Google and the Future of Healthcare

Mike: I'm Mike O'Toole. The Unconventionals is a podcast series produced and distributed by PJA Advertising. Along with our academic partners are Columbia Business School, we're proud to bring you the Unconventionals. The companies we feature aren't clients. There's no financial relationship, no promotional agenda. Just the stories of companies and entrepreneurs that remind us that the biggest risk in marketing is being like everyone else. Japhia: Next on PJA Radio's the Unconventionals. Mark: There are over 165,000 health and fitness apps in the various app stores. Mike: 165,000 apps. How many of those get used? Mark: 36 of them make up 50% of all downloads. Mike: That's a signal to noise problem, right there. Mark: Yeah, it's a signal to noise problem for sure. It's really hard to stand out. The app or the platform that we've built and are continuing to develop with Fit is really a platform for unsiloing that data and aggregating in one place so that you can get a single view of yourself. Mike: 165,000 fitness apps, and only 36 of those apps get 50% of all downloads. What do you take from this? Well healthcare, at least the fitness, lifestyle, prevention corner of the market is not an innovation problem. We don't need more fitness apps, but you could say it's an insight problem. Which one of these apps could actually help me? It's certainly an integration problem. I might be more inclined to download and use those apps if they added up to a more complete picture of my health. Today on the Unconventionals, we're talking to Google and we're talking to Google about solving big problems in healthcare. Our guest is Mark Rosenthal who is head of health services at the company. We'll talk more about this fitness example later, but this point about apps, that the problem is, at least in part, about insight and integration, you could say that about healthcare in general. We'd waste less time and money and drive better outcomes if we were better at connecting information, connecting systems, bringing expertise to bear at the right place and time. Now Google isn't a healthcare company. The company isn't in the business of helping us live healthier lives, nor do they have anything to do with healthcare services. They don't treat patients, they don't fund care, they don't make drugs or devices, but if you want to know where healthcare advances will come from, you could so worse than watching where Google is placing its bets. Google isn't shy about it's mission. The company seeks to organize the world's information and make it universally accessible and useful. Now let's talk about scale. Google processes 2 trillion searches a year, and 1 in 20 of those queries are healthcare related. Google's core value to healthcare starts with those 100 billion healthcare related searches. Think about what those queries can tell us, particularly when you add intelligence to the task. Machine intelligence is core to Google. If you think about the fundamental task of search, ranking and prediction, whether it's language, speech, translation, image and video processing, it's based on machine learning. Mark: I think the best way to think about Google and what we're doing is as an enabler using the assets that we have that are unique to us, right? In healthcare specifically, the question that we are thinking about is how do we apply the best of what we do, which is computing power, machine learning, and data to an industry like healthcare to solve big problems Mike: There are big problems, right? Mark: There are many. Mike: What do you guys see? What are some of the challenges you see in healthcare that you think Google is suited to addressing? Mark: I think the challenge of prevention, as opposed to treatment is one big one that everybody's trying to solve, right? If we can apply an unfiltered lens of machine learning and data to a problem where we don't have any desired outcome or any bias or any interest, then that potentially leads to different results or different outcomes. Mike: I know you're talking there about promoting healthier behaviors and lifestyles. Mark: It could be promoting healthier behaviors and lifestyles or it could also be taking a problem like diabetes, for example, and saying how do we take a different approach to preventing or curing or treating this disease that affects so many people globally, right? We have or project lens in partnership with Novartis that we're working on which is an ocular blood glucose monitor, measures blood glucose through tears, and there's a great user benefit to that for diabetics, right? You don't have to prick your finger to measure you blood sugar anymore. Mike: Use your contact lens, basically. Mark: That's right, and it measures it through your tears, so it's less disruptive, but on the data side, all of a sudden we have real-time data that we're able to collect about a disease and if you think about the long view of that, when you can pair that up with nutritional information because every body is different, right? So when you can pair that up with nutritional information and understand how an individuals body is metabolizing his or her food, then all of a sudden you have a great, user-specific treatment or understanding of that body. When you can do that at scale, it can lead to some great developments in terms of prevention or cures. Mike: Let's talk for a second about those 100 billion health queries. A good percentage of those drive doctors crazy. We've all been guilty of jumping to the darkest conclusion based on innocent symptoms. In fact, if you want a fun waste of time, check out the Buzzfeed lists on crazy healthcare searches. Now speaking of Buzzfeed, the title of one article captured the meme quality of this for me. Life Is What Happens While You're Googling Symptoms of Cancer. One of Google's responses to this is something called symptom search. This means adding context, say age, gender, where you live, to healthcare searches to make them smarter. Mark: Well I think we're living in an age of the empowered patient where the center of gravity is shifting from the provider to the patient and mobile is a big enabler of that, right? When I go to my doctor, if my doctor gives me a diagnosis of pre-diabetes and a regiment to follow to help me with that, I walk out of the doctor's office, I'm already on my mobile phone before I even get to the elevator of the building looking up pre-diabetes, how to prevent, and really trying to figure out, is this the right plan for me or what should I be doing. Mike: Or you wake up tired and you go online and you find out you've got, maybe some really terrible disease that you don't really have. Mark: That's right. One of the things we're doing to address that, we've just recently launched symptom search, right? The challenge with the health information that I think you're getting at is you go online and you do a search for your symptoms and the result is you have some rare disease that affects half of half of half of a half of a percent globally, but you have it because you're tired and you have a headache, right? I think what we're trying to do is marry information from providers like the Mayo Clinic with signals or intent or context that we understand about the user, right? If you think back 6 or 8 months ago if you searched for headache and fever in Massachusetts and you got a diagnosis of Zika before Zika made its way into the US, which by the way, won't happen here in Massachusetts because those mosquitoes don't live or can't survive here. Mike: Good to know. One less thing to worry about. Mark: One less thing to worry about if you're in Massachusetts. We can inform the result with that type of context. Mike: My agency PJA has built a lot of marketing campaigns for companies that make medical devices and equipment, and we learned early on, the hard way, that there's a bright line you don't cross. You never take credit for the caregiver's job. They're the ones who treat patients. They have the expertise, they bring the compassion. Everyone else is just enabling that. There's an analogy in there for Google. You know it drives doctors crazy when patients come in preloaded with a diagnosis, but if Google doesn't cross that line, if they're helping us be better prepared for conversations with our doctors, well we're all better off. When you get in to this, there's a lot of healthcare providers who are frustrated with this online, Googling health symptoms. I'm sure you find providers, too, that are open to working with you, that want to work with you. Can you talk about that? How do you find those people? How do they behave? How do those conversations go? Mark: I think generally, providers do have the mission of helping people be well, right? If we can enable that, then at the end of the day, our goals are aligned. Even thought it might be frustrating for a doctor to have to adapt to a new consumer who's walking in knowledgeable and empowered, maybe with more questions than they had 5 or 10 years ago, it's still going to bring a higher level of care to that patient. A great example is with the Mayo Clinic. There's a great story, I believe it's from Zeitgeist, Google's big, annual conference a couple years ago. There was an interview between our fireside chat between Tom Brokaw and John Noseworty, CEO of the Mayo Clinic where he talks about a mother who's child was at home, very ill, losing weight, and dying. This was in the Pacific Northwest. They couldn't get a diagnosis and the mother was doing a lot of her own research, went onto YouTube and found a video from the Mayo Clinic about POTS. Mike: Just for background, POTS is short for postural orthostatic tachycardia syndrome, and if you suffer from this relatively rare and mysterious syndrome, your heart rate increases suddenly and substantially when you stand up from a lying down position. It can be chronic and totally debilitating and for our purposes here, pretty hard to diagnose. Mark: Called the Mayo Clinic, the Mayo Clinic said, "Would you like to speak to Dr. Fisher who is the POTS specialist at the Mayo Clinic." The mother said, "Well, I didn't think I would be able to speak to Dr. Fisher." He got on the phone with this mother and she told him about her child and the symptoms and he said, "It sounds like your child does have POTS. How soon can you get here?" She took him out- Mike: Not like you're crazy, just has a headache. Mark: Not you're crazy, just has a headache. Sounds like he has POTS. The mother took the child to the Mayo Clinic in Rochester, Minnesota, was diagnosed with POTS, and is now recovering, gaining weight, and getting healthy again within weeks, right? Mike: That's a great story, yeah. Mark: That's how it should work. That's absolutely how it should work. We're living in an empowered consumer age, right? If you have to make a purchase today, you want to buy a new car, you do your homework. You look it up, you look up the Kelly Blue Book value, you go out to Google, and you walk into the car dealership knowing what the dealer paid, what you should pay, what the average consumer pays, knowing what your trade-in's worth. Mike: Why wouldn't we do that as empowered healthcare consumers? There's more at stake to those decisions than almost anything. Mark: That's right. That's right. Mike: I don't know if you know the term accountable self. It used to be big a few years back but you don't hear it much anymore. It's a way of characterizing the wearables movement. Tracking steps, leap, heart-rate, other data, because the theory goes, when you track the numbers, you'll change your behavior. Now I'm a totally religious FitBit wearer and step counter. I find it motivating to reach my 16,000 steps a day, but I'm also aware of some of the weird, counterproductive incentives. My FitBit doesn't translate cycling to steps that well, so I actually bike a lot less than I used to. That doesn't make any sense. Google sees a play here and it isn't in a new kind of device. While Google does make some consumer products, and we'll talk about that in a minute, for the most part they're a platform company. Think the Google Android operating system. This is how Google has approached the wearables market. Not having a horse in this race means they're free to pursue a different prize which is the information spun out by these 80 million or so wearables that were sold in 2015 and all the apps that run on them. Also to help people like me make better decisions by connecting some of that information. Mark: We have, I guess, a couple of places that we're playing there, right? The first is with Android Wear, so wearable devices like smartwatches, like the one I'm wearing. Then marrying that to the Fit platform, so a platform to sort of unsilo data from all of the disparate health and fitness apps that are out there. There are over 165,000 health and fitness apps in the various app stores. How do we unsilo that data and create a single view of the user or of the patient or of the person, right? Mike: 165,000 apps. How many of those get used? How many of those, really? Mark: 36 of them make up 50% of all downloads. Mike: That's a signal to noise problem, right there. Mark: Yeah, it's a signal to noise problem for sure. It's really hard to stand out. For us, we're not really building apps for that purpose. The app or the platform that we've built and are continuing to develop with Fit is really a platform for unbundling all of those other apps, unsiloing that data and aggregating in one place so that you can get a single view of yourself. Again, if you go back to the contact lens example and the long view that I laid out before of having the data in real-time of your blood glucose and matching that to your nutritional information, you need a platform that can do that because a contact lens doesn't track what you consume. You have to track that somewhere else, but then you have to have a platform to put it together, and that's an opportunity for Fit. Mike: Google does make some products. They sell a whole lot of $35 Chromecast devices that let you display your computer, smartphone content on your TV. You have a sense that for Google, Chromecast is about making internet content, think search and YouTube, more ubiquitous, than it is about marketing hardware. Turns out this is true with other Google devices. They also feel like they're meant to kickstart new markets or technologies rather than be blockbuster products in their own rite. In some of the best applications, some of the best demonstrations for these products, happen to be in the healthcare market. Mark: I think at our core, at its core, Google is a consumer-driven company, and the products that we make and the platforms that we build are really designed for the masses, but what's really exciting about working at a company like Google and seeing the things that are developed is seeing how users and both consumer and professional take the products that are developed and the platforms that are developed and build for themselves, right? Everything we do is built on an open platform and so we have Google Cardboard, just a $20 piece of cardboard for example, for virtual reality where you just drop your phone in, it's got a couple of lenses and there are all kinds of apps now that have been developed for use there. Our own YouTube to lots of others that are on the market. Mike: We were playing with some fun ones in the office here, right? It's not just for consumers, it sounds like. Mark: No, it's not. There's a great story about a baby who was born with one lung and half a heart. The doctors told the parents that there was no hope of saving the baby and to take him home and just sort of wait for the inevitable. They didn't think they could find a path to a successful surgery because millimeters matter when you're dealing in the heart and the lungs and these sensitive parts of the body. What they were able to do was actually create a 3D image, viewable through virtual reality on Google Cardboard, a $20 piece of cardboard, and they were able to build a surgical plan and they saved the baby's life. It's an amazing story and we have those applications across other products too. If you think about Google Glass, which was built as a consumer product, and there were a lot of memes about people who were wearing Glass, right? Mike: Yes there were, yeah. Mark: From a healthcare standpoint, it's been a great success because doctors have really taken the opportunity to say, "Okay, we have a use case for this." Number 1, when you're in medical school and you're observing a surgery, typically you're standing behind the surgeon and you're looking over the surgeon's shoulder while they're doing the procedure and that's a hard vantage point to get. Now with Glass, because the camera's right there, you can get the view that the doctor is seeing. So you're right there while the doctor is doing the surgery and you're able to see it just the way the doctor does, and that's a great learning experience, right? Mike: That's a great story around Google Glass. What else? Are there other applications there? Mark: Sure, I think so. If you think of all the functionality that a product like Glass has, right, it's got a built-in camera so and built-in screen so it can do things like take pictures or facial recognition, it's connected to your phone so it can pull data right in from your phone. If you think about things like Google Now cards which are sort of on demand reminders, it's answers before you ask, if you're familiar with Google Now. It's our move from demand to assisted suggest, right? How do we put that front and center with a product like Glass which is right on somebody's face. If you're sitting across from somebody and you forget their name, maybe it pulls in an image from your Google Photos account and says this is Mike. Mike: That would be awesome, especially for those of us on the wrong side of 50. Mark: That's right. Mike: Yeah, yeah. Mark: That's right, or if you're someone with Autism and you have trouble connecting expression to emotion. Maybe there's an app that can be developed that says, okay, this person is smiling, and smiling equals happy, right? This person is frowning and frowning equals sad. This person has furrowed eyebrows and that equals angry, right? I think the hope is, whether it's Fit or Wear or Glass or Cardboard, that we're building these great platforms and that others will use those open platforms, those open APIs to build amazing apps that can do some really cool things. Mike: Coming up, the next 3 billion people in the world will come online through mobile devices, not computers. What opportunity does this create for healthcare? We'll talk about it after the break. Japhia: You're listening to the Unconventionals, a podcast produced and distributed by PJA Advertising. We're always on the hunt for great business stories. Not about share price or scale, but about the element of surprise. To find out how to apply the best practices and behaviors of companies like GE, Warby Parker, and Big Ass Fans to your business, visit our website, AgencyPJA.com. Our academic sponsor is the Center on Global Brand Leadership at Columbia Business School which turns the research of academia's foremost thinkers on branding into practical tools and insight for real world application. To learn more, visit GlobalBrands.org. Mike: Welcome back to the Unconventionals. We're talking to Mark Rosenthal, health services head at Google. What Google is best at is providing machine learning to make sense of the vast data it has at its fingertips. For healthcare, this means enabling more informed healthcare decisions for us and our caregivers. How does that work for people without access to a smartphone or computer? You gave that great example about the Mayo Clinic and the kid in the Pacific Northwest. That's essentially an access problem. Based on caregivers there, maybe the family didn't have access to somebody who could figure out what his problem was. Let's talk about access. That's one example. Where is access a challenge? Mark: I think if we look here in the US, that's a great example for a developed country, right? Fortunately that mother who was doing that search and found that video on YouTube was able to get online, had a computer or a mobile device or a tablet, was able to find that video, had a phone to call the doctor, and had the means by which to get on a plan and fly to Rochester, Minnesota but for 70% of the world, that's not possible. We've got about 2 and half billion people online today and a population of 7 billion, so what about the rest of the world? What about people in developing nations who are afflicted with all kind of different health issues. How do we solve for them? If we can deliver connectivity to those remote parts of the world, then the next thing is to get those people online. Mike: Right, what does that enable if you're connected? Mark: We believe, I believe, that the next 3 billion people are going to come online via mobile devices. What does that mean in terms or delivery and technology and service for those users? For starters, on our side it means that we're going to have all of the rich data that comes along with a mobile device, right? Your laptop isn't location enabled in the same way that your mobile device is location enabled, right? We're going to have very rich data about those people and those populations, but we're also going to be preserve them in a very specific and tailored way in a mobile first world. Mike: They're connected, it's probably through mobile device, so what does that make possible? Do you have any stories there? Mark: Yeah, absolutely. There's a great example of Android making impact health. There's an app, this is not our app, but it's an app for Android called Pocket Optician which enables a modified smartphone to look at the retina in the back of the eye, and in rural Africa, there are about 285 million people who are blind or visually impaired, but 4 out of 5 of those cases are preventable. This Pocket Optician app has already been able to help 1,000 people to avoid blindness. The way it works is it scans the back of the retina, it sends the scan to a doctor in wherever the doctor is, developed nation X, Y, or Z, the doctor sends back the results and the treatment plan, if necessary, right? Mike: That's just a connected smartphone with some remote information. Mark: Connected smartphone with an app built on an open platform that allows connectivity. Mike: For much of the developing world, this new era of information enabled healthcare will be a mobile first experience, but healthcare delivery will change in important ways for all of us, aided and abetted by our devices. Think about how smartphones have changed how we consume content. It's a much more personal experience. One example is movies. It's Netflix world and my kids never go to the movies with their friends. You also see this change in how we want healthcare delivered. Mark: Number 1, I think there's a high level of adoption or interest today. There's a stat from 2014, 6 out of 7 people in the US would prefer a virtual doctor visit than to actually go to the office. The current is moving toward, I don't ever want to leave my house for anything. It also, going back to our conversation about access and the globalization of healthcare, it enables better care for people who really need it, right? If we have the ability to connect via a video conference for the doctor to be able to actually look at the patient and not just talk about it on the phone, and then potentially use other apps or other devices that are connected to understand all of the vitals, right? We can basically do the entire physical that we used to go to the doctor for in our home. There are devices for all of that stuff now that are connected. If my doctor says, take your blood pressure with your blood pressure cuff, then I'll go ahead and do it. We just did a really interesting project with the MBA class at Hold International Business School over in Cambridge, and part of the project was to look at the healthcare and medical devices industry and provide some forecasting and really come up with some ideas, and they had some ... I mean, these are grad students, smart and young and ambitious and they came up with some awesome ideas. They talked about an idea around creating the health cabinet and that basically by 2050, every home in the US would have a health cabinet where you would just sort of open it up and you'd sit there and there would be a screen that connects to your doctor and you'd have your blood pressure cuff and you'd have all your other stuff and it would just be in your home. You wouldn't even have to leave. The stepping stone to that was that they would develop health cabinets for pharmacies, so instead of having to go to your doctor, you could just walk into your nearest pharmacy, sit down in the health cabinet, open it up, press your doctor's contact information, connect, and do all the things you needed to do right there in the pharmacy, and there's a pharmacist right there to help you or somebody else in the pharmacy, clinician, to help you if you need it, right? Just really interesting idea on where the market might be going. Mike: Thanks to Google and thanks to Mark Rosenthal for his time and insights, and for helping us break-in our new recording studio in Cambridge. Japhia: The Unconventionals is written and produced by Mike O'Toole with Reid Mangan. Production and technical direction by Reid Mangan. Promotion and distribution by Greg Straface and Graham Spector. Additional media by Anthony Gentles and Ryan Doe with Ahis Osefo. Our executive director is Phil Johnson with PJA Advertising and Marketing. I'm Japhia Leahy. To listen to more episodes of the Unconventionals, visit AgencyPJA.com/TheUnconventionals. Mike: This is PJA Radio.