Before we jump into the conversation, learn
more about Verily, I thought we'd start the
conversation with learning about you.
And I always love talking with doctors, with
doctorpreneurs, with people who are really
at the intersection of both practicing in
the real world with care, but also reinventing
the future of care.
So, was there an aha moment for you where
you knew your path, where you knew you wanted
to become a doctor and, and make that transition
into technology as well?
So I think being a doctor, and in fact I would
just say, every person in the room here today
who's caring about health understands that
health and disease really are the grand unifier.
And I'll give you an example.
I practice critical care cardiology and every
time I'm with a patient we sometimes are able
to save someone's life, but sometimes it's
the last moment of their life and it is such
an amazing gift to be able to be part of health
and healthcare.
So to me, conferences like this, when we get
together and we say, “what can we do be
doing differently?” is so motivating.
The interesting thing about healthcare and
technology, is when I was in college I remember
thinking the reason I wanted to be a physician
was to help people, and at the time I may
have had a misperception around technology,
in general, as something being distanced,
cold, separate, numeric.
And as it turns out, from the talks we heard
today and what we're hearing at the conference
generally, technology actually can be a grand
unifier, it can be something that brings people
together.
So what became apparent to me was to make
global impact, really bringing technology
and health together, offered a huge opportunity.
So now, 20 plus years later, it's all coming
full circle.
And was there a moment, even when you were
younger though, that you knew, I want to be
a doctor?
Like, did you always know that you wanted
to help people improve their health and well-being?
So, one example.
Both my parents are physicians.
My mom's a child psychiatrist, my dad's an
ENT surgeon.
And for, for us I remember actively saying,
“I'm gonna do anything but be a doctor.”
However they do point to, we had an outbreak
of chickenpox, and it went around the entire
neighborhood, and what I did was I took this
little book, and I recorded all the kids in
the neighborhood, and I went and applied calamine
lotion to all of them.
And to me, I started to see and I would track,
it was an epidemiologic book.
Who was getting better, who was getting worse,
which siblings were getting affected.
So, I think it was just core to what I do,
despite my, my trying to break out of a family
tradition.
It's just, it's in my genes.
I, and the reason I was really digging into
that, is because I feel like we're at this
unique moment, really, where a lot of people
that are maybe in med school today, they're
wondering, why am I here, should I be here,
what's the future of being a doctor?
So I just always like learning that story
and so important to have great doctors.
So I was really curious about that.
So, let's let's shift gears to, to Verily.
There's a lot of excitement around Verily.
A lot of people, I don't think, understand
what Verily is.
What is Verily?
What's your mission, what's your organization's
moonshot?
So, we grew out of Google and Google’s mission
is to organize the world's information.
But as everyone here knows there's a whole
sector of life science and health that has
its own environment, and we can talk much
more about that.
So, when I first joined Google I joined Google
X which is the moonshot factory.
And we were sitting beside the driverless
car, Project Loon, a group working on access
and energy, and there was a relatively small
group thinking about what information in healthcare
would we need to collect differently, organize
and activate.
And at the time, again, I joined Google X,
we were research and development focused at
the time, but very quickly grew and now we're
really all about hitting big problems using
new science and technology and also when it's
appropriate partnering with groups like Sanofi
that you just heard from.
And it’s been wonderful to work with Ameet
and his team.
We also are partnering with GSK on electroceuticals,
as well as thinking broadly about robotic
surgery with Johnson & Johnson.
So again, we have, in the span of three years,
progressed tremendously and I see so much
energy and enthusiasm behind the work of taking
technology, but understanding the realities
of healthcare and life science.
So we are now Verily.
We've graduated and we're an independent company
under the Alphabet family.
So do you consider yourself more a healthcare
company, or a technology company, or a data
company, or is it all of those combined?
We're a healthcare and life science company
that's using the next-generation tools and
technologies that are now available.
But what you'll see from folks that we both
work with, in addition to the industry partners
I just mentioned, we're working with major
medical centers, including right now, Duke
and Stanford, Brigham and Women's Hospital.
So we consider ourselves, really, a healthcare
and life science-based company and that is
critically important to us.
And let's talk a little bit about collaboration.
I know that was discussed a little in the
last session.
We're at this moment where healthcare companies
are designing these unique collaborations
with technology companies, with data companies.
Can you talk a little bit more about some
of those collaborations that, that you do?
You mentioned Sanofi and, and there's Onduo.
Could you talk about those a little?
Sure.
What we found is there is an urgency in healthcare
and the way that I'm always reminded whenever
we meet with patients that are either patients
that I'm working with, advocacy groups, you
can't leave that conversation without feeling
a sense of, we have to do something now.
And you and I have been able to talk a little
bit about why is this moment different than
other, other moments.
And what we've seen is if you're really trying
to solve a big problem, there’s sometimes
times where it's much easier to move individually.
I've talked to a number of companies that
are here and I would really cherish that,
that moment, if that's right for you.
At the same time there may be certain conditions,
diseases, areas where it makes so much more
sense to say what is it that, for example,
Sanofi and a Verily together could do that's
different.
And we've incredibly enjoyed working with
Sanofi.
They have a deep history in treating patients
with diabetes and we're bringing a lot of
the technology, the infrastructure, outreach,
the trying to delight the user to the extent
we can in healthcare.
And so, we understand bringing these two groups
together is likely going to supercharge the
work that we do.
You think that's a trend that will continue
much more in the future?
I mean, I feel like for many decades, really,
there was a lot of siloed companies holding
a lot of IP, a lot of things very close to
the vest, let's say.
And now it seems like we're seeing more of
these unique collaborations.
Do you feel like that's the new forward?
That's where we're going to start to see a
lot more of those collaborations?
I'm seeing a lot of it, and again, the times
it works best is where the, the aim is aligned,
the incentives are aligned, and people genuinely
respect the work that the groups each are
bringing to the table.
And sometimes that requires checking your
own assumptions.
We even find that within Verily how do we
bring together scientists, health economists,
electrical engineers, mechanical engineers,
people who do backend software, each one of
these individuals is going to be stronger
if we come together and say, “Okay, here's
the piece I bring.”
But I certainly won't be successful if I show
up every day and say, “Well, let me tell
you how we do it in healthcare.”
That's just not going to end up being as effective.
So, I'm seeing the same thing internally in
companies as I'm seeing externally with these
partnerships.
Yeah.
And what about with startups?
There's a lot of extraordinary startups here,
today and obviously around this week, and
around the world today.
How do you think about the the next generation
of innovators?
The ones that are just coming in, and what
would your advice be for them on how to develop
these collaborations that you all have been
successful with?
Well, one thing I want to pick up on is the
end of your opening session, where people
were physically locking arms and saying I
don't, I don't think people are gonna get
ahead on their own.
And so, this idea of creating a collective
group of people.
You may run quickly as an independent company.
We now have a partner space that has been
really fun to work with companies that are
now just starting.
And the more we realize that if we focus,
and this happens in medicine all the time.
You may have a really hard shift.
You may be up for 36 hours, but what we always
remember, and this is what we teach residents
and medical students, is if you think about
the patient and you think about what you're
actually focused on, you'll never go wrong.
And so I think the same can be said for startups
and for companies saying, “I know what my
mission is, but how can I turn to other people
and help this global mission?”
And, and maybe it's a little bit of Karma,
but I think it comes back to help folks and
I am seeing more openness than I would have
ever expected to see.
And what's your, your sense of the moment
we're in?
You mentioned Verily, sort of, came out of
X and I feel like this concept of moonshot
thinking has been around for a while, but
something seems different today, then even
24 months ago or three years ago.
It just seems like there's new conditions.
You know, we look a lot at the changing business
models.
We look a lot at the increased demand because
of the chronic disease epidemic and aging
populations creating this massive demand.
We're seeing thousands of entrepreneurs and
tons of capital come into the sector and we're
also seeing this happen all around the world.
What signals are you seeing and do you believe
something's changed that now is different
than even a few years ago, in terms of the
possibility of where we can go?
The biggest change I'm seeing is what health
even means.
And if you think about the term, an electronic
health record, and that it's usually physicians
or healthcare providers that are entering
information into that.
It makes me start to think that health only
happens in the four walls of a hospital or
of a clinic.
But if you think about your own health and
you think about the people around you, it's
the biology that's happening every day.
So, I might be up here and my heart rate might
be going a little bit faster.
It may be the decision that I make at lunch
today.
It's all of these small decisions that really,
truly, define health.
And there's also a continuum of biology that
extends outside of what we just see.
And I'll give you a very tangible example.
In the cardiac critical care unit I might
be able to see someone's heart rate, and their
blood pressure, and their inner cardiac pressures,
but the minute that person leaves the hospital
all of those things are still going on.
And so, I see this concept of what's really
happening to someone.
And there's a lot of talk about people's social
circumstances, but the ability to understand
that health is much broader, I think is changing
how we're going to collect that information
and make it useful.
So I think that's one major change that makes
now a different moment.
It's kind of the liberation or the democratization
of what the concept of health is.
And then the second thing, we've already talked
about it this morning, an interest in trying
to create interesting partnerships.
And I give the FDA a lot of credit for setting
up a pre-certification program and we’re
one of the companies partnering with the FDA
because we know that it's going to be interesting
and challenging as we create new algorithms
and new ways of understanding health.
We want to have an open door and a transparent
policy so we can get these solutions out to
patients as quickly as possible.
But I'm seeing those two things.
One's kind of conceptual and one's very practical.
And we'll have Bruce Greenstein here tomorrow
from HHS, so it is interesting.
There's more guidance, there's there's seems
to be more opportunity for startups than ever
before and very excited about that.
As you think about, in particular from the
doctor’s perspective, but we talk about
health.
There's, we talk about innovation.
What does success look like though, as we,
as Health Transformers, as innovators, as
companies.
What should we be striving for?
What are we really trying to do here at the
end of the day?
In your mind what does success look like?
I think we're really trying to improve life.
And if you think about traditional healthcare
outcomes.
We think about, can we actually, and I'll
see it through the lens.
I spent many years as a cardiovascular clinical
trialist and we would run large trials where
we were trying to understand whether one intervention
or another, one device or another, one compound
or another, actually improved heart clinical
endpoints.
And so, we looked at things like cardiovascular
death, myocardial infarctions, stroke.
Could we actually improve outcomes?
And I think there's now going to be another
lens.
Not only can we improve healthcare outcomes,
but can we improve the quality of someone's
life as well?
And so, I think every single group that I've
talked to at the conference is, in some ways,
trying to make patients lives better.
And I think better though, is involving in
a creative and an important term, so that
we understand how whatever you're working
on is truly making someone's life better.
It may be extending life, it may be improving
quality of life, but all of these things are
going to be metrics that we, no pun intended,
live and die by.
So this, to me, is how we know that we're
making a difference.
Do you think that's one reason we're starting
to see a lot of companies from outside of
healthcare coming into healthcare?
So, CES is going on this week as well in Vegas
and we've seen a number of technology companies,
but also consumer companies coming into healthcare.
Do you think it's because we're all just trying
to improve life and, and there is a deeper
understanding now that that's ultimately what
is going to transform the outcomes?
Part of it is giving people the right information
so that life can be improved and I'll give
a really concrete example.
So, you might come in, say you and I are in,
we're in clinic today.
Yes, it's great to see you.
It looks like your blood pressure is 180 over
90, so I have a 10-minute encounter with you,
I'm going to try to explain what hypertension
is.
I'm gonna put you on two new medications.
I want you to take those every day and you
should figure out how to monitor your blood
pressure.
That's a lot of information that needs to
be exchanged about explaining the condition,
bringing you along, figuring out what your
insurance is, and then figuring out how you
are gonna actually measure this outcome.
And what I'm seeing is tools that could help
this interaction.
Maybe it's a blood-pressure cuff that you're
able to use at home that transmits the blood
pressure value so that you don't have to come
back in two weeks to have your blood pressure
checked.
But the more information that's out there,
the better you can be an advocate of your
own health.
And so, when I look at a lot of the consumer
plays that are going on right now, it’s
ways of trying to make your life just a little
bit easier.
And that's been done in so many different
industries and I think now's a moment to say,
why not health?
Yeah and it seems like a lot of the, the progress
that's being made now, the opportunity is
really to, to take these new tools, to take
this new data, to take these new learnings,
and then design it invisibly into our lives.
You know, whether that's our car seats, or
our bathrooms, or our refrigerators, or whatever
the case may be, I feel like there's a great
opportunity and I hope a lot of the innovators
in this room start pushing towards that to
take that next step.
To take the extraordinary learnings from the
data, and technology, and the tools that Verily
is designing and then figure out how we transition
that into, invisibly, into our lives.
Yes that's such a good point.
We've experimented with a lot of these non-invasive
ways of trying to understand information and
I think that there's sometimes an interesting
tension.
We may talk to a company or they may be talking
to investors and the investors want to know
how much the engagement is or we may want
to know that, but that's probably the wrong
way of thinking about it, as you said.
It's much more likely, how do you put things
into objects that people are using every single
day?
How do we bring the barrier down to actually
get people engaged and interested in using
these kinds of tools and devices?
Because I always come back to the concept
of value.
And, while I think there's something different
about the moment we're in right now for the
reasons we discussed, at the same time if
you think about technology broadly, and I
use this example, cardiologists and doctors
use stethoscopes.
That's a technology.
We've been using it for 200 years because
it helps us understand your heart.
We use cardiac imaging because that helps
us.
And so, the more we think about these tools
that's just something that adds value and
fits into our overall process, the easier
it is.
So, I try not to, I try to think about that
the reason why today is different, but also
never underestimate if something's valuable.
So, I'm sure everyone checked some news this
morning.
You probably have a favorite app that you
use.
You go there because it's valuable.
And I think with healthcare we need to do
the same things, whether it's a patient, whether
it's a doctor, or a health system.
And, you know, you're really at the intersection,
as we said, of technology data in healthcare.
There's a lot of, what I would call, the legacy
healthcare systems that are starting to either
collaborate with or think about collaborating
with startups or just technology in general.
What would your thoughts on that be?
What would your advice be, because oftentimes
the challenge is a culture shock.
There's, there's different cultures, you know.
What have you learned that might be helpful
to organizations that are trying to make that
marriage happen?
So I'll, I'll answer it in two ways.
One thing that's been really fun and challenging
is working with a number of different companies
and figuring out, how do you bring people
together and really listen and value where
their perspective may be coming from?
I think it's sometimes can be a natural tendency
for folks, even really innovative companies
and groups, to say, “We got this figured
out,” and the same may be true for more
traditional companies.
But what I've seen is if we, really, it comes
down to valuing and and having gratitude as
you brought up this morning and saying, how,
how can we actually focus back on what our
problem is?
Let's make progress and let's listen to one
another.
And the other thing, so that's one interesting
thing.
The other one I've noticed as a company, one
of Verily’s values is this concept of starting
with yes.
And it doesn't mean that you need to say yes
to everything and it doesn't mean, as Ameet
brought up in the talk before, that you have
to meet with everybody.
But what it means is when someone comes to
you with an idea, it may be a natural tendency
to think about all the reasons why that wouldn't
work.
So, you might come to me and say, “I've
got this amazing idea,” and immediately
I'm, have you thought about this and that?
It's the way critical thinkers work.
But if you pause for a minute and say, you
know, I'm gonna start with yes and think about
could this happen?
Could this be possible?
Then it really changes the entire dialogue.
So, I'm seeing both ways of thinking, externally
with partners, and then even internally.
The culture that you create as an organization
is going to flow through every decision that's
made.
So for me that's been a value that has been
incredibly fun to practice and I think it's
one that I hear from a lot of the startups
that I've talked to today.
t really is a way of thinking.
It’s a mindset and it's, the questions not,
if we can make it work, but how do we make
it work?
Because even the impossible can be possible
when you have that, that mindset.
I think that's extraordinary.
So, let's talk about the future.
Where are we going?
What are you optimistic about?
Both in the near term, but also, you know,
our mission is over the next 25 years accomplishing
these health moonshots.
Some people think we're crazy when, when we
say that but, you know, it's, it's an exponential
opportunity here.
What are you excited about?
I'm gonna go back to a theme that I started
to talk about before, because it truly is
what's most exciting to me.
This redefinition and understanding of health,
biology, and health decisions.
And I think we're at a moment right now where,
if you look at the investments over 2017 and
2018, really understanding tools to collect
health information in a much different way.
The actual infrastructure that is going to
be built so that this information can be parsed
and understood.
That's where next-generation analytics are
gonna be layered on top.
And then the most important thing is figuring
out what actually improves outcomes, what
leads to value.
But there's a moment now where all three of
those things are coming together and to me
that, that just can't be beat.
Wow.
So we are gonna open it up to questions.
So start preparing your questions.
We have several folks with, with microphones,
so if anybody does have a question just raise
your hand and, and before you ask your question,
if you could say your name and the organization
you’re with that'd be very helpful and also
talk right into the microphone.
Anybody have questions?
Right over here.
Hi.
Lisa Hagerty-McMahon at WaveEdge Capital.
Just, you mentioned FDA pre-certification,
the process, and that it's a new thing.
With all the new technologies that you are
giving, I'm guessing, throwing a lot in front
of the FDA that they've just never seen and
are trying to figure out how to work with.
I'm wondering if you can talk a little bit
about what that process involves.
So, certification with the agency.
So, the question for people couldn't who couldn't
hear it, was about, how does a company work
with the FDA on the pre-certification process?
And thank you for the question.
Yeah, it's been really interesting to think
about, how do you safely get new tools into
the hands of patients and providers, and what
we've seen.
And I would say this is probably true of everything
that's out there, but there's now an awareness
that if you have a new software platform,
for example.
How are you going to decide when you move
forward when it's locked?
What happens with iteration?
And what we've seen with the FDA pre-certification
process, is a real openness.
I mean, it's starting with a dialogue of what
is the FDA wanting to solve for?
How do we put patient safety first and foremost?
We have had a very open conversation.
FDA comes on-site, they go to many of the
different companies to try to understand how
do we really do best-in-class safety, but
at the same time move quickly?
And the place where I'm seeing it most tangibly
is around a lot of AI applied to imaging,
for example.
And there are new tools that are out there.
They likely will scale the accessibility of
certain products.
The product we’re closest to is screening
for diabetic retinopathy.
The idea that diabetes is one of the leading
causes of blindness worldwide.
We know that the number of optometrists and
ophthalmologists who can actually read all
of the fundus images is limited.
How do we create tools where there are automated
reads?
And so, this is a project where we've been
partnering to make sure that everyone is on
the same page as we move forward and I'm seeing
many, many companies work directly with the
FDA.
So it’s not something unique to us, but
it's something that I'm particularly proud
of, that we're doing.
Thank you.
And while someone's doing their next, preparing
the next question, I wanted to follow up on,
sort of related to the FDA, on a trend we're
noticing, and really for a while, but as the
maker movement of, of people building healthcare
in their garage or kitchen really accelerates
pretty quickly, I don't know if you have any
thoughts on that.
We didn't talk about this earlier, but I'm
just curious, like from a doctor's perspective,
how does the regulatory organization, the
technology organizations, the healthcare organization,
keep pace with change when consumers are building
healthcare in their, in their homes now?
Yeah.
Do you have any thoughts on that?
So, an example that people frequently turn
to is the type 1 diabetes community, where
a lot of people move forward to try to understand
their continuous glucose data and what it
means for therapy.
And there's some great articles, including
in JAMA and others, that really talk about
this.
And we're trying to figure out, how do you
actually partner with individuals, people
with type 1 diabetes?
How do you make this, make this a reality?
And how do you stay ahead of it?
So that's one thing.
The second one is there are a lot of people
coming up with a lot of good ideas and one
philosophy we've had is we're trying to tackle
today's problems, something like diabetes.
We're also incredibly interested in broader
health signals, and so we've engaged with
both Duke and Stanford to do something called
Project Baseline, which is saying we're not
going to be content just solving today's problems,
but we're looking for the next generation
of signals.
The only reason we can treat diabetes with
the clarity we can, is we understand the relationship
between glucose and diabetes, but there are
so many other signals that are out there.
And so, what we do is have a very open mind
to people who are making their own products,
thinking about their own innovations, because
that is where the world is going to be going.
I know some people are really terrified of
this prospect, but other people are very excited
and I think a lot of the opportunity for reinvention
and invention is when it just, sort of, happens
this way, so exciting future.
Other questions?
Yes.
Can you say your name and company.
Sure.
I'm Camilo Erazo.
I'm the CEO for the National Center for Health
Information Systems in Chile.
And I'm a doctor myself and my work involves
collaborating and partnering with people coming
also from an engineering background, and that
type of collaboration I think is very important.
But I think you mentioned, and for many of
the ideas that you shared, they need to collaborate
further with people coming, for example, from,
for example, from behavioral sciences and
social sciences and I was wondering if that
is something that you are doing and how you're
addressing that which can be quite challenging,
for like, large tech companies that, maybe,
don't have those natural tendency to look
into that world?
Yeah.
So, this concept of where does behavioral
health come in is so important.
And what folks will make fun of me at work
for saying is, we can create all these different
widgets, but unless we understand where someone's
coming from, the behaviors that people are
choosing every day, then we've totally missed
the mark.
And I'll tell you a little bit about my own,
kind of, journey into this.
I was, I mentioned I was running large-scale
clinical trials.
We would report out with one medicine versus
another, there might be a 20% relative risk
reduction.
But I thought, and this was about 15 years
ago, there's got to be something different.
And we started collecting genetic samples,
in this whole world of precision medicine
many people quickly go to genetics and molecular
readouts.
But I've now, instead of just talking about
genome and phenome, it’s genotype, behavior
type, and phenotype.
And so, personally, what we've done is we
have a number of folks who spend their entire
careers, we have psychologists, people who
specialize on, we have user, what we call
user experience researchers, to really understand
are we making a difference?
So, it cannot be ignored and it's something
we've embraced personally.
Excellent.
More questions, there’s one back here.
Let’s wait for the microphone please because
we need it for the live stream.
Thank you.
Hi, my name is Mohanjit Jolly, I'm with a
fund called Iron Pillar, which is a US-India
cross-border investment platform.
So, question, really, is from a Verily standpoint
how do you start thinking about, sort of,
democratization of this technology across
the globe rather than having it be very U.S.
centric which, unfortunately, I think a lot
of companies, you know, end up focusing on,
because the market here is, obviously, massive,
but when you think, think about diabetes and
other problems the emerging economies actually
need that, you know, just as much, if not
more so, than, than the emerged economies,
if you will.
So, the question is how do you, and I'm paraphrasing,
how does a company not become myopic and only
see the world in front of you?
And I'll take it even further.
How do you go beyond seeing Silicon Valley
to seeing the United States, which is a very
diverse country, to thinking about international,
the international perspective.
And I'll tell you how we've handled it.
One is to say from the beginning that there
is an entire world of people.
And something Unity and I have been talking
about is how do we think about all of the
billions, and we were talking about that earlier,
I'll give you three tangible examples.
One is, from the very beginning, we've partnered
with other governments, so we have ongoing
projects with the NHS, as well as with the
Netherlands.
And then the example I gave around screening
for diabetic retinopathy.
We're thinking about the entire end-to-end
solution.
So creating cameras, the screening, and then
what do you actually do on the care side.
And we're exploring that, not only in the
United States, but also in India.
Because as you said, there may, and there
likely are going to be very different, if
not bigger, applications as you think broadly.
And the third tangible example is we took
a strategic investment from Temasek, which
is a fund based out of Singapore.
And so, I would say whoever you are and whatever
company you're working on, thinking about
how do you embrace globalization from the
very beginning, even if you start some of
your initiatives in the United States.
I would just add on to this, I think, you
know, I just want to say this, given some
of the people that are in the room.
For any organization that's not thinking about
the global opportunity in health, I just think
it's, not only a missed opportunity, it's,
it's just unacceptable.
There's seven and a half billion people in
the world and the reason we say we're organizing
a global army of Health Transformers is because
billions of people do not have access to basic
care right now.
You know, we tend to think about the three
trillion dollar healthcare market or talked
about, basically, three hundred and fifty
million people when we’re in the United
States, but the opportunity is extraordinary.
And I think what some companies are learning,
some businesses are learning, is that there's
a whole new way of thinking about the healthcare
market and it has to do with the whole world.
It has to do with people that can't afford
care, which poses some really, or creates
some really interesting questions, around
what are the business models of the future?
What, you know, one of our moonshots, the
cost to zero, we're very purposeful about
why we say zero.
What if healthcare didn't cost any money?
You know, and people think that's just insane,
right?
Well, I don't know.
I remember when we used to have to spend a
dollar fifty to call London, you know, and
Skype, and WhatsApp, and all sorts of things
resolved that issue.
And so, I think there's, in some instances,
an opportunity to leverage global thinking
to radically transform the future of health.
So, I appreciate that, that question.
Other questions?
Well, okay.
Yeah.
Kevin Halteman from Kaiser Permanente.
Can you talk really loudly please?
So, Kevin Halteman from Kaiser Permanente,
hello.
So, my question is in regards to, you've been
part of Google X, which is in broader, within
broader Google, and then interacting with
startup teams through partnerships.
I'm curious if you could share any other tips
for big companies engaging with innovation
teams, moonshot teams, startups, and what
makes those relationships, interactions, thrive
or what puddles would you recommend to avoid
stepping in?
So, the concept of how, how do smaller startups
work with Big company.
BIg companies.
Got it.
So, thank you.
This idea of how do you actually form partnerships
at work, how are you gonna move forward.
Ameet nicely talked about timelines.
What I've seen, generally, is when people
are focused on, I'm trying to solve a given
problem and how can certain pieces come together,
it works really well.
There's nothing wrong with having big, broad
conversations, but it's sometimes harder to
figure out exactly how the different pieces
would plug in.
And so, there are companies that we work with,
and I mentioned the partner space that we
now have, where it absolutely aligns.
I feel so good about them being around our
teams, near our scientists, near our labs,
because it's a really tangible problem they're
trying to solve and I feel confident that
we can do something real to accelerate their
business.
So, my general advice is to really think about
the problem you're trying to ask and think
about who's gonna add value beyond just a
label, a name, or a brand.
I think there was another question over here
please.
We'll just wait for the microphone.
Hi, Laurie McGraw with the American Medical
Association, also responsible for the AMA’s
Integrated Health Model Initiative.
I'm curious how you think about the organization
of data.
You've got a lot of data that you're working
with and how you expect the standards to be
semantically interoperable with all of the
healthcare technology that's already in place
in hospitals and clinics today.
So, it's a great question.
By the way, hello to this side of the room.
So, this idea of, unlike other industries,
where if you think about other tech examples,
people go wow, you know, tech company came
in and everything was changed.
In many cases some of the companies were starting
fresh and creating new regulatory requirements,
new data standards.
In healthcare we all have to be very aware
of the tremendous work that's already been
done, systems that are in place.
And I think working with groups like your
own to make sure that folks know the standards.
If anything, lean in and bring coalition's
together.
One thing that we've done, there's the President's
Precision Medicine Initiative now, known as
All of Us.
And in addition to Project Baseline that I
mentioned earlier, and Project Baseline is
a concept of really thinking about comprehensive
health data.
Anything from genomics, to people's personal
preferences, to behavior, behavioral health.
And thinking the infrastructure there, we've
also worked, and now are the data core, for
the All of Us program with the idea that it's
much more powerful for us all to come together,
understand what standards we want to move
forward.
And again, I know your organization is deeply
involved and I applaud you for the work that
you do, because it's different than other
fields where everything is just going to be
starting from scratch.
And so, I think, I saw the title that was
in the brochure that they chose, I guess for
me personally with feet on the ground, head
in the sky, I think when a company wants to
be involved in healthcare and life science,
it’s really important to understand and
have our feet on the ground to know what is
already out there and how can we just accelerate
the work that's underway.
There's a question back there.
Hi, my name is Lisa Spellman, I'm the Secretary-General
for DICOM and I thought this is going to be
way too geeky of a question to ask, but now
that have heard two standards questions, what
message would you have to the international
standards community?
What can we be doing to further these efforts?
Yeah.
So, this is a question about, and I'm happy
to answer anything.
International standards.
So, we have a number of, what I would encourage,
both the committees as well as companies like
our own, is to make sure that we constantly
communicate and we have several people on
our team specifically there, to make sure
that we don't miss the mark.
And what I would encourage organizations like
the ones we're hearing from now, is stand
up, have a voice, make sure people are hearing
your perspective.
Because Unity is the one who really said we
need to lock arms and figure out how to do
the right thing for patients and it's only
through really open communication around what
the best standards should be.
And certainly for groups like your own that
have thought tremendously about it, please
share your message.
Do you think, and we'll go to your question
here in a second, that with blockchain and
things moving so quickly, that some sort of
new standard just materializes organically
that leaps us forward in a way, maybe, we
weren't expecting?
It may.
You know, we have a lot of conversations about
blockchain utility, where is it gonna fit.
To me, it comes down to really what's the
problem we're trying to solve.
So, it may.
And it may, there was also questions around
here versus other environments internationally.
I think if there's a strong enough need and
use case it may very well, but I see all of
these things, whether it's blockchain, AI,
big data, deep data, they're all just tools
for us to try to answer problems and there's
no place more clear than in healthcare and
life science.
So, use the tools that help you solve the
problems you're trying to solve.
I love it.
There was a question over here.
Hi Dr. Mega.
My name is Rebecca Hu and I represent Earlybird
Venture Capital, a Berlin-based health tech
firm, a venture firm.
And my question is in regards to the quantified
self, especially with growing interest in
understanding largely misunderstood parts
of our bodies, such as the brain and microbiome.
How do you bridge the disconnect between trying
to conduct large retrospective studies and
trying to collect as much data to refine algorithms
to understand these systems, versus the fear
that we're collecting the wrong data points
in the first place.
So, I think it, there really is an approach
to saying, we almost have to step back and
understand these systems.
And the examples that were given is how do
we understand the microbiome and how do we
think about the brain, and brain health, and
neurology, areas where our tools have been
still emerging.
And the way I think about it, and we think
about it as a company, is what do we need
to do to truly collect gold standard data
from these different elements?
And we have a program going on in both those
areas, I'm happy to chat about it.
But we have to start with just the ability,
can you collect and organize it?
But unless we figure out the value and what
we're gonna do with it, it does fall short.
So, you need to be committed and we're certainly
committed to all three steps.
Because what comes up frequently is just because
you have a lot of data, and certainly when
I put on my physician hat or talk to my physician
colleagues, no one's saying, “hey you know
what I really want? is like a ton more data,
because that's gonna make my visit better.”
What people are asking for is curated, actionable
information.
I'm fairly optimistic that we're gonna learn
a lot more, for example, about both the areas
that you talked about and then they can be
applied, but it's, we're all gonna have to
roll up our sleeves and do the heavy lifting
and the hard work to figure out what it means.
Other questions?
One right here.
This is a question Can you say who, you're
name and company?
I'm Sam Ali, with Denka, Japanese company
based here in Talk as loud as you can.
I'm based here in California, but I work with
Denka, a Japanese company on the corporate
venture side.
And the question is, that I think the main
challenge is, right now, is there there's
a lot of innovation, but I think there's a
big gap in applying new technologies and products
into medical practice and I think the studies
show there's a gap or a lag of about 20 years.
And it's a big challenge to change medical
practice when the doctors are so busy and
they are not necessarily up to date on all
the emerging technologies.
And so, this is a question, or a comment,
or, to Jessica, or to anybody here in the
room is, what can we do to accelerate the
adoption of medical innovation, sometimes
approved and fully authorized applications
that take such a long time.
So, the question really is pertaining to the
long lifecycle it takes to truly change medical
practice, and what I'm seeing, there are different
ways that we can think about it.
Certainly, very invasive products, they have
a regulatory and a adoption pathway for a
reason, But places where I'm starting to see
the timelines shortened are on rapid ways
of collecting clinical evidence and there
are tools in practice where, the last conversation
highlighted this idea, of really engaging
directly with patients, getting folks involved,
ways of more seamlessly integrating that information.
So, I remember just a few years ago running
clinical trials and I would get a PDF back
and I'd circle different variables in red
and I'd then put that on my shelf and that
days is coming and going.
So, there are much smarter ways of looking
for trends, picking up signals, running adaptive
studies.
And then the final one is, how do we actually
think about that last translation, that last
mile and getting things into practice?
And for anyone, and Unity, you asked this
earlier, for anyone who is in the health system.
A medical student, a doctor, nurses, care
providers, occupational therapists, physical
therapists, come to meetings like this.
And we need to make sure that we don't do
technology in a bubble, but that we are constantly
reaching out to our colleagues who know a
lot about health, how healthcare works.
And so, I met with a great medical student
who's one of the volunteers here today and
he's in his third year of rotations, but he
volunteered, because he wanted to be part
of the conversation.
And I think that's where you're gonna end
up changing the end.
I think, certainly, I find that people are
open to traditional education, but nothing
beats actual personal investment.
Wonderful.
So, we're, time for one more question and
then I got one question to wrap things up.
Microphone please.
Thank You.
Marta Gaia Zanchi from the Stanford Byers
Center for Biodesign.
I'm interested in health technology innovation
processes and my question for you is how do
you think the health technology innovation
process at Verily changes from Google, if
it has, how do you think the industry in general
has adopted and learned in innovating in this
sector, and if you think that there are any
weaknesses that as a community we need to
work on when we think about innovating in
health technology?
So, the concept of innovating in healthcare,
health technology, and life science, is one
that comes up a lot.
One thing I feel really fortunate about, the
question was how do we do that at Verily?
We have to have the basics underway and we've
spent several years building a quality system,
regulatory system, clinical operations, just
things you need to, to really get things launched.
And I'm not saying everyone needs all these
pieces, we're happy to share the pieces that
we've worked on.
But if you understand the landscape you're
entering in, then you can be as creative as
you want.
So, I think one thing that's different about
industries, and the question came up earlier,
that are already mature industries, as opposed
to just inventing something out of nowhere,
is just making sure that we're familiar with
what are the ground rules and then how can
we transform on top of that?
So, I think it's, it goes back to the overall
premise of really understanding where we are,
keeping our feet on the ground, but then giving
that freedom and that's starting with yes
to innovate differently.
The other thing I think that I see in life
science and healthcare which gets to your
question about this lifecycle, is going back
to our theme of helping one another.
If they’re mistakes that you've made, if
they’re mistakes we've made, we'll be open
with that, because there are things that we
all need to learn.
And when I say mistakes, I mean that broadly.
Biology’s tough.
There's obviously engineering risk and there's
biologic risk and if you run an excellent
study, and this is something that's so ingrained
in me having run clinical trials.
You can run a wonderful clinical trial.
You can do the best research.
But as it turns out, biology can be really
challenging and I think to embrace biology
and to say that's the beauty of it keeps us
from becoming so closed and keeps innovation
forward thinking.
Well, Jessica, I just want to thank you, and
before we go, would you wrap up with a dream,
a wish, an ask, perhaps, of this community,
the ecosystem, the people in this room, on
what we should all do to to help transform
health.
What I would say, I think health is so universal
and you can so quickly get bogged down in
all of the things we just discussed that will,
that will stifle innovation.
But I think to stay optimistic.
Figure out the way of getting things done.
Partner with groups that are trying to figure
out how to move through the system.
I would just hold on to that enthusiasm and
energy, because there's nothing more important
than health.
Thank you.
Jessica, Thank you for being here and everything
that you do.
Wonderful.
[Applause]
