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Interview with Matt Holt about Health 2.0

Matthew Holt is the eccentric Co-Chairman of the Health 2.0 Conference.  Before helping launch the Health 2.0 movement, Matt was a survey researcher at Harris Interactive, as well as being involved with the Institute for the Future.  In 2003, he started The Health Care Blog, one of the first blogs of its kind to specifically address the trials and tribulations of health care. Matt has an undergraduate degree from the University of Cambridge and a Master of Science degree in Health Services Research from Stanford University.


1) Often great innovation is figuring out what will not change over time (in contrast to being “disruptive”). In that spirit, what are three commonalities of companies/innovators that you have seen have successful longevity in the health technology space?

One, companies that have developed for the inpatient side of the hospital and grow from there. Put more broadly, you need to get embedded properly in an organization, which does not change dramatically over time and is willing to adopt you. The two obvious examples are Neil Patterson with Cerner and Judy Faulkner with Epic. The industry on this side of things does not move that fast, so if you are lucky enough to get your foot in the door, your company is inherently going to have longevity. Getting the timing right is very important as well.

Two, the need for care is not going away, so companies that make care more accessible. I believe telehealth will have longevity for this reason. Teladoc has been around 15 years, MDLive has been around at least a decade. These companies have longevity because they have an expansive model, which works for health plans, pharmacy chains, providers as well as direct-to-consumer. Provide a solution to a long-standing problem, and you should do relatively well.

Three, companies that build broad-based platforms. Additionally, you need to figure out your user interface and experience so it is good enough that a lot of people adopt it. Companies that build quality technology to track activity, diet and other lifestyle choices [like the companies Under Armour scooped up in this space] are good examples.

2) Insurers are starting to fund the tracking of consumer consumption of healthy activities that support personal well-being (e.g. United/Fitbit, Aetna/Apple, etc). How do you see this flow of capital effecting consumer health technology in the foreseeable future?

The good and bad reality of this situation is that as a consumer product good, health wearables are getting so cheap they are becoming ubiquitous; however, they are also getting commoditized. The commitment is low — similar to a gym membership — and like a gym membership, you see a lot of drop off after the initial purchase.

Insurers are getting involved because the costs of entry are lower and they are looking for any way to motivate us — if even by a nudge — toward healthier behaviors. There is discourse in the wellness space if this stuff actually makes a difference. That said, this trend is a win for most in the chain. Manufacturers sell more devices, payers are not investing much and get to see if this moves the needle, employers get to say they are doing something, and employees get these devices for next to nothing. In short, I agree it’s a trend. I think that we’ll see more of this kind of stuff as we try to figure it out whether there are real rewards to tracking behavior beyond professional athletes and peak performers and condition-specific wearables, where I believe there is enough evidence to make the assertion that wearables add a lot of value.

3) Currently, there are unprecedented health technology advancements (e.g. CRISPR) that have the potential to significantly accelerate human evolution. In this context, how do you believe health technology will redefine what it means to be human over the next generation?

This is a question better suited for Daniel Kraft, but I’ll give it a try. I always used to joke that I thought that the future of health care was when most people could email their doctor, which many of us still cannot do effectively yet we want to move on to cure Cancer and using Big Data.

Let’s start that we know that if we exercise and eat better, that’s half the battle. I have little doubt that eventually technology is going to make that easier, better, faster and make it more effortless. In that sense, the construct of willpower might change.

It is important to consider how this technology is affecting our environments, too. It is changing how we think about providing service to people. Something as simple as improving food portability could help change our eating habits for the better. Maybe CRISPR can change your genetics so that sugar tastes bad. Who knows?

The next generation will see us aiming at improving the impact and efficacy of drugs on diseases by manipulating the drugs and/or the genome to improve outcomes. At some point we might start designing humans to avoid disease all together and to live longer, but that will be a while. For those interested in that, I recommend checking out Aubrey de Grey’s stuff. He outlines eight things we need to fix to make this happen. It is worth watching if this topic interests you.

4) There have been a lot of digital health products that purport they can change user behavior. However, history suggests that many of these products and services have overpromised and under-delivered on their claims. What is a good example of a company getting it right in the “behavior change” genre, and what can we learn from them?

Companies that are doing this well have pervasive mechanisms for compliance. Medisafe is one that I like in this area. Good companies look at deliberately getting you from X to Y. However, some areas are hard. For instance, nutrition is particularly hard, and even with great technology, the truth is people just do not keep up with that type of change because technology has not solved the problem that some behavior change is hard.

That said, technology around cognitive behavior therapy treatments — treating things like anxiety, depression, PTSD and insomnia — seem to be making headway. A British company called Big Health has come out with a program called Sleepio that is really interesting.

Canary Health is also another interesting example. They have created technology to bring Kate Lorig’s work on self-management to a broader audience, and that has helped people with diabetes change their lives for the better — so there are examples of success in this space.

5) What is the last thing you remember regarding Health 2.0 that made you sincerely say to yourself, “this changes everything” and why?

Okay, I am going to steal my answer here from Indu Subaiya. It is the advancements in Google Home and Amazon’s Alexa in combination with FHIR. This is really exciting her.

If you split up the various layers of interoperability — and say maybe voice is the first layer — FHIR can then get into the data and stick it in to any functional layer you want. In fact, FHIR (if it works), may actually change how we deliver care and how patients experience care.

That’s the big picture excitement. Small picture, there’s a real cool company called Medal we had on last year, which figured out how you get data out of a EMR by basically printing it using the print driver from a standard computer. Super clever idea, totally bypassing the need for APIs. One more, which was shown this year, is a company called Suggestic. They have got this super cool augmented reality, where you hold your phone up over a menu and it makes you aware of the things you can and cannot have based on your dietary restrictions.

 

Interview with Steve Groves about Fitness Technology

Steven Groves is the CIO of GoodLife Fitness, the largest fitness provider in Canada (and the fifth-largest fitness provider in the world). In addition to this role, Steve also spent more than 11 years on the Board of Directors of London Bridge Child Care Services, recognized throughout North America as a leader in the area of non-profit early childhood education. He was recently recognized by Forbes as one of the Top 20 Social CIOs.


1) If you had a magic wand and could improve a way technology is being misused in health clubs today, what would it be and why?

I think at this point, my perception is that we are not focused enough on a holistic view of the member beyond the four walls of our own clubs. I do not think we are necessarily misusing technology. Rather, the focus has been too much on technology that can be used exclusively to advance our clubs’ agenda, which is different than looking at technology for the betterment of our members — whether or not they choose to do some of their activities inside of our clubs or outside of our clubs.

When some of the first wearables came into our industry, things like the bodybugg — back whenever that was — bodybugg was intend to be worn predominantly outside of the club. Ironically, many probably took it off to work out because it was clunky. It seems to me as though — we as an industry —are not really focused enough on the overall outcomes that our members are looking for. We could be better at helping them with the selection of the right technology to get the results they’re paying us for. The truth is this technology is not necessarily going to be specifically aligned with improving what is happening within the four walls of our club.

2) There is a growing acknowledgement in our industry that we need to be better at catering to a wider spectrum of consumer types, e.g. age groups, aspiration types, gender differences, etc. This is in contrast to prescribing a “one size fits all”offering. How have you seen technology most amply and effectively applied to help support this effort?

One example is ResMed. They are a medical company. My understanding is they are one of the largest manufacturers of CPAP devices. They have also created bedside devices. Being the experts in sleep, they have created this bedside device that uses sonar-style technology, and the device passively monitors your sleep activity. Previous versions of sleep monitoring devices were either uncomfortable or [the new ones] do not work that well. So what ResMed did is devised this device that sits there and it monitors your sleep: it monitors your breathing, it monitors the temperature of the room, it monitors sound levels in the room … it can basically see your body in the dark. The signal from the device is bouncing off the water in your body and can pass through everything else, so it can actually see right through your blankets, any material you might have on top of you. I could not believe how accurate this thing is … from your phone you get this wave pattern that is reflective of exactly your breathing pattern.

So ResMed, having such a massive data set that they have collected about how people sleep, by their claim, can accurately predict when you’re in light sleep, when you’re in deep sleep, when you’re in REM sleep, when you’re actually awake. And then the device picks up on a whole bunch of other pieces of information around the environment that you are sleeping in. So there’s the noise level, and room temperature, and maybe one or two more data points. From a personalization standpoint, coming back to your question, what I found was most interesting is that after it learned about your sleep patterns for a week, it starts to get prescriptive. It asks you an eight-question survey each day. How much caffeine did you have today? How much alcohol did you have today? Etc. Then it starts to prescribe ways to improve.For instance, it started creating for me — clearly, very unique to my own personal situation — it was the first true prescription that I have seen that was catering to my own personal unique needs. This is circumventing the spectrum all together; this is catered to the individual.

3) What can United States club operators learn from our Neighbors to the North? Where are areas of difference that Canadian clubs get right and the United Statesmaybe could do better?

It may be a naïve perspective, because honestly I do not spend a lot of time within U.S. club operations, but my sense is that U.S. operators have the luxury of having so many other competitors and peers within the country — in other words, the sheer number of clubs is massive — that I don’t think U.S. operators necessarily feel the need to look outside of the Americas, or let’s say North America even, for ideas and new ways of doing things. I get a sense that your market is very insulated in that way.

Whereas in Canada, we are small — especially here at GoodLife — we do not really have any peers in the country. The second-largest club chain in the country is also ours, Fit4Less. What we do, and I think we do quite well, is work with a lot of club operators globally. We have really benefited from some of the learnings that we have gathered from people in Europe and Asia — in particular Australia.

This may be an unfair assessment — a naïve assessment. However, I get the sense the U.S. market is a bit of an echo chamber.There is a lot that we can learn from other operators from the East, and from others in the West. I get the sense in the United States there is a feeling that you do not need to necessarily go outside your country’s boundaries for ideas. If true, that is limiting.

4) Discourse about data “interoperability”in the health club industry has almost boiled over, and the concept of data interoperability means different things to different operators and CIOs. What does it mean to you and why (or why not) is interoperability in our industry important?

I want to deal with technology I can plugin to a system and have it functionally do what I want. I like the software IFTTT. I think in the case of IFTTT, they call this type of flow “channels.” I want to be able to take hardware and software — ranging for IoT and SaaS platforms — and feel confident anything that will be useful to the clubs and/or our members can be channeled, plugging into a workflow management system I control.

I want the same easeI use IFTTT to get my Nest thermostat to report that my living room is over 80 degrees through a text message sent to my mobile phone — I want this ease of integration with the technology I use to run our clubs.

So when people say to me, “What does interoperabilitymean to you?” I use that as an example just to get them thinking about it. If a new member rides a piece of Life Fitness cardio equipment — they jump on one of our bikes — and it is the first time that they’ve been on that bike, and they’ve tapped their RFID to acknowledge they’re on the bike (so we know it’s them) I want to be able to have that trigger fire an event somewhere. For example, the trigger goes to a CRM platform that fires off a quick email giving them tips on that particular piece of equipment, and how they should be using it properly and safely … a simple recipe to enhance the member experience.

If I can start to get you to understand IFTTT, then I can start talking to you about and Enterprise Services Bus, and the integration of APIs, and having an open API architecture. So many of the APIs in our industry do not expose even 30 percent of the features and functionality of the actual UX of the system. This is frustrating, because I do not always want to have to use the UX of the platform that we purchase, and in many cases we as technology experts arrogantly think we can do better, and so we really want to write something ourselves. The current state of affairs is limiting. We end up having to write our own APIs in a lot of cases, just to create an abstraction layer. Salesforce and Amazon Web Services built their products with an API integration strategy top of mind, then theyadded the UX/UI layer. The fact that much of the technology in our industry was built the opposite way just shows a level of immaturity that our industry still has.

5) In your opinion, what is your favorite underappreciated and/or unknown health club technological addition? An uncommon product or service that almost always results in a significant return on investment for the club that adopts it.

ShapeLog is intriguing for me in this regard. I found out about ShapeLog through the Fitness Industry Technology Council podcast that Josh Trent does. I had never heard of it before, and quite frankly I have not heard of anybody else talk about it since. It is a fairly simple technology in that it is a device that you mount on the cable of selector equipment — the pulley equipment that we all have in our clubs — and what it does is it is able to measure the tension that’s being applied to the cable as the weight is being lifted off by the user.

It’s able to measure the tension, and from that it is able to calculate how much weight you’re lifting. Which in and of itself is kind of cool, then wirelessly they can send that information, so that it displays on your device. They are effectively able to record your workout. The part that really intrigued me was the fact that how you and I lift weight is unique to each of us, and apparently is almost as unique as our own fingerprints. What this product is doing is capturing 100 pieces of data per second — I believe that is the number they had given us in the demo — through native accelerometers and tension monitoring. The device creates a unique pattern of my lifting and lowering of the weight and stores this information in its database. Now, the next time I sit down and I do my next set of reps, it knows that that was me, and so it is actually able to track my workouts without me having to go up and log in, or tap an RFID chip onto the equipment. It eliminates a set in the identification process, making the ability to track less invasive and more passive.

Interview with Daniel Freedman about Virtual Fitness

Daniel Freedman graduated from the London School of Economics (LSE). He started his career as a journalist and worked for several publications, including the Wall Street Journal and Forbes. He contributed to the bestseller “The Black Banners,” a book about Sept. 11 and the United States’ war with al-Qaeda that was published in 2012. Freedman later shifted his interest to the technology sector, working at tech startup Apploi and co-founding CyecureBox, a cyber security tool. After transitioning from Manhattan to Baltimore, he has been focusing on the development of BurnAlong, a startup that aims to help people find the time to exercise. During his eclectic career, Freedman has also held posts at the United Nations and the U.S. Senate.


1) What currently excites you about virtual fitness? How have things evolved from the days of Jane Fonda VHS tapes to the virtual fitness experience a user can consume today?

I think what’s really changed today is virtual fitness is allowing people to bridge the online and the offline fitness experience. New ways of delivering virtual fitness can finally bring people the “real” experience that they want, as opposed to having disconnected, lonely experiences with static content.

If you look at video games, the virtual world bridges that divide. If I go back to when I was a kid, if I wanted to play video games with a friend, I had to travel to their home. Today, my nieces can play with one another and/or their friends online, from their respective homes in different cities. They can see and speak to each other no matter where they are in the world. It’s the same in the business world where work tools like Skype and Google Hangouts have connected us.

What’s exciting to me in the fitness space is being able to bridge the divide and give everyone access to the experiences they want, when they want them. Fitness is about relationships, purpose and motivation. New advances in virtual fitness now allow us to do that at scale, with your workout buddies wherever they might be.

2) What are the limitations of delivering virtual fitness, and how have you seen this effectively mitigated?

If you go into any gym or studio, anywhere in the world, and ask, “Who is the most popular instructor here?” And then you ask them, “When was the last time someone said they can’t make a class, or was away for the summer, or traveling for work, and so could you film the class?” Odds are the instructor will say it was within the last two to three days. This reflects a massive lost opportunity for gyms and studios, because their members would prefer to choose a virtual experience with their favorite instructor, rather than strangers, if given that option.

BurnAlong does that, bridging that divide, giving people the connection to their favorite instructors/their friends, at a time and/or place convenient for them. And instructors can gain an insight into what people are doing outside of the gym, and help keep them on track.

3) Throughout the process of your product development, what has surprised you about virtual fitness delivery and consumption while building BurnAlong?

One big surprise is the willingness of people to try something different from home, or get started on their fitness journey. We see with companies, that often people have heard about top local instructors, they’re very curious to try them out, they’ve just never had the time, or confidence, or motivation, to actually take the class. But being able to experience it at home, from the comfort of their own home, makes a big difference.

We see this especially with companies and their employees. Right now, for many, five percent of employees participate in wellness programming. What we’ve found is that it’s not that the other 95 percent of the company isn’t interested. On the contrary, there are just a lot of barriers to attend (e.g. schedule, family commitments, aversion to working out with co-workers in an open setting, etc.). We found that virtual fitness is great for those who do not like exercising in front of others (especially colleagues and/or strangers).

For instance, yoga can be intimidating if you do not understand it. Virtual fitness allows someone who wants to be a little more confident before they subject themselves to other peers seeing them engage in activity [to get some practice]. They can get accustomed to movements, gain familiarity before engaging in the activity in a group setting.

For an instructor, this can be quite eye opening. Big personalities can be intimidating. Virtual fitness allows participants to understand the instructor, the class, they get to know the routines — a relationship is built before having to step in an unfamiliar setting. Through this process, a user can take steps to understand group dynamics before leaning in.

Virtual fitness is a great way to onboard new entrants into fitness who would have been too intimidated to ever get started otherwise.

4) Exergaming is a facet of virtual fitness that has had a lot of press but seemingly always falls flat after the initial hype (i.e. Wii Fit, Pokemon Go, etc.). Why do you think gamification has ultimately not lived up to the hype, and do you see this changing in the future?

Anything can get boring, unless it’s changed up. It’s the same limitation of the old way of delivering virtual fitness — where you’ve only got the same 10 options and the expectation is you are meant to keep going through that same 10 classes over and over again. Most people who buy fitness DVDs don’t buy only one; these folks have got piles of them. They want choice and variety. If there were only 10 books that everyone wanted to read, there wouldn’t be a need for Amazon, right? So too for fitness, there’s not just 10 ways of working out; the rise of boutiques reflects the desire for so many different people to work out in so many different ways.

The appeal of attending fitness classes in person with friends is that while the workout may be similar, the instructor will change things up, and your friends will chat about different things. The conversation is going to be different every week. What virtual fitness can now do is bring that variety to you in your home, with your friends, with fresh content from instructors, when you can’t make it in-person.

5) How do you see fitness evolving over the next five to ten years? How will virtual fitness change the way people currently consume fitness?

What we believe in at BurnAlong, and what our product is based on, is that people increasingly want unique experiences. I think virtual fitness has got the power of bringing fitness to people wherever they are — that specific type of experience that they want whenever and wherever they want it. We believe the virtual compliments the in-person experience, rather than replacing it (which most online companies believe).

The virtual can also bring special classes to places where previously people didn’t have that experience. People talk to friends across the country and all over the world about their favorite instructors; now those friends can experience those classes with that friend. Geography no longer needs to be a limitation.

In five years, I might wake up planning to attend my favorite cardio class at eight o’clock in the morning, but I wake up and Amazon’s Alexa or Google Home or another connected device will say to me, “Daniel, your noon meeting has just been moved, and you do not have time to physically attend your eight o’clock class. However, I’ve notified your instructor that you’re going to be joining online rather than in person.”

My co-worker Harry who takes the class with me is in London for work, and will be taking the same class virtually since it is his favorite, too. We choose to take the class live together. I log in at eight o’clock, wave to Harry and the instructor, who sees me and says, “Thanks for joining Daniel. Sorry you couldn’t come in person. You know I see your heart rate is already at 140, good run earlier … Daniel, you are already ready to go!”

It’s an experience where, just because you cannot do something in person, you are no longer limited. The virtual world bridges that divide, makes people more efficient, and allows them to use their time more effectively without sacrificing quality. This will only continue to improve in the years ahead

You should never be in a situation where just because you are traveling this week, or just because you can’t get a babysitter, or just because you had to work late … you can’t get the type of fitness experience and expert guidance you value and deserve.

Interview with Ryan Tarzy about Digital Health

Ryan Tarzy received his B.A. in Economics and Applied Mathematics from Northwestern University. Early in his career, he realized that his talents involved combining the role of an entrepreneur with that of an advisor. Since then, Ryan has been passionately working on moving healthcare forward and has founded or led several digital health startups. In 2003, he co-founded MediKeeper, one of the earliest digital health startups. He later served as CEO of Personal Health Labs, a lab focused on R&D in areas such as health gaming and interoperability.  He now serves as Director of the Incubation Studio at CoverMyMeds. Prior to CoverMyMeds, he served as Co-Founder of Playful Bee and SVP of Business Development for PokitDok. He has recently begun to angel invest in digital health startups.


1) Many have attributed the impressive evolution and expansion of digital health to a move towards human-centered design, suggesting that a lot of previous health technology was engineered in a such a way that user experience was an afterthought. In your opinion, to be a success in digital health is user experience more important than utility? And why?

I think it is absolutely accurate that in the past, user-centered design has arguably been an afterthought. However, as we evolve into this next wave of digital health beyond Health 2.0, I think it is unfortunately still true that neither utility nor user-centered design is the most important factor of success. I would say at this point, success relies primarily on a solid business model. You can have fantastic user-centered design, you can have some utility, but if you have not figured out the way you’re going to get reimbursed, the way you’re going to get paid, or have a compelling value proposition for the direct consumer, then you are still going to struggle to be successful in digital health.

That said, I do believe user-centered design is driving some really exciting things coming out of the new wave of companies in digital health. I’m really encouraged by that, and I hope that it continues. I think that it does become a differentiating factor when you compare multiple companies, all of which have the reimbursement model and/or revenue model figured out.

2) As an investor in digital health startups, what do you look for in early stage companies trying to make it in health tech? And, what is a common flaw of new entrants that you feel could be easily avoided?

First and foremost, I look at the founders. Founders, to me, are the No. 1 determinant for success. I look for founders that, if they haven’t done this before, have deep domain expertise. They have dealt with the business problem before, they understand it, and they’re now trying to solve it through their own company.

I also look for founders that have a combination of passion and hustle that makes me confident that they’re going to be able to get past the inevitable roadblocks and hiccups that are going to take place when you’re trying to tackle an industry like health care. Those are the top two things I look for.

Lastly, I look for companies that I feel like I can provide an unfair advantage (while advising them). I want to feel like I can bring a lot more to the table than just monetary value as an investor.

In terms of things that I think are common mistakes … ultimately the sales cycles in health care are just really long. What I see is most new entrants will come in vastly underestimating the sale cycle and struggle. When you have these long sales cycles, what kills you is waiting on those maybes. You really have to aggressively develop process to manage the pipeline and be able to move beyond that first LOI, or unpaid pilot, and get yourself more quickly to a proven revenue model — a robust pipeline that is bringing in recurring revenue.

Another common mistake is a great idea, with a lack of domain expertise. It sounds self-serving as a healthcare investor with deep domain expertise to say this, but it is always good to have someone with healthcare expertise as an investor and/or advisor in the group. You need an advisor with specific knowledge in the area that you’re trying to tackle.

For example, a lot of people lump life science investors in with health IT and digital health investors — these are completely different businesses. One is dealing with long development cycles and a completely different type of regulation. The other is more about reimbursement cycles and enterprise sales and understanding the intricate players in the space. They are just different animals. You need someone, depending on which area you’re tackling, with that specific type of healthcare domain expertise. Very few can do both.

3) In 2014, Robert Szczerba wrote an interesting article: If Google Health Failed, Why Will Your Health Portal Company Succeed? We still have not seen a true runaway success in this area. What will it take to finally get there?

This is very personal to me because the first company I co-founded was one of the early personal health record companies. My co-founders and I built the company on the premise that there is this need, this obvious need, for a more central place for individuals to manage their health information. Back then we called it personal health records (PHRs), now you might call it a health portal. It just still feels like something that should exist but, I agree, at this point there has not been a huge success in this space yet.

What’s really interesting about this is there’s information leaking out that both Google and Apple are now attacking this space with new technologies. The ubiquity of smartphones, or even now through smartwatches, might potentially be a new opportunity for this to take hold.

I’ve always believed that the ideal health information exchange is the “HIE of One,” where the individual is the conduit of their own health information. The panacea of interoperability to create a universal portal, whether it’s Google Health or Microsoft HealthVault, is the wrong way to think about it. We need the ability for an individual to easily be able to take control of their health information and have control of the back and forth. Then, consume their data in whatever portal they want. I hope this is where things are going and I’m excited to see Apple coming into the market and Google seemingly retrying to attack this market. I’m really intrigued to see what they come up with.

4) What is your take on the longevity of today’s wearables? There are numerous articles with click-bait titles indicating the smartphone is dead within five years. One could argue that might be the same fate for most wearables today. Where do you see the puck heading for wearables?

I feel like five years is too aggressive to say the smartphone will die, but I may be wrong. I think that I’m much more pessimistic about the future of wearables as they exist today. We are seeing the early stages of these devices; they have passionate followers; they literally have millions of users out there. If you believe that wearables are going to become a more ubiquitous thing — I will say today’s wearables will likely be starkly different five years from now. Looks at Apple’s AirPods, those will change the smartphone and are technically a wearable. Wearables will evolve in ways we cannot predict.

It comes down to, what do you define as a wearable? Staying with the AirPods example, this is a sign that we’ll be utilizing voice for data entry … speech will be integrated into our car, which is integrated into our watch and into our AirPods. And really, the cloud becomes more and more the world we live in versus having our nose in our smartphone.

So although I am pessimistic that devices like the Fitbit will have legs five years from now, I am optimist about the future of computing being more integrated into all parts of our life in a, hopefully, more user-centric way without having to have our nose buried in our smartphone all the time. As voice gets more and more compelling, we will not need to physical interact with devices, limiting the need to “wear” anything.

5) In your opinion, what are two underrated and/or little-known companies right now in digital health that you believe are positioned to make a huge impact (in the future) and why?

1) LeapCure: This is a company that has really cracked the code on recruiting patients for clinical trials. It is fascinating to me that over 60 percent of clinical trials fail due to patient recruitment issues. That’s just staggering to me and just seems like such a big problem that we haven’t been able to crack.

This company has been able to use techniques that have been utilized in other non-health care markets to micro-target individuals — even for very rare diseases. One of their customers specifically specializes in rare diseases for children. So, truly the needle in the haystack kind of problem: how do you find the less than 20 patients in the country that would qualify for this clinic trial?

They are able to do that, and will likely make a huge impact. They are reducing the cost of patient recruitment and increasing the success rate of clinical trials. That could have a far-reaching impact on the industry. So, I’m really bullish on that and what they’re doing and excited to work with their team as an investor and board observer.

2) Paubox:  Sometimes seemingly boring companies on the surface are in the best position to make an impact. Paubox operates in the area of email and disaster recovery. Sounds incredibly boring for healthcare but, what they’ve done is, they have cracked the code of how to deliver HIPAA-secure email — and they do that in a way that is user-friendly. You can finally simply use your Gmail account as a doctor, and they’re able to make that HIPAA secure for communication with patients. All the friction created by email alerts that push you to a portal, only to hassle with additional passwords and clunky communication channels. Paubox solves all that. Finally, you can simply email your doctor … like you email the rest of the world.

 

Interview with Matthew Nock about N-of-1 Experiments

Matthew Nock, Ph.D. is one of the leading experts on n-of-1 experiments and single-case experimental designs. Matthew became a MacArthur Fellow in 2011 receiving the MacArthur “Genius” Award. He studied at Yale and now is a professor at Harvard where he also runs the Nock Lab. In addition to his research interests, Dr. Nock has been counsel to the World Health Organization’s World Mental Health Survey Initiative, the National Institutes of Health, the American Psychological Association, as well as other prestigious health organizations.


1) Assuming I have captured the basic methods of single-case experimental design (SCED):

  1. Identification of specific target behavior
  2. Continuous and valid measurements
  3. A baseline period (data is gathered before the intervention is applied)
  4. Stability of the specific target behavior (target behavior changes only when the intervention is applied)
  5. Systematic application of intervention

What are the considerations, risks and advantages for someone partaking in self-experimentation — someone who wants to use these methods to help determine the efficacy of a new habit or practice (e.g. determining the effect of meditation on mood)?

These are the basic methods, but it is important to note there are some variations in how you would apply different types of single-case experiments. Once the intervention is applied, then something else is going to happen next, right? For instance, there is “AB-AB design” also known as “withdrawal design.” In this application, you apply the intervention, you then remove the intervention and examine whether the behavior/condition reverts to the baseline level. You then reapply the intervention — so the A state stays as baseline, the B state stays as an intervention — so you do AB, AB and measure the change.

For instance, if you wanted to see if a reward program for not smoking cigarettes worked for you. You start with cigarette smoking as your baseline. Let’s say you smoke two packs a day. Now you apply the reward (intervention). After the reward you now smoke half a pack a day. You then remove the reward (intervention), going back to baseline (smoking without a reward for not smoking), and you see if you go back to two packs a day. You then reapply the intervention (in this case the reward) in an attempt to determine that it is when, and only when, the intervention is applied that your behavior changes. This method helps you rule out alternative explanations. For instance, in this hypothetical example you rule out that you stopped smoking because of some historical event, or your wife told you she’s going to leave you if you don’t stop smoking at the exact time you started the intervention.

What you are trying to accomplish is identifying the result from the experiment is from the intervention and nothing else. You can do an AB-AB design as described, or, if you have access to other participants, you can do a multiple baseline design. In this example, the first person, they would have a one-week baseline and then you apply the intervention; the second person would have a two-week baseline, then you apply the intervention; for the third person, a three-week baseline then you apply the intervention. Again, if you can show when, and only when, you apply the intervention something has changed, you have evidence that your intervention causes change in people.

A single person can also use a multiple-baseline approach across behaviors. For instance, I am trying to change my smoking and drinking and eating. I could apply the intervention to my smoking, then apply it to my eating, and then apply it to my drinking. If I see that when, and only when, I apply the intervention my target behavior changes, it provides evidence that my intervention is effective. You can apply the multiple baseline approach across people or across behaviors.

If someone is self-experimenting, they will want to do their best to collect their own data objectively. Using these methods on yourself, you run the risk of tricking yourself into seeing something that is not there or failing to see something that is there. When it is a clinician or a researcher observing you, they are going to be, with their own objective eyes, carefully measuring some behavior of interest. If you are not carefully measuring objectively what it is you want to change, again, you might see change that is not there or fail to see change that is there. It is important to do your best to objectively measure.

The benefit of this approach is you are the one following the data. You have a real-world answer to whether or not your intervention is working. It can be just a little bit of extra work to do something like this, to quantitatively, objectively measure your own behavior. However, in my opinion, that is also a benefit: knowing what’s effective; knowing what can change your behavior at a fairly minimal cost.

2) For many, “lifestyle design” is about optimization. For example, using meditation as the hypothetical again, it appears that many find benefit from only minimal exposure (Creswell, Pacilio, Lindsay, & Brown, 2014), but one could posit the effective duration is unique to the individual. Since interventions generally come with an opportunity cost, reducing this cost has a benefit. What are some good strategies for expediting the determination of the minimum effective dose (MED) of any given intervention?

In my mind, there are two philosophies about this. One is start small, and measure carefully the effects of the small dose/intervention, and then increase, increase, increase, until you see maximum benefit(s) and then you might know how much is needed. The other is the opposite; start with the maximum dose and then work down from there. Each has pros and cons, right? It certainly depends on what it is you’re using as an intervention. If there is any toxicity associated with the intervention — drugs are an obvious example — if there are toxic side effects to an experimental drug, you would want to start very small and work up to see what is the needed dose to cause change. The benefit here is you are not exposing the subject to toxicity; the downside is it could take longer for an effect and the person could be engaging their harmful behavior, or suffer from disease, for longer intervals of time than giving them more from the onset. On the flip side, if you start with the maximum dose, you generally will know right away whether it has an effect and then you can work down from the initial amount. The downside is you are now exposing the subject to any toxic side effects from potential overdose. If you are certain the intervention does not have any toxicity and/or limited risk, I think the best thing to do is start with the maximum amount and then work down from there to see how much is needed to maintain the effect.

3) Technology is making the recording and analysis of self-experimentation more accessible. There are an abundance of consumer and condition-specific wearables for collecting data, ecological momentary assessment (EMA) protocols are accessible to anyone with a smartphone, the statistical package R is free to use — enabling anyone willing to take on the learning curve the ability to crunch their own numbers. What technology and innovation excites you in this area? And, is there anything that is currently helping democratize one’s ability to run these types of experiments?

There are a lot of tools at the ready now with smartphones and other wearable devices, so people can collect and analyze their own data quite easily. The big bridge is people often are not going to want to learn something like an open-source statistical program. Learning a statistical program like R, even though it is free, is not a minor endeavor. People want ready-made solutions to problems, so they want an app that is turnkey and ready to go. Technology that is going to monitor their behavior, apply the intervention, whatever it is … to the extent that we can create applications that bridge that gap for people, that are easy to use, people will likely use them.

So yes, there is some great open-source stuff out there, but getting someone to figure out how to collect their own data effectively, then create and apply their own intervention, learn statistics (even if it is free to do), analyze their data; wow, this basically requires an intervention in and of itself to get someone to do that.

The thing that excites me most right now is using wearable devices and smartphones to collect data about people and apply interventions that are beyond their own awareness. There are apps available now that allow us to collect data from people’s smartphones passively. We can monitor their GPS, we can monitor their sleep, we can monitor their activity level, who they’re calling, who they’re texting, who’s calling them, who’s texting them, and we may pick up information that can predict future behavior that people are not aware of themselves.

For instance, if a person’s activity level is decreasing, they have outgoing calls and texts and none are getting returned, and their sleep becomes more irregular, we might predict this person is becoming more depressed. So a condition a person may not even realize they have themselves — we can use information from their phone to help identify potential problems and deploy an intervention remotely before the condition can cause any negative effects. We now have e-interventions, smartphone interventions, where people can engage in a little quick, game-like app that they can play to try and change their behavior. The old model of going to a doctor, the doctor does an assessment and tells me I have a problem, then gives me some kind of treatment — this model is changing. We can now go out and find people who are in need of help before they know they need it, and send interventions out to them that they can use and apply themselves. We can deploy this on demand, 24 hours a day, 7 days a week, whenever it works for the individual.

4) You are a Harvard psychologist. You are also one of the leading experts on destructive behavior. There seems to be a resurgence of William James’ ideas lately, specifically that if we master our free will and make ourselves 100 percent accountable for our actions, this process will increase our chance of positive outcomes. Do you believe in the validity of this assertion? And, given your expertise working with people where this process might pose difficulties, what are some strategies to assist one to increase their ability to be accountable in this area?

My department resides in a building called William James Hall, so the spirit of William James is still present. The idea of holding ourselves 100 percent accountable, as it pertains to the way I am interpreting your question, comes down to the rewards and the costs of a behavior. If we want to change our own behavior, we need to accurately understand to what extent the behavior in which we are engaging is rewarding or beneficial. We also want to accurately understand what the costs involved are. We have to seriously evaluate both the rewards and cost. For instance, if I am smoking cigarettes, I probably feel good after I smoke. In this case, what are the rewards and costs of smoking? It means realizing there are benefits, but there are also significant costs engaging in the behavior. I need to weigh both, but to do so I need to accurately consider present and future elements of the behavior.

So for me, holding ourselves accountable means realistically realizing the cost and benefits of our behavior and weighing those carefully. If the costs are going to ultimately outweigh the benefits, then I think we have a chance of decreasing risky behavior. If the benefits are perceived as outweighing the costs, it is much tougher to change someone’s behavior. For instance, take a self-destructive behavior like cutting oneself or burning oneself, why would someone do that? It turns out that cutting yourself or burning yourself, for many people, removes aversive thoughts and feelings. This behavior has a benefit for them. For these people, the reward of removing these thoughts appear to outweigh the costs of seeing tissue damage, and so they engage in the behavior. Getting people to stop engaging in this behavior is a lot about figuring out other ways to get the existing benefit for alternative behaviors that do not carry such a heavy cost.

I think the same is true with smoking, drinking and overeating — as well as other problematic behaviors. These behaviors have associated rewards, but they also can come with significant costs. To make good choices, we need people to understand and appropriately weight the costs and the benefits. An important part of the process of behavior chance is to figure out ways to have people find similar benefits that do not carry the same costs of the behavior one hopes to change. The challenge is how to get yourself to feel good and/or distract yourself from aversive psychological states, without doing harm to your mind and/or body. If the spirit of your question is, “How do we increase our chance of positive outcomes?” then you can look at it as benefit-cost=outcome. To do this, you need accurate information about the behavior’s costs so you are not discounting and/or ignoring these. Then look at the behavior’s benefits and find suitable alternatives that offer comparable benefits without the associated costs of the behavior you are trying to change.

5) A young student has walked into your office and proclaimed they want to become the leading expert on self-experimentation. What are three rabbit holes you suggest they explore (i.e. ideas, concepts, models)?

Three rabbit holes they should explore …

1) Read up on the decades of research that people have done on single-case experiments and N of 1 designs. There are a lot of well-worked out-methods and approaches to measuring behavior and carefully, systematically applying an intervention to change behavior, as well as observing the effect of the intervention. When you really understand these validated methods, then you are aware when you are truly doing experimentation. We have existing study designs where one can carefully observe the outcome of self-experimentation in an empirical manner — opposed to reinventing the wheel, there are decades of existing work that one can build on, so mastering the current available literature in this area is a big one.

2) Mastering new technology. As we discussed earlier, there have been significant, recent advances in technology available to people interested in experimentation in the form of smartphones, wearable devices, the Internet and free access to educational information. We have easy access to data at our fingertips now. Through technology we can easily measure our real-world behaviors. Mastering new technology will allow a person to tap into a huge new source of objective data on our behavior.

3) Once you master experimental design and you master the latest technology, the last rabbit hole I’d suggest is how to engage and measurement your experiments. You need to figure out how you can use advances in technology to develop new interventions based on what we already know works. Questions like, “Are we effectively using carrots and/or sticks? Are there ways that we can use computers, the Internet, smartphones, wearable devices, to try and apply new interventions?” The new frontier regarding behavior change is to master the way that we try and modify people’s behavior (or modify our own behavior?). With the right creativity — coupled with an existing mastery of the first and second rabbit holes — there is a lot that can be done using the new tools that we have at our disposal. We now have the ability to apply personalized behavior-change interventions, in real-time, at scale.

There is a downside to this third rabbit hole, too, though, especially if you are building tools that help others self-experiment. There are now thousands of thousands of apps out there that are purported to improve health and well-being. However, by my reading, there is very little data to support that most of these apps are actually effective in any meaningful way. Moreover, there is little evidence to suggest that most of these apps will actually change anyone’s behavior. Worse, there is a financial incentive to create apps and to market to people, “This app will make you healthier and happier.” In my opinion, there is not a good public understanding of how to evaluate scientific evidence. That makes it difficult for most to evaluate claims about effective treatment and/or interventions. It’s the Wild, Wild West out there.

Before scientific medicine, people just created their own methods. They could sell snake oil. They could put anything in a bag or box and sell it to us as effective. Some were and some weren’t, and many times the ones that were effective, weren’t effective for the reasons that people thought. Luckily, now we have a much better infrastructure where, if you are going to sell some kind of FDA-approved medication, you have to know what is in it and show that it is effective in randomized clinical trials. It’s on you, you’ve got to have experimental data. I think of the app world as similar to the Wild, Wild West. People are now deploying things that they say are treatments and there is not a good, systematic infrastructure in place to know which ones are experimentally sound and which ones are not. Similar to the thoughts expressed in the previous question, there needs to be a clear benefit to making experimentally sound apps. This benefit could be a special designation, like FDA approval or FDA approval equivalent. Something that ensures it has been tested, with evidence showing that it works. If the app does not have that, then some kind of repercussion for the makers. Until we have that system in place, I think you will continue to see a market full of snake oil.

Interview with Cathy Presland about Tracking Progress

Cathy Presland, a former economist, runs the program World-Changers’ Circle that takes five action-takers on a 6-month journey of transformation. She is an expert on leadership, both personal and professional, and inspires people to look beyond themselves when they make their life and business decisions. Cathy draws her knowledge from over twenty years of experience working with governments and international organizations on different public policies, programs and regulations. Cathy is a respected motivational speaker, teacher, mentor, facilitator and an author. Her book, Write! Stop Waiting, Start Writing. A Step-by-step Guide to Turn What You Know into a Book, is an international bestseller and is just one of the ways Cathy is supporting people who feel they have an idea that they want to share with the world.


1) If someone is looking to create a system to track their process towards some sort of desired change and/or personal improvement, how would you coach them through building this architecture so they can successfully develop a measuring protocol that assists them with meaningful metrics that assist with experimentation and continual improvement?

I think that at the core of any kind of monitoring is the question: is the process serving the end goal? Sometimes this is just a feeling, and sometimes, it is some kind of a quantified measuring protocol. I’m not so interested in numbers; I’m interested in where we are trying to get — How can we make the process more joyful, therefore, making it easier to get to the goal, regardless of the number? In my experience, if we put a measurement around a goal too early, the number becomes more important than the result we’re aiming for and there is no scope for creativity. We’re then quick to jump to self-criticism about not hitting some made-up target which sets off a cycle of demotivation. Measurements are especially not helpful in the early stages when we are just setting up doing something. Sometimes, you first need to do something to test your theory without having to deal with the danger of negative feedback that can come from creating your own metrics. If you want quantification, do a two-week experiment and see how you feel. You can put some measurement around it later if you feel you want to move it forward. So, very rarely would I rush into measurement from the outset.

I’ve got a client at the moment, for example, who’s applied for a number of jobs, and she’s not getting the results she wants. So, we had a conversation about what else could she be spending that time doing? It transpired that it wasn’t working for her because she wasn’t really inspired by the jobs she was applying for. This was the start of an honest conversation. I’m interested in what is going on in our minds that is creating good or bad feelings. When my client has an insight, and she realizes that she wants to be doing something differently, she should just be able to go off and do it. She doesn’t necessarily need to monitor things. Too much measurement can strain your results I think. It may be just about how honest we’re being with ourselves about the things we are doing, whether the things that we’re doing are going to give us the results that we want.

2) When someone is faced with assessing a life change where the present state/status quo is comfortable and satisfactory, and the future state being evaluated is high risk but high reward (i.e. the change requires deviating from an existing desirable state) — what effective strategies, processes and/or frameworks have you found useful for individuals to use to increase the likelihood of making a successful decision?

Life is never a low-risk, high-risk situation in my experience. The future is always unknown. None of us literally knows what we’re going to be hit with personally, professionally, so to me, that is never what it’s about. The actual situation is less important. The only thing that really matters is how we’re thinking about the current situation and what moves we’re making.

I don’t have a framework I could prescribe. What I do have is a philosophy. I do think there is a place that we can come from, because, as individuals, we’re so tiny and meaningless. And, the less consideration I give to me, the more contribution I’ve got to make to one person, to my children, to my family. I try to have a discussion around what is important to the person in that coaching conversation. What is it that they feel in this moment is the right thing for them to do? It’s about removing your personality and your ego as much as possible, so you can analyze your decision in terms of these questions:

  • Am I doing this because I think I’m going to be happier in some way, which is a red flag because our feelings don’t come from our circumstances?
  • What is the greater good in this situation? What feels ‘right’?

And, at the same time, I also think that the right thing is something that we create in our imaginations. So, I don’t see that as a fixed thing; I see that as a drive, a movement, an action at this point in time.

3) In contrast to the previous question, it is my opinion (given the immense amount of advice currently available about improving performance) that people often get stuck consumed by integrating seemingly endless methods (e.g. life hacks, productivity approaches, etc.) that either act as distractions and/or worse — impede progress towards what really is desired. What is your opinion on this assertion and do you have a process with your clients on making strategic decisions on what not to do? Lastly, in this regard are there commonalities that lend themselves to general advice that would benefit most people about what not to do?

I certainly see life hacks as distractions. And, I think that they can impede progress when people give them an importance that they don’t deserve. A lot of life hacks, especially in the personal development world, are designed to try to create some kind of space. Meditation, or anything in that zone, is designed to try to create some space so we can get some clarity. But, the process often becomes an end in itself, like, “I’ve got to meditate”. And we forget that we have access to that space in our heads at any moment. Some people have found life hacks helpful, but the reality is that we don’t need them.

We’re very good at making up things that we think we want and then trying to think our way there.  We go into this cycle of over-thinking, whereas, if we actually just gave ourselves mental space, we’d probably already know what it is that we want to do. But, we just don’t accept it, or we don’t see it, or we don’t think this is it; we kind of don’t know what it looks like. So we spend a lot of time chasing things that we don’t really want to do, or things that other people have, which are completely pointless wastes of time.

People that have enough perspective to know that something is not real or is going to pass, do better in life. We need to distinguish between what’s real and what isn’t. Generally, there are some things that look more real than others to people. Money is a typical example here. Many of us think money will create a feeling of security but the security comes from within us, not from something external. Similarly, doing something because it’s going to lead to something else taking an action or a path “so that…” or because there is an ulterior motive beyond the immediate is generally a wrong decision, too, and you are fooling yourselves if you are taking intermediate steps to something. If there’s something that you want to create, there’s always a more direct way to do it. For instance, “If I make lots of money, then I can create a foundation to do good in the world.” It’s like, why not just do good in the world now?

The other kind of big general thing that I will comment on is that people seem to think there is somewhere to get to. However, there’s no forward motion. It’s a real trap to believe that there is forward motion because then we’re always trying to get somewhere that we’re never going to get to. It’s just motion, in all sorts of directions and, often, that can be hard for people to conceptualize because we are so conditioned that there is a timeline in life, a journey from A to B. That’s a myth, there is only where we are now.

4) What are good indicators that it might be time to give up on a big idea/plan/goal? Using my own goal as the example, the Boston Marathon has always been a stretch goal, albeit an achievable pursuit — until recently where I was advised never to run long distances again. The Web is cluttered with advice to never give up on your dream, but science suggests this “inspirational” messaging has had some significant negative consequences. What is a suitable gauge and process for determining a goal has realistically fallen out of reach?

For me, this comes down to removing the ego from the decisions that we make. It is about heading in a certain direction and making the most of the opportunities we have rather than regretting those that are not open to us right now. It’s kind of direction versus outcome. And what is important for me is the direction and coming from a higher self … it can be difficult for us to create that separation between what we feel and what we actually decide to do. So, the higher the perspective we get on this, the easier it is to take those clear decisions. That’s where I would work with somebody. We feel what we feel; it’s not for me to tell somebody that what they’re feeling isn’t valid, because that’s what’s coming up for them. But, I will work with them in a way to show them that this isn’t meaningful in the way that they think it might be.

When a big goal falls out of reach, it doesn’t take away from you that direction that you’re heading in. For you, for example, it’s not in the cards to do the Boston Marathon anymore. Or, maybe it is. Or, maybe you can explore something else and get another route for experimentation and/or exploration. But, if you stay attached to the Boston Marathon, you’re going to lose the creativity to try out lots of different things on route to getting there. The reality is that we have very little control over what happens. We don’t know what’s around the corner; we don’t know who we’re going to meet. And, the more open and positive we are to the possibilities that are in front of us, the more fantastic things happen.

5) You run a program called World-Changers Circle. Although daring big might not be for everyone, what are some of the undervalued intangible rewards you have witnessed from those that succeed at big things?

I think that it is human nature to want to do something that goes beyond ourselves. People come to me because they want to do something meaningful, and this doesn’t have to be grandiose. Amazing things can happen when we get our egos out of the way, and these things happen faster than we expect when we do this too. You take bigger actions and make bigger asks when you’re not coming from a place of ego. There are a lot of benefits from taking a different perspective and looking differently at the world: you get calmer, have better relationships. You realize that it is actually more about how you’re looking at things rather than anything that other people have done. You realize that the world is driven internally more than externally.

Interview with Raj Raghunathan about Happiness

Professor Raj Raghunathan specializes in psychology, marketing, as well as the philosophy of happiness and decision making. He graduated from Birla Institute of Technology and Science and completed his MBA at the Indian Institute of Management. In 2000, he earned his Ph.D. at the Stern School of Business, New York University. He is a Professor of Marketing at the McCombs School of Business at the University of Texas at Austin. Prof. Raghunathan developed an online course called A Life of Happiness and Fulfillmenta 6-week course on Coursera platform. The course includes knowledge from the fields of psychology, neuroscience and behavioral decision theory. It has had over 75,000 enrollments and has been featured as a Top 10 course offered by Coursera. In 2016, Raghunathan also published the book, If You Are So Smart, Why Aren’t You Happy? Raj’s book explores how to become happy and draws on the concepts Prof. Raj calls ‘happiness habits’ and ‘happiness sins’. Raj has received several National Science Foundation Career Grant Awards. He is an associate editor at the Journal of Consumer Psychology, guest associate editor at the Journal of Marketing Research and is on the editorial boards of the Journal of Marketing and the Journal of Consumer Research.


1) The mechanisms of a happy and fulfilling life can now be explained using science. How do you define happiness as an academic? Does it have quantifiable components or is it truly a subjective measure?

Somewhat surprisingly, happiness is both a subjective experience and measurable. The subjective part comes in two ways — the things that make different people happy, and the types of emotions with which people implicitly equate the term “happiness”. The idea that different things make different people happy is, of course, straightforward. Going sailing may reliably make some  person happy, while for others, it won’t float their boat (so to speak).

The idea that different people equate happiness with different terms is a little more subtle. Prof. Barbara Frederickson of the University of North Carolina finds and suggests (based on work by Dacher Keltner, a researcher at UC Berkeley) that “positivity” comes in 10 main varieties including joy, love, serenity, hope, awe, gratitude, laughter and interest. To me, happiness is the same thing as what Prof. Frederickson calls “positivity.” In other words, in my book, you are happy so long as you are experiencing one or more of these (and other) positive emotions.

What is really interesting about all of this is that, as Prof. Ed Diener and his colleagues have found, the simplest way to measure happiness is essentially by asking people how happy they are across a few items (like, “all things considered, would you consider yourself happy right now?”). This is a highly reliable and valid method. For instance, people’s subjective reports of happiness are highly correlated with some objective correlates of happiness, like serotonin (positive correlation) or cortisol (negative correlation) levels. Likewise, people who report higher levels of happiness tend to have a thicker left pre-frontal cortex, and also tend to be thought of as being happier by their close friends, etc.

So, in a nutshell, what might appear at first blush to be a problem for happiness research, namely, that happiness is too subjective, turns out to be not such a big problem after all.

2) In your work, you suggest that being creative and having fun are habits that should be cultivated to reach higher levels of happiness. Since fun is a very subjective concept (i.e. what is fun for one person, is not necessarily fun for somebody else) how do you suggest fun might be studied more rigorously?

As I mentioned in my response to the previous question, while it is true that what is fun for one may not be fun for another, what we subjectively experience when we say we are having fun is more similar than dissimilar across people. So, for example, even if my idea of fun (say, going on a hike) is quite different from that of yours (cuddling up with a book), you will understand what I mean when I say, “Going on a hike is really fun.” You might say, “that’s not what I would call fun, but hey — different strokes for different folks!”

The point is that it’s important to have fun — in whichever way that works for you. Why? Because you are likely to be more creative, more healthy, more productive and more altruistic when you are having fun (more generally, when you are happy) than when you are not.

3) Your work points out that people who are more educated and successful are not necessarily happier. However, one could argue that with expanded education comes broader knowledge and awareness of critical issues (e.g. global warming, poverty, discrimination, injustice, the division of people), and this insight could have a negative effect on one’s sense of happiness. Can one have a thirst for universal knowledge and increase their happiness at the same time? What, in your opinion, is the relationship between seeking truth and happiness?

It is true that more knowledge and more awareness can lower happiness levels. There was a study that a few of my marketing colleagues (including Ziv Carmon and Klaus Wertenbroch) conducted in which they showed that those who spend more effort and thought in coming to a decision about which product to buy are generally less satisfied with the product than those who make it based on lower levels of effort. A main reason for this is that, when you know more, the more you know what else is possible; so, you are less happy with what you have.

The mechanism to which you allude in your question (to conclude why better informed people may be less happy) is a related one. You suggest that being informed and knowledgeable about all of the ways in which the world is screwed up may be a buzz kill. True. And this certainly seems like an important reason why the smart-and the-successful are not so happy. But I also think that there’s merit to the argument that some of the very things that make us smart or successful — like a need to be superior, the desire to control others or outcomes, or that of engaging in elaborate analyses — when taken to unhealthily high levels, can also undermine happiness levels.

A final reason why success lowers happiness has to do with how access to the yardsticks of success — fame, money, power, etc. — can make us more self-centered and materialistic. Several findings show that being self-centered and materialistic are not good form for obtaining happiness.

4) From the perspective of neuroscience, emotions are important for our decision-making processes. In a Business Insider article, you warn ‘mind addiction’ can make us ignore our gut instincts and feelings (see: ‘Mind addiction’ could help explain why smart people aren’t as happy as they could be). From your research, why do you think we have found ways to short-circuit our intuition?

Great question. It’s not that thinking through problems and overcoming emotions is always bad. Clearly, we have all experienced situations where our emotions have hijacked — or at least derailed — our decision-making process. Impulsive consumption behaviors (e.g., overeating) are all examples of this. So, one big reason why many of us become suspicious of emotions is because we do not want to commit this mistake again. But in an attempting to avoid the mistake of being too impulsive, many of us run the risk of becoming “mind-addicted”.

I think society too plays a big role in instilling mind addiction. Take schooling. Children almost never get to learn about how emotions and instincts can be useful in decision-making. That is, pre-college education almost exclusively encourages the “mind” route to solving problems and making decisions.

On top of that, most of the goals we are encouraged to pursue, from individual ones (e.g., saving enough for retirement, losing a certain amount of weight) to societal ones (e.g., increasing GDP) are quantitative in nature. So, we end up never pursuing qualitative goals (like being happy, or enhancing levels of trust in society). This overly quantitative (vs. qualitative) focus also makes us more prone to relying on the mind to solve problems, getting us increasingly out of touch with our instincts and feelings.

A final reason for mind addiction may be that women are not as well-represented in positions of leadership. So, to the extent that listening to, understanding, acknowledging, and utilizing emotions is a more feminine trait than a masculine trait, society reinforces mind addiction.

5) Mindfulness has become a very popular concept recently, and you often mention it in your work as being a habit that can support happiness. Purportedly, Maslow never published the final version of his hierarchy of needs pyramid in which self-actualization is followed by self-transcendence. Do you think that mindfulness practice might ultimately prove to be a useful tool towards self-transcendence? Or, alternatively, do you see this practice as more a simple, yet very effective, evidence-based cognitive technique to help identify that a lot of what makes us unhappy is merely a waterfall of mindless thoughts and we have more power over these than most believe?

Good question again. I personally think mindfulness has the potential to both offer the “lower order” benefit of reducing stress and enhancing happiness and the “higher order” benefit of self-transcendence. What I mean by self-transcendence (and I imagine you do too) is not something that is necessarily mystical or spiritual. Rather, it’s just the subjective experience of not perceiving oneself as separate from something that we would “normally” consider external. So, for example, when we are so involved in an activity that we lose track of time, or do not feel self-conscious (the critical voice in the back of the head is gone), we merge with the activity to experience a state that Prof. Mihaly Csikszentmihalyi has famously called “flow.” Flow is a transcendental experience in the sense that there is a subjective feeling that one has merged with the activity in which one is involved.

Likewise, being in love is self-transcendental, because one feels this sense of merging with the object of one’s love.

In a similar way, mindfulness can provide a transcendental experience — providing one is able to do it correctly, which may require practice. By “doing it correctly,” I mean doing what is often considered the main aim of mindfulness — “being aware without judgment”. Being aware without judgment means being aware from the perspective of what might be called “bare attention”. Bare attention is very different from mind attention. Mind attention is what leads us to judge, categorize, comment, etc. on whatever is going on. Bare attention, on the other hand, means just being aware of the object of one’s attention without the accompanying commentary. It is difficult to do, but can be learned through practice. Once one is able to successfully take the stance of bare attention, one experiences this transcendental sense of being merged with the object of observation, resulting in what Douglas Harding called a “headless experience”. Sam Harris describes this experience very well in his book, Waking Up, as well.

Interview with Chip Conley about Creating Joy

Chip Conley began his journey in creating “joy” by transforming a seedy motel in the Tenderloin District of San Francisco into the legendary Phoenix hotel. Under the umbrella Joie de Vivre (translated to mean: the exuberant enjoyment of life), the endeavor grew to 40 unique hotels spread across California. He has authored several books, including Emotional Equations, PEAK and The Rebel Rules. Currently Chip serves as the Head of Global Hospitality & Strategy at Airbnb and the Chief Strategy Officer of Everfest, a company that connects the festival community online.


1) Now that you have immersed yourself in the world of festivals, what are the commonalities that make these experiences so impactful and life changing? For instance, there are elements that distinguish the Rise Festival from say, an Outside Lands. What are the essential elements of exceptional festivals that set them apart from a run-of-the-mill collective experience?

There is a French sociologist named Émile Durkheim, and in 1912 he wrote about the nature of pilgrimages. He coined the expression “collective effervescence” that really describes what makes a festival different. He used this term in the context of religious pilgrimages, but I actually think a festival where you become part of the installation — in an environment where people are somewhat out of their customary social environment — that is where transformation tends to happen. When you go to a concert, generally you go there for the day and then you go somewhere else. Collective effervescence happens when your sense of ego almost evaporates and what it is replaced with is a sense of common mission, and a common connection, with other people — that’s the beauty of a festival. The more digital we get, the more ritual we need. In this context, ritual is the IRL experience vs. the URL experience. The URL experience is what we do online, IRL is “in real life,” and I think that the more we are possessed by our gadgets, the more we need to have opportunities for connection in real life. Furthermore, there is no doubt that habitat influences our behavior and what we are willing to accept. A particular festival may have a set of guiding principles (e.g. Burning Man’s 10 Principles). What is really great when a festival does have principles — and they are well-advertised and promoted — is as an attendee you know what you are getting yourself into and also what is expected of you to participate.

2) You are well known for creating physical space and visceral experiences that create joy. Like any good master, you have pulled elements from other disciplines ranging from positive psychology to physical art. What is one of the most profound lessons you have learned along the way? Perhaps one you found the most surprising about the craft of creating joy?

I have always loved throwing parties. I throw the grand opening parties for my hotels, and every five years I throw a party somewhere in the world for just my friends. I did this last year in Baja with 125 friends. It was great. I just threw a party for 20,000 people in Los Angeles for Airbnb. What would normally be considered a conference, we reimagined as a festival and broke conventional rules. This was the third event of this type for Airbnb, and this time we wanted the format to be a bit uncomfortable at first. Not uncomfortable physically, but more like the attendees did not know what they were getting themselves into. A level of curiosity like, “I do not feel like I am in a normal environment.” This level of stress can actually help people to find parts of themselves that they did not know exist. We had the event in a somewhat sketchy area of Los Angeles. There are historic, beautiful theaters that we used as part of the installation. We took over five historic theaters, we took over about seven different retail spaces, and at least three parking lots. We used this environment for workshop spaces, conversation spaces and creative spaces for people to connect. What I believe is that what is remarkable — what creates joy — is when something surprises you and then it delights you. There can be surprise and disappointment or there can be surprise and delight — when it is surprise and delight, it is unexpected. Unexpected delight is memorable. I think interesting juxtapositions do this very well. When juxtaposition is done well, our brain is literally going through a process of having to imagine two things together, for instance, art and spirituality. The blending of ideas can lead to illumination. You see something in a way you never thought of before. The best way to describe someone who is a great festival producer: they are a curator. So, you try to curate an experience, create a habitat for people to have peak experiences. When there is nice mix of unfamiliarity and you push through boundaries — joy comes with that feeling that some level of accomplishment, some level of progress, has taken place. This growth allows you to feel a sense of exhilaration.

3) In your book, The Rebel Rules, you talk about the benefit of sabbaticals to avoid burnout. For many, these opportunities will only manifest a handful of times in a lifetime. As such, in your experience examining both successful “rebels” and those with an affinity for wanderlust, have you identified any strategies for those who embark on soul-searching expeditions to help maximize their outcome?

Creating space (whatever space means in the context of some individual freedom) and seeing what emerges is pretty important. Now, you literally could do that on a weekend. You could say, “Okay, this weekend I am going to put an office message that just says: I’M NOT CHECKING EMAILS THIS WEEKEND.” You hide your phone. For two days you go digital free. You go through a digital detox and maybe you have nothing planned, you literally just allow spontaneity or serendipity to rule those two days. That process might actually start to bring some things up for you, including fear. A lot of us like structure, a lot of us like to have a calendar that is full because it lets us know, “Okay, this is what I accomplished today.” There are a lot of people that need to ‘accomplish’ things to feel alive. So, I think not everyone needs a six-month sabbatical — at least not as a first step. Even if you have the opportunity to take a sabbatical because your life has created a transition, it might be foolish to assume that you know what you are going to get out of a sabbatical. For me, my sabbatical was not really even a true sabbatical, but more along the lines of “what’s juicy for me right now?” For me it was festivals, and I started going on that path, and I went to five festivals in Asia in the winter of 2013 and came back starting Fest300. Then, all of a sudden, out of that emerged the founders of the Airbnb approaching me and saying, “we want to turn our little tech company into a hospitality company, will you help us do it?” I have been doing that for almost four years now. Sometimes you have to make space to grow; I might not have taken the call from Brian Chesky four years ago if I had not taken time for renewal. When you create space, you are in a better place to take the blinders off, which gives you the opportunity to see things you might not have seen otherwise. So making space is one strategy. A second strategy is meditation. I try to meditate twice a day if I can. That experience is my form of a daily sabbatical, because it allows me to decompress and disconnect. It does not have to be meditation — some people like taking afternoon naps, for others it is going for that four-mile run that they do every day. Whatever it is that helps you to break with the linear mind. However, there is not a prescription that is right for everybody. I think for me, knowing my tendencies, having a really open field is probably wise because if I am too prescriptive about what I want at the end of a six-month sabbatical, the end result will be a linear to-do list, which defeats the purpose. With that said, realize your sabbatical probably should be the opposite of what you normally have. For me, I need space to be open to new ideas. For someone else, they may need a sabbatical because they are so lost that the purpose of their sabbatical is more oriented around a mission or some level of achievement.

4) There can be a bit of an underbelly to festival culture, where it is purported that some that identify with this lifestyle and chase experience, do so with hedonistic self-interest. A recent example are some of the complaints coming from Standing Rock (http://www.independent.co.uk/arts-entertainment/music/news/standing-rock-north-dakota-access-pipeline-burning-man-festival-a7443266.html). In consideration that this may exist, how does contribution, responsibility and ethics factor into organizing any collective experience?

I think hedonism in moderation is appropriate, self-interest is not necessarily a bad thing. However, festivals can become an addiction, just like so many other things in life. I think one of the things that Burning Man has done quite brilliantly is creating 10 principles that define this community. The main event and other events around the world that are sanctioned to be Burning Man affiliated help this community to hold ourselves accountable when we see people not living up to them. No one is perfect of course, and the Burning Man principles are not right for every festival. The problem with a lot of festivals is they lack principles. Often when you lack principles what you get is the lowest common denominator. Without an inherent culture, you get something that takes people to their basic instincts. Getting back to your first question, I think the part that is truly beautiful is when you see that collective effervescence happen. Collective effervescence means that people are losing their sense of ego and their sense of identity and, in the process, feeling connected to something bigger than themselves. I think that if principles are articulated well, and these principles are lived out in such a way that they help people move beyond their own selfish needs (in the process of experiencing the festival), then principles have the potential to create a better legacy for the event. If an event is something that is purely hedonistic — and it is important to note that there are festivals that survive and do quite well within that environment — you diminish the ability to somehow feel like there is something bigger than your own personal, hedonistic needs. Great festivals elevate people and help people to transcend their own petty grievances and desires. A great festival is a community of people experiencing something together. So, if it’s a collection of individuals as opposed to a community of like-minded people, the risk is, if you look at Maslow’s hierarchy, pretty low on the pyramid with regards to experience. At these type of events the moment that somebody else is attracting you as an individual to something over here, or a new shiny object there, whimsy just takes you over there because you don’t feel any connection to the purpose of the event. Festivals are at their best when they really do help people to feel connected to something bigger than themselves.

So the issue you have highlighted is not a festival problem — the definition of addiction is using something as a distraction, as a means of not feeling something. Festivals can play this role. If you just constantly go to festivals because you cannot live your normal life, or live in real life and/or you are searching for a utopian experience… festivals always come to an end. If you are going to festivals as a way to vacate in some manner, I think you need to ask yourself, “What could I do in my ‘normal’ life to make it better?”

5) If someone wanted to follow in your footsteps in the pursuit of creating joy, but was at the beginning of their journey and was looking for mentorship, what three pieces of advice would you impart on them to begin acquiring the mastery to be successful in this pursuit?

1) Understanding who you were as a little kid always helps, because weirdly there are clues in your childhood that help you understand what it is that gave you that sense of timeless wonder. Timeless wonder is usually a pretty healthy place to seek out in that Joseph Campbell “follow your bliss” approach to life. So, start by doing a personal archeology project about your childhood. Talk to your friends, talk to your brothers and sisters, your parents, whoever you spent time with as a child. Look at pictures of yourself at childhood and get a sense of what it was that gave you bliss. How can you manifest that in your adult life? I was always fascinated about Walt Disney and how he created Disneyland. I was fascinated by creating experiences for kids in the neighborhood, so… I would do just that. I would create a restaurant in my mom’s dining room for instance. There are clues there — find them.

2) Look at who you admire. Who are the people out there in the world as adults who are living their life in such a way that they could be a model for you? Who is actually having joy in how they experience their life? Who is doing it in a way that gives them a sense that they are living their calling? This does not have to be just in the work world; you could live your calling as a political activist, you could live your calling as an Ironman athlete, you could live your calling as a grandmother. Figuring out what it is that gives you that sense of passion in life and seeing it in other people — this helps you develop a better picture of what life might look like for you.

3) The way to bring joy to people is helping them to feel like they are a kid again. The Celebrity Pool Toss has been going on for 25 years now — a fundraiser we do at my first hotel, The Phoenix. It is a fundraiser for TNDC’s afterschool program for kids. We have created a fundraiser based upon the high bidder getting to toss a celebrity in the swimming pool of the hotel. The reason that it has lived for 25 years now — raising over $7 million for afterschool programs — is because it allows people to act like a kid. Auctions are a bit fun too, but the process of actually throwing someone in the pool is very childlike. I think providing people that sense of being able to break out of their normal formality — helping people feel less contained. Burning Man is a somewhat extreme example. Getting the chance to toss people in the pool is a very simple example, but still effective of reconnecting with a sense of freedom that might have gotten lost in adulthood.

A word of caution for those looking to create an event. Some people find joy in being spectators, others in being participants. Some events are better suited for everybody to be a participant, some are suited for some people to be participants and some to spectate. I think a key to success is to make sure people know what they are opting in for. So, if you are creating an event with the aim of creating joy — if your idea centers around everybody participating, you better make sure the attendees know that in advance.

Interview at the Motionsoft Technology Summit about Big Data

This quarter’s Business, Innovation and Entrepreneurship interview is the compilation of getting to discuss “big data” analytics with four exceptional thought leaders at the Motionsoft Technology Summit this year (2016). These four gentlemen in no particular order are: Jafar Adibi, Ph.D., the President, Co-founder, and CTO of re|unify; Jeffrey Cooper, the Senior Manager of Business Development at Samsung; Mark Newman, the President of Heads Up Analytics, and Keith Catanzano, a Partner at 2River Consulting Group. The answers below are summations of their respective answers, as such they are not represented as verbatim but edited for readability and context.


1) When a company is either building a data model (or working with a third party for this type of service), what considerations should an operator have regarding the crossroad of complexity and usability?  There are scenarios where too many disparate and incomplete data sets can make it difficult to find the signal from the noise; what are the trade-offs as the amount of available business intelligence information continues to increase? And what considerations should we take into account to maximize any investment in mining data?

[Jafar Adibi]: You need to figure out what problem you are trying to solve. Clients will come to me with data, rich sets of data, and say, “Jafar, now go figure out something to do. Find something interesting.” Generally, this is a waste of time. People believe finding correlations (any correlations) are going to help their business, but that is often not the case. When you identify your problem, we are better set up to solve it. There are different analytic methods for classification problems, association problems, and other questions that are not necessarily answered through correlative means. Getting to the right question will help you establish what data sets are important.

Then you need to figure out your budget. There will always be noise in your data, especially data from business intelligence. We can build a model to take the noise into consideration. However, using more data is obviously expensive, so that goes back to what are you trying to solve for. We can exclude data that will not answer your question, which saves you time and money. As such, you want to keep return on investment (ROI) in mind as you think about the question you are asking. Ask yourself, “If I answer this question, how much money with I gain/save?” The answer to the ROI question gives you a ballpark on what it might be worth regarding your investment in a data model.

2) It seems to me that a lot of ad hoc advice about using data for business intelligence is disseminated on broad-based assumptions derived from general population data. However, is this not one of the follies of “Big Data”? Companies are basing important decisions on arguably misleading benchmarks, rather than creating a narrative specific to their population (or at least a sample from their specific population); What are strategies to ensure we are making the best decision based on our company’s unique attributes?

[Mark Newman]: The most important thing is to trust your own expertise. You should intuitively know the customers you are trying to attract. You should have an idea of what strategies you are trying to pursue. You should already know what the important problems are you need to solve. What you don’t want to do is look to data to validate some preconceived answer to your problem. Instead, you want to devote your own educated guesses as to what to do — and then you want to use data to test those rigorously to keep yourself honest.

I think there are two ingredients to doing that. The first is to agree with your colleagues on the definitions of the terms that you are using in your data. If all the stakeholders do not agree on the definition of the numbers, then you all are not going to have an organized lexicon/narrative to work with. You have to agree on key metrics that you are going to use to allow for the monitoring of health and progress within your organization.

The second ingredient that you want to have is to follow an experimental approach that is constantly evolving. Your customers and prospects are going to react differently to your products and services over time. Reasons:

  • They might have more experience with you as your brand matures
  • As consumer groups mature, they change their goals
  • Your previous pitches are now stale, and customers react to them differently
  • Different competitors in the marketplace

What works today does not work tomorrow. Instead of some one-and-done, super solution to what you are trying to accomplish — instead you want to have some kind of innovative, incremental approach in the beginning. If you follow that, then over time, the data is going to have a narrative that reflects who you are, and what you are trying to do, and what works best for you.

3) Until recently, most data aggregation efforts have told a fairly unsophisticated narrative, and inspired relatively unremarkable initiatives in an effort to capitalize on data mining. How can we improve our use of data? And, how can companies do better at making data more actionable?

[Keith Catanzano]: What is the question the company is trying to answer? It is important to not just say, “How do you make data actionable?” We are probably all guilty at some point of looking at a data model and saying, “Look at the results, they’re awesome!” I think intriguing insights can be challenging in terms of making data actionable. There is a ton of data out there. Once you find ways to bring yours together, there is a lot you can see using data by way of insights. At some point you need to do something with the insights. In order to do that, obviously, it’s important to know who your customers are [assuming trying to influence their behavior is your goal], but also why are they customers. However, in this use case the why is more important than the who. The “why” is ultimately what you are going to try to make actionable, because to take action you are going to need to pull some type of lever to influence consumer behavior. There are lots of ways to work with communication or outreach in an attempt to accomplish this, but the effort requires the company to take a deliberate approach regarding how data is used to take action.

It is also important to note that making data actionable is generally not a one-shot deal, and architecting a campaign that changes an entire group’s behavior in some way probably will take a series of events that includes multiple levers I mentioned. So to make data more actionable, an organization should sit down and say, “What is the level of energy I want to put into solving or addressing this problem?” And that’s probably both a financial decision and a brand decision. For instance, a brand manager might ask, “Is this the kind of consumer group that we want to continue to attract? Yes; OK, well … indicators show we may be struggling with this particular group, so let’s double down because from a brand perspective, that’s how we want to be seen.” An alternative scenario here is the data suggests (to the brand manager) that too much effort is being spent focusing on the wrong group. Without asking the right questions, the data just suggests that marketing is ineffective. To finish, a company really needs shared responsibility to make data truly actionable. Ultimately, as an organization you determine what resources you want to put against data analytics, but knowing what question(s) you wanted answered first is important to making data actionable.

4) How will health club and health club member data evolve over the next several years — what will prove to be important signals for our industry in addition to financial, transactional and activity data?

[Jeffery Cooper]: So besides activity data from wearables, there will be a lot of contextual data the health clubs can now potentially get. With corporate wellness taking off you are going to see deep integration with insurance companies and insurance data. I believe, along those lines, health clubs will also be integrated more with the medical industry. As prevention becomes more associated with a basic level of fitness, I believe you will see medical data become relevant.

In that regard, I think prevention of chronic diseases is eventually going to drive a lot of people toward health clubs from the medical side of things. Right now, in most cases, doctors cannot write a prescription for a health club, but that could change as more complex sensors begin to validate the efficacy of fitness interventions.

Genomics data is another revolutionary area. You already have things like 23andMe, but there is a company Helix, which has been recently funded. Their idea is to sequence your genes, and license this data back through health care providers and fitness applications. With genomic data, consumers can make better choices (and health clubs can cater to them better). With this data, people can ask:

  • Am I suited for bodybuilding?
  • Am I suited for endurance?
  • From the limited time I have, where am I going to see the best results?

As science becomes more advanced, these companies will snapshot your genome once, and then as the science learns more and more about the genome — health clubs can take preemptive, proactive actions from that data to keep their members healthier longer, keep them out of the hospital and improve their overall quality of life.

5) Why does “Big Data” often fall short on delivering on its value promise?

[Mark Newman]: Personally, I feel that part of the problem is the way output data get reported. I feel that in data science to deliver a static report, it is potentially a sign that we have not done our job properly. The reason for that is because when we deliver a page of numbers, there is often no context to the end-user. When you are able to create/refine a business question, you generally make the presumptive problem simpler than it first appeared. Before you set off looking to get value from data, your organization should come up with your desired thresholds and metrics. Then instead of looking at static reports that, at best, will give you trailing indicators — build a dashboard that gives you real-time intelligence based on the most important metrics for your business. This dashboard should be something that your employees can always go to — not just some report that gets delivered on your desk — but something that is readily available on an ongoing basis. You also need to evaluate and monitor the efficacy of this dashboard on an ongoing basis. For instance, if you have a forecasting dashboard and there is a forecast your company is trying to meet, is the dashboard valuable and helping you meet your forecast?

I believe both dashboards that monitor things that drive your business forward, as well as insights that are actionable, are at least two things that give you some evaluation of whether “Big Data” is helpful and valuable within the context of your own particular situation. The other thing is that you really want to be doing analyses all the time. You want your data strategy to evolve past sending out graphs and numbers — to actually be working to build a story of what’s going on in your organization — and back up your story with reliable and meaningful communication so every stakeholder is seeing the same thing and you can all agree that your chosen data model(s) is providing value and is meaningful within the context of your particular business.

Interview with Dr. Henry DePhillips about Telemedicine

Dr. Henry DePhillips is the Chief Medical Officer of Teladoc. At Teladoc, Dr. DePhillips is responsible for maintaining the exceptional delivery of clinical care delivered through Teladoc’s telemedicine digital health platform. Prior to Teladoc, Dr. DePhillips held several high-level leadership positions in health care. His positions included a previous role as the Chief Medical Officer at MEDecision, working as the Senior Medical Director at Independence Blue Cross of Pennsylvania, and a role as Head of Business Development, North America for McKinsey’s international Health Systems Institute. Dr. DePhillips is a health technology fanatic who is passionate about telemedicine and shifting health care from a provider-centric model to one that better values the needs of the patient.


1) How do you see telemedicine affecting employee burnout and workplace wellness?

What I am seeing is that telemedicine provides employees quick and inexpensive access to services that contribute to their well-being. Employees also generally perceive the telemedicine experience as more enjoyable than traveling to see a physician. Employees like what we provide, so our service grows as it is better understood by employees. When people get the care they need in a timely manner, this reduces workplace wellness issues — concerns like presenteeism — because employees now have easy access to care rather than “powering through” health conditions that could have unwanted consequences if ignored.  These consequences range from getting other employees sick to compounding personal medical issues by not seeking treatment.

2) What are some of the aspects of American work culture you see uniquely contributing to issues of presenteeism and employees “powering through” illness?

There is a combination of cultural factors here in the United States. One is financial, many American employees can no longer afford to miss a day of work. A second is functional. In many U.S. companies that have downsized staff, if someone misses work then there is no longer anyone to cover their role/position — calling in sick is simply not an option. A third is cultural considerations. In America it is a sign of toughness and/or commitment if an employee powers through their illness. For instance, it can be viewed as a “badge of courage” if you come in with the flu. Lastly, there are logistical considerations. In many cases when someone should see a doctor, they are unable to do so because scheduling is difficult given other considerations. This last factor is where I see services like Teladoc playing an important role. With telemedicine it is no longer a burden to see a doctor. With the traditional approach you generally must take time off work, schedule an appointment, travel from work to see your physician. Now, if an employee is in need of care, it is as close as their keyboard or mobile phone. An experience that used to be three to four hours can now be accomplished in 30 minutes with telemedicine — and unless you need to pick up a prescription, your experience can all take place in a virtual environment of your choosing.

3) How do you see telemedicine playing a role in helping improve the patient experience?

With Teladoc you can update your electronic medical record in minutes, request a board-certified physician to meet with you at a time that works with your schedule, interact with your physician using the digital modality of your choice (phone, video conferencing, digital photos, etc.), and have prescriptions sent to a location that is convenient for you. In my opinion, it is simply a better experience.

4) There are reports that over 15 million people now use telehealth, which is a 50 percent increase in usage from numbers reported in 2013. Who is driving this growth?

Telemedicine is still perceived as a rather new way of receiving care, so we have plenty of early adopters (now) but you are going to see increased utilization blossom as we move into the early majority. Those that would rather take a conservative/traditional approach will likely become more open to telemedicine as the technology matures. “Try it once, and you will like it for life,” really applies to our technology. We see that once users try it once they often return, at least here at Teladoc. In certain populations it is a no brainer — single parents with kids, those that travel for business — again anyone with logistical considerations will likely become lifelong users once they try it once.

5) Why do you think there is a significant proportion of physicians that have an aversion to telemedicine?

It is an evolution. It is a work in progress. Health care as an industry tends to be fairly conservative when it comes to technology. Think back to the Marcus Welby, M.D. days and we have not evolved much since then in regards to care. Health care is still a very provider-centric experience. The provider tells you the times that work for them, you go to the provider’s place of practice, the provider basically makes you adhere to what is convenient for the provider. I see telemedicine as the first major shift towards a consumer-centric approach. Under the current antiquated paradigm, a patient has to say, “I am sick, where must I go to receive care?” However, with telemedicine the patient can now ask, “I am sick, how can I most efficiently get the care I need?” And now, care is as close as the smartphone sitting on the bed stand. The doctor now comes to you, at a time convenient for you. At Teladoc, the average time between requesting a visit and being able to see a physician is 10 minutes. My job as the CMO of Teladoc is to make sure that the quality of care that people expect [from the old model] is the best it possibly can be [in the new model] as we go through this evolution. It is important to note, telemedicine is meant to address a subset of medical problems that has been specifically selected to work with telecare, problems that can be accurately and successfully treated using this form. In most cases I believe telemedicine will provide the end-user a superior experience, but there are going to be some specialties where telemedicine doesn’t make sense, and that is okay too.