I have the problem in my grasp

PUBLISHED ON  April 4, 2014

WRITTEN BY  Roni Zeiger

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SusannahFoxSusannah Fox
"Approach every day with humility, curiosity, and a sense of possibility." - @rzeiger
4 weeks ago
hotmessbrittBrittany Nicole
@JustBethanne @rzeiger @MeredithGould @AfternoonNapper @gfry check out the hashtag #spooniereads for updates and information!
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I didn’t expect to be so taken by Larry Smarr’s 10 years worth of clinical data he’s collected on himself — perhaps more than anyone before him — even though I knew it led to an important diagnosis and provides a view of the future patient.


During the above demo at yesterday’s Quantified Self Public Health Symposium, he tells the story of how he has determined the relative amounts of various bacteria that live in the colons of healthy people, versus those with ulcerative colitis or Crohn’s disease. His own “micriobiome” is on the left in red, and matches the blue pattern of Crohn’s disease, and not the green of ulcerative colitis or purple of normals. He, not his initial doctors, figured this out.

Few people have the resources to do what he’s done, but this takes nothing away from the power of the story and that’s the part I can’t stop thinking about. He has also 3D printed the segment of his colon affected by disease, held here by Susannah Fox:


The picture directly above shows him holding the replica of his disease. “I have the problem in my grasp,” he says. This reminds me of the unstoppable passion we often see in parents of children with rare or undiagnosed diseases, and that one shouldn’t get between a mama bear and her cub. We have a tremendous opportunity in health care to tap into the motivation and innovation of patients and caregivers everywhere. Thank you, Larry, for the inspiration.





Listening at bedtime

PUBLISHED ON  March 20, 2014

WRITTEN BY  Roni Zeiger

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At bedtime, my daughter and I sometimes play word or number games instead of reading. The other night, she suggested we play a variant of Pictionary, where one of us thinks of a word and tries to get the other to guess it by drawing it. She also suggested we make it harder by having the drawer keep her eyes closed. I jokingly responded, what if we have the guesser keep his eyes closed? That led us to invent a game where the guesser indeed keeps his or her eyes closed, and the drawer limits what they can draw — first we did single digit numbers. It was fascinating and tons of fun to learn to LISTEN to what each number sounds like when written in pencil. (Pencils make much better sounds than pens.) Numbers consistently vary by how many strokes and the cadence of how the strokes are combined — each has a personality. Since I cross my sevens, four and seven sound almost the same, but the final line in seven is crisper and shorter than the final line in four.


We then had the nerve to guess which animal the other was drawing, limiting the options to a list of five. That was harder, but we learned to listen for a cat’s whiskers and a pig’s curly tail.

Here’s to being a better listener!

Empathy for patients AND doctors

PUBLISHED ON  March 12, 2014

WRITTEN BY  Roni Zeiger

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We all know our health care system doesn’t work very well and that it often harms patients. A more subtle point is that for the same reasons, it harms doctors, who came to the profession to do more than they’re typically able to. We can talk about this so that patients and doctors have more empathy for each other.

Empathy is a key requirement for design thinking. Mutual empathy may be a formula for various kinds of collaborative design, but I can’t imagine a more important example than patients and doctors designing better health care together. Maybe an equally important example: patients and researchers better understanding each other and designing better research together. (Thank you Michael Seid for accidentally explaining this to me.)


PUBLISHED ON  February 11, 2014

WRITTEN BY  Roni Zeiger

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Last night, my wife and I took extra long looks at our children as we watched them sleep before heading to bed ourselves. They looked more fragile, precious, so much younger in their sweet sleep. We talked about how grateful we are for them. We breathed deep as we smelled their heads when sneaking in a last kiss good night.

This morning I read a mother’s painful words: “What can you do so we don’t lose him?

I am more grateful for what we have in this world, and driven to more effectively connect us and the knowledge we need to answer her question.

When Super Power Meets Super Passion

PUBLISHED ON  January 27, 2014

WRITTEN BY  Roni Zeiger

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It’s not only fun to talk about super powers, it’s useful. A recent post by Susannah Fox thoughtfully suggests that all of us have a super power in our networks, our communities. Here let’s explore a more traditional (!) notion of superpowers. Each of us has one and perhaps our most important professional responsibility is to identify ours and nurture it.

Deservedly or not, I get questions from many individuals and startups in the health technology world asking me for advice. I’m starting to think that the answer is usually that you must find your super power and your super passion.

To health professionals or students asking for career advice, I try to explain that the secret is to do whatever it takes to follow your passion. Without passion, no job will be will be impactful (or fun) for a sustained period of time. And take a step back to consider: what a privilege to be living in arguably the first time in history when so many of us can choose what we do for a living.

To startups I ask, what problem can you solve better than anyone else can? There are other requirements for a successful business — e.g., are you solving a problem that someone really wants solved, will someone pay for it, is your solution better than currently available solution(s), can you maintain a competitive advantage — but if someone else can do it better, why bother?

We can synthesize the advice to the individual and the startup by saying that each of us, personally and as organizations, should be doing what we are most passionate about and what we can do better than anyone else. What if teachers sought to identify every student’s super power, and curricula were flexible enough to let students learn in the context of their evolving passions? What if continuing medical education included feedback from patients that helped clinicians hone their super power? What if health care delivery systems supported collaboration among clinicians that allowed them to complement each other’s super powers and super passions? What if funders of research and funders of companies sought to maximize the number of people and organizations using their super power to pursue their super passion?

What’s your super power? What’s your super passion?

The thing formerly known as the PHR

PUBLISHED ON  January 6, 2014

WRITTEN BY  Roni Zeiger

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While I don’t think anything called a personal health record or PHR will succeed — too much baggage with that term — the start of 2014 seems like a good time to reflect on the future of the-thing-formerly-known-as-the-PHR.

The biggest success story here has been Kaiser, where nearly 2/3 of users use its “personal health record”. I put the term in quotes because the usage isn’t really about the record at all, it’s about specific functionality, namely getting a prescription refilled, emailing your doctor, or scheduling an appointment. The only part that has anything to do with health records is looking up test results, and that’s usually just about whether your latest results are ok or not.

So it’s about helping real people solve real health problems, about getting health stuff done in the right context. (Quick side note: the PHR I worked on at Google failed fundamentally because it didn’t help many people solve real problems.) When the context is interacting with your doctor for a refill or appointment, patient portals like Kaiser’s are outstanding. What about all of the other contexts that matter for our health?

I expect to see more “vertical” tools and solutions that tackle specific problems exceptionally well. While in the health world we tend to want one solution that does everything, the consumer technology world suggests that the commitment and focus of innovators who are passionate about their problem leads to winning products. I’ll bet on Misfit Wearables over Nike in the self-tracking space, and while I can’t live without Gmail or Google Docs, if I need a nearby restaurant I go to Yelp.

We’ll see someone — perhaps CareDox — do an awesome job with immunization tracking + school and camp forms, because that’s a pain point and doctor’s offices don’t have enough incentive to do it really well on their own. My favorite (and biased) example is Hula, a service which helps you get STD testing, retrieve the results, AND share the verified results with someone before having sex with them. Might sound crazy to some, but think about the number of people for whom this should be a touch point for health and prevention. I said biased because I’m an advisor to Hula, though I’ll also mention that I asked them if I could be an advisor, not the other way around.

Let’s get vertical.

Pharma Can Sing Like a Virgin

PUBLISHED ON  December 26, 2013

WRITTEN BY  Roni Zeiger

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After watching the entertaining AND educational Virgin Airlines safety video a couple times at 30,000 feet over the holidays, I started thinking… if Virgin can buck the decades-long trend of tedious and probably useless safety demonstrations — despite being highly regulated by the FAA — what might an analogy be for pharma and the FDA?

Obviously Virgin pulled in expertise far outside of those who simply know the FAA rules. They asked, what are we really trying to accomplish here? Absolutely, we need to check a regulatory box. Some engaging educational material – great idea. (Has anyone studied yet knowledge retention of the new video compared to a traditional one?) Entertainment while people are stuck in their seats? That sounds good for business.

This approach might be applied to the design of drug inserts or informed consent forms for clinical trials. Are FDA constraints tougher than FAA’s? Then we just need to be more creative. Also think about how low the bar is: how often does someone learn something useful from a drug insert or actually get informed by informed consent?

The biggest lesson here for me is about iteration. The sexy 2013 safety video referenced above has gotten tons of buzz including 8 million YouTube views so far. But this started with Virgin’s cute cartoon 2008 safety video with “only” 100,00 YouTube views.

Let’s iterate!

Collaboration is Sexy

PUBLISHED ON  December 1, 2013

WRITTEN BY  Roni Zeiger

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Medical breakthroughs can be sexy. They can also distract us from life-saving, low-hanging fruit.

A new drug often makes waves in the headlines and the stock market when it’s shown to improve relevant outcomes. Somehow it’s not quite as newsworthy when remission rates increase from 55% to 68% in kids with Crohn’s disease… if it happens simply by improved communication among doctors. I believe more improvements in healthcare in the coming years will come from this kind of “systems thinking” than from traditional drug development.

To be sure, it’s easier to focus on improving one piece of the system, and financial incentives are stronger for developing a drug that works in an artificially constrained context, than for making un-patentable improvements to the way we deliver care.

But we’re starting to see just how sexy the opportunities can be. Atul Gawande has millions of fans savoring his stories about interventions as mundane as using checklists to make sure the surgeon, nurse, and anesthesiologist talk to each other before starting surgery.

It’s daunting — and exciting — that the many systems we depend on for health care are so complex, it’s almost silly to focus on point solutions. Even more exciting is that patients are not only part of the system, but that they can and must be part of the solution. A simple and delightful example: when Sweden’s emergency response services saw they didn’t have the manpower to provide prompt CPR to all cardiac emergencies, they invited lay people trained in CPR to respond to emergency calls. Which was more brilliant: the simple design of the system which sends a text message to all CPR-trained volunteers within 500 meters of the emergency, or the cultural innovation that allows non-experts to help?

Why is it so hard for a system designed to be about knowledge flowing from scientists and physicians to patients, to evolve into a more collaborative one? Perhaps Machiavelli explains it best: “It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.

More simply, change sucks, especially for those who have (and like) power. But change is in the air, and I think it’s because we’re seeing beautiful things happen if improvements are allowed to come from non-experts. Not only might a patient-driven improvement be a good one, but the fact it originates from the patient can start a virtuous cycle of self-efficacy.

Psychology aside, it’s a no-brainer that we need to let patients help. There are countless smart ones who are able and willing to help us take better care of them — take better care of each other. And once the ideas start flowing, next thing you know we’ll have doormen in Manhattan volunteering to help keep the elderly living safely and independently. That’s sexy.

Telemedicine circa 1923

PUBLISHED ON  October 23, 2013

WRITTEN BY  Roni Zeiger

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Another gem from Dr. Dolittle, as he prepares to leave his turtle friend, Mudface, who responded well to Dr. Dolittle’s gout treatment:

“He made up the six bottles of gout mixture and presented them to Mudface with instructions in how it should be taken. He told him that… it would always be possible to get word to Puddleby. He would ask several birds of passage to stop here occasionally; and if the gout got any worse he wanted Mudface to let him know by letter.”

Ninety years after this was written, we have the technology to do what Hugh Lofting imagined, where a doctor in England can care for a patient in West Africa. Our telemedicine solutions may not be as elegant as knowing the secret languages of animals and collaborating with them to spread messages and deliver packages globally, but we’ll get there.

Crisis and Clarity

PUBLISHED ON  October 19, 2013

WRITTEN BY  Roni Zeiger

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I was sitting in bed in the neurological ICU, the only conscious patient, when I decided it was time to leave an awesome job at Google to start an even more important adventure.  I recently met one of my new heroes, Terri Wingham, who needed a fresh meaningful start after surviving breast cancer, and now guides other survivors on international adventures that change the world.

It’s a story we hear again and again: a brush with mortality, a life-changing crisis, gives us clarity about what we should be doing.  Perhaps we get better access to our courage, certainly we feel urgency.  Some of the best business minds teach us that scarcity breeds clarity, and I think that applies to everything we do.

Make a date with your spouse or another loved one and talk to each other about what you might change if an unexpected crisis forced you to reconsider everything.  Maybe you can make the change now.