Category Archives: entrepreneurship

cool, data saving lives, entrepreneurship, healthcare, rapid learning health systems, research methodology

His Brother’s Keeper – The PatientsLikeMe story

Heyworth is the founder and former CEO of the ALS Therapy Development Institute (ALS TDI), a non-profit biotechnology organization driven to developing treatments for amyotrophic lateral sclerosis (ALS). The first half of Heyworth’s talk focused on his emotional motivation for ALS TDI, which began when his younger brother Stephen was diagnosed with ALS. Heyworth’s investigation into the options available for managing his brother’s disease revealed a disturbing fact: as much as 80% of ALS research outcomes could not be replicated, making much of the support for ALS clinical trials statistically unsubstantiated.

Heyworth raised the question of how we can move forward when there are faults in the data at the heart of our assumptions. The fact that ALS, considered one of the best-researched medical conditions, might have no real supportable data drove Heyworth to establish ALS TDI in 1999 with the aim to champion a new model of disease research based outside of academia and for-profit organizations. Heyworth’s story was captured by author Jonathan Weiner in His Brother’s Keeper and by the PBS documentary So Much So Fast.  Heywood’s discussion also touched on his work as co-founder of PatientsLikeMe, an online resource for disease-specific medical information. The tool allows patients to track their diseases and share this information with others dealing with the same conditions. PatientsLikeMe disrupts the current system of clinical trials with patient-driven databases that provide insight into the efficacy of specific treatments.

Taken from: http://www.medgadget.com/2013/11/futuremed-day-4-the-end-of-the-beginning.html

entrepreneurship, healthcare, musings, quotes & aphorisms

Advertising… the original Cognitive Behavioural Therapy.

The more I look at and think about cognitive behavioural therapy, the more I become persuaded that it is way less complicated than it sounds, but at the same time, quite a powerful way to change someone’s mind and/or behaviour.

In an odd way, it’s like academics and researchers are catching up to business, discovering that it’s possible to influence thinking in others using methods such as speaking with people, or sms’ing them, then applying the term cognitive behavioural therapy, when in actual fact, it’s just advertising (or promotion, or whatever well-worn and proven marketing modality best applies).

complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, meaning, musings, nutrition, policy, quotes & aphorisms, rapid learning health systems, research methodology

The behaviour change arms race…

Behavior change is difficult, but to date it has dominated by industries, such as the processed food industry, who have mastered the art of mass market behaviour change through a withering combination of product research, development and engineering, marketing, advertising and promotion, all founded on an unstoppable and lucrative business model. At this moment in history, industry is the unopposed, global behaviour change super power. Serious capital investment with serious returns but with the unfortunate side-effect of producing a global epidemic of non-communicable disease.

The institutions charged with protecting the public’s health have been caught flat footed. Rather than trying to neutralise industry’s behaviour change efforts, medically-dominated health systems have instead chosen to layer their own lucrative pharmaceutical and surgical business model on top.

Doctors quite legitimately pay lip service to the “diet and exercise” mantra because they know it doesn’t work. And why doesn’t it work? Because anyone can say eat healthier food and exercise, thus making it difficult to justify their years of training and high fees. It’s much better for doctors to note “diet and exercise”, but then pump the drug and surgery options.

So what needs to happen?

A countervailing super power must be established. Not one founded around a powerful business model, but rather a movement of interested citizens, concerned by the grotesque monentization of the population’s health. In effect, a competing super power in the behaviour change arms race.

Key characteristics:

  • protect the children
  • use evidence, but don’t wait for conclusive results
  • empower with data
  • apply political dark arts

Funding sources:

  • social impact bonds
  • crowd sourcing
  • private health insurers
  • government (not a good time for this)

Inspirations

  • Purpose.com
  • GetUp.org.au

 

cool, entrepreneurship, quotes & aphorisms, technology

Craig Venter – visioneer

visioneer (n): a scientist who has not only a clear, big and somewhat hubristic view of the future and his role in it, but the technical know how to make it happen along with the skills to bring money and people to their ideas.

digital biological converter (DBC): converts data into life

“The trouble is the field of science, medicine, universities, biotech companies – you name it – have been so splintered, layers, sub-divided, hacked that people can spend their entire career studying one tiny little cog of life,” he says, “If I could change the science system my prescription for changing the whole thing would be organising it around big goals and building teams to do it. That is what we do – I have created team science versus the university system with 200 prima donnas each with their own little space.”

Source: http://www.theguardian.com/science/2013/oct/13/craig-ventner-mars

PDF: Craig Venter_ ‘This isn’t a fantasy look at the future

complex adaptive systems, entrepreneurship, meaning, politics, technology

Jeremy Heimans :: movement entrepreneur

From: Aim higher than president

Movement entrepreneurs are digitally savvy outsiders who create new sources of power by aggregating and mobilizing the voices of many.

Tips:

  • Use institutional power but don’t become institutionalised – small groups of passionate people are lean and nimble and have autonomy are more powerful than those in power.
  • Build a movement, not a cult of personality – less susceptible to cock ups.
  • A movement is not an internet meme – build for the long term.
data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, politics, rapid learning health systems

Excruciating Clarity

PROBLEM

  • Contemporary health systems, and the health R&D systems that inform their behaviour, are failing to address the major threat of chronic disease because they are bound to legacy business models that depend on process over outcome.
  • These characteristics are leading to increasing health care costs in the absence of improving population health outcomes.
  • In frustration, Governments around the world are indicating that there is no more new money, with health systems being asked to operate within their current (and in some cases, diminishing) means.

SOLUTION

  • In response, the accepted business model for health care is slowly changing from a fee-for-service regime, to a value-based approach where providers are paid to improve health outcomes.
  • Similarly, the business model for medical research is changing, from a publish-or-perish, incremental-impirical regime, to a value-based approach where research is recognised ultimately for its clinical outcomes impact.
  • These changes will take time to occur is Australia, but are already well underway in the US, the UK and China.
  • To preserve their sustainability and viability, modern health systems will need to become sentient, focusing on prevention of harm from the contemporary modern food systems.
  • While health systems will always need to attend to illness as and when it presents, they will need to fund these activities out of savings made by avoiding preventable illness.
  • To achieve this, future health systems, and the R&D systems that inform them will be sentient, and feature the application of behavioural economics, real-time analytics, and predictive analytics to deliver low-unit-cost automated behavioural interventions.

OPPORTUNITY

  • The great Canadian ice hockey player Wayne Gretzky is often quoted as saying “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.”
  • As a respected, successful and self-described entrepreneurial research institute, the George Institute is uniquely placed in Australia, but also internationally, to lead, and ultimately profit from these seismic disruptions in health system operations and performance.
  • There is an opportunity for the George Institute to establish a scalable, for-profit wellness generating clinic (working title: George Wellness) that, as a baseline, applies the latest understanding of wellness and prevention to a recruited population, but then uses continuous/frequent monitoring and real time analysis to develop a proprietary, preventive learning algorithm that delivers wellness to, while protecting this population from various harms in a powerful and demonstrable way.
complex adaptive systems, data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, quantified self, rapid learning health systems, technology

Lunch date with Dickon

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Thursday, 24 October 2013 8:09 PM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

Beautifully captured Dickon, and thank you for the eBook (it won’t go anywhere).

References for some of my contributions:

–          Online CBT pioneer: Prof. Helen Christensen/Black Dog Institute > blackdoginstitute.org.au // moodgym etc.

–          Research on protein and satiety in locusts, mice and men > Stephen Simpson

–          The Vitality Group (Sth Africa) – 15 min intro video on front page helpful, similarly 1hr webinar http://www.thevitalitygroup.com/

–          A short White Paper on Health Insurance billing analytics

 

Things we didn’t even get to, but expect to at some stage:

–          Antifragile by Nassim Nicholas Taleb (author of Black Swan) >> totally rocked my world, suspect you might enjoy

–          Very strong case for plant based diet by Michael Greger MD

–          4 Hour Body by Timothy Ferris >> where I started my body hacking journey (slow carbs, protein, cruciferous, blow out, but also stuff on sex etc.)

–          Proteus Digital Health – end to end health monitoring, including blood composition via skin patches (warning: interesting but potential ufero)

–          Scanadu – personal medical tricorder

–          Ginger.io – behavioural health analytics platform

–          Omada Health – evidence-driven, online preventive health programs

–          Eatery by Massive Health – recently acquired by Jawbone, but previously doing some interesting things with diet, analytics and amazon’s mechanical turk  (warning: interesting but potential ufero)

–          Kaggle – data modelling competition platform (I’m mates with its founding chairman)

 

Rough vision for what I want to get going over the next 5 years (from diary post):

Over the next five years, I want to develop a health-generating, outcome-remunerated, scalable, for-profit enterprise dedicated to the effective (i.e. live outcome data and analytics, a la rapid learning health system), efficient (i.e. probably not involving doctors) optimization of population health through the application of mobile-mediated behavioural economics, epigenetics, ubiquitous sensors, real time, predictive analytics and the social determinants of health.

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 24 October 2013 7:11 PM
To: ‘Paul Nicolarakis’
Subject: RE: Singpaore

 

Notes from our lunch

 

CBT apps are as effective as face to face with professionals. Mood Gym

 

Body by science – Doug McGuff – high intensity, simple exercises.

 

Eatstop eat attached.  A quick and easy read. I bought it, so please don’t forward it on to others just in case my name is encoded into the pdf somehow.

 

Leangains.com – 16-8 protocol. Obviously this guy is genetically gifted, but the fasting technique works for me too.  The key is ‘never any guilt’ if you mess up one day, simply forget it and try the next day.

 

80/20 rule for weight loss 80% being diet, the 20% being exercise.

 

Vitality – south Africa – interesting model to approach insurance companies.

 

Your potential opportunity with the data analysis for medical insurance claims/fraud. Possibility for the same sales approach that they used in the stock trading world.

 

Cauli dabbed with macadamia oil in an 210 degrees fan oven. Crunchy yet still moistish in the centre. Excellent snack food. I suggested adding turmeric (curcumin) for it’s anti inflammatory characteristics. Though not to modify the taste as that is already in order.

 

Standing desks (we both use them and see the benefits).

 

Feel free to add what I missed.

 

Dickon

 

 

 

 

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Wednesday, 23 October, 2013 7:18 PM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

 

Great. How about 1230 for something meaty at:

 

Royal Mail

2 Finlayson Green

Ascott Raffles Place

 

http://www.ladyironchef.com/2012/12/the-royal-mail-prime-ribs-singapore/

 

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Wednesday, 23 October 2013 7:02 PM
To: Paul Nicolarakis
Subject: Re: Singpaore

 

Looking good for lunch. Name the time and place. I’m easy.

Sent from my iPhone
On 23 Oct, 2013, at 15:21, “Paul Nicolarakis” <paul.nicolarakis@outlook.com> wrote:

How are you looking for tomorrow? Any chance of lunch or afternoon instead of evening?

 

 

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Friday, 18 October 2013 10:56 AM
To: ‘Dickon Smart-Gill’
Subject: RE: Singpaore

 

done

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 17 October 2013 12:59 PM
To: Paul Nicolarakis
Subject: Re: Singpaore

 

Pencil in the evening of the 24 th.

Sent from my iPhone
On 17 Oct, 2013, at 8:15, “Paul Nicolarakis” <paul.nicolarakis@outlook.com> wrote:

I’m currently leaving on the 25th Dickon, but may stay longer… shall we try for something on the 24th?

 

Cheers, Paul

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Thursday, 17 October 2013 12:01 PM
To: ‘Paul Nicolarakis’
Subject: RE: Singpaore

 

Hi Paul,

 

I’m in Bangkok now.

 

However, on the 24th, 25th 26th, I’m in Singapore.

 

Does that overlap with your travel?

 

Dickon

 

From: Paul Nicolarakis [mailto:paul.nicolarakis@outlook.com]
Sent: Thursday, 17 October, 2013 5:31 AM
To: ‘Dickon Smart-Gill’
Subject: Singpaore

 

Checking in again… will be in Singapore next week, let me know if you’re around for a bevvy. Cheers, Paul

 

 

 

From: Dickon Smart-Gill [mailto:dickon@outlook.com]
Sent: Saturday, 14 September 2013 12:47 PM
To: ‘Paul Nicolarakis’
Subject: RE: g’day

 

I’m in Bangkok right now and will still be in Bangkok on Wednesday.

 

Thanks for the invite, if I were in singapore I would definitely have met up with you.

 

Dickon

 

From: Paul Nicolarakis [mailto:blackfriar@gmail.com]
Sent: Saturday, 14 September, 2013 5:05 AM
To: Dickon Smart-Gill
Subject: g’day

 

Hey Dickon,
Am in town through to Wednesday – would be good to catch up if you’re around?
Cheers, Paul

data saving lives, entrepreneurship, healthy habits, quotes & aphorisms, rapid learning health systems

Today’s the day I realised it’s time for me to step up

Had a really interesting day today.

Have settled nicely into the VLCD regime and feel I could persist with it as required. Caffeine delivered by green tea has added a pleasant boost.

I had a terrific meeting with Fiona Turnball and David Pieris at the George Institute.

I also met with the producer of an eHealth event in Melbourne who has asked me to speak (interestingly, George Margelis, the MC of the session, didn’t think to contact me, so am grateful that Steve Leeder did).

Bought Floppy’s 30th birthday opal from the least likely of vendors and prepped for the Hong Kong trip.

Among all that, I had a typically entertaining chat with Mark Hayman. Among the many pearls, one stuck out:

“I’ve reached a time in my life where I no longer want to be pissed off by what others say and do, and instead be happy to piss others off with what I say and do”

I also managed to crystallize what I want to dedicate the remainder of my professional life to. In essence, I want to develop a health creating, outcome remunerated, scalable, for-profit business dedicated to the effective, efficient population health optimization utilizing all the insights of behavioural economics, epigenetics, ubiquitous sensors, real time, predictive analytics and the social determinants of health.

entrepreneurship, healthcare, rapid learning health systems

Paying for clinical performance

This is a decent blog post about the frailties of paying for performance, providing interesting observations on the disabling impact of financial incentives associated with intrinsic motivation in nuanced professional jobs (a la Dan Pink).

It also gives some interesting insights into how the structure of incentives to address cognitive biases like loss aversion to deliver greater impact e.g. paying up front for quality with the possibility of a refund on those payments if the measures are not met.

From the last paragraph: “While health care providers want to help the patient in front of them, they may not feel obligated (or have the incentive) to solve system-level problems stemming from factors they feel are outside their control. One potential solution lies in broader health reform, such as global payment for populations rather than piece-rate bonuses for individual patients. Coupled with public quality reporting, global payment reform has the potential to expand the scope of provider accountability, take advantage of providers’ intrinsic motivation, and improve population health. Such efforts may hold more promise for value improvement in US health care than attempts to exploit providers’ extrinsic motivation through tweaks to fee-for-service payment.”

I think we need to fire up both the clinician’s and patient’s intrinsic motivations to drive real improvements in health. Some sort of clinician involved version of the Vitality Group program.

Doubts About Pay-for-Performance in Health Care – HBR (PDF)