About Christopher Herot
Chris Herot has been the founder and CTO or CEO of several Boston-area software companies, most recently Convoq/Zingdom Communications, where he provides strategic and technical advice to clients worldwide in the areas of audio, video, and social media.
Ever since he left what is now MIT's Media Laboratory, he has been building interactive systems to enable people to create and communicate. What he enjoys most is learning about new technologies and finding ways to deploy them to solve human problems. To do this, he has started three companies and formed new entrepreneurial businesses within larger enterprises.
Latest Posts by Christopher Herot
In the film Sleeper (1973) Woody Allen’s character wakes up from cryostasis 200 years in the future to discover many things have changed. In this exchange his doctors discuss how thinking on diet has evolved:
Dr. Melik: This morning for breakfast he requested something called "wheat germ, organic honey and tiger's milk." Dr. Aragon: [chuckling] Oh, yes. Those are the charmed substances that some years ago were thought to contain life-preserving properties. Dr. Melik: You mean there was no deep fat? No steak or cream pies or... hot fudge? Dr. Aragon: Those were thought to be unhealthy... precisely the opposite of what we now know to be true. Dr. Melik: Incredible.
Recently I was at the Joslin Diabetes Innovation 2013 conference and came down to breakfast to find the doctors at my table spooning the ham and eggs out of the hotel’s wrap sandwiches and throwing the bread away.
It turns out that the rise in obesity (and diabetes) in the U.S. coincided with the dietary guidelines being revised to encourage everyone to eat less meat and saturated fats and eat more pasta and carbohydrates. My breakfast companions explained that the lipids that give you heart disease come not from eating saturated fats but from eating carbs, which the liver then turns into the small LDL particles that cause atherosclerosis.
The British Medical Journal (BMJ) recently reported that saturated fat may actually be protective, especially if it comes from dairy products containing vitamins A and D. Red meat may not be so bad either – the increase in coronary heart disease and diabetes previously blamed on meat may be explained by the nitrates and sodium used as preservatives in processed meats.
Furthermore, the widespread use of statins to lower cholesterol in otherwise healthy people may be causing more harm than good. According to a study cited in the article even for people who have suffered a heart attack, adopting a Mediterranean diet is almost three times as powerful in reducing mortality as taking a statin. That may not include hot fudge sundaes and steaks, but it also doesn’t include junk food, soda, and margarine, none of which taste all that good anyway.
Photo credit: bobbysbloomington. com
Remember the Dick Tracy 2-way wrist TV? WiMM Labs brought this capability one step closer with the WiMM One, an Android-based wrist device that retails for $199. In addition to serving as a watch (of course!) it can download applications from its own App Store, including a calendar that syncs to Google Calendar, a news reader, calculator, compass, pedometer, weather, timer, and stopwatch. The picture at right is just a simulaton (using the Gallery app), and the 667MHz ARM11 CPU is not quite enough to do real-time video, but with Bluetooth, WiFi, 2 GB of memory, we are pretty close.
It’s not exactly a beautiful piece of jewelry, coming in a black plastic case 32mm x 36mm, and the battery doesn’t even last for a full day, so this model is really just a developer platform, but it does have some cool features, such as a connection to your iPhone or Android phone that displays the incoming caller-ID along with a button for sending the call to voice mail. Just the thing for dealing with those calls that come in during a meeting.
WiMM will soon have some competition from Pebble, who recently raised $10M on Kickstarter and have already taken 85,000 orders for a watch to ship in 2013.
The TEDMED conference took place last week in San Diego but it took me this long to digest all of the content and follow up on all the connections I made there.
Both TED and TEDMED were founded by Richard Saul Wurman, who apparently experienced seller’s remorse after he sold both conferences and each expanded well beyond his original vision. While the two events are now completely independent, they follow a similar formula: the red TED logo, speakers who are either famous or should be, polished presentations interspersed with some entertainment and long breaks, and a venue that is far enough off the beaten track that the speakers hang around for the entire event rather than helicopter in just for their talk. As at TED, the audience is sufficiently varied and interesting that any random conversation in the coffee line or at lunch will always result in an interesting conversation and often lead to a long-lasting connection. In addition to the expected practicing doctors, hospital executives and entrepreneurs I met a researcher at MIT building medical devices for the developing world and a number of designers, artists, and authors.
The Masters of Ceremony were Marc Hodosh, who had shared that role with Richard in past years, and Jay Walker who purchased the conference this year. Jay was the founder of Priceline.com and a long-term TED participant who seems to have found his calling on the TEDMED stage as he interspersed introductions and lively Q&A with showing materials from his extraordinary library of rare books.
The general theme of the conference can be summed up in two sentences:
- There are amazing advances coming in medical technology.
- These may or may not make it through the FDA approval process in time to save your life.
- Eythor Bender of Ekso Bionics demonstrated an exoskeleton that allowed a paraplegic to walk.
- Daniel Kraft showing what medicine can learn from other fields such as aviation.
- Calvin Harley of Telome Health describing how we might halt the aging process by regrowing the DNA on the end of your chromosomes. (A Russian researcher on aging cautioned me that you might not want to rush out and start gobbling down the “nutritional supplement” quite yet - remember Vitamin E?)
- Architech Michael Graves now in a wheel chair, decribing his frustration with poorly designed hospital rooms,
- Lance Armstrong describing the decisions he and his doctor needed to make in treating his cancer.
- Quyen Nguyen of UC San Diego, showing a video of a flourescent dye that binds to tumor cells to make them more visible during surgery (photo at right).
- Diana Nyad describing her attempt to swim from Cuba to Florida and her encounters with box jellyfish.
- Paul Stamets on medicines derived from mushrooms.
- Gabor Forgacs of Organovo demonstrating an inkjet printer that was modified to “print” organs from a supply of cells.
- Yoav Medan of InSightec describing one of the breakthroughs that did get FDA approval: a device that uses focused ultrasound to do surgery without making an incision in the patient.
- Mehmood Kahn, Chief Scientifc Officer of PepsiCo arguing that we needed processed foods (albeit of higher quality) if we were to feed the earth’s seven billion inhabitants. (Although e-Patient Dave tweeted that this does not explain high fructose cory syrup.)
- Dean Kamen describing his frustration in trying to get FDA clearance for a robotic arm he developed for war veterans. (Photo at right).
- Nate Ball, an engineer and beatbox artist demonstrating how he makes all those sounds. On stage. By having Dr. Nguyen thread fiber optics through his nose so we could see an image of his vocal cords as he made various sounds.
- Charles Pel, Physcient describing a new model of retractor that uses force sensors to back-off before it damages bones or tissue.
Next year, the conference moves to Washington, DC. In a move that can only be described as audacious, Jay Walker plans to double the size of the conference and take on the DC establishment. If anyone has the enthusiasm and resources to do it, it would be Jay.
The Health 2.0 conference returned to San Francisco for the fifth year. Attendance continued to set records at 1500 this time around. The zeitgeist continues to be that of information technologists eager to fix all the problems of health care. With 35% doctors carrying iPads and 85% with smartphones, there is plenty of opportunity for technology, but this year there was also a closer attention to payment models and to incentives for use, both financial and psychological.
In his keynote, Mark Smith, President of the California Health Care Foundation, (photo at right) said that while technologies such as the Internet had transformed banking, travel and research, that medical consultations were still being done the same way as they had for the past fifty years. However, it is not enough to provide technology. He stressed that he wanted to fund projects that incorporated financial models that would encourage use. He said too much of what he’s seen in the past resembled the Underpants Gnomes of South Park, with business models consisting of 1. Invent Widget, 2. ????, 3. Profits!
Smith said that the most important element of any new initiative was that it reduce costs, not just by shifting them around but by reducing the “perverse incentives” that encourage volume above all else. Other opportunities lie in improving convenience to patients, rapid learning for providers on how to make sense of the increasing volume of data, and enrollment for the uninsured. As an example of how this could work, he cited how Kaiser-Permanente’s introduction of Electronic Health Records reduced specialist visits by 25%.
There was plenty of innovation on display on the stage and in the exhibit hall, such as:
- A heart rate tracker from Basis that you wear like a wrist watch.
- A web site from GoodRx that does comparison shopping for prescription drugs.
- Consumer health management and social media systems from WellnessFX, Nomura Social, HealthTap, OneRecovery
- GE Intel Care Innovations home monitoring and communication system
One of the most interesting talks was from Alexandra Drane of Eliza. She used her company’s automated phone call system to conduct a survey of patients, asking them to rank the problems in their life in terms of how much those things mattered to them and how much they received support on those issues from the medical establishment. The ratio, which she called the Ostrich Index, was around 1.0 for typical medical issues such as obesity, but far higher for other sources of stress such as consumer debt. Furthermore, people with multiple issues that high Ostrich Indexes were far more likely to suffer from serious illness. Her message to the audience was that it needed to take a much broader perspective on issues that affected health and that “health is life, not what’s measured in the doctor’s office.”
Telemedicine has been a field with a bright future- for several decades now. Recently Joseph Ternullo, Associate Director of the Partners’ Center for Connected Health, shared his thoughts on what factors were holding back its development.
Joe was speaking at Monday’s meeting of the New England Healthcare Executives Group and pointed out that while analysts have estimated the telemedicine market at $5-30 billion, that pales in comparison to the estimated $1.5 trillion that is spent in the United States on healthcare.
Joe named out six issues that were at fault:
- Gaps in offerings
- Usability and Design
- Behavioral issues
Joe said that technology was only 15% of the problem. We have plenty of things that work today, from videoconferencing to devices that automatically gather vital signs at home. While the technology will continue to improve, the problem today is more a matter of getting products into a form that is easily integrated into the delivery of health care. As William Gibson observed, “The future is already here – it’s just not evenly distributed.”
A more mundane but pressing problem is matching current offerings with the resources and practices of the health care sector. Joe pointed out how doctors, nurses, and patients were ill-equipped to deal with the logistics of procuring, installing and maintaining telemedicine equipment.
He saw an opportunity for low-cost middlement that could drop-ship a home monitoring system, integrate it into the patient’s health record, and retrieve equipment when it was no longer needed or when it needed repair. Another problem is that most products are oriented to the management of one particular disease, while the patient population most in need of this technology are likley to have mutliple co-morbid conditions.
Usability and design have become an issue as technology becomes widely adopted. With users’ expectations being set by devices such as the iPhone and iPad, what comes from the IT department looks clunky by comparison. For any new technology to be widely adopted these days it needs to be as easy to pick up and use as the consumer products people use in their daily life.
Influencing behavior was perhaps the most interesting. As Joe put it, “I wish there were a technology that motivated me.”
We have plenty of technology that can measure physiological data and even tell us when we are engaging in unhealthy behavior, but the health care world has a lot to learn from the gaming industry how to get people to actually change what they do. In the panel discussion that followed, several people mentioned the work that BJ Fogg was doing at Stanford and the talk he gave at last year’s Connected Health Symposium.
Joe said he was thinking of writing a paper on these points. I hope he does so and starts a conversation going.
During the great debate over health care reform, one recurring question was why the USA spends twice as much per capita on health care as other industrialized nations, yet our life expectancy ranks 28th in the world, behind the UK, Korea, Luxembourg and Malta.
As the graph at right shows, the US (red dots) onced rank near the top, and while it has improved, the rest of the world has improved much more.
The National Research Council took a close look at the data and came up with some surprising results. The report published this week, Explaining Divergent Levels of Longevity in High-Income Countries, listed all the usual suspects, such as obesity, sedentary lifestyle, and uneven access to health care, but surprisingly, the number one cause, accounting for 78 percent of the gap for women and 41 percent for men was smoking.
While anyone who has traveled to Europe or Asia might think people in those countries smoked far more than American’s, back in the 1940′s and 50′s when today’s aging population was growing up the USA was relatively wealthier than most of today’s rich nations and had an agricultural environment uniquely suited to growing tobacco.
The red line in the graph at right shows smoking in the USA, which was far higher than the rest of the world until it peaked in the 60s. If there is one cause for optimism, it is that the earlier decline in smoking should make for more rapid improvement in the future.
Similarly, while Americans lead the world in obesity and sedentary lifestyle, the rest of the world is catching up — apparently there is a limit to how much you can eat if you never get up from in front of the TV.
The other piece of good news is that the health care system in the US is pretty good at fixing people up when we get sick.
It’s just that our unhealthy behavior gets us into more trouble than the health care system can fix.
In a brilliant two-page article that illustrates why we need investigative reporting, New York Times writer David Segal details how Internet merchant Vitaly Borker (aliases Tony Russo and Stanley Bolds) discovered that complaints from his customers could be good for his business. As complaints about his DecorMyEyes eyeglass business poured in to sites such as Get Satisfaction, ComplaintsBoard.com and ConsumerAffairs.com, his Google page rank actually increased. While Googling “DecorMyEyes” by itself returned numerous complaints, Googling the name of an eyeglass designer such as “Lafont” prominently features Vitaly’s own website, sans complaints. Apparently the links from the negative listings increased his Google Juice.
One could argue that the fault lay less with Google than with the complaint sites not using the “nofollow” attribute or consumers not being more thorough checking out a new merchant, but according to the article, just about every other institution that would be expected to help also shirked their responsibility. In a two-page description of one consumer’s experience, Segal tells how Citibank fell for a fake phone call, MasterCard and eBay cut off Borker only to have him re-register, and the New York Police were slow to act even after the consumer received threatening emails and harassing phone calls. It wasn’t until the New York Times started nosing around that any of these places took definitive action.
While it’s tempting to blame laziness or bureaucratic incompetence, I think there is something more insidious at work. All the institutions we count on to protect the consumer have replaced human judgment with algorithms, and the people who answer the phones at these places (when you can find a human at all) are just reading scripts and pressing the few limited buttons at their disposal. The Citibank representative actually told the consumer “Listen, this isn’t our problem. This has nothing to do with us.” It is arguably true that removing humans from the process delivers better results overall, but a few sociopaths have figured out how to game the algorithms such as by keeping the volume of credit card charge-backs just under the threshold that would get them bounced from the system. In those cases, one wonders what would have happened if Segal, who also writes the Haggler series for the Times, hadn’t gotten involved.
In this particular case Borker was arrested, MasterCard and eBay promised to keep him off their systems but the DecorMyEyes site is still promising “new and guaranteed authentic designer eye wear.”
At yesterday’s Future Forward retreat, Reed Sturtevant and Katie Rae organized a lunch table discussion on Smartphones as Building Blocks, i.e. what kinds of applications transcend the boundaries of an individual phone and become something large of which the phone is a part. When he was at Sun, John Gage famously said ”the network is the computer.” Now in the mobile world the computer, or more properly what we do with computers, may involve multiple devices of various sizes.
When Reed brought up this topic, my first thought was the way doctors want to use the IPhones and iPads they are already carrying to retrieve patient records, lab results and even real-time vital signs from wherever they happen to be. Other people brought up using the mobile phone as a controller for other systems, from games to TVs. After some more discussion, I proposed the following taxonomy of roles that a mobile device could play:
- User Interface – bringing the screen to the app. Rather than putting a screen and keyboard on everything, why not use the ones that are already in your pocket. An early examples were “universal remotes” for your TV, such as L5, Flipr, Bobby and Sonos, but the phone can also be used to control toys and games, or to interact with a fixed object such as a kiosk or billboard.
- Identity – A mobile phone can supply two factor identification: something you have (the phone) and something you know (a password you type into the phone.) This can be used to make purchases or unlock a door. OpenWays and Assa Abloy provide this capability to hotels, and Apple recently applied for a patent on Peer-to-peer transaction devices and methods.
- Storage – this was the original use of the iPod – to store music
- Connectivity – the phone is the obvious place to establish connectivity to the outside world, since it already contains a radio to connect to the cellular network, but many phones also include WiFi, Bluetooth, and Near Field Communications.
- Docking Station – In addition to radio links, the phone usually includes a USB or proprietary connector that can be used to hook up anything from a headphone to a blood glucose meter.
Many interesting applications combine multiple roles, such as accepting data from something plugged into the USB port and passing that up along the wireless link. We are just at the beginning of seeing what’s possible.