TEDMED 2014: Changing the Game & Curing the Sickness of Fear
The first (and only other) time I attended a TED event was in 1996, in NYC. This was also the first and only time the main TED event was held in New York, because, as the organizers later explained, it was too difficult to get people to stay at the event and not explore all the other equally fascinating dramas percolating around them in Manhattan. Still, even as an easily distracted New Yorker, I found plenty to keep me engaged right there at the Lincoln Square Theater. So much so that it became a life and career-altering experience, one that (in part) led me to start my own digital marketing company in 1998.
So when leaving for last week's TEDMED 2014 in Washington DC (and, more or less simultaneously, in San Francisco) I was more than a little nostalgic, and curious… about whether my spirit and career trajectory would be equally moved this time.
Well, as it turned out, the answer is no and… yes.
Inspirations were in shorter supply. And there were some surprising annoyances.
But TEDMED did make a dent in my consciousness. Most critically, as I will explain, I found at TEDMED a couple of major repeating themes weaving through the 3-day event that resonated with some of the most important trends that are now dramatically reshaping the pharma/biotech/medical device landscape.
I got a TEDache.
TEDMED is a very prestigious, not to say exclusive, event. At one point, one of the TEDMED “hosts” (basically MCs with a playlist of advanced degrees) asked the “delegates” (not “attendees”) to stand up if they were an MD, a PhD, a published author, or into Shakira (I may have made up one of those). Based on this highly scientific poll, I estimate about 2/3 of attendees at the Kennedy Center held advanced degrees, and everyone I met seemed very, very smart indeed.
Given its place in the cultural landscape (somewhere between Burning Man and the National Book Awards), TED events have naturally become a bit of an ego-romp. Almost without exception, the hosts felt it necessary to make some superfluous and cloying remark after every talk (“That was amazing,” “An extraordinary talk,” “I will be thinking about that for a while,” “Just amazing”). It was odd and off-putting that the hosts thought it necessary to tell us what to think about what we just had witnessed.
I was also disappointed that many of the speakers came across as stiff and overly-coached. TED is famous for its rigid insistence on preparing and delivering a “Talk” (never a “speech”) in a particular, TED-approved way. For naturally gifted performers, the approach doesn't harm their performances. But for less experienced public speakers, the formulaic story structure, locked-down position at center stage, and extreme reliance on “jazz hands” is so obviously coached as to be distracting.
Spectacular High Notes
But these are mere quibbles. The great thing about TEDMED—the promise of the brand—is that it will inspire you to see the world differently. And with that shift in consciousness, you can do work that is more insightful, more inventive and more courageous. On this most important score, TEDMED succeeded in some spectacular ways.
The sessions were arranged as a series of nine lecture pods each with a particular theme. The curators sought to inspire us to think very differently about the self-imposed limitations we bring to healthcare. With an uber-theme of “Unlocking Imagination”, the nine session subthemes included:
Turn it Upside Down—all about how looking at healthcare from radically different perspectives helps uncover major insights (e.g., according to Dr. Ted Kaptchuk of Harvard Medical School, placebos alone can cause clinically significant improvements, simply by changing the patient's perception of a caring environment).
Stealing Smart—how borrowing ideas from other disciplines can lead to surprising breakthroughs (e.g., cardiologist Barbara Natterson-Horowitz of UCLA Medical School borrowing from what she learned at the Los Angeles Zoo to better understand human health).
Don't You Dare Talk About This—in which we learned how speaking the unspeakable is sometimes a powerful means to consider a different path (e.g., Carl Hart, a former drug dealer turned Columbia University neuroscientist, provocatively advocating that the best way to reduce drug abuse is to legalize all drugs, even heroin and cocaine).
Lots of this was stimulating and unexpected, and a little of it was downright—yes—inspirational. My two favorites: Diana Nyad explaining how she never gave up her dream of swimming from Cuba to Florida even after four failed attempts (she succeeded—completing the 110 mile swim in 2013, at age 64); and artist Kitra Cahana's intimate story of her Rabbi father's collapse into Locked-in Syndrome and eventual climb (part way) back out, sustained by the love of his family and the largeness of his spirituality: “I'm living in a broken world and there is holy work to do.” A chilling yet intimately uplifting story.
What Matters to Pharma/Biotech and Med Device Companies
Two themes in particular emerged from TEDMED that held significance and relevance to our world of pharma/biotech/medical devices. The first provided insight about the impact of technology breakthroughs on the prevailing structures of healthcare economics (including the economics of established industry leaders); the second explored the role played by fear and risk avoidance in delivering medical care (which is arguably the greatest impediment to progress in our industry as well.)
Jay Walker, billionaire founder of Priceline, inventor, and since 2011, Curator and Chairman of TEDMED, bounced on stage to set the stage for the rapid acceleration of change we are about to see, driven by technology, that is pushing us inexorably into what some have called “the second half of the chessboard.”
“Health and medicine will change more in the next 20 years than in the last 20,000 years,” Mr. Walker predicted.
It's a big claim, so big that it's difficult to wrap your head around it. But due to the maturation of technology, the explosion of data, ubiquitous access to that data, and the emergence of “synthetic biology,” healthcare is transforming in virtually every dimension, reshaping the existing ecosystem, including quite possibly the structure, form and even the identity of the companies that will succeed in this new environment.
One such industry-disrupting company represented at TEDMED was Theranos, whose 30-year-old founder and CEO Elizabeth Holmes dropped out of Stanford to reinvent the business of lab diagnostics. Theranos has reconsidered virtually every element of lab testing, from reducing the pain of blood collection, through dramatically lowering the cost, democratizing the distribution model and perfecting the user experience—walk into a Walgreens, give a small, nearly pain-free blood sample, download the Theranos app, and get results on your phone within 48 hours. What's more, that single sample can be used to run multiple tests, thus dramatically reducing the cost of testing and empowering people to get direct access to their medical data.
The Theranos model is not an incremental change to the Lab Diagnostics business; it is a fundamental reconstruction of the business model. And if works as advertised, it promises to upend a gigantic but staid industry.
I decided to see for myself (Theranos had set up a mini-lab next door to the Kennedy Center). As someone who has always hated having my blood drawn and wondered why do you need so much? and why can't you run several tests using the same sample? I was impressed by the simplicity, convenience, speed and, yes, painlessness of the entire process. And I did get my results within 48 hours.
The company is still tiny, and operating only in California and Arizona. But the model seems solid and indeed inevitable: by combining the best of mobile and diagnostic technology with a truly customer-centric vision, a visionary company can deliver a dramatically superior and yet less expensive healthcare solution.
In so doing, companies like Theranos threaten the established order. The natural question occurs then: can “established” healthcare companies transform and compete?
“A Sickness of Fear”
That question connects to the second big theme from TEDMED I found highly relevant to the pharma/biotech/med device industries. In order for an established organization to transform, it must be willing to take risks. Because continuing to do what you have always done guarantees that you will not evolve, and therefore you will eventually expire as a vital enterprise. Moreover, taking baby steps towards change (a position many organizations retreat to) is an approach that is destined to be stillborn. So, in this environment, “taking risks” and “being bold” are not merely platitudes, they are essential survival behaviors.
So it was with particular interest that I noted how many talks at TEDMED addressed the unwillingness of the healthcare industry in general to take risks.
Some speakers got at the animating cause beneath this resistance. Leana Wen, an emergency medicine physician at George Washington University, asserted that the healthcare community was not only battling the fear of sickness, but also a “Sickness of Fear.” Her drive to encourage doctors to pledge total transparency to their patients and the medical community was met with a vitriolic reaction from some doctors, including death threats. “Transparency is scary,” admitted Dr. Wen. “But that's how we overcome the sickness of fear.”
Yet another speaker, Army Surgeon General Patricia Horoho, also cited fear as a major nemesis of the US health industry, where 400,000 deaths occur every year due to medical errors and preventable harm. “The enemy is our silence, our complacency and a lack of confidence.”
Sound familiar? These days, most companies are aware that the world is changing dramatically, yet many are unwilling to take the risks required to truly reinvent their businesses.
This reluctance to take risks is ironic, because if you realize the larger dynamics at play, you'll also realize that the status quo is the most dangerous place to be. You have to have the courage to transform your business in order for your business to survive at all. That's not hyperbole; that's our new “speed of change” reality.
Google “Pharma Innovation” and see what you get
It's encouraging that a number of industry leaders have in fact embarked down the path of real innovation; but, partly because of the secretive nature of the industry, knowledge of these initiatives is under the radar and so only vaguely understood, as is the case in the following examples.
(Disclosure: I am a member of the Google Healthcare Advisory Board. But I am not revealing anything here that has not already been made public.)
Novartis's Alcon division is licensing Google's “smart lens” technology for ocular medical uses, AbbVie has entered into a $500 million long-term development agreement with Google's Calico R&D startup to develop anti-aging products, and several companies are embedding their medicines with “ingestible” sensing technology from Proteus Digital Health.
At my companies, Heartbeat Ideas and Heartbeat West, we are working with a number of clients who are engaged with equally forward-thinking initiatives. But of course, if I told you anything about them I would be contractually obliged to shoot myself.
Instead, I will end with a final TEDMED take on the extraordinary future we are all stepping into. The most far-reaching view of which came from Dr. Francis Collins, NIH Director, leader of the Human Genome Project, and general visionary for the future of our species.
Welcome to “the Century of Biology”
In the course of about eight minutes, Dr. Collins rattled off a head-spinning list of advances right on the near horizon:
1) Personalized Medicine, partly made possible by genome sampling dropping under $1,000, which will also enable better matching of therapies to an individual's particular biology. We are reaching the point where we can analyze cancer at the DNA level and link it to targeted therapies; “This will be mainstream therapy quite soon,” promised Dr. Collins.
2) Mobile Health Technology, allowing people to realize the vision of real-time monitoring and improvement of their well-being. We all know the Fitbit and Jawbone Up stories by now, and with Healthkit, Apple has made Health apps central to all of its new products. But this is just the very beginning of a transformation that promises to fundamentally change how patients manage and improve their health.
3) The ability to sequence microbes and individual biomes to better understand their impact on health.
4) Mapping the brain. We finally have the computational ability to really get to an understanding of brain function.
5) Biochips. We are near the point where we can put your genome on a chip and then test the biochip for drug reactions, rather than testing our bodies.
6) Vaccines. Besides new scourges like Ebola, vaccines may be able to finally inoculate us from old enemies like HIV.In short, we are living at the cusp of a golden age of science, in “the century of biology,” if only we have the vision, the energy and the courage to bring it to life.
The arc of his vision did indeed trigger in me a sharp spark of energy, and I didn't even need to be told by a TEDMED Host how fortunate I was to hear it.
Bill Drummy is founder and CEO of Heartbeat Ideas & Heartbeat West.