It really got me thinking why struggle to become a product manager of an existing product that was someone else’s vision. Moreover, the world still needs a lot of products considering the term ‘product’ is so broadly defined. It no longer means an Iphone, the Apple Health app is a product too having the capability to revolutionize the way healthcare is practiced. A instagram account with 1mn+ followers is a product as it helps that audience to save time spent on analysis, they just simply follow the person with whom their needs resonate the most.

The products that the world needs are just not products of convenience, but also products that help us remain humane and sane. Technology now cuts through our daily life so much that the most natural experiences in life are also inflicted by it. Your most amazing travel experiences have to be captured by GoPro and put up on Facebook. Is this the new normal of ‘natural’ life?

Both yes or no for that question necessitates more products. If that is indeed the new normal of natural life more products are needed to make that experience all the more natural, think Virtual Reality products simulating your body and minds placed in Africa but feeling like being in Iceland! And for those seeking more real and raw natural experience they need products to cut off from the world, think of Airbnb giving you options to cut off from the world and have edge of the world experiences.

With technology we are just getting better at offering individualized experiences, in the process also accentuating our need for customized service or product and in turn substantiating my hypothesis — that we need more products!

It is interesting to see these two buzz words pop up in the healthcare industry lately. These two approaches/systems ‘appear’ to be sitting on two extreme ends of healthcare services spectrum. In reality they are very much intertwined as both are strongly data-driven and hot spots for some major healthcare disruptions!

Population Health as defined by The American Journal of Population Health:

The health outcomes of a group of individuals, including the distribution of such outcomes within the group

So far, most population health management have been based on dividing patients using risk stratification algorithms. These algorithms are based on data from claims, EHR, and social determinants data (Do take a look at City Health Dashboard!).

Additionally, we have novel population health data sources like PGHD — Patient-Generated Health Data which comprises data from patient portals and other wearable and IoT devices. Another critical dataset is the medical adherence data which could either be derived based on socioeconomic data or using upcoming technologies to monitor adherence.

Precision Health, on the other hand, takes into consideration the differences in people’s genes,environments and lifestyles to select a suitable medical treatment. This has led to invention of specialized targeted medical treatments like immunotherapy. In addition to aforementioned data sources, genomic data is helpful in implementation precision health.

In semantics, the two terms sound contradictory to each other but in principle they are very much interdependent, let’s see how!

• As genomic testing becomes cheaper, it could soon become part of the annual health checkups to keep a check on a particular cohort’s genetic mutations. For instance, a population working in a chemical industry and hence exposed to harmful chemicals could constantly be monitored for genetic mutations and treatments developed to save this population and generations to follow.
• As we learn how multiple gene mutations could lead to life-threatening disorders, monitoring population genetic variations could help in disease prevention, lifestyle change implementation and early identification of disease symptoms. Cohorts could be formed based on risk assessment and population health management tools could be deployed accordingly.
• Several studies have signaled towards impact of lifestyle choices on genetic mutation, the top of mind example if smoking correlated with aggravating the genetic mutations leading to cancer. In the time to come, we might see a growing correlation between social determinants and genetic variation data.

29% of healthcare providers use precision medicine already, however its used to design treatment plans specially so in case of oncology and other life threatening disorders, often to match patients with some clinical trials. This definitely paves way for managing other chronic diseases which contribute the most to global disease burden and needs much of population health management efforts.

Gradually, this is changing as research efforts are being are being targeted at a wider patient pool as well as healthy individuals of all age groups through the ‘All of Us Research Program’ by National Institutes of Health. The program aims to learn more about how individual differences in lifestyle, environment and biological make-up can influence health and disease. These differences could help in making the population health risk algorithms more accurate and reliable.

As we embark on this path to understand the underlying patterns of genetic variations, we would come closer to the goal of using precision health as a preventive mechanism. Speaking of the model for an integrated healthcare system, as you can see precision health would play a critical role in population health management!

Two sides of a coin — Population Health and Precision Health was originally published in Tincture on Medium, where people are continuing the conversation by highlighting and responding to this story.

In the evolution process we, human beings, discovered various natural resources (Metals) on the way, molded and transformed it to meet our Needs (Tools) and then Wants (I-pads). Knowledge in form of manuscripts, languages, literature was one of the first man-made resource that was created and has benefited the mankind. This knowledge was then used to form theories, laws and principles that led us to the the Industrial era to Today — the era of Data!

‘Data’ is the next-level of man-made resource and it is available in abundance..

Data Generation

Individuals — Data from our personal devices including Facebook, Youtube, Watsapp, Health apps, Fitness apps and a zillion apps that makes us feed and store data.

Organisations — Data from machines, information systems, publications, research and corporate data (marketing, sales, finance).

Government—Data collected for regulatory requirements, social surveys, information banks created for the public.

This is the most simplified version, feel free to chip in if I left out something critical!

As more and more of this resource was being created, a new industrial ecosystem has been set up which revolves around Data. In this system,

Servers and Cloud work as Capital Equipment

Intellectual labor has replaced physical labor

Apple’s App Store and Google Play form the marketplace

VC Firms are replacing Banks for financing these data-centric businesses

Currency is Bitcoin

Being ‘lean’ is using Artificial Intelligence

Data is the next generation man-made resource, which is expected to drive an efficient use of depleting natural resources. However, the quintessential benefit of Data would be its ability to make a difference to that section of human population who still don't have access to basic needs of Good Health and Education.

Will data be able to do that ? May be. Will it be able to do that on a global scale? This is a big question mark!

It is exciting to witness the enthusiasm of longevity industry (yes, it’s an industry now!) to rebuild, regenerate and reprogram our cells, tissues, organs and DNA using chips, programs, software, algorithms and big data. But will they be able to create another revolution like Industry 4.0? Live longer to find out!

Health span vs Immortality

Interestingly, there are contradicting viewpoints on the righteousness of striving for longevity artificially with a growing tug-of-war between health span vs immortality.

The ‘health span’ school of thought is focused on simply increasing the number of years without a significant illness. On the other hand, pursuers of immortality refer to the idea of, as the name says, being immortal much like the wish of Dmitry Itskov, the “godfather” of the Russian Internet, to live until the age of 10,000.

Research — Multiple plathways

We can look at the ongoing research on longevity as the short-term and long-term approach.

The short-term goal is to treat the current leading cause of death — the chronic conditions like cancer, heart disease, stroke and dementia. In the long term, research bodies and companies are focused on deciphering the genetic key to ageing and reverse/stop/reset the process (which is the primary topic of discussion here).

Their efforts include testing hormones & drugs to a spooky vampire approach — infusing young blood into old. In medical science, a new class of drugs have emerged called ‘Geroprotectors’ — drugs that could decelerate aging altogether. Several compounds are being tested as geroprotectors with Resveratrol, a compound in red wine, being one but was discarded soon as a youth elixir and the next one in pipeline is Metformin, an anti-diabetic drug.

Off late, there has been an uptick in involvement of the tech leaders including Larry Ellison of Oracle, Larry Page & Sergey Brinn of Google, Pierre Omidyar of eBay, Mark Zuckerberg of Facebook, Jeff Bezos of Amazon, and Peter Thiel of PayPal.

For centuries, explorers have searched the world for the fountain of youth. Today’s billionaires believe they can create it, using technology and data. -The Washington Post

Listed below are few of the talked-about products/research that I found interesting:

• Calico, Google’s venture, is rumoured to be developing a drug to mimic foxo3, a gene associated with exceptional life span. Also intriguing are 300 mole-rats under study, which no one has a clue about as the firm is highly secretive about its research.
• Strategies for Engineered Negligible Senescence (SENS), co-founded by Aubrey de Grey (also the author of Ending Ageing) and with Peter Thiel as one of the investors, is working on drugs that cure seven types of age-related damage: “Loss of cells, excessive cell division, inadequate cell death, garbage inside the cell, garbage outside the cell, mutations in the mitochondria, and crosslinking of the extracellular matrix.”
• Some independent researchers are trying to understand the role of individual factors like GDF11 and the enzyme telomerase. Read here about biotech firm BioViva’s experiment to increase telomere length.
• Buck Institute for Research on Aging has a portfolio of about 100 compounds that extend life in invertebrates with a drug called ‘rapamycin’ being closets to a trial stage.
• Separate teams at Harvard, Stanford, and UC San Francisco are working on blood transfer from an adolescent mice into an old one, aiming to determine what chemical aspect of youthful blood benefits mature tissue. In fact a firm called Ambrosia, founded by Jesse Karmazin, is conducting one of its kind human trial to carry out such blood transfusions.
• In 2012, Tom Rando and his Stanford colleague Howard Chang published a paper noting that a fertilized human egg has properties of eternal youth: sperm and eggs can age, but every embryo resets the clock. This is another area of exploration.
• Elysium Health’s product ‘Basis’ is sold as a daily supplement for long-term well being at a cellular level. The main ingredient is NAD+, a compound which increases cell rejuvenation and believed to decline in humans as they age. Read more about Basis here.
• Unity Biotechnology is focusing on senescent cell treatments i.e. removal of senescent cells that are believed to be causal agent of various disorders like inflammatory joint diseases and eye diseases. Read more about this here.

As few of these researches move from animal-model phase to human trial, it’ll be interesting to see how many of these longevity innovators reach the finish line and benefit humans, of all strata, to live longer OR healthier!

PS — Those who are interested learning more, do read the TWP’s The Human Upgrade Series I, II, III, IV. Stay updated on the topic by following LONGEVITY 2017 of Time

Hunt for the Longevity Pill was originally published in Tincture on Medium, where people are continuing the conversation by highlighting and responding to this story.

A lot, on the surface! What’s underneath only time will tell…

Digital Health is not just a hot subject in Healthcare but it is also a new frontier that the tech geeks and hence the investors want to explore. My cue for this was from an audio podcast of Rock Health which notes that the H2 of 2017 witnessed a new record of investment in the healthcare with a total investment of $3.5 billion and also the largest number ever, 188 companies, receiving this investment. Read Rock Health’s full report here.

Now, that the stage is set for understanding how magnanimous this space is, let’s look at the the major themes around which these digital health firms are mushrooming.

• The App world — Numerous health related apps have come up over the last couple of years. This includes app version of the health encyclopedia WebMd which is not only a tool for symptom checker but also has a long list of drugs with information related to its uses, side effects, precautions, drug interaction, overdose effects. Micromedex, is a paid app for the same purpose as WebMd. Then you have apps like OneRx which helps you in drug price comparison.
• The App world 2.0 — With advent of precision medicine, several ailment specific apps have also been ‘invented’ for diabetes (Sugar Sense), asthma (AsthmaMD), stress (Stress Check). There is a wide array of fitness apps (Zombies Run!, StrongLifts 5x5, Motion Traxx) to choose from in addition to health wearables like Fitbit and Apple’s Health app which track your physical activity on a daily basis and gives you a beautiful-to-look-at analysis of your day.
• Telehealth/Telemedicine — The telehealth industry has picked up momentum with increased use of technology in the healthcare industry. Firms like Doctor on Demand, Health Tap, Teladoc allow you to consult doctors from the comfort of your home and also at a much lower cost. Read about these here. It’ll be interesting to look at how involved or supportive are the health insurance firms of patients using telehealth for chronic ailments?Will it be a game changer in this extremely expensive healthcare market?
• Internet of Things- In the era of this mobile savvy populous, it is no surprise that the healthcare industry players, namely providers, patients, insurance companies are drifting towards increased use of cloud for saving data related to medical records, drug information, scientific literature etc. HIPAA laws have acted as an enabler in this migration from traditional paper filing methods to digital.
• Healthcare Bots — Chatbots are being used to ensure access to health services in wee hours. These services range from taking doctor appointments, test results and prescription refills. Also, under research are bots which would help in carrying out medical surgeries insuring extreme precision. However, whether these bots can outsmart the human wisdom is something only time will tell.
• Smart Technology — From data savvy pacemakers (Medtronic app) to in-research glucose monitoring smart lens (considered a high-risk project now), we are seeing some really innovative technologies like AliveCor’s FDA-cleared mobile heart solution which could help in real-time monitoring of a patient’s health condition and take preemptive action. What else? We also have FDA approved digital medicines now with adherence tracking sensor that goes right inside our body sending out data signals, Creepy!

Creepier — There is now a preserve-your-brain-and-upload-it company!

The list does not end here, as there are more players active in undefined and overlapping categories mentioned above. It is therefore no surprise that 30% of world’s store data is generated in healthcare industry.

As more and more patient’s data gets digitized, the concern for data security gets graver. We are living in a time when our psycho-graphic data is used to influence our political decisions and we have no clue about it! Here goes my message to the Torchbearers of Digital Health — Keep our health data ‘secure’ because it is far more precious, it impacts our decision to survive!

What’s happening in Digital Health? was originally published in Tincture on Medium, where people are continuing the conversation by highlighting and responding to this story.

As kids, we wrote articles about my favorite teacher, my best friend, but never did we write about my favorite or ideal doctor.

Partly I would owe the reason to the fear of doctors that kids have! To the extent we often chose being a well behaved kid over being sent to a doctor for an injection. But good or bad, the reality is that a doctor is one professional who is present in our life from the time we were born till we die.

Now being a grown up and having visited a variety of doctors for myself and for my family members, I believe I am finally ready to write an essay on my ideal doctor !! Having enough doctors my entire life in India (not experienced in the US) I can say with confidence I have encountered them all — The Social Bird, The Busy Bee, The Scarecrow.

The Social Bird

The doctors in this category have all the time in the world to look after me, though, rarely encountered they do exist. They are not over cautious running 100 tests for a lower back pain. With them even the biggest emergency does not seem as threatening as it would have with any other doctor.

They really are my favourite.

They remember you and even have nick names for their patients (one of them actually called my brother ‘Spider Man’ after he fractured his leg). On the adverse side, this very nature may give some patients the feeling that he is not serious enough driving patients away for a second opinion just to be sure.

The Busy Bee

This one really is so busy that I have to literally walk behind him/her as she/he moves from one patient to another, just to get his/her attention. Once I do manage to do that, I would have to get a detailed patient history, my background if I am a caregiver and pose my list of questions just so he conveys my answer to the Nurse! In an OPD setting, before you can even settle down in that not so comfortable chair, you have your medication on prescription and you are headed out.

Dear Doctor, We, patients, come to you sometimes not for a medication but assurance that probably all we need is just a chill pill. These could be early signs of a bigger problem setting in. So just some positive words would go a long way in our physical and mental wellbeing.

The Scarecrow

When I encountered this type of doctor, in my mind I could already see myself as a cancer patient, since that is what she had made out of my malnutrition mark on my skin. Thank god for my second opinion with my social bird that I was able to continue leading a normal healthy life for 10 years now.

All this makes me think, how big a role doctors play in everyone’s lives. In developing countries like India, when a doctor saves a patient’s lives they are considered no less than Gods. Thus, it is imperative a profession that is considered so noble stays away from the highly commercial world that we have created around ourselves even when it comes to saving humanity.

To be able to do that, I feel its critical that doctors utilize Patient Empathy as a tool to deal with all their patients focusing on one patient at a time.

What is Patient Empathy?

In my view, patient empathy does not mean just sympathizing but it requires for a doctor to have a high Emotional Quotient.

Simply stated a doctor needs to identify the type of patient- Cool, Calm, Anxious, Hyper and modulate their communication with them accordingly. It’s unfair to burden a doctor with additional pathways and frameworks when they are already burdened with a burgeoning medical knowledge. Thus it’s essential to inculcate these behavioral understanding in the educating years of a doctor.

Empathetics, a company founded by Dr. Helen Riess, provides innovative empathy and interpersonal skills training for medical professionals leveraging new, scientifically proven methods. It is also believed that empathy in a clinical context can lean to better diagnosis and improved patient care.

Stanford medicine has a ‘Compassion Cultivation Training’, an 8 week educational program aimed at enhancing the qualities of empathy, compassion and kindness. Duke’s oncology fellows are required to do a course called ‘Oncotalk’, part of medical institute’s effort to teach doctors skills in clinical sympathy. Columbia University School of Medicine has pioneered a course in ‘Narrative Medicine’ aiming to fortify clinical with narrative competence.

Patient Empathy could be the key differentiating factor for providers in this millennium when technology is substituting for a lot many functions that were performed by doctors traditionally. Patient Empathy could be the primal human connection to Patient Care!

cleveland clinic empathy video - Bing video

Doctor — Primal Human Connection to Patient Care was originally published in Tincture on Medium, where people are continuing the conversation by highlighting and responding to this story.

In midst of the technological outbreak in healthcare, it is no surprise to think of the future of healthcare as an integrated data-driven system with a change in mindset to preventive care. While Machine Learning and Artificial Intelligence will be drivers from the Technology industry, Genomic sequencing and splicing would be at the forefront from the medical science field.

From here to future

A lot is happening around in healthcare in terms of innovation be it Artificial intelligence for better diagnosis, patient support apps, chat-bots, technological advances in medical and surgical science, the entire healthcare spectrum is , so far, positively infected by technological intervention. However, it’s essential to begin connecting the dots for each strata of patients. This classification of patients would begin with their genetic make-up.

With advent of CRISPR we could see the notion of prenatal gene splicing become widely acceptable, provided we are able to take a position on the issue of having ‘designer babies’.

Ancestry data and a common genetic pool data could be used to formulate analytical models that could help in determining the ‘likelihood probability’ for an individual to seek treatment for a disease in future.

How does everyone benefit?

The advantage of such a system comes in the form of efficiencies. For pharmaceuticals, production of medicine would be lean, based on the genetic testing data we can make predictions about what medicines would the patients need in future. As several research outlets unravel new diseases based on unidentified genetic patterns and regular health monitoring, pharmaceuticals can benefit from this data in commercializing (clinical trials, manufacturing scaling) the research in anticipation of future diseases.

The payers would be better equipped in planning and forecasting based on the continuous collection of data from existing disease burden and the likelihood of new diseases based on research data. They’d also be better prepared for the short term planning based on information flow from wellness institutes and medical devices with real-time data collection and analytics.

Nutrigenomics will play a critical role in preventive care, along with evolving med devices today for continuous monitoring of diabetes, hypertension which would be helpful in reducing the chronic burden on healthcare system.

As per CDC data in 2012, one in four adults had two or more chronic health conditions.

Hospitals would be envisaged as the front-line operator for continuous health monitoring, including diagnostics and mandatory health checkup and responsible for monitoring of data collected from medical devices. With continuous data exchange with research, pharmaceuticals, med devices, payers, hospitals will be the place with most of patient interaction.

Getting there…

I was able to envision this model based on plethora of healthcare innovations that are happening around us today. I know we still have a long way to go as the innovators continue to disrupt this industry at a fast pace. However, it would be interesting to see who would be the enablers of this integration:

• Would it be the government through its laws and policies? But then again, politics would always be a hindrance.
• Would it be disruptors like Amazon? Issue here would be vesting too much power in just one hand.

Ideally it should be the patients as they are at the center of it and will be the biggest beneficiary of such an integrated system, hopefully!

A Vision For An Integrated Healthcare System was originally published in Tincture on Medium, where people are continuing the conversation by highlighting and responding to this story.