Continuous Human Body Measurements Will Make Us Better

Shankar Chandran

Shankar Chandran

As Vice President of the Samsung Catalyst Fund at the Samsung Strategy and Innovation Center in Menlo Park, Calif., Shankar Chandran spearheads strategic investments in disruptive technologies with a special focus on mobile health. Earlier positions in engineering, business development, and management, as well as experience inventing and taking eight technologies through the patent process, and degrees in engineering, materials science, and business equip Chandran for eyeing early stage and disruptive venture capital investments in technologies targeted at high growth sectors including cloud infrastructure, mobile technology, mobile health, next-generation user interfaces, and the internet of things.

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

Chandran: It’s the coming together of sensors and algorithms. The human body is the most complex system out there and the only time we are used to measuring anything in the human body is when we go for our annual physical. Now, technology and market forces are converging to the point where sensors are becoming accurate enough and algorithms are becoming sophisticated enough to take continuous measurements of the human body. That is the most remarkable innovation in front of us. It never existed before.

The Samsung Gear Fit, for example, can be worn on your wrist and measures your heart rate continuously. And that is just the beginning. Imagine measuring not only heart rate, but also other important vital signs continuously and noninvasively. That changes the paradigm of collecting data about the body. And what is in the market today is just baby steps toward what is likely to happen over the next three to five years.

Here’s an example: Years ago, when jet engines were adopted, they were an incredibly complex system. They would take a jet engine down for preventive maintenance every 30,000 miles or so. Today we have hundreds of sensors in every engine that constantly measure so-called “vital signs.” The moment something varies from what is normal they take it down. They don’t want to wait until the thing fails, obviously. Consider that the human body is way more complex than a jet engine; we just haven’t been able to measure a lot of things very well until now.

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

Chandran: One of the key things for an entrepreneur in any of the new emerging health tech categories, such as digital health and mobile health, to think about as they develop their technology, product, and vision, is that it’s going to have to work for a lot of different people. We’re all different with respect to genetics, ethnicity, age, sex, habits, lifestyles, and so many other parameters that affect us. All of these things matter when it comes to doing something about heath tech. To be successful, entrepreneurs have to have a very broad vision that works for a very large segment of the population.

Does that apply at Samsung? Samsung’s success is probably the opposite: We’re a consumer electronics company. We have the ability to micro-market what we can do. We’re able to slice and dice the market and build so many variations of the same product that may work, for instance in Korea but not Japan, in the U.S. but not China. For instance, we make 100 different Galaxy phones to make it work anywhere in the world.

But it’s hard to micro-market a health tech algorithm or sensor that’s going to make people’s lives better. It’s going to have to work for everyone. So for entrepreneurial success in health tech, the vision needs to be broad. That’s a challenge that very few companies have been able to manage very well.

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

Chandran: First and foremost, the entrepreneur’s idea needs to be highly disruptive, and not just an incremental turn on something that exists already. It must fundamentally solve, through ingenuity, a problem that is very hard to solve. Collaborators, regardless of geographies, will naturally gravitate toward the most disruptive ideas.

Also, the solution to the problem needs to have a large enough impact. It needs to work for a large market. Big companies, global corporations, and established companies naturally gravitate toward large opportunities. If they see the potential for a little company that is solving a problem with a large addressable market, then that matters.

Third—and perhaps the most important key—is that the entrepreneur needs to have the ability to tell the story extremely well. New companies need to rise above the noise. Their ability to tell the story must answer the biggest questions about how disruptive they are and how they are solving a big problem effectively. If they can do that, that’s what will let them rise above the noise and attract people. In fact, the phones won’t stop ringing.

The greatest technology communicator I have ever had the opportunity to listen to in my career has been Steve Jobs. People might not know the number of times he would practice before he got on stage to present anything new. I have personally heard that he would practice at least 50–60 times before he gave a keynote at Apple’s worldwide developer conference or at the launch of the new iPod or iPhone. That tells you a lot. It says that communicating the quality of the idea and the size of the opportunity and the impact it’s going to have on people’s lives is as an important an entrepreneurial trait as it is to actually invent the thing.

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?

Chandran: Technologies will help us fundamentally change our habits to live a better life. These will be individualized technologies that measure the human body and generate data that can be compared to the population in general. It will be continuous—every second or several times a second, depending on the vital signs being measured. We will measure multiple vital signs to get insights about a person. We will use those to change habits around eating, sleeping, managing stress, and more.

As we all know, there’s $8 trillion spent around the world on health care; $3 trillion of that is spent in the U.S., primarily on diagnosing and fixing chronic diseases. If what I am predicting happens, then we prevent that spending on the chronic diseases by delaying or eliminating some of them. That becomes a big deal. That is the biggest transformation I think is possible over the next 5 or 10 years.

Chandran is a Curator for The Hive at TEDMED 2014.

TEDMED COO, Shirley Bergin, says over-50 crowd are real winners at AARP @50+ LivePitch

Finalists at the AARP Health Innovation @50+ LivePitch in Boston last week included a lab-quality DIY diagnostic kit and a smart phone that can tell when it’s user is getting a bad case of the wobbles.

Clearly, this is not your mother’s health technology, said TEDMED COO Shirley Bergin, who was one of the judges for the event.

““There really is something to the idea that today’s 50-year-old is yesterday’s 40. The way this group thinks about technology is sophisticated, from invisible sensors to wearable technology. They’re definitely ready to participate in a productive way,” she said.

Photo: Christopher Sherman/AARP

Photo: Christopher Sherman/AARP

The judges chose Lift Labs as their winner, which makes a spoon that automatically and unobtrusively prevents those with tremors from spilling food, an advance very much geared toward life quality.

The audience choice was Careticker, a web based program that helps caregivers track activities to earn incentives and to connect with other caregivers.

“Careticker is very focused on what I thought was a big theme; we’re living longer and taking care of those we love for longer periods of time,” Bergin said, adding that health tech innovation for this crowd seemed to center on needs-based items for an audience that was very much on the move.

“The psychographics of a 50-plus today is one of a very active individual, not somebody who’s thinking they’re on the last journey of life. They want to take advantage of all the world has to offer, and look for technology that facilitates an active lifestyle and promotes a good quality of life,” she says.

Shirley Bergin Photo: Christopher Sherman/AARP

Shirley Bergin Photo: Christopher Sherman/AARP

In a couple of weeks, TEDMED will begin releasing the names of startups joining its own innovation showcase, the TEDMED Hive.  After reviewing the hundreds of Hiva applicants, the AARP contestants and those at SXSW, at which she was also a tech innovation judge, Bergin says the market seems to be shifting to a more mature phase of implementation and commercial viability.

For example, while you’re still seeing startups focused on big data, it’s more focused about how that data is going to enable you to take care of yourself, manage a chronic disease or facilitate some improved state of being.  How is all of that data going to improve our health?

Entrepreneurs are also coming to terms with a venture capital pool that is finite, she says, and are delivering more sophisticated business model presentations; still mission-based, but with an eye as to how the work will scale commercially. One thing that might help:  joining forces.

“Startups are trying to approach solutions from different angles, so I hope there will be more awareness that other people are addressing the same problems. My hope is that those are going to be more collaborations as well as innovations,” Bergin said.

Case study: From research to web platform, a behavior change program that’s working

As healthcare pays ever-closer attention to programs and research that measure the relationship of patient engagement to outcomes and medical costs, one company has developed a program that delivers the golden egg of behavior change results.

Prevent is a web-based platform by Omada Health that aims to help patients with prediabetes avoid the full-blown disease. It’s a translation of results from the NIH-funded Diabetes Prevention Program (DPP) study, and encourages lifestyle tweaks like exercise and healthier eating. Participants are given a digital scale and join a small online community of some 12 people with of those of similar BMI’s, age and locales for what Cameron Sepah, PhD, Omada’s Medical Director, calls “the dynamic of group therapy in an online experience.” They also undergo an intensive 16-week online training program that includes live health coaching, and move to a maintenance program for the remainder of one year.

The company has published the results of its research study, showing an average weight loss of 5% over the course of a year, and a 0.4% reduction in A1c (a hemoglobin linked to blood sugar levels). Sepah credits the company’s success in great measure to Prevent’s design and user interface. Omada’s team includes former employers from Google, IDEO and Amazon, a fine pedigree.

Secondly, Sepah says, the DPP program – now disseminated nationally by the Centers for Disease Control and Prevention – was well validated from the beginning with its broad and intensive research. Prevent is constructed to closely follow its best practices.

“The [DPP] program itself was very resource intensive and expensive. That’s the challenge in terms of translating to the real world,” he says, adding that to date there have been some 30 translations of it with varying success rates.

In contrast, Prevent has thus far been proven to be cost-effective and accessible to socioeconomically diverse patients. Omada sells it to insurers, employers, and health systems, to whom it guarantees a positive ROI. The company recently closed its Series B funding, raising $23 million to accompany the $4.5 million it raised last year.

Going forward, Omada may venture into management for other conditions in which behavior change modifications are key, Sepah says, such as smoking, insomnia, hypertension or back pain, with the next product rollout slated for 2015.

Which Comes First, A Knockout Biz Plan or the Next Big Thing?

The aptly named Health Tech Hatch (HTH) helps entrepreneurs, many of whom are quite young, fund and test their dream projects. The company offers crowdfunding support and concept testing and feedback. HTH has advised a number of campaigns on Indiegogo.com, one a group of Johns Hopkins undergraduates competing for the Qualcomm Tricorder XPRIZE with a smartphone enabled diagnostic device. Another project is developing a curriculum for a venture classes in health innovation, in pilot with a university in the Midwest, says Patricia Salber, HTH’s founder and CEO.

Web“To date, there haven’t been academic projects that have raised big funding or gone viral, like Scanadu or Lumo Back, so we’re working to help them design a curriculum that they can use to show students how to build a business plan,” she says, adding that all too often entrepreneurs will come late to the realization that even before funding they need to consider building communities, looking for donors and rolling out public relations. Colleges are also adding venture courses to keep those who would drop out and form a company a la Gates & Co. in schools, Salber says.

What are trends in healthcare innovation?

“We’re in the era of validation,” Salber says.

“People have designed all this stuff but we still have relatively little information as to whether it works. Other folks would say it’s all about integration. We’ve built all these silos, but now what we’re seeing is people trying to figure out how to build these into a platform. I just want to look at my steps on a Fitbit platform; I’d really like everything to be in one place,” she says.

“Plus, by and large most health apps aren’t being used. We need to figure out how to really engage people. I think that’s going to happen when physicians start to prescribe apps,” Salber says.

Catalyst is an ongoing series about health innovation, focusing on companies from the TEDMED Hive. For more information about The Hive 2014, click here.

TMIcon

In Catalyst this week: Computer-assisted therapy, and an online feasibility facilitator

Mental illness is the single largest cause of disability in developed countries, even more than cancer and heart disease, says the Centers for Disease Control and Prevention. And depression in particular is under-treated in the U.S.; only half of those who suffer get help, particularly some minority groups.

We already use the Internet for countless patient interactions – why not as an adjunct to therapy? Empower Interactive, a TEDMED Hive 2013 company, developed a web-based program, Good Days Ahead, for those who suffer with anxiety, stress or depression.

“There’s a great volume of clinical evidence you can deliver some aspects of psychotherapy by software,” says Eve Phillips, CEO, who explored the potential of the technology while working as a research affiliate in the Synthetic Neurobiology Group at the MIT Media Lab.

Good Days is available in two strengths, so to speak. One is a clinical version to complement talk therapy. Roughly half of a treatment module contains targeted online education, while the other half is work one-on-one with a therapist, who can review information on how the patient is using the system.

The wellbeing version is a self-coping tool that aims to help those with mild symptoms of anxiety and depression. A related mobile app, ReThink, allows users of both platforms to record thoughts and emotions, accompanied by photos, for later reflection. Anonymized, aggregated data gives administrators feedback on user activities and outcomes.

Good Days was co-authored by psychiatrist Aaron Beck, generally considered to be the founder of cognitive-behavioral therapy (CBT). It is a treatment that examines the way that our thoughts and perceptions of situations influence our actions and how we feel emotionally. Research consistently shows that computer-assisted CBT is as effective as standard therapy, and patients using these programs better understand what CBT is and how it works. It’s more cost-effective and easier to disseminate. That’s key in an area like mental health, which is under treated in the U.S. and around the globe. CBT is also helpful for those suffering with chronic pain.

For those reasons and more, Empower has already been working with the United States Army to help enlisted personnel and veterans. They’re also working with Sutter Health and San Francisco Health Plan, and have pilot programs with other major insurers and health systems.

“Some groups are trying to integrate behavioral health into primary care, or do it in a more saleable and consistent way, or perhaps under the umbrella of under chronic disease management,” Phillips says.

Eventually, Phillips hopes to craft a program for kids and teens, too – another under-served population, and certainly one at ease with computer screens.

Building A Global Research Superhighway

“LinkedIn on steroids” is how Dr. Fabio Thiers, founder and CEO of The Hive 2013 company ViS Research, describes the web platform that helps trial planners to find investigators and sign up the perfect research center. An analytics-slash-communications tool, ViS helps planners source and sort investigators by capabilities, expertise, current trials and available patient populations, and then contact them on the closed system. Currently, some 330,000 investigators from 178 countries are represented on the system, comprising 417,000 disease-specific centers.  The data is visualized according to location.