by Lucie Greene
There are other factors, too. New technologies are making it easier, faster, and cheaper for companies to offer what were previously highly specialized tests and personalized analyses, giving way to a whole wave of health monitoring that was previously unavailable. The cost of sequencing a single human genome has fallen from $100 million in 2001 to under $1,500 today. Low-cost sensors enable people to monitor the air quality around them or (with wearable forms) their skin hydration. Advances in AI reduce costs in health care by aggregating massive amounts of data, creating cognitive health predictions. AI is also being applied in new consumer services such as Viome’s.
Affordable DNA and blood testing are now positioned as direct-to-consumer products. Personal genomics company 23andMe has launched a testing kit it sells directly to the consumer that complies with the U.S. Food and Drug Administration rules on personal genetics testing. For $199, people can order a kit that will help them understand not only their DNA and ancestry but also their health, including genetic health risks (your risk of getting certain diseases), wellness, and carrier status (whether you carry certain inherited conditions). Bill Gates and Jeff Bezos have both invested in Illumina 2016, a biotech company working toward cheap DNA sequencing. It recently launched Grail, which aims to detect cancer in its early stages through DNA testing.
Wellness is also being revolutionized with new hyper-tailored services previously only available to professional athletes. We charted these new services emerging from 2016 at JWT. WellnessFX, an at-home blood test, has advanced analysis of blood, genetics, and the microbiome alongside recommendations to improve diet and exercise. The company recently launched its first testing kit, the $111 Lifelong Vitality package, which monitors key markers of women’s health.
Blueprint for Athletes is a diagnostic service that conducts detailed blood tests to measure key indicators of muscle status, endurance, nutrition, and other factors that impact athletic performance. With consumer versions of the Blueprint test priced at $225 to $500, the company is aiming toward serious and weekend athletes. InsideTracker also has at-home blood tests. It analyzes biomarkers such as vitamin levels and cholesterol to give users personalized recommendations and an “inner age” metric. Home kits start at $199.
“Health care is moving to the home,” Paul Jacobson, CEO of WellnessFX, told us. “Everything we’re doing is geared toward new technology that’s making the experience of collecting samples more convenient. As that happens, eventually you’re going to get your results on your cellphone directly. You’re probably going to be able to bypass labs.”
Disrupting the diagnostic testing industry alone could reap massive rewards. The global blood testing market is expected to reach $63 billion by 2024, according to Grand View Research. At-home testing is a rapidly expanding business; the direct-to-consumer lab test market was worth $131 million in 2015, up from just $15 million in 2010.
There are also hybrid services sprouting. New preventative health platforms include Omada Health, which works with employers to provide a digital diabetes prevention program via coaching, a tailored dashboard, and apps to monitor and encourage healthy behavior. “Welcome to the start of a life-changing journey. Omada is a digital behavior change program that can help people lose weight, reduce your risk of chronic disease, and feel better than you have in years.” Similarly, Noom is aimed at preventing obesity, prediabetes, and hypertension by promoting behavioral change—Samsung Ventures invested in Noom in December 2016.
Taken together, the bigger picture presents an increasing blur between the idea of traditional professional health care and what previously would have been lifestyle health categories. But it’s a blur that is creating a health boom for Silicon Valley in the area of new consumer products.
Tech is also being wrapped into traditional hospitals with new partnerships between tech companies and institutions. IBM Watson Health, IBM’s AI venture, has been working with hospitals from India to the U.S. on a variety of applications such as using data analysis to identify tailored cancer treatments faster, match patients with clinical trials, and accelerate drug discovery.
Early on, the McKinsey Global Institute estimated that applying AI and big-data strategies to better inform decision-making could generate up to $100 billion in value annually across the U.S. health-care system, “by optimizing innovation, improving the efficiency of research and clinical trials, and building new tools for physicians, consumers, insurers, and regulators to meet the promise of more individualized approaches.”
In 2017, it wrote of AI’s impact: “The private sector has long recognized the potential inherent in the new technologies. Self-learning software and cognitive systems can either already be found throughout the value chain or are on the verge of deployment: forecasting and pricing tools for purchasing and inventory management, chatbots for customer service, delivery drones for the last mile. AI applications can help companies to optimize services and lower costs, accelerate processes, and make better decisions.
“A similar development is taking place in the health-care sector, although exploration of the possibilities that artificial intelligence offers in the field of medical care and management is in its early stages.
“The most progress to date has been made with AI use cases around providers: medical centers are increasingly using early detection systems supported by algorithms or automated recognition of patterns in patient data.
“Less known are the opportunities that the use of smart technology enables for health insurers.”
AI will inevitably be one of the key tools used by Bezos, Buffet, and Dimon in their new model health-care company.
Tech entrepreneur Naveen Jain is bullish on Silicon Valley’s ability to transform health care. “We’re going to bypass doctors. Hospitals. Just like what’s happening in education too,” he enthuses of Silicon Valley’s new ventures to transform health and education and make them more efficient and accessible—and to create life-changing innovations that transform our relationship with illness entirely, thanks to biotech, AI, and life sciences research.
Jain is not known for understatement. He believes that businesses—frustrated by slow, outmoded systems—will collectively start to change health care by going straight to consumers with new alternatives. Just as Elon Musk did in sidestepping car dealerships to market his Tesla vehicles directly to consumers, so too will new industries move into health care, encroaching on the established guard.
He’s also confident about Silicon Valley’s abilities to transform the way we live. In the near future, he believes, health advances led by technology will have the ability to eradicate disease by diagnosing at early stages. Jain is an investor in Viome, for example, which uses at-home microbiome testing to offer hyper-specific diet regimes. (It’s been shown that gut health is integral to not only maintaining general well-being, but also warding off chronic diseases.) Viome customers send a stool sample to Viome’s laboratories; the sample is analyzed to assess gut health and metabolism and create a picture of the customer’s body on a molecular level. This is then translated, using machine learning, into a diagnosis and diet recommendation.
Viome’s website, much like its investor, is filled with fanfare. Dreamy images of people atop mountains are layered with messaging: “What if technology could expand humanity’s healthy lifespan?” Meanwhile, it touts its scientific credentials including having an “exclusive license to technology first developed at the prestigious Los Alamos National Laboratory.”
To Jain, the possibilities of tech to transform health are endless: “What happens to life insurance if people are not dying?” he asks. “What happens to life insurance when sickness becomes optional, or even aging becomes optional?” (This thanks to diagnostic technologies that can warn you in advance and allow you to correct the onset of chronic illnesses associated with aging.) “All the traditional industries are now at a point where they all could be disrupted. And the old guard is going to die, and when the old guards die, it’s a
freer game for every entrepreneur to go capture that market, because there’s a brand-new technology and everybody has the same access to it.”
Dismissing concerns about privacy, Jain believes that direct-to-consumer models of health services will actually better serve consumer interests. “Uber has had to change its policy in response to consumer wants,” he says. In Jain’s world, citizens of the future will be the ultimate regulators of health because health-care providers will now be consumer brands, no longer at the mercy of a complex layered health-care system immune to consumer pressure.
Silicon Valley is changing health in other less revolutionary ways, too. As with all the other services and sectors it has disrupted, it is positioning health services as “brands” with pithy language, an emphasis on easy-to-understand transparency, and lifestyle design cues. It’s also using apps and social media in creative ways. HealthTap has created Dr. A.I., an interactive doctor skill on Amazon Echo that uses artificial and “emotional” intelligence to be a talking virtual doctor for customers in search of medical insights and advice. Zoom+ is a new-wave health clinic with visits on-demand (like the Uber of health), and has an app and chatbot for additional questions. Baidu, the Chinese tech company, has created an artificial-intelligence-powered chatbot character named Melody who can give health advice. Many of these have all the trappings of the most successful lifestyle brands. They are presented with bright colors and sleek design.
Dr. Molly Maloof, a San Francisco–based physician, technologist, and wellness expert who advises many Silicon Valley health startups, has acutely observed Silicon Valley’s expansion into health. She is a well-being and health “influencer,” frequently found posting on Instagram trying out hyperbaric oxygen therapy, cooking superfood recipes, and recommending yoga brands. “There’s a lot of interest in early-stage biotech,” she says. “People are moving past software and looking at science as a service; novel ways of doing drug development; decentralizing drug development. There’s some really interesting stuff coming from a new perspective on synthetic biology, digitizing the process of creating synthetic biology.
“There’s a really big push toward data collection and aggregation,” she adds. The next step is artificial intelligence and companies making sense of the data. “The hope is that, as we learn more about disease and more about how to parse it out and understand what it’s made of, perhaps we’ll come up with an even better system than we have today.” Maloof believes the next opportunity will be in understanding “optimal health states.” “We need just as many systems for improving health as fixing disease. I see that as a big wide-open space.”
Could Silicon Valley replace our current health-care systems? There are tremendous benefits to this idea, but also drawbacks, beyond sharing data and privacy which has—as mentioned in an earlier chapter—already spooked British residents who discovered National Health Service had been sharing patient information with Google-owned artificial-intelligence company DeepMind. There is the fact that Silicon Valley is not representative of all people. Already this has been shown in its late awakening in its technology products focusing on women’s health, for one. Apple was famously late to add reproductive health to its HealthKit monitoring suite on the iPhone. They have generally overlooked women’s health, fertility, and maternity tech as an opportunity, which seems dumb, apart from anything else because women represent 51 percent of the consumer electronics market, according to HBR.
Today, the landscape is changing, especially as brands recognize the opportunity. As female-founded tech startups slowly start to attract funding, it’s giving way to some important new products. One example of this is Willow, a discreet breast pump that lets mothers express silently while still going about their day-to-day lives (it can be worn under regular clothing and comes in a chic shade of pale blue). Willow was launched at CES in 2017 and has since been named one of Time magazine’s top 25 Best Inventions for 2017. The reason it was so successful was its empathetic approach to design. “In this space, normally everyone focuses on the baby. We’re really focused on the mom,” Willow president and CEO Naomi Kelman told us. “It’s subtle but it’s different. In particular we say, how can we make moms’ lives easier and better?”
The response has been rapturous.
“Someone Finally Invented A Breast Pump That Isn’t Completely Awful,” wrote HuffPost senior reporter Emily Peck, describing it as huge step forward for womankind. “Finally, Silicon Valley has moved beyond funding yet another food-delivery or Uber-like app and is bringing something truly revolutionary and necessary to market: a breast pump that won’t make you feel like a sad bovine attached to a medieval torture device.”
There are countless other examples of this. Sweden-based Natural Cycles is the first app to be officially approved for use as a contraceptive. It detects a woman’s ovulation and calculates her fertile days; it was developed by CERN scientist Elina Berglund Scherwitzl, who founded the company with her husband Raoul Scherwitzl. It has been certified in the EU as a recognized form of contraception. NextGen Jane is a U.S.-based feminine care brand that tracks key health metrics using menstrual blood, so women can track their reproductive health.
How many products have we missed because a company didn’t get access to funding? Skewing predominantly male, Silicon Valley’s understanding of female-centric and female-designed products will be inevitably limited. But it could be missing out on countless opportunities as a result. There’s also the issue of Silicon Valley’s algorithmic approach to everything. The understood biases in algorithms are now widely known, so what if men are programming everything? Including women’s health services?
Technology and algorithms are making things faster, cheaper, more personalized, and more accurate, but could this also work against us? If you are overweight, should you pay for more insurance, or be given less access to credit? If 23andMe discovers you are a carrier of an inherited condition, will that affect whether you are granted fertility treatment? Beyond health as a category of its own, there is also potential for data to be connected to the vast swath of other services that Silicon Valley already plays in, from finance to loans to employment. What are the implications of these private, commercial companies—which now offer credit, payment plans, and financing—knowing if you are HIV positive or have a history of health problems? It’s a dangerous entanglement of private information that could be used against anyone.
In throwing vast amounts of money at various causes, Silicon Valley’s biases and interests will have a magnified and distorting effect. In response to the wider privatization of science, or “science philanthropy,” concern has already been voiced in some journals that having powerful individuals or private companies fund research may skew its focus (philanthropy experts say much the same about their area) or perhaps orient its direction.
In terms of research, this might have a socioeconomic or racial slant (in other words, illnesses and issues most prevalent in poor communities of color may get tackled last or ignored). Already, Amazon has come under fire for only introducing Amazon Prime to zip codes with more affluent residents, overlooking neighborhoods with lower-income consumers. What happens when it’s only certain areas of health being addressed? Or when only certain populations are receiving the lion’s share of health care and attention?
Most of Silicon Valley’s innovations are, naturally, tech-solutionist in outlook, but tech advisor Maloof points out that (as with everything) their high-volume hype, glossy websites, and soaring rhetoric promising empowerment and “optional” disease doesn’t always mean their outcomes will be as transformative as expected.
“There is a prevailing belief in Silicon Valley that they can solve all problems with technology,” says Maloof. “I’m seeing companies trying to tackle gigantic problems that are far more complicated than they realize. People are seeing big diseases and the experience of health care in America as being fairly horrible, and finding ways to decentralize health care and give more patients a sense of
autonomy—give them more information about their health, give them more access to their medical records, and give them more opportunity to track their health over time. But it hasn’t blown anybody away yet. I don’t think we’ve seen any studies that show that these offer a superior alternative to the analog version of what they do.”
There’s an element of risk in having Silicon Valley’s unicorn-lusting, scale-quickly approach to health too—health is by its very nature not as predictable as algorithms. Humans are humans, after all. In other words, the dubious prospect of combining the Silicon Valley model (venture-capital cash, fast scaling, and big headlines) with the messy world of health. “The thing about health care is that you can’t go around the rules of the game,” says Maloof. “You can’t play the game the same way you might play with a hardware startup, because the regulations are real. You can’t ignore them. And doctors and health-care policy makers demand research. If you really want to disrupt health care, you have to think long-term.”
One interesting thread to consider in relation to Silicon Valley’s move into health is what its technologies, in the macro sense, are doing to our health generally. Tech may be stepping in to help us monitor aspects of our health, but many of its technologies are cumulatively creating health adverse conditions—making us more sedentary, changing our habits, and even affecting our minds. According to Nielsen Company, adults now spend over ten hours a day on screen time. Aside from the well-known side effects of using virtual reality, VR experts like Jacquelyn Ford Morie have pointed to rising questions about VR’s impact on developing balance and children’s relationship to memory (VR is so immersive, it has the potential to distort children’s abilities to distinguish between real and virtual memories). “Nobody wants to do the research because it might show that maybe we shouldn’t be doing it,” says Morie. “That to me is the biggest gap. We don’t have control groups.”
