A right-to-die ethicist faces her hardest choice

Peggy Battin spent most of her academic work exploring a contentious topic that many of us shy away from: decision making at the end of life. Peggy’s field of study took an almost unbearably personal turn when it became time for her husband, Brooke, to decide how to die following a near-debilitating cycling accident.

We reached out to Peggy, asking her to tell us more about what she thinks makes her TEDMED 2014 talk an especially timely one that can help us better understand the current debate over physician aid-in-dying. Here is her response:

Think about the competing tensions over how we die—on the one hand, the desire to be self-determining as much as possible, even at the very end of life, and on the other, the worry that giving people control over their own dying will leave them open to pressures, expectations, and abuse.

I want to be able to die when I want, where I want, with the people I love around me; but I don’t want to be pushed or cajoled or forced into it—not by family members or friends, not by overworked doctors, not by profit-motivated insurers.

Peggy Battin speaks at TEDMED 2014.  Photo: Jerod Harris, TEDMED.

Peggy Battin speaks at TEDMED 2014. Photo: Jerod Harris, TEDMED.

These tensions are fanned by activist groups on both sides. On the one side are the various right-to-die groups, like Compassion and Choices, the Final Exit Network, and many others; physician aid-in-dying, usually called Death With Dignity, has already become legal in four (and a half) U.S. states: Oregon, Washington, Montana, Vermont, and parts of New Mexico. Physician-assisted suicide and active voluntary euthanasia are also legal in the Netherlands, Belgium, Luxembourg, and Switzerland. There are active court cases and/or legislative measures in the United Kingdom, Canada, Australia, France, and much of the developed world.

Why must I be kept alive at such expense when, if I am dying, I would rather die in an earlier, easier, gentler way? That should be my basic right.

On the other side, opposing these measures on the grounds of both moral concern and fears of abuse, are a variety of groups implacably opposed to euthanasia in any form, from the disability-rights group Not Dead Yet to the Catholic Church.

But, you see, if there are such cost savings to be had, don’t you think you might be pressured into it? That’s what “death panels” are all about.

These tensions are further stoked by changes in background epidemiology and concerns over health care costs. The vast majority of people in the developed world now die slow deaths, deaths of heart disease, cancer, various forms of organ failure, the dementias, all of which have characteristically long downhill tail-off slopes, patterns of decreasing function that can also involve pain and suffering, and that also may involve substantial demands on family members and health care. As the populations of the developed countries become increasingly “gray,” this problem intensifies.

Against these tensions, this talk portrays one man’s life and the death that he chooses, a death that is on the border between these two camps: Because it involves the withdrawal of treatment, it legally and morally counts as a “natural” death, but because it involves this man’s own choice of time, place, and the people around him, including medical staff, it looks very much like an assisted death.

Notably Ig Nobel: Science humor

Author and newspaper columnist Marc Abrahams is the editor of the science humor magazine Annals of Improbable Research. At TEDMED 2014 he shared laughter- and thought-provoking stories behind some of the winners of the Ig Nobel Prize Ceremony, which he founded and hosts. Almost all humor aside, Marc snuck away from his duties for a few moments to answer questions for us.

Marc Abrahams at TEDMED 2014: Science Humor

Marc Abrahams at TEDMED 2014. Photo: Sandy Huffaker for TEDMED

Why does this talk matter now? What impact do you hope the talk will have?

People are sometimes given very serious advice about their health by Very Important People who know little and assume much. Look at the crazy advice that some politicians and some journalists are giving us — “Don’t vaccinate your kids!”, “Ebola was created by evil people who want to attack the American public!”. If someone — no matter who it is — tells you something that seems absurd, the best thing you can do is laugh, if it strikes you as funny… and then go find out the facts, and think about them. And THEN decide what you think about their advice.

What kind of meaningful or surprising connections did you make at TEDMED?

Three people each told me about scarily good candidates for future Ig Nobel Prizes. I probably would never have heard of any of those nominees if I hadn’t gone to TEDMED. (Sorry — I am not permitted to tell you anything about those nominees. We have rules, y’know.)

What is the legacy you want to leave?

I hope I helped at least a few people decide that it’s okay to make their own decisions — rather than simply accept what some authoritative person told them — about what’s good and what’s bad, and what’s important and what’s not.  

Anything else you wish you could have included in your talk?

Well, of course I wanted to tell the story of homosexual necrophilia in the mallard duck. But there wasn’t time. And anyway, Kees Moeliker, the scientist who made that discovery, is the best person to tell that story, which he did in an obscure biology journal, and then at the 2003 Ig Nobel Prize ceremony, and then again years later in a TED talk.

Can you share some highlights from the 2014 Ig Nobel Prize ceremony?

The on-stage demonstration of the technique that won this year’s Ig Nobel Prize for medicine. It was awarded to a team from the U.S. and India for treating “uncontrollable” nosebleeds using the method of nasal packing with strips of cured pork. Before that night, I had never in my life met anyone who had disguised himself as a polar bear to frighten a reindeer. I am very pleased with the premiere performance — as part of the ceremony  — of “What’s Eating You”, the mini-opera about a couple who decided to stop eating regular food, and instead get all their nutrients from pills. The lead singers were magnificent, and so was the chorus of their intestinal microbes.

What was your favorite winner from the 2014 Ig Nobel prize ceremony?

I am entranced by the Nutrition Prize winners — Raquel Rubio, Anna Jofré, Belén Martín, Teresa Aymerich, and Margarita Garriga, who published a study titled “Characterization of Lactic Acid Bacteria Isolated from Infant Faeces as Potential Probiotic Starter Cultures for Fermented Sausages.” They could not travel to the ceremony, so instead sent us a mesmerizing half-minute-long video in which they explain what they did and why, and then eat some of the sausage. MA2

Claim your experience: Beyond the survivor identity

In her 2014 TEDMED talk, Debra Jarvis, a writer and former hospital chaplain, offered a witty and daring look at the way that survivors of disease and trauma can achieve new levels of emotional and psychological healing. We caught up with Debra in between her sabbatical adventures in Europe.

Debra Jarvis, Cancer Survivor

Debra Jarvis at TEDMED 2014, Photo: Sandy Huffaker

What motivated you to speak at TEDMED?

As a chaplain I always walk the line between science and spirituality. I knew that I had a unique perspective as a hospital chaplain, as a family member of someone with cancer and as a patient myself. So I had seen the issue of survivorship from all these different perspectives and knew TEDMED was a perfect venue to give a voice to the many patients who talked to me over the years. I spoke for a lot of people in that talk.

Why does this talk matter now? What impact do you hope the talk will have?

This talk matters now because the pressure to be a “participating” survivor is high and although I think funding cancer research is important, taking on this identity can keep people stuck.  Although the context of my talk is specific — taking on “cancer survivor” as an identity — I hope  that listeners/viewers will realize that the problem is universal. Taking on any kind of “victim/survivor” identity is deadly. It can be cancer, it can be a car crash, it can be being dumped by a lover! My suggestion remains the same: Process your feelings, mine the experience for all it’s worth and then move on. Keep growing. Keep becoming.

What kind of meaningful or surprising connections did you make at TEDMED?

The best thing for me about TEDMED was being around so many people who are using their power for good. As Spiderman’s uncle said, “With great power comes great responsibility.” And so many of the speakers there were using their brains, education and energy to find solutions to some of the world’s thorniest problems. They are taking on great responsibilities, and that is inspiring.

What is the legacy you want to leave?

“Claim your experience. Don’t let it claim you.”

Anything else you wish you could have included in your talk?   

I wish I had time to talk about knowing the difference between being truly wounded and simply not getting what you want. The latter is your ego stamping its little foot and whining. I would have also loved to talk about what it would be like to not carry a wound, but instead carry a scar. A scar is so much stronger than the original tissue! And finally, I wish I could have included why I think we get so excited about surviving: It’s because we are so afraid of death. It’s like, “You’re a survivor!” but the unspoken thought is, “For now.” Because ultimately, no one survives. Americans in particular are loathe to face this. I would have loved to talk about teaching our children not to fear death and to give some great examples I’ve seen of how to do that.

An Extraordinary Out-of-Body Journey

In her TEDMED 2014 talk, photographer Kitra Cahana shared a new visual language accompanying the extraordinary story of her father’s severe brainstem stroke, a catastrophe that they transformed into an inspiring and imaginative spiritual journey. She spoke with us via email about her talk and her father’s progress.

What motivated you to speak at TEDMED?

It’s very difficult to express the sublime and the surreal in words and photographs. I wanted to attempt to communicate all that my family had experienced in the summer of 2011 – my father’s brain stem stroke, and the profound spiritual awakening that followed – with others. When my father first had his stroke, I wrote down these words, and whispered them to him when I first came to his bedside: “We only ever needed one pair of hands, two legs, a respiratory system to keep the world afloat between us.” This became my mantra. We can sustain ourselves through each other. This is what my father taught us; he said that all who came into his room of healing should expect to be healed themselves. Healing has to be mutual.

Kitra Cahana at TEDMED 2014. Photo: TEDMED/Sandy Huffaker

Kitra Cahana at TEDMED 2014. Photo: TEDMED

The stroke ruptured my reality as well as his. In those initial months, so devoted to his limp body and to allowing him to communicate all that was bursting to come out from within, I saw sides of myself I never knew existed. I would have loved for him to have spoken at TEDMED himself. But as in the hospital, where my mother, sisters, brother and I acted as his mouthpiece, so too do we continue to act in that capacity, sharing his words and his Torah with others.

Why does this talk matter now? What impact do you hope the talk will have?

To me, this talk should be timeless. In fact, part of my father’s message is that he hopes others will step outside of the space-time hustle and bustle that many of us are so used to. He experiences life in a kind of slow-time (that’s what he’s called it), watching with curiosity as his body reawakens tingle by tingle, twitch by twitch. He spent and continues to spend hours alone with himself. That space of aloneness with his thoughts is not a place of anxiety, but a place of joy and introspection.

I hope that others get a sense of this slow-space-time, where you exist only with yourself, with those other humans that you are intimate with, and – my father would also say – with G-d. I tried to recreate this kind of in-betweenness (in between the inside and the outside, heaven and earth, body and mind) in the video series and photographs that I have been working on and that I presented in the TEDMED talk.

What kind of meaningful or surprising connections did you make at TEDMED?

I met a wonderful woman at TEDMED who runs a high-end rehabilitation center in Boca Raton, Dr. Lisa Corsa. Our chance encounter at the coat check turned into a half-hour consultation, wherein she reaffirmed our family’s sense of what intensive rehabilitation should look like. A body that has had every system affected as severely as my father’s needs hours of attention each day if there’s any intention for it to make functional progress. A body that doesn’t move hardens; it stiffens and withers away.

We have a wonderful circle of volunteers who give so much of themselves, but it’s not enough. Dr. Corsa helped me get a sense of how far we have to go to advocate and fundraise for my father to receive the minimum amount of proper care and attention. He’s currently living in an institution with limited human resources, and as a result we are only able to provide limited access to physiotherapists each week. She affirmed my resolve to fight for my father’s right to basic daily movement and to seek the funds for intensive physiotherapy, so that he can eventually move back home.

Please share anything else you wish you could have included in your talk.

Since my father’s stroke, I have become involved in a global community of people who have experienced brain stem strokes, either personally or on the part of a loved one. They are either still fully locked-in, or have since made great progress, including some partial to full recoveries. We share and compare our experiences online.

So many of those who have experienced being locked-in were written off too early. Their families were told to expect very little. As a result, they did not receive proper rehabilitation therapies, nor were their bodies moved on a daily basis to maintain a minimum quality of comfort and life. I’ve seen health care professionals refuse to address the locked-in patient directly, speaking about him or her in the third person, insensitive to the fact that the person is still completely conscious and able to communicate. We struggle every day to sensitize health care professionals and institutions.

Healing is taxing. But what is even more taxing is trying to heal in systems and institutions that drain the already low reserves of patients and their support systems. My father was able to have the spiritual experience that he had because he had a family and a congregation that preserved him in his role as father, husband and rabbi and advocated for him when he wasn’t able to.

How sleep deep cleans your brain

Jeffrey Iliff at TEDMED 2014. Photo: TEDMED/Sandy Huffaker

Jeffrey Iliff at TEDMED 2014. Photo: TEDMED/Sandy Huffaker

 

In his TEDMED 2014 talk, neuroscientist Jeffrey Iliff illuminated a newly discovered, critical function of the brain during sleep: a natural cleansing system that keeps toxic proteins at bay.  We spoke to him via email about his talk.

What motivated you to speak at TEDMED?

TEDMED offered the unique opportunity to tell the story of our research – not just its facts, but also its story. As a neuroscientist, I go to the lab every day expecting to see something new within the brain, its pieces, processes, and the systems that comprise it that no one has ever seen before. What we find within the brain – its simplicity, minimalism, functionality, and its beauty – are a continuous source of wonder to me. In the methods, results, and careful interpretation of our findings, this wonder can easily be distilled. When the outside world looks in at our work, they may only see cells, blood, water, and so many solutes; not the beauty I see through the eyepieces of a microscope. TEDMED gave me the chance to tell the story of our work as we experience it, as the story that it is.

Why does this talk matter now? What impact do you hope the talk will have?

First, I think that it is a subject to which every person can relate. Each of us who is in school, works long hours at a job, or has kids to keep them up when they’re sick, deals with the inescapable fact that sleep is necessary for our brains to work correctly. Learning that parts of the way our brains work can make intuitive sense is comforting, and makes our brains seem a little less like these strange alien machines that no one can really understand.

I think that the research itself is timely, as well. An increasing number of clinical studies have begun to link such seemingly disparate processes as sleep, neurodegenerative disease, cardiovascular disease, brain injury and others. The science that we describe, and that is the subject of my talk, is fundamental to the basic function of the brain and may help to explain many of these puzzling associations. My hope is that my TEDMED talk will spur people’s imaginations and encourage them to dive headfirst into these questions and, in doing so, drive the field forward far beyond these small contributions that we’ve made.

What kind of meaningful or surprising connections did you make at TEDMED?

During the conference, I was approached by several people who were attending TEDMED for their own professional reasons, but who had also dealt – either personally or within their immediate families – with conditions that are likely impacted by the biology that we are studying. For those of us who are scientists, but not physicians, it is incredibly easy to view our work academically, to equate progress with papers and grants, and to view treatments as ideas and hypotheses to be tested. To an extent, this is completely appropriate. But, I was reminded that, when I talk about “Alzheimer’s patients” in a scientific talk, those words stand for millions of mothers and fathers, grandfathers and grandmothers who live with this disease every day – each loved and missed as they slip slowly away. In the face of this reality, the thin replies of “We don’t know yet,” “Here’s what we think is happening,” or “Here’s something we’re testing in our mice” seem hollow and inadequate. It was a stark reminder to focus not only on what, but also whom we are trying to cure with all of this amazing science.

A chorus of support for those struggling with mental illness

Entrepreneur Jen Hyatt, founder and CEO of Big White Wall, an online mental health support and treatment platform, talked to the TEDMED 2014 audience about how social networks can provide healing help to those who feel isolated in their struggles with mental illness. We spoke with her via email about her talk.

What motivated you to speak at TEDMED?

TEDMED’s global reach presents an unparalleled opportunity to “converse with the world.” TEDMED’s ethos, the ability to share knowledge and offbeat thinking that creates surprising sparks between innovators and disruptors from across the globe, is very dear to my heart. Focusing on the people who are creating new, or even strange or unusual, speaks to the greatest challenges facing health care offers the opportunity for transforming moribund systems. Being part of that, sharing knowledge and ideas, was a real privilege. So my message, as part of that, is that the economic and human cost of poor mental health is tragic in proportion, yet has a digital and human sized solution.

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Jen Hyatt at TEDMED 2014 Photo: TEDMED/Sandy Huffaker

Why does this talk matter now? What impact do you hope the talk will have?

Conventional methods of addressing poor mental health cannot meet the volume of need. We see this crisis in provision – lack of treatment, barriers to access, high costs and the pain caused by a lack of support for mental health – across the whole world. In my TEDMED talk, I showed that the human need for connection and community is thousands of years old. Yet it’s only now, with the growth of digital technology and online social networks, that we have the potential to truly transform mental health care with the support of online communities and a broad choice of support and recovery tools, so no one has to struggle alone. We need to shift the healthcare journey from one where people are passive and isolated to one where they are active and supported.

What is the legacy you want to leave?

An emotionally literate world, in which there is no more mental health stigma, and no one left struggling without help. Every human being should have one-click access to support and recovery tools for improving how they are feeling, and I hope that will be Big White Wall (BWW)’s legacy, and mine. A world in which your emotion is known without needing to speak it provides support that is integral to our lives.

Please share anything else you wish you could have included in your talk.

I wish I could have shared the vibrant images that our community members use to show their journeys from darkness to light, from struggle to recovery, and all the moments in between. Big White Wall centers on a shared, anonymous digital social space, supported 24/7 by professional staff. This center draws much of its strength from the power of peers – not trained professionals, but people just like you and me. Not necessarily the people who see themselves as leaders or helpers, but the struggling, the lost, the unhappy and the confused. I wish I could have showed a bit of their struggle, their strength and the amazing support they offer.

Watch Jen Hyatt’s TEDMED 2014 talk here.

A medical school in Cuba trains doctors to serve the world’s neediest

American journalist and Havana resident Gail Reed spoke at TEDMED 2014 about a Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own all over the world. She talked with TEDMED about the Latin American Medical School and its contributions to global health.

Why does this talk matter now? What impact do you hope it will have?

Ridden by Ebola today, other emerging infections tomorrow, and always by chronic diseases—our world needs strong health systems, staffed by well-trained and dedicated people. And their education must be the result of enlightened decisions from policymakers who put health first, learning from the likes of the Latin American Medical School to make these new health professionals the rule, not the exception. Now is the time for medical educators to make the changes needed to give us the kind of physicians we need. And to bring the profession into the movement for universal health care, bringing doctors to the forefront with other health workers. To walk the walk.

Gail Reed at TEDMED 2014

Gail Reed at TEDMED 2014 Photo: TEDMED/Sandy Huffaker

I hope that people seeing the talk will be inspired to act to support the Latin American Medical School graduates through our organization, MEDICC. I hope policymakers will take the School’s courageous experiment to heart, and then take another look at their budgets and find more for health and medical school scholarships; and that governments will find a way to employ these new doctors in the public health sector, in places where they are most needed. I hope the graduates will never ever wonder about their importance to global health, for they and others like them are vital to turning around our global health crisis, in which one billion people still have no health care—millions, even, in the USA. And finally, I hope we will recognize Cuba’s contribution to global health, including the nearly 500 nurses and doctors on the front lines against Ebola in West Africa, as an example of what is possible and as a challenge to others to do more. Today, Cuba has over 50,000 health professionals serving in 66 countries, 65% of them women. Since 1963, 77,000 of them have given their services—and some their lives—in Africa.

What motivated you to speak at TEDMED?

As a journalist in Cuba, I realized I was witnessing an extraordinary experiment in health solidarity with the world’s poorest people: The thousands of scholarships offered by Havana’s Latin American Medical School to students from low-income families in 123 countries, who pledge to serve in communities poor like their own. I was struck by the fact that a country, an institution, believed these young people could themselves be the answer to the call for doctors where there were none. And I was astounded, too, that this audacious experiment has remained essentially an untold story. Audacity is right at home on TEDMED’s stage, so it seemed the perfect opportunity. I also thought the TEDMED audience would ‘get it,’ the urgency and responsibility we all have to support these new doctors, who represent the potential of imagination when commitment drives it into bold action.

What is the legacy you want to leave?

The talk’s legacy is in the hands of thousands of young doctors continuing to graduate from the School in Havana, who are bringing health care to some of the world’s most vulnerable people. Their school and their example should remind us that this is one world, with one fate and one humanity, and that the odds are there to beat: Health for all is possible.  

Want to learn more about Gail and her efforts? Visit her speaker page on TEDMED.com.

TMIcon

From the Internet of Things to the Internet of the Body

As Managing Director of Healthcare at GE Ventures, Leslie Bottorff invests in healthcare industry startup companies—with a preference for medical technologies and emerging business models. Her 15 years of venture capital investing experience includes her roles as managing director at ONSET Ventures, and investments and board seats at Sadra Medical, which was sold to Boston Scientific; Spinal Concepts, which was sold to Abbott Labs; Neuronetics; Relievant; and VisionCare Ophthalmic.

Earlier in her career, Bottorff spent 19 years in operating roles at large andventure- backed companies including Medtronic’s CardioRhythm division, Embolic Protection (acquired by Boston Scientific), Nellcor (now Covidien), Ventritex (now St. Jude), Menlo Care (acquired by J & J), and GE Healthcare. She has also served on advisory boards or as guest faculty at several universities including Purdue, Stanford, and UC Berkeley.

TEDMED: What’s the most remarkable innovation you are seeing in health tech or medicine, and what is driving it?

Bottorff: We’re seeing tremendous innovation in personal monitoring and in therapies for a wide variety of diseases. Combining therapies, diagnostics and digital communications is creating a more effective systems approach to patient care management. This means helping patients who are in the hospital or coming out of the hospital, living at home with chronic diseases as well as helping people who are not ill, but taking steps towards preventative care.

This is analogous to the emergence of the Industrial Internet, which GE is a major proponent of. This convergence of personal monitoring technology and advanced wireless communication is a pretty big opportunity for what I’ll call, the “Internet of the Body”. This convergence is going to be the driving force behind the advances we are seeing today.

In addition to personal monitoring, another area of remarkable innovation is noninvasive technologies to treat and diagnose conditions related to the nervous system. We’ll be able to take advantage of some of the electronics and connectivity that is now available. As one example, GE has a brain initiative being led by our Healthymagination unit.

TEDMED: What’s the most important factor for entrepreneurial success inhealth tech—and is that different from your own key to success?

Bottorff: It’s important for entrepreneurs to embrace innovation throughcollaboration and not think they have to be experts in everything to bring the many pieces of the puzzle together themselves. This is a multi-functional area. You have to recruit a strong multidisciplinary team and maintain focus. This industry is being re-invented as we speak; nobody’s got the formula. So it’s important to maintain focus and persevere to understand the needs of your target customer. Those factors are very synergistic to GE’s. We also need to stay focused, and we also need to innovate, which is why we stay close to the new thinkers and innovators. In a young and small company, you can be agile and you succeed or fail in much faster cycles than a large company. At GE, we think the best way to focus on what’s next and what’s coming is to partner with entrepreneurs and startups. We aim to help accelerate their growth and help them commercialize their ideas to really move the needle. At the same time, they may have the problem that they’re not able to scale, get big, or get reach. That’s the kind of thing we can help them with and one of the many reasons why we feel like it’s so important for us to collaborate.

TEDMED: For entrepreneurs with needle-moving ideas in global health, what are the keys to finding collaborators and supporters across specialties, industries, and geographies?

Bottorff: We’re an infrastructure company that has global reach and global distribution. We see ourselves partnering with all sorts of external partners, including startup companies with great ideas for products and business entities in many of the countries we’re based in. Having operations in 170 countries, we can take the innovations that are going to be most appropriate to the right markets and geographies and help an entrepreneur do that parsing—to ask if their product is a fit for the infrastructure of a given market. So we can say to entrepreneurs, “Let’s talk about how we can help you most, because you don’t have the scale to get all markets .”

TEDMED: In 2020, you’re asked to give a TEDMED talk about the biggest transformation you helped bring about in your field. What is it?

Bottorff: GE would love to play an important leadership role in coordinating what will be an end-to-end system that delivers on the promise, and not just the hype of  “Digital Health”.

A lot of people have grand visions of how Digital Health is going to transform and improve healthcare, and that is exciting. But, getting from point A (where we are  now) to point B (the ideal future vision) is trickier than coming up with a grand vision. It’s going to require a lot of cooperation with a lot of parties and GE intends  to be right in the middle of it to help make it happen. The transformation between now and 2020 or 2030 will be remarkable.

The Hive 2014: The Next 10 Startups

As promised, today we’re announcing 10 more breakthrough startups that will join the TEDMED Hive 2014. This September 10-12 in Washington, DC and San Francisco, each will share their products and ideas for progress in health and medicine with our Delegates. Visit TEDMED.com for fascinating background info on these newly announced entrepreneurs, and to revisit the 10 startups announced last week.

Screen Shot 2014-06-12 at 3.55.54 PMScreen Shot 2014-06-12 at 3.56.09 PMScreen Shot 2014-06-12 at 3.56.22 PMToday, we’re also getting to know Hive Curator Sumbal Desai, Associate Chief Medical Officer for Strategy and Innovation at Stanford Hospital and Clinics, via our weekly Q&A blog series. She shares insights on how healthcare is reshaping itself to fit consumers’ digital expectations.

We’ll release more Hive startups next week.  Until then, follow the latest news @TEDMED.

Q2 Checkup: What Is Shaping Digital Health Innovation in 2014?

By Aman Bhandari

With 2014 halfway behind us, it’s time for a bi-annual look back at digital health innovation so far.  What have been our major influencers?

Six months is a very short time span in which to say anything is shaping a sector, but it’s also a good time frame for a snapshot. It wasn’t until I started thinking about what’s happened recently that I realized how dizzying the activity has been across the spectrum and potentially at scale. This is critical. In this year alone we are seeing some of the biggest players make bets and shifts, from the Office of the National Coordinator for Health Information Technology (ONC) to Apple, which means the digital health ecosystem will be impacted, and it could happen at scale.

-1First, look at the activity and record levels of venture funding in the digital health space; $700M in Q1 2014 alone, an 87% year over year increase according to Rock Health. This recent Harvard Business Review piece nicely summarizes why the time to be in digital health is now. There has (finally) been some chatter that we are approaching bubble territory in digital health, and while that may be true, there are at least three areas of optimism thanks to the infrastructure and ecosystem evolving at all levels: Continued Federal activity, Fortune 500/Wall Street involvement, and diversified venture funding.

1. Federal Government: Continued Data Liquidity Push
The federal activity from this year is across the board. Some highlights that will challenge entrepreneurs to develop a continued drive for enhanced data and information liquidity with an improved consumer experience over the long run include the following:

  • ONC releases 10 year interoperability vision
  • ONC re-organizes and creates an API committee. This wouldn’t have happened as recently as two years ago.
  • Medicare announces an historic data release of physician payment data revises other data related guidelines, potentially opening more access to commercial entities
  • FDA Open Data releases millions of files to entrepreneuers in a more accessible format
  • Healthcare.gov helps enroll millions of people

2. Digital Health at Scale: Fortune 500 Involvement

Following on CMS data transparency efforts, some of the largest health insurers, including Aetna, United Health and Humana, announced they will release payment data to consumers. And speaking of consumers, technology companies including Intel, Samsung, and Apple have entered in a big way, and it’s clear that wearables have gone mainstream. The Fortune 500 are paying attention and are also forming collaborations across silos, such as the Apple Epic and Mayo partnership, including:

  • Intel’s $100M+ acquisition of Basis
  • Samsung’s $50M digital health fund + S Health launch
  • The Apple Health Kit
  • Health insurance giants making payment data public

3. Startup Diversification & Investment: New Entrants

The third signal flare from 2014 to watch is the increased diversity of players including some who haven’t been as involved previously. This includes investments this year from venture funds Social+Capital and Andreessen Horowitz (a16z). Some of the new entrants are driving record amounts of funding and are bringing greater assets to bear.  Here are some highlights of startup activity:

  • Flatiron Health had one of the largest series B rounds in the digital health space ($130M)
  • Omada Health gets $28M series B lead by a16z
  • Better raises $5M from Social+Capital
  • Nant Health receives $100M from the Kuwait Investment Authority
  • 16 digital health acquisitions to date

Digital health innovation is still the wild West, admittedly, and there are many hurdles. What’s clear is that these three areas have backing from actors who can scale and bring on the best talent in the world. They’re creating a robust ecosystem that is shaping innovation in digital health. Across the board, there is a larger theme taking shape of capturing, aggregating and democratizing access to data, which is spurring entrepreneurial activity and the consumerization of health. In addition, novel cross-silo partnerships are forming. Collaboration across the health and tech sectors is no longer an option; it is a necessity if we are going to drive meaningful change in healthcare.

Which three things would you point to as harbingers for 2014?   TMIcon

 

Aman Bhandari has worked in corporate, non-profit and government organizations. He formerly worked for Todd Park, the US CTO, at the White House, where he helped to launch a variety of global and national health policy initiatives at the intersection of health IT, data, and innovation. He also co-launched the Health2.0 code-a-thon and developer challenge series. Follow him @GHideas.