Seemi Kazmi is currently an executive director and global lead for Digital Health Solutions at Novartis. In this role she is responsible for developing technology solutions that help patients and physicians diagnose, treat and manage disease. Seemi started her career as a nuclear physicist and in her pursuit of the cool and innovative, has explored everything from telecommunications to augmented reality at leading companies like Nokia, Qualcomm, and Amgen.
Timestamps:
1:37 - Sleep technology
5:11 - User experience's role in changing human behavior
6:45 - How do you change human behavior?
11:17 - How do you incentivize people to care more about their health?
14:02 - The role emotion plays in human behavior
16:24 - Habit forming
19:09 - Apple's consumer healthcare products
25:01 - Is it possible for a small startup to take on big pharma?
29:02 - Is innovation easier in countries with government provided healthcare?
31:06 - Interesting consumer healthcare companies
32:40 - Is the evidence burden too high?
34:47 - Is America the best place to start a healthcare company?
36:56 - Is digital healthcare just for the rich?
39:51 - Will tech companies ever take over digital health completely?
42:58 - How can someone in software break into digital health?
45:24 - Seemi's favorite piece of technology
Music by - https://twitter.com/AdiSoundsGood
Seemi Kazmi is currently an executive director and global lead for Digital Health Solutions at Novartis. In this role she is responsible for developing technology solutions that help patients and physicians diagnose, treat and manage disease. Seemi started her career as a nuclear physicist and in her pursuit of the cool and innovative, has explored everything from telecommunications to augmented reality at leading companies like Nokia, Qualcomm, and Amgen.
Timestamps:
1:37 - Sleep technology
5:11 - User experience's role in changing human behavior
6:45 - How do you change human behavior?
11:17 - How do you incentivize people to care more about their health?
14:02 - The role emotion plays in human behavior
16:24 - Habit forming
19:09 - Apple's consumer healthcare products
25:01 - Is it possible for a small startup to take on big pharma?
29:02 - Is innovation easier in countries with government provided healthcare?
31:06 - Interesting consumer healthcare companies
32:40 - Is the evidence burden too high?
34:47 - Is America the best place to start a healthcare company?
36:56 - Is digital healthcare just for the rich?
39:51 - Will tech companies ever take over digital health completely?
42:58 - How can someone in software break into digital health?
45:24 - Seemi's favorite piece of technology
Music by - https://twitter.com/AdiSoundsGood
The most interesting one that I've seen is is actually a cure for a treatment for lazy eyes. No, a lot of kids are born with the two eyes that don't have binocular vision. You know, they work kind of independently of each other when they should. So what this company is doing is they created a game a game, they gamified it. They worked actually with the gaming company, you'll be solved, I think. And they said let's create a game that exercises that forces the eyes to align. So it's a video game out, literally looks like a video game, but they have proved that it will actually fix your lazy eye. So thank you very much for joining us. My pleasure and very honored to be here. so just to start with, I wanted to ask you about something which is very near and dear to my heart, which is sleep. Vasanth. And I have had some debates about whether, you know, there's all these companies that sell mattresses. They'll give you a better night's sleep and all these sleep trackers that are on your arm. And we've had some debates about whether you could actually get like nine hours of sleep in seven hours with these new pieces of technology. I personally don't believe that's true. What do you think? Are you bullish on this or bearish? I don't know yet. I don't know yet because it's, it's a little complicated. It's a matter of the technology can only do so much, right? The technology can help you pick up what's your sleep patterns, right? So it can help you. You wear all these sensors, you sleep on the mattresses that are sensing how long you're sleeping. What's the quality of your sleep. Do you move around too much? Do you snore, et cetera, et cetera. And it can help you create a pattern of your sleep habits. There are, you can also look at evidence and based on the evidence, you can create apps and other kinds of software that can tell you how to behave so that you can make your sleep better. Right. So if you're, if you're sleeping, You know, really late after midnight and your sensor picks that up. It might give you a nudge that, Hey, you might consider having an earlier bedtime, but to really, for you to sleep the nine at 10 hours, you have to follow that advice. And. As humans, we are notoriously irrational, you're notoriously international, especially when it comes to things that are you know, to do with our help and to do with our financial wellbeing, things like that, things that are really important. We rarely follow the, the, the good advice on that. So that to me is the bigger problem to solve, you know, to have that behavior modification that comes out of nudges. Now. Today, there are a lot of There's a lot of technology. There's a lot of software, a lot of mobile apps that do a pretty good job of understanding human behavior and therefore trying to modify it. But I haven't seen anything that's highly, it's been highly successful at changing human behavior. There really isn't a great habit building app, which is, which is what you would meet. Right. So, which is what you would need that, that really understands why you behave a certain way and then give you that actionable insight on what to do about it, to change that behavior. Once we close that loop from understanding our sleep patterns, to getting the proper nudge, to actually acting upon the nudge. It's getting better. Right. I actually read a book by this by this very prominent sleep scientist at Berkeley and in Matthew Walker, he wrote this book called why we sleep. So he said in it that most Americans only get like six hours of, of decent sleep at night. And it's not because they don't get in bed for eight hours. It's because they just blast their eyes with blue lights because they drink a cup of coffee, like three hours beforehand. So. It does make sense. It does make sense that if you can actually have data that says like, Hey, like you're in bed, which we're not actually getting good sleep, then that insight could at least in theory, prompt better behavior. Yeah. I've been thinking about the Berlin and FinTech, right? If you have a great banking app, which, which a lot of them are now, which gives you your spending patterns, right. You can look at it and with great data visualization, you can look at it and go. Dang. I didn't realize that I, I spent so much of my money eating out. And then you might do something about it yourself, or if the app is even better, or if you have another way of, of reminding you in the moment that the next time you're going out, it senses that you're blowing out and tells you stop. You know, you're, you're going to regret this. This is going to blow your budget. That will drive real behavior change. Right? So it's the same with helpful behaviors. You know, if you have, if you have the right insight and you have an aha moment, you'll be that much more motivated to change your behavior. I definitely agree with that. I think that like billions of dollars of startups have come out of like, not necessarily brand new technology, but UX solutions like Twitter is nothing but a UX solution. Slack is nothing but a UX solution. And I say nothing, but as if that's a small thing, but it's a massive thing. It completely changes like how human beings interact with the world. Yeah, no, I, I you're, you're talking about a subject that I'm so passionate about. I always see I'm a, I usually say I'm a technologist, right. But actually I'm not, I'm actually much more passionate about the use of technology. Right? How do people use it? How, how do you design it so that the impact of technology is even greater that the intended use actually drives. The expected output, right? So the technology is almost, you know, it's just it's just the infrastructure, right? It's what you do with the technology. That's more important and, and how you, how you design it so that do the end user, the technology should be invisible, right? So it's not so much that technology for technology's sake, but the it's it's, as you said, it's the user experience of that particular technology. So, how do we solve this? How do we solve these problems? You said that like you, you know, these apps will tell people to go to sleep at this time, but they won't actually listen to it. So what are some ways that this can actually succeed in digital health? It's the holy grail, right? How do you change human behavior? It's it's not, it's not easy. You'll see a little bits of brilliance and the more you personalize it, the more you understand individual drivers of human behavior, the better you can be at designing technology. Right and designing the solution. So in digital health, I'll give you a very common problem is on adherence to medication. You finally went to a doctor, told them your symptoms got a diagnosis. They wrote you a prescription. You'll take it the first two days, and then slowly your habit starts deteriorating. And the number of people who are what we call nonadherent or noncompliant to their, to what the doctor said about taking the medication about, you know, lifestyle choices, et cetera, is tremendous 50% of the people in many areas in many fairly significant diseases fall off treatment. Or they'll start delaying treatment and it's not always forgetfulness. So non-adherence is not really a problem. It's the symptom of something that's going on in their lives. Right? So some people might have beliefs about medicine saying, eh, I don't think you know, this, this has too many side effects. I'm sure this is poison. I'm not going to put stuff in my body. That's poisonous. I think my disease is fine. It could be completely erroneous, completely erroneous in that case. It's a different solution than somebody who just forgets. Right? So somebody like me, I just forget to take medication on time because I'm not disciplined. So for me, a timely reminder would be a highly effective solution in getting me to change behavior. But for the person who has believed that, you know, I, I don't really think this, I should be taking this I'm okay. Even though the doctor said, so. Then there is you have to treat it differently that the design should push perhaps proper education for them, you know, and, and maybe connecting them to people like them or people that they trust telling them more about the drug or whatever. There could be some people who without telling their doctor actually find the copay too expensive. So for them, if you send them a reminder, they're only going to be more upset about it that, Hey, stopped reminding me that I have to take this every day. I can't afford this. Right. I can only afford to take it every other day. In that case, perhaps the solution is you, you showcase some of the financial programs that companies offer government software, et cetera, that they may not be aware. So the, the point is that. It has to be that much personalized. The intervention has to be personalized. It has to be at the right time. It has to be using the right channels. Some people respond really well to SMS messages, others respond to their, their child picking up the phone, calling them, right. So somehow you have to really talk fully create a very individualized solution for them. Very difficult to do, but we are heading towards that. You're heading, we've already had it to where we already have personalized medicine, right? People are doing, finding out exactly what genetic makeup you have and therefore you should be using this. Therapy versus that. Similarly we are getting better and better with the AI and machine learning algorithms, but understanding human behavior and even predicting as I had as working on a project where we were developing an algorithm, which we. We're predicting, who's going to drop off the treatment after the, you know, out of the a hundred people, which ones would drop off because it's a machine learning algorithm and based on multiple inputs, you could start seeing patterns. If you have great data. There are large amounts of it and smart people looking for signals in that data, you could perhaps pick up enough patterns to figure out, ah, this person they're respond better to this message sent by this channel at this time. And then they'll do something about it, right? It sounds almost like you've built an algorithm that tells you the people that are the most self-destructive. Yeah, I guess. Yeah. I think there's like some very obvious parallels. I mean, I think it just extends beyond trying to change human behavior to help other humans, like, let me change your behavior so you can help yourself is such a hard thing to do. Even, even in if you look at like the financial markets, all the apps that are being developed to help people trade really the, they sort of incentivize self-destructive behavior. I've talked to farmers about this a lot, but it's like, I I'm not even certain that it's a UI. Whether a UI fix will help people change their behavior. I think it's like an incentive issue, which I think you mentioned what would you say are sort of the best incentives to that? That actually change human behavior? This will incentivize you to not be self destructive. Is there something like that in the digital health space? So that's what we look for. So in patients, what we are finding that if you tell them, Hey you will get better. Your blood pressure will drop by this much. And your, you know, this particular LDL will drop, will drop by this much. If you stay on treatment, that message doesn't always resonate. What resonates is something deeply personal? So, you know, for somebody who has a heart condition, let's say, and they have a hard time keeping on medication, they respond better to their own metric and say, you will, you have a higher chance of attending your grandson's graduation. If you take this medication versus not. Right. That resonates. That's a big driver for them because that's really personal. So again, everybody's motivation and drivers are personal. That's why it's so hard to solve. So not everybody thinks about how I'll do better, because look, my LDL will get better. They have different metrics that they measure. So people who have mobility issues. Every time we talk to them about, you know, certain validated biomarkers that, oh, this particular level of this biomarker in your blood is reducing and your RH factors reduce. It didn't mean anything to them. We told them, Hey, do you remember that? You used to be able to walk the dog one block. Now you walk at five blocks and they go, oh yeah, that makes sense. Yeah. My medicine is working. So that drives. Motivation is very different and it's very personal and that's why it's so hard to design for. But, but if you can personalize that motivation for someone like me, I don't, I don't respond not deliberately, but I don't respond well to Hey, you'll feel better. I respond better to, Hey, you, you need to be better to, to be better for your, to be able to help your kids. Right. So it, it, to me, it's a little bit more external, so it really depends on your personality type. And what drives you? I think this kind of goes back to the UX thing that I was mentioning earlier as well, in the sense that like Facebook has absolutely dominated adherence. Like I think the average person spends like two hours a day or something insane like that on social media, Facebook, Twitter, Instagram, whatever. And they employ a lot of, kind of maybe dark shady tactics to do this, but a big one that they use is emotion. That's why they show you stuff that gets you angry or gets you excited or joyous. And it, yeah, it kind of sounds like you guys are. Maybe employing some of the similar, similar techniques, but for good, rather than for lining your wallet. Yeah. I mean absolutely. When you design for behavior change you have to connect with the emotion. Right? Most of human behavior is driven by us feeling good about ourselves doing something. If it doesn't make you feel good, you're not gonna do it. Right. Most people don't stick to exercise regimens because it's so darn painful the first few weeks it's so uncomfortable, right? If you get past that threshold, you start feeling good. You've got that endorphin rush in and things like that. Apparently it becomes addictive. I said, apparently because I haven't been, I haven't treated that, that threshold. It's always painful for me. So people will do things that make them feel good. So for Facebook and that instance. The number of likes, they were getting the number of people responding or commenting to them about things that they posted is a huge driver. You feel good? Oh, I got noticed, right. Similarly able to express your anger about other things and your frustration, et cetera, by, you know, commenting randomly on things and, you know, making angry faces. It also makes you feel good. You know, you got to let out all your angst. So, so they, everything has to tap into behavior. That's why, I mean, you have to have been doing the designing helpful products and helpful technology. You really have to be with really very empathetic to the patient. It's it's it's consumer technology is actually easier because most consumers will, as you said, you know, 90% of behavior will be the same. Most people feel really good about being able to get noticed and in when you're a patient you're dealing with so much else, right. You're, you're dealing with the disease burden. In addition to being irrational human beings. So it's that much harder to have empathy for the disease burden and what it's doing to the life, to their life. And also to kind of figure it out that they're not just a patient and most of them don't want to be reminded of their sickness. They want to be reminded of their health. That's. All of that has to factor in, into designing a good digital health solution that, that that can actually drive behavior change and have an impact on, on their health outcomes. So are there any kind of like takeaway home tips for this, like, forget building something digital, but just what you've learned about habit forming. Like if you wanted to stick to some exercise program or follow some good diet, like what techniques would you use to self motivate that like I could employ a restaurant could employer, our listeners can employ. It's, it's fairly well known now because of there's. So many people have been working on it. You have to divide, you have to set a goal, an achievable goal. So there's a target goal that you have to help the person set. Right? And then you have to divide it up into small achievable steps and, you know, help them. Get to their final goal by, by these incremental steps so that they feel successful at every stage. That's number one, you have to constantly remind them of why they are doing that. So what is that inner motivation? So if their motivation is to attend their daughter's reading and therefore they need to feel better by then by next year, keep reminding them of that so that they stay motivated. You have to do it in such a way that they feel supported. Right. So for people who are, who need that coaching and that constant support coaching really works. So whether it's a human or it's a, or it's a chat bot doing the coaching, it just depends on the person. That's really powerful too. You have to design a coaching program, a coach that's constantly encouraging and. You have to tell them if you fall off the track, it's okay. It's okay. You'll get back. Right. So that they don't feel like complete failures at any point. So there's a bunch of things, but the first and foremost is to help them understand what things are getting in the way of them not achieving their goals. You know, so that the collection of data, we are using sensors, et cetera, and visualizing it for them. This is what you actually do is a huge motivator. You know, they themselves go, my God was I really spending. Four hours a day of sitting on the couch, watching TV. I can't believe it. Right. So I didn't think it was that long. And so once you start looking at that you, you, you can get a better sense of the design. So apple has done a pretty decent job of driving healthful behaviors with the apple watch and, you know, closing the rings and all that. This apply a lot of those principles. The data visualization is really simple and, and. You know, immediate, so you have to keep it simple. Don't make it complicated. Don't make it seem hard to then just be kind of positive about it. Great example. I, at first I, I found the stand-up every hour notifications on my apple watch to be like the most annoying thing in the world. But once I closed those rings and got those really fun animations a few times now, like I'm chasing that high every single day, right? Yeah, exactly. So speaking of apple, I think they're making, I've heard, they're making a lot of plays in the, in the health space. So can you kind of expand on what exactly their role in this? Yeah, so it was interesting deal a few years ago. Let's say 10 years give or take, right. It's been 10 years now. I can't believe it. Well, the, the use of technology in health care or rather sick care, you know, we call it healthcare, but really we it's sick care, the use of technology and healthcare. Can we, sorry, can you, can you expand on that? Like what do you mean by sick care versus healthcare? So, so when I think about the healthcare ecosystem, I'm thinking of doctors, I'm thinking of pharmaceutical companies, et cetera, right? So these are not talking. Actually, if you think about, are they taking care of sickness? They're not care of health as such what we call. Health care actually takes care of sick people. Right? And the other piece where you're promoting healthy habits and prevention of disease is doesn't fall under the, probably more like I've heard that's more effective. Preventative care is better for you than, than like reactive of course. But think about it. How many times would it, would your doctor, would you go see your doctor and get prescribed? I'll go to the gym five times and be monitored, right? It's it's we do take care of, we do. You know, we've got our language mixed up here, I think. But apple was so the use of technology helped the healthcare ecosystem. Let's say all the players in the healthcare space, doctors, pharmaceutical companies, nurses insurance companies, not early adopters of technology, not early adopters, they're way behind the way behind it, the adoption of, of cool technologies. So. But about 10 years ago, all that changed, right? Everybody decided that, Hey, you know what, we can't, we can no longer just be prescribing drugs. We, it has to be more holistic because we're spending a lot of money and it's costing our healthcare system, a lot of money because people are ending up in hospital and having all these challenges. So we have to do more. We have to do more preventive preventive care, as you said, and we have to also make sure that once a person has been diagnosed with a disease, ensure the best possible outcomes, because not only is it better for the patient, it's actually better for the entire healthcare ecosystem. It's cheaper, right? For overall, it's cheaper to keep people out of hospital and maintained and, and, and on a healthier path then B that have them admitted in the hospital. So when that happened The tech companies started going, Hey, I can do stuff. I know technology. I can do a lot of cool stuff here. So they started getting into the healthcare space and then pharma companies, I worked for a big pharma. We started going, oh, I can do technology and I can, you know, so, so all the, all the technologies wanted to become healthcare people and the healthcare people, pharma, et cetera, wanted to suddenly become technologists. So apple was one of the first ones because they had hardware and they had software and they have a fan following of their products there. So they've a beautifully poised to make a difference. So a couple of years ago, Tim cook, I don't know if you guys remember. He even said I think it was 2019 is talking about the apple watch and other services coming up, that if he looks to the future, he will he predicts that apple will be known for making the biggest difference in healthcare. Which at that time was like, wait, what? And then you started looking at the investments that we're making and what they're doing is actually, it's actually pretty phenomenal because they have the reach, right? So to be able to influence lots of lots of human lives, they have the fan following the habit captured patient. Patient population, right? So they do not have to reach out to two people and force them to adopt anything. People already use their products so much. Right. So what they do is what they've done in the, in, at recently is They've added more and more health related features into their products. So the apple watch it has it has all kinds of sensors in there that can predict even heart conditions and pick up and diagnose heart conditions. Before the patient themselves is aware that I might have an issue. Right? So one of the, so there they're started partnering with a lot of pharma companies. They did a lot of health study and, you know, apple health study with millions of people at bear. They're collecting data through the sensors, in their watch and through the demographic data for the, from the use of their phone and based on all that. They can, they're coming up with algorithms that are pretty good at predicting certain diseases, they're diseases or disorders or conditions that can be picked up. Depression can be picked up. As I said, heart-related a lot of things can be the sensors can sense. They're starting to actually have go into the space of medically regulated devices, right? So you're, you have to get an FDA clearance. If you're going to say, Hey, I can predict heart failure. But you have to have, you have to get the evidence and show it to the FDA. So that's happening. So I think that they're doing a fairly good job of this. The, the, where I think they can do better is. Working in the regulated space, because at, at its heart, apple is a, is a consumer company. And they'll have to work with the FDA and with with the regulating bodies to make, to figure out how do you regulate a consumer device, which has so many medical features in it, because almost everything gets regulated as a medical device. And then it's really difficult to update it and to test it and to produce all the right evidence, et cetera, et cetera. I wanted to talk about that because Yeah, sort of, sort of, one of the hardest things about building in healthcare is because the biggest bottleneck being the regulation, you have to go through all these sort of watchdogs and the FDA you were mentioning. And so for us and I always talking about, well, when is the quote, unquote two guys in a, or people in a garage going to build the next great software company. Is that even possible in the healthcare space? How are you going to go up against the sort of behemoths that are no other way around all these regulations? It's possible. If you partner with the right people, that's the business model. I've seen a lot of the startups take. They, they have a great idea that really innovative. And I work with a lot of startups, right? Because the real innovation comes out of this kind of passion that people have. So, what they'll do is, and there's a lot of investment money right now flowing into digital health, a lot of investors and kind of, sometimes it cockamamie things. You go really, they got, they got funded for that idea, right? So you will always get seed money if your idea's good. And if you can show value. Right. So the question is now, how far can you take it as two kids in a garage? You have to start getting in and talking to people and leveraging the external partnerships. So that's, that's a very common business model. So I rebook with a lot of startups. They have cool ideas. We know the FDA, we know what it takes to do clinical research and to produce the evidence that's required by the FDA. And it's a win-win. So, so what happens is these partnerships made in heaven, but they're not always successful because, you know, if you're talking to a large company, there's a lot of bureaucracy. There's a lot of things like that. And, and smaller companies, just the startups with two kids in a garage have a very different mindset. So it has to be done carefully, but that's one Bible will do it. The other way is if you start showing incremental value, you know, so if you start showing incremental value, you will get the investment. So I have a lot of examples of companies that are, can you give us, can you give us some something you'd like to highlight? Yeah. So there's, there's there's a few different companies. There's one that we worked with in the heart failures. Young peoples decided that let's start collecting data of all kinds, temperature blood pressure, heart rate, heart rate, variability, and weight, weight, gain shortness of breath, things like that, whatever we can collect and see if we can figure, feed it, to do an algorithm and figure out if it's heart failure. Right. So figure it out and, and, and be able to predict heart failure before. It becomes really apparent. So there's a company called bioform. This has a lot of good AI algorithms. They just have a great credibility because they partnered first with the right academic institutions to, to went to the really credible institutions and Did studies with them first they're smaller studies that perhaps don't require as much of an investment. And then they started talking to other bigger companies and other bigger investors saying, Hey, we do a larger study than perhaps this this particular algorithm that we're using might get widespread adoption. And, and the journey continues from there. So there's a, quite a few companies like that. It's a hard field only because of there's so much uncertainty around how, what is the exact business model? How do you make money? You know, who pays for this? Did that's the harder problem right now? You know, people have a lot of ideas. What is unclear and what you don't have control over is who pays for this stuff. So would a patient. Pay for something. Patients are so used to their insurance companies, paying for everything, and they're paying just a small copay. That's psychologically you, if you tell them, oh, this will help with your heart failure. The first thing they ask is, wait, is this covered by my insurance? And insurance companies are harder to convince. Doctors are harder to convince is this recommended by my doctor? That's the other question? Right? So those are some other aspects that will prevent people from building a successful business and that have to be sorted out. That whole thing is just being sorted out. Would this be easier in a country like Canada, where they have government provided healthcare? Well as long, but then you have to cover the government, right? The government is still the payer. So you have to, who is the payer? You have to convince them. So it either has to be the patient it's actually easier. And whether their self pay. So where people in countries where people are so much used to just paying out of pocket for medicines, they'll go. All right. One other thing I have to pay for, for being healthy. So they're there. The psychology is a little better to overcome. But in countries where you're used to somebody else. Paying a majority of your costs, either your employer or your insurance company or the government, it becomes much harder because now you have other people to convince you have got the whole ecosystem to convince that, Hey, that, so this is, this is one of the challenges in digital therapeutics. So It's a relatively new area where we are not just saying in digital health where we are not just talking about solutions that you give in combination with the medicine. You're actually making claims that the software is the medicine. Right? So it's yes. And imagine the evidentiary burden there, because now you have to show that the piece of software, somebody using the piece of software compared to somebody who's getting the standard of care. Right or not using software, but getting the normal, whatever treatment they get is will do better because it, software is actually curing whatever disease. So exactly. Yeah. Yeah. So this is for like mental health things or it's also for physical elements. It could be for physical elements, especially for physical ailments as well. Right. Because mental health is great. Right? Mental health is the obvious one. Because meant a lot of mental, mental health related conditions can be treated by counseling. Now whether the counselor is human versus AI, if your AI is really, really good and you're using the same principles of cognitive behavioral therapy, et cetera, the standard psychologic psychology principles that that that our counselor would use. You know, it, it will be effective. So that's one area. The other area of physical is a lot of things can be solved with physical exercise. So, so things that are more actually physically structurally you know, effecting your structure you can provide the same kind of. Physical therapy to an app and you could through through digital means than you would through having them go to a physical therapist. The, the most interesting one that I've seen is is actually a cure for a treatment for lazy eyes. No, a lot of kids are born with the two eyes that don't have binocular vision. You know, they work kind of independently of each other when they should. So what this company is doing is they created a game a game, they gamified it. They worked actually with the gaming company, you'll be solved, I think. And they said let's create a game that exercises that forces the eyes to align. So it's a video game out, literally looks like a video game, but they have proved that it will actually fix your lazy eye. So there's a lot of things like that. Similarly, ADHD, you know, with ADHD, there's a, there's a, there's a company Akili interactive. That's done clinical research to show that there. Quote unquote game, but you know, it isn't really a game it's, it's basically software as a therapy. We'll train those areas of the brain that can help people focus better. No. So, so it's like with neurofeedback and those mechanisms it's based on solid science, but the manifestation is instead of eating chemical, now you're making those same changes in the brain, but using software. So yeah I think going back to this idea of having a really high evidence burden that the FDA requires, or a lot of these sort of companies require. Is that a good or bad thing? I almost feel like having the bar be set so high would disincentivize people from even attempting to solve real problems. I like the idea of solving like ADHD or lazy eye, but you know, like the really big sort of inherent problems that exist within large, large societies. Yeah. Is evidence burden too high, but you're risking people's health too. Exactly. Exactly. I think the evidence burden is high because the cost is right. If you, if you don't have, if you can't prove safety and efficacy to to a high standard, then you might cause harm and in healthcare, that's what you have to be aware of. Right. So if you're, if you're. If you have a bug in software and in a mobile phone and it drops a call, no big deal right here, it could kill people or, or, you know, that's at its at its worst case. Then you start to start, have to worry about, Hey, what's the evidence. So yes. We, we always, as pharma, we, as a pharmaceutical working for a pharmaceutical company, I always feel like, yes, it takes forever and sometimes frustrating, but I can totally understand it. I think that there needs to be a standard of evidence, truly burden. If you're claiming it depends on what you're claiming. You're claiming that your, that your piece of software is curing disease. You have to, you have to be pretty sure that it is. I think that's a, well, I think that's a good answer. Like since I've been developing software for some time, I think most other software engineers would agree with me that. Once you read enough software, you realize how crazy it is that we're depending on other software developers work for like driving a car or like flying an airplane. Like that's some code somebody wrote, they probably Googled answers and copy and paste it from stack overflow. And we're like, depending on that for our lives. But the reason we can is because they have these. Yeah. I, I think, I think regulation is important. The more, the more you like the more code you write, the more you realize, like we should have more. So let me ask you this. See me. If you were starting a digital healthcare company today, is America the best place to start it? Would you go somewhere where, like, if you personally wanted to create a company that made money help people, is America the best place to start it? I don't see why not, you know, we are. We are one of the most innovative nations in the world. We are risk takers. So I, I actually think that we can drive. So evidentiary burden is important, but the other thing that's important is that you have to right size, the evidentiary burden don't make me produce. You know, mountains of evidence that something works. If all I'm doing is reminding a patient because see, what's the worst that can happen. That I send them a reminder of the wrong time. Right. Big deal. Right. So, so in those you have to right size the risk with evidentiary burden. If I'm creating like something that would affect their heart or their lungs or something like that. Great. Hold me to a high standard. But if all I'm doing is very slight modifications in their habits, then you have to right-size that regulation. So the good news is the FDA is actually working very hard and understanding how to regulate digital software that is closely tied to diseases in the right way. So that's why I think it is the right place to start a digital health company because you'll get the investors are here. The risk takers are here. People are willing to put their money where their mouth is. So you'll get a lot of. You'll get a lot of encouragement. You'll be had credible testing test beds. So all the most of the big healthcare systems and universities and the, and the culture of research and, and really high quality research all exist. So I actually think this is a wonderful place. I think digital health solution developed in the U S as a higher credibility than in a country where the regulations were relaxed because you know that you've met a higher bar. So you have a higher chance of making an actual impact on a patient's life. That's fair. Totally fair. So, one question I did want to ask is with regard to digital health particularly apple they have all these incredible sensors and all this incredible technology, but not everyone can afford an apple product. So as digital healthcare, just for the rich. Sometimes I do sometimes feel that we are solving first world problems. But apple is, is not the best example if you're talking about affordability agreed, but there are a lot of solutions that are really, really inexpensive and they are actually meant to be deployed in the underserved areas of the world. So I was. Blown away by some of the really great work that a small digital tool can do in tuberculosis, for instance. So there are all these remote villages let's say in Africa or in Asia where it's very difficult first. There's not enough hospitals. It's not enough doctors. So what happens is you've got somebody going on a mobile clinic trying to diagnose people with tuberculosis, and then there's. The added issue that first you have to diagnose them. And then the treatment regimen is fairly intense. They have to be on all kinds of drugs for six months or so. And you have to monitor whether they're making progress or not very, very difficult in an underserved area, but under-resourced area. There is a digital, there are several digital solutions where the, they run out AI algorithms and machine learning algorithms to to kind of pick up signals of tuber closest. We are just how the patient cops. So they can pick up a phone and a doctor in a central place anywhere in the world can listen to their cough and the AI will read it and say, tuberculosis, this cough is due to tuberculosis, versus that it can also pick up whether or not the treatment is working. If the cough is getting better, just because it gets the digital signature of a tubercular cough versus other types of cough that is life changing for these areas. So. There are, I don't know if apple is the best example for four, but digital health is actually should. The maximum impact is it'll have is in these underserved areas. This technology is relatively cheap, right? Humans, doctors. And human resources are expensive, right? Specialist resources are expensive. Technology solutions are the great equalizer, right? Everybody in, in, in a lot of countries, data is become very, very inexpensive. Everybody has a cell phone. So using the cell phone as a means of it, doesn't have to be an apple phone, but using a cellular phone as a means of delivering healthcare through different technologies is going to be really impactful. If the, if the willingness is there and it is, I mean, there's a lot of. Lot of initiatives in Africa and other underserved areas that is doing that. We have deployed a lot of digital health solutions. I think so technology has this sort of great pulling power that over time it tends to begin, you know, it goes into like some sort of new industry, it builds some new innovations and then before, you know, it they've taken over the industry. We're seeing that with Hollywood right now. There's any number of examples. And so if we look at sort of the digital health space right now, the big tech companies like apple and the Googles of the world, maybe in terms of like the total GDP being built. In the space, they take up 5% and the remaining 95% is being done by I dunno if this proportion is correct, but the remaining 95% is being done by the existing sort of big pharma companies, 30 years from now. What does that proportion look like? Where does tech stand up against the big pharma companies? I don't think that it's tech versus big pharma. Really. I think it's tech versus. A physician. Hmm. So there is the tech will produce algorithms, very good algorithms. It's already producing algorithm that can diagnose disease that can produce treatment regimens and also treatment plans, and then provide the continuous care continuum to keep a patient healthy as possible. So there is that. A lot of discussion going on in the space of is it is an AI bot going to replace a physician. So that's, that's been debated forever. And I don't think, I think it's a matter of how you view it right now, at least in the short term. I think I think of tech as enhancing the position's powers. Right. So giving them additional information, additional knowledge, making their life easier eventually ever evolves to get the same kind of you know, features, et cetera, that, that experience and common sense and empathy that a human has that a human physician has. I don't know, but that's way into the future in the short term, I don't, I just see tech as being highly helpful in, in removing some of the inefficiencies that are inherent in healthcare right now in optimizing healthcare. That's the first thing that it should do and is doing now right. Slowly. It didn't. That is pretty slow. DEC versus pharma currently, the way we use the pharma's core businesses creating is making medicines right now. Our drug discovery process is very slow and very labor intensive and time incentive and resource intensive. That is helping a lot there too. It's helping us identify targets to and what kind of molecules to create. It's making our manufacturing, operations faster R and D operations faster or clinical trials faster. Will it ever replace it where it can, you can create a model of of of a compound and then create a medicine out of all. That, to me sounds very futuristic right now. And so futuristic and I mean, I'm sure it'll happen, but it's so futuristic that I feel like we shouldn't be worrying about all that right now. Let's use tech for good and optimizing and helping get better patient outcomes today and tomorrow we'll take care of it. So let's say that one of our listeners is software engineer and they hear this and they say rather than making my own social media app, I want to make something good for my legacy and for the human race. And I want to work in health and digital health. What advice do you give to them? Who should they link up with? What should they start reading about? How do they do this? So get educated is the first thing. Right? And then there isn't anything. I think, keep that motivation alive if they're doing it for the right reasons, right. They're doing it truly because they feel like I need to leave a legacy and leave something behind. They're already way ahead. Like they're already way ahead and they're already poised for success. So all they have to do is now kind of use this motivation and use this drive. To, to get educated and into what are the real patient problems to solve, right? What are those things that really make an impact and start small, choose one thing and usually choose something that's really personal to you. If, if, if you live in there's a lot of digital health solutions that came out of somebody watching their grandfather struggling through a condition, right? So choose something personal. If you can choose that and want to work in that space, that would be fantastic. I do you are, you have a very high chance of success. I think working in pharma is a great way to go. I think working in health tech, meaning the, the health or life sciences side of big, technology's a great way to go and help and working in the intersection of these two is the ideal way. You know, where you're looking to see where is big tech partnered with. With pharma and biotech to make really cool solutions right. And working in that space is, is always a good thing. I don't know. I haven't really given it too much thought about. Digital health. I just don't see it as very different than any other career. Right. Other than the motivation part, it's just the use of tech in a space that in a new space it's, it's the use case is different. So get really if, if, if it's a software engineer get really good at software, it's really good at the user experience and then go for it all comes back to user experience. I, you know, I love this and I'll always start and end on that. Well, I think that's a great note to wrap things up here. So to start our final question that we wanted to ask, what is a great piece of technology that you want to highlight that you think is one of the most interesting, fascinating, best piece of technology you've encountered in recent memory or even of all time? It could be software, hardware, and whatever, whatever floats your boat. Okay. If it's software, I would hands down, hands down, say the Google search engine. And it's probably an answer you've heard before. And that's because I think it was truly transformational for everybody. Right. For everybody, everybody Googles, everything. Right. And it has become part of your vocabulary. So I think that, I think attracts, I think it's by far the number one piece of impactful software that everybody uses in their daily lives. That's our episode for this week. Thank you so much for listening. Make sure to subscribe to us and rate us on Apple podcasts. We would really appreciate the support. You can also follow me on Twitter at F Z from Cupertino and Busan. The ad next facade. See you guys next week.