as a small company we forged ahead as we always have, and we were the first to do this. It is sort of interesting that we started small and it was very quiet, but now everyone is talking about it and Google says they are going to follow us.
What do you think makes your company stand out? Can you share a story?
Our company stands out because of our people, who are mostly from Iowa. There’s a good quality of life here and it’s a good place to be. Everyone is so smart and engaged and motivated. We are so small compared to the biggest company in the world and still forging ahead and breaking ground everywhere. We are also unique in that we place great emphasis on understanding algorithms and correcting their biases — though algorithms will never be perfect.
4. Are you working on any new or exciting projects now? Autonomous AI means you can move from specialty diagnoses from people like me to primary care, which is where most patients are. If you seek healthcare, you want it to be close to you because it is easier to make an appointment and it is more convenient. The closer our system is to patients, the more patients can use it and the more affordable it can be. Typically, automation means lower costs. Any time we can make products that lower the cost of healthcare and improve quality and accessibility, we should do it.
What advice would you give to other CEOs or founders to help their employees to thrive?
Respect employees’ expectations and professionalism. Make sure they feel comfortable sharing their opinions even when they’re different from what you think. Respect the people you work with, listen to them, value them — that is why you hired them. Reward them — that is how you keep them. It is the same way, as you would do with patients. It’s mostly about listening and respect, and it comes down to treating people how you want to be treated.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are?
Gary Seamans, our chairman and CEO, has an amazing business background. He was Involved in an IPO with a company he brought up. He is very experienced and has an enormous network and he’s my mentor. I am a physician and a scientist. I may be an entrepreneur but really only for early stage companies. Moving it to the next level is a big challenge and having someone like Gary is why we have gotten where we are. The relationship we have is not one in which we calmly explain to each other what we think is right. There is a lot of shouting, which is good. It is healthy. Sometimes people are shocked when they hear us, but it works very well for us. The challenge with mentoring entrepreneurs is that you can only get started if you go against the grain. You need thick skin to start, but you need to realize you have to learn things along the way, so that is interesting.
How have you used your success to bring goodness to the world?
I wish I could do more of it. I am a physician/scientist. I could be a doctor and still see patients, but I realize as a scientist and entrepreneur I can do more benefit. Instead of a few thousand patients, I can reach millions. I want to reach everyone with diabetes or at risk of glaucoma. My success is measured by how many lives our system improves or reduces blindness for. That is how I measure success. If it were about money or prestige, I would have stopped long ago.
Can you share the top five ways that technology is changing the experience of going to the doctor? (Please share a story or example for each.)
Like with everything, especially with technology, it is about how you use it that makes the difference. Technology is neither good nor bad. In some ways it can improve quality, but it also certainly has made my colleagues and me less productive and able to see fewer patients than we did before. When we first started working with technology we thought it would be common good for everyone, but it’s not panned out the way we hoped. The way you use technology is as important as the technology itself. It should either make doctors more productive or more efficient. IT can do that, but we need to get better at it.
I expect AI to have a substantial impact. In the case of DR and people with diabetes, it will make diagnosis and treatment much more assessible to patients. Many patients don’t get the care they should, with accessibility the primary challenge — meaning the care is not where they are and it is too much trouble to wait for. If you make it much closer to patients, more patients will have treatment for their diseases. By treating more patients at the front line of care, more are taken out early if they don’t have the disease and then the specialist can concentrate on the patients with disease. That is good, because it’s why the specialist became a doctor in the first place.
Robotic surgery is a ways off, but you will see a lot more autonomous systems that make clinical diagnoses by themselves. We need a lot more of autonomous AI to drive the affordability of healthcare and improve quality. We will hopefully eventually see surgery being done by AI or robotics. There’s a lot of potential for IT in healthcare. We are getting better at understanding disease and why patients have it. That means that we can deliver treatment that is much more tailored to a specific patient. However, we have challenges ahead in where technology is going to take us in terms of tailored treatments because we don’t know if these treatments are safe.
Can you please give us your favorite “Life Lesson Quote”?
The main fuel to speed the world’s progress is our stock of knowledge, and the brake is our lack of imagination.– Julian Simon
Some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this :-)
Peter Thiel. He is a person I greatly admire. He is technology risk-aware and understands AI like no one else. He founded PayPal and Palantir and is an amazing person. It won’t happen but it would be very exciting.