Digital Transformation and the Health Care Biz: My (Somewhat Skeptical) Takeaways For HBS


I’m deeply skeptical that I have much knowledge to impart to Harvard Business School (HBS) students.  After all, they’re the ones clever enough to pursue a two year advanced degree (“six months of education crammed into two years,” they joke), while across town, my classmates and I ran gels, plated cells, memorized structures, and took call for a decade or more (in some cases) — and all for the privilege of eventually working for our fleece-vested colleagues (see also this 2011 Scott Gottlieb piece, and my 2012 Forbes post).

Even so, I was recently invited to appear as a guest on a new podcast out of HBS called “Under The Datascope,” where I answered questions about my experiences and perspective as a physician, scientist, technologist, drug developer, and investor. The episode (here),released today, is part of a series hosted by Gabriel Eichler and sponsored by the Kraft Precision Medicine Accelerator (Go Pats!) at HBS, featuring interviews with people working on and thinking about data, analytics, and precision medicine.

There’s a lot of content packed into the nineteen minute episode, and I thought it might make sense to capture some of the highlights – though I suspect the entire episode, and the series more generally, is likely to be of interest to readers.

Biomedical entrepreneurs drive science into durable application. After struggling during my clinical and research training with the persistent gap between promising science and clinical application, I came to appreciate that biomedical entrepreneurship represents the distilled essence of the translational impulse. (See this 2005 Nature Biotechnologycommentary, for example, this related version that was published in the San Francisco Chronicle, and this and thisfrom Forbes.)

Biomedical entrepreneurship requires humility and humanity, not tech fetishization and solutionism. Driving science into application requires not only the best (more precisely, the most suitable) technologies that are available, but also a deep sense of, and respect for, the complexities of biology and what I described as the “humanistic center of medicine and patient care.”  (Regular readers will recognize this as a recurrent theme of this column — e.g. this 2011 post, “What Silicon Valley Doesn’t Understand About Medicine”).

Good doctors have always customized care. The mantra of precision medicine – “right drug for the right patient at the right time” – is not a radical new idea, peculiar to the molecular age. Admirable doctors have long tried to individualize treatments based not only on the biology of disease, as best it could be understood, but also based on the physician’s knowledge of the patient’s circumstances and preferences. It’s also critically important not to be excessively reductionist, and to recognize a person isn’t just the sum of their molecular mutations; everyone exists in a much broader context. See hereand here as well.

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The Next Big Thing is You


An optimistic introduction to what could come after the VC funded cycle of disruptions and consolidations.

Various new kinds of software, we are endlessly being told, are the Next Big Thing, just about to disrupt like a volcano of New e-Things that will certainly upend all of the things in the next X years. After you’ve read enough in this genre, it turns into a guessing game: will they put X at 5 years, or 9, or 7? You can usually tell by the adjectives in the first three sentences, as the rhetoric is at best overblown Ciceronian pomp and at worst Ted Talk runoff. I like to fill out a bingo card seeing how many rhetorical and ideological crimes I can identify in a given breathless Medium “article” promoting a new startup, written by someone literally overleveraged in the success of its product offering. Here’s a partial list, in case you want to make up bingo cards of your own:

  • Misappropriated macroeconomic jargon
  • Consequences of disruption and other economic violence naturalized and downplayed via bastardized theories by Darwin or Malthus
  • Milton Friedman-esque swipes at central banks as irredeemable cabals that hate freedom
  • The word “gamechanger
  • Endruns around anti-trust law dressed up as Quantum Leaps for Mankind
  • Any pricepoint under $150/month dismissed as “less than you spend on your coffee every morning”
  • A photo of a “founder” or two standing on a stage at a trade show, preferably wearing a cordless mic
  • Market prolepsis
  • Smarmy appeals to how obviously governments can’t be trusted with the task of regulation, or with “data” itself

Venture capital is the real audience of these missives, and, as Mike Judge’s blunt, Aspie CEO seminally quips on the HBO comedy, Silicon Valley, “The stock is the product.” The winner of this debate tournament is whoever promises the most disruption, since that is what the gamblers came to bet on. As we say in Spanish, “A río revuelto, ganancia de pescadores”—when the waters are choppy, [only] the fisherman comes out ahead. (And no, there are not fisherwomen in this analogy.)

These mammoth disruptions very rarely correspond to giant technical leaps, however; most of them are results of the tiniest of innovations in user experience design, marketing, or convenience engineering. From a computer science point of view, these disruptive apps are apex predators on many levels. They centralize or repackage the data traces left by human experience in a tidy, privatized bureaucracy of monetizable information, but to do so, they stand on the shoulders of data processing giants, mammoth infrastructural investments, decades-long collective refinements funding by private-public partnerships and backroom deals with national-security agencies. In just a few short decades, to the tune of neoliberalism’s mantra (“but who will pay for it, surely not me, or us?”), all of this mammoth infrastructural apparatus was rapidly and irrevocably privatized in both legal substance and public perception. The casino of speculative finance not only wrested away from government any control or even regulatory power over the internet “industry,” but in the process it has also convinced the public that many new, dangerous economic practices and social structures are permanent, natural, and inherent to “the internet age”.

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