Who are you? Who am I? | Week 21

May | Health and Fitness | Week 21 | 5/28/2023

What ideas do you have on the future of health? 

Think for a second, that the body is like a large corporation. From the outside looking in, we see the advertisements, we see the big flashy buildings, the products that hit the stores. From the exterior, a company looks and appears to be put together. But the reality of what is happening inside the buildings, in the board rooms, at the desks of thousands of employees, could be and is very different than the outside vantage point. A business is a complex system of smaller businesses. For example, Amazon, my company, is really Alexa (Devices), Cloud (AWS), Retail (Fulfilment) and a dozen other businesses which make up Amazon.com. Individuals in a company are the same as cells in a body. They are performing the function of the lowest level of necessary requirement, specific tasks like Finance, HR, Sales, akin to white blood cell, red blood cell, neuron. Small teams are like organs. Verticals are like organ systems. The global sales department is really comprised of North America, Europe, Asia, etc. The Cardiovascular system is comprised of the heart, the lungs, the capillaries, etc. And the S team of CEO, CFO, CTO are akin to the brain and spinal chord. They control, manage and support every function of the body or corporation at the highest level. A company may look great on the outside but have rot on the inside. The new building just went up on 5th Ave but the head of global sales is embezzling money and running the company into the ground. This is like having metastatic cancer. 

I work in Business Finance, which is a specific job function whereby we form teams that report up to the CFO, but help financially ensure the operations of the CEO by supporting specific businesses inside the purview of the CEO. For example, one might be a Finance partner to a sales operations team, a marketing team, an engineering team. In such a position, we are able to objectively assess a business because we don't report to the business. We're able to meaningfully support a business or vertical because we have seen a dozen other business verticals. Therefore, we can offer insight into what works and what doesn't and how to implement strategies which are adaptive and proven. In business finance, when we move to support a new business, we take a three step approach. [1] Report on the business - OpEx, Headcount, Revenue, year on year growth. [2] Deliver insights about the business by developing metrics such as Productivity, Cost of Sales, Return on Investment. Then showcase to leadership how those metrics change with business decision. And [3] influence the business by creating a mental model to assess the health of the business and create a common language for decision making. Examples include Cost, Speed, Quality, or Price, Convenience, Selection. Then use metrics, models, and the trust you've built to drive business decision. Sit in the meetings with directors and make recommendations, to drive meaningful outcomes. 

I envision a healthcare-patient social contract the same way. The healthcare provider can simply make recommendations about what to do, but he/she cannot do them themselves. Right now, we do have such a system as that, but the problem is, most of healthcare stops at [1] and picks back up at [3] without ever doing the very arduous, trust-earning work of [2]. At 50, you go in for your first "required" colonoscopy and a doctor reports on the health of the business - "we had to take a tissue sample, which looked like a polyp, we'll get back to you." Then, the doctor makes a recommendations about what to do to avoid further polyps. But what about from ages 10 to 50 when the colon cell metastasized and became cancerous? This is the preventative health aspect of our system that is nonexistent, and it is where I focus the majority of my attention on the future of health(care). 

In an essay I authored January 2018 entitled Half Full Health, I wrote, "But what makes us healthy? We assume that if we avoid the unhealthy, our bodies will therefore be at the base state: healthy. But what if we're missing something? What if the base state isn't the healthiest we can be? I'm convinced there's another level. I think of health as a number line. Smoking and drinking frequently puts you at a -10 health (for the sake of this). Not smoking and drinking puts you at a 0 (base state). But what if we can get to +10? How do we get there?"

The answer? Preventative Medicine. The work to get there? [1] Better aligned conclusions in the scientific community of lifespan-promoting-behaviors, [2] better dissemination mechanisms of said conclusions to the general public, and [3] more engaged patients. 

There are clear blockers to preventative medicine: Cost, the Silo-ing of medical disciplines and Data availability. Reducing cost, melding disparate data, and creating systems of cross functional medicine should fix the issue of [1] better aligned scientific consensus. Putting on my business finance hat, I believe there is low hanging fruit. Right now, genetic screening and personalized medicine are reserved for the wealthy. But there are mechanisms, with drastically reduced costs, leading to data banks which are under utilized. 23&Me has collected and analyzed health data from millions of willing participants, through saliva samples. At one time, I took my health raw data from 23&Me and uploaded it to Dr. Rhonda Patrick's database for $7. The output gave me her personalized recommendation of supplementation I should be taking. There should be entire medical enterprises pursuing this level of detail, which can monetize a data set that they did not have to collect. Going one step further, there is a layer deeper to this, crowd-sourced study. For example, I envision a website, where you can go and upload your medical history, your 23&Me data and even your own medical records. A generative AI platform will group you with people based on your results and form cohorts. Researchers can then choose cohorts of people to run statistical analysis on or recruit for further study. Again, with 23&ME, we've seen willing participants pay real money for less than that. It is a wasted opportunity.

Speaking of data driven medicine, the company who makes the All-In-One medical smart technology wins. The data output, by the way, from such a device could feed the above generative AI platform, in a quaternary category we could call bio statistics. At the current moment, we have 15 pieces of fragmented technology with no unifying hardware or software. We have blood-glucose monitors, we have smart watches to track movement, smart rings to track sleep and body temperature, non-invasive hemoglobin monitors, and more. The device which can give you a complete blood count (CBC) a comprehensive metabolic panel (CMP), a hormone panel, body temperature, respiration rate, and measure your body fat, blood pressure and heart rate every 10 minutes, wins. 

In summary, the goal for the future of health is Preventative Medicine, with broad scale scientific consensus which is disseminated properly and proactively, leading to longer health spans for the average individual. To do that we must fix the issues of cost, siloed medical disciplines and data availability. My strategy is as follows: if we can [A] synergize the output of a collectively exhaustive smart technology with a [B] generative-AI platform that can analyze millions of records of health data from willing participants and craft a [C] symbiotic research system comprised of willing participants and collaborating researchers, we can develop Preventative Medicine at scale.