If you hear hoofbeats…

PUBLISHED ON  July 7, 2014

WRITTEN BY  Roni Zeiger

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We often say in medicine, “If you hear hoofbeats, think horses, not zebras.” Put another way, if you hear wheezing, asthma is much more likely than a roundworm infection in the lungs. Young doctors especially need to be reminded of this, because we spend a disproportionate amount of medical school learning about exotic diagnoses.

I had a rare opportunity this summer to travel to Africa. In the Serengeti National Park in Tanzania, I was amazed by zebras literally as far as my eye could see.


An academic reaction is simply that the prevalence of zebras in the Serengeti means the saying about hoofbeats doesn’t apply. But there’s something transformative about being surrounded by more zebras than one can count. While it’s true that there aren’t that many zebras in the world, there are more people with rare diseases than most of us realize.

Let’s think of each other often, and collaborate to solve problems faster.

When you get to a fork in the road, stay there

PUBLISHED ON  May 5, 2014

WRITTEN BY  Roni Zeiger

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Career advice often includes mention of forks in the road or intersections that represent key decision points. Our future depends on which way we go, which job we choose, which school. I’m starting to think it’s exactly the opposite.


All the exciting things in my career have happened precisely at those intersections. Maybe better advice is to hurry up along the road you’re on until you get to an interesting intersection, then stay right there. I first thought I’d live at the intersection of molecular biology and medicine, initially planning to do an MD-PhD in order to solve the mysteries of cancer in a lab. I then changed course to pursue full time clinical medicine… until I saw how much impact I could have at the intersection of medicine and computer science. My focus here was first on building software for doctors until I learned what was happening at the intersection of the suddenly ubiquitous Google search box and the unmet health information needs of millions of people.

I worked at Google until I started seeing that so many of the complex questions people have about their health aren’t well answered in a document yet — but those same questions are often discussed in online communities, where a network of microexperts often provides useful feedback. So now, building Smart Patients, I sit at the intersection of stories and science.

Innovation seems to happen at intersections of ideas or fields that haven’t really been mixed together before. At what intersection are you uniquely suited to innovate?

I have the problem in my grasp

PUBLISHED ON  April 4, 2014

WRITTEN BY  Roni Zeiger

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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.