D.A. Wallach, Recording Artist; Co-founder and General Partner, Time BioVentures
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TechTranscript
00:00 Well, thank you very much.
00:02 It's great to be here following an actual death panel.
00:06 And as you heard in my introduction,
00:10 I'm a bit of an odd duck.
00:12 I run a biotech and health care venture fund in LA
00:15 called Time BioVentures.
00:17 But this was my previous life.
00:20 And as you can tell from this photo,
00:22 you should take everything I say today with a grain of salt.
00:26 I want to talk a little bit about the parallels
00:29 between the lessons we've learned in the music industry
00:32 and what I perhaps see on the horizon for the health care
00:35 sector.
00:36 And when I was in college and got my first record deal,
00:40 we entered the industry at a remarkable time
00:43 when things were in total freefall.
00:45 So what you see in this graph here
00:47 is US recorded music revenue over time,
00:50 starting from about 1970.
00:52 And the peak is the absolute bonanza of an era
00:57 that the '90s were as the recorded music industry
00:59 resold the entire history of music on compact discs.
01:04 People were just rolling in cash.
01:07 And when we got our first record deal in 2007,
01:10 this freefall had been catalyzed by the advent of Napster
01:15 and then YouTube, and with it, the erosion of consumer
01:18 spending on recorded music.
01:21 So you probably remember these record stores.
01:23 They were progressively going out of business at this time.
01:27 And a couple of years after we entered the industry,
01:30 I had the good fortune of meeting
01:31 the founders of Spotify.
01:33 And when I saw their product, I was just completely blown away
01:36 by the potential that I saw in it to get people
01:38 paying for music again.
01:40 It was such a compelling product that you
01:42 could imagine consumers going from free music
01:45 to something for which they would
01:47 pay a monthly subscription.
01:49 And that's exactly what happened.
01:52 The old music supply chain was, I think,
01:54 to a lot of folks at that time clearly anachronistic.
01:58 And you'll remember these days, it
02:00 was basically this very clunky, intermediated system
02:03 to get content to consumers.
02:05 So you'd go into a brick and mortar record store,
02:08 and you'd sort of prostrate in front of some grand wizard
02:10 of music who would query their huge brain for all
02:15 of the history of records.
02:16 And they'd recommend to you just the perfect record
02:18 to get, in this example, the Jimi Hendrix experience.
02:21 And that record typically would have
02:23 come through one of just a few record labels,
02:25 like Capitol or Sony, that were basically the sole distribution
02:29 channel through which artists could get their content
02:33 into their fan base.
02:35 And Spotify succeeded by dramatically simplifying
02:39 that connection between consumers and content.
02:42 And it put all consumers on an equal footing,
02:46 such that they could access the same catalog of music
02:48 globally for a very low monthly price.
02:52 And here's the end of that story,
02:54 or at least up until today, what's
02:56 happened with streaming, which is depicted in green here.
02:59 Consumers started to pay and revived the industry.
03:05 Health care, in some ways, has the exact opposite problem,
03:08 which is that we're spending too much,
03:10 and the amount that we're spending is growing too fast.
03:14 And most of that spending is on our hospital-centric business
03:19 model.
03:20 So as you can see from this breakdown of the $4.5 trillion
03:24 we're spending in the US per year, something between 70%
03:27 and 80% of it is basically going to human-mediated health care
03:31 services, be it in hospitals or brick and mortar clinics.
03:35 And this model, as I see it, is really
03:39 trapped in an 18th and 19th century factory paradigm,
03:44 where the concept is basically get a bunch of big brains
03:46 into big buildings, and you'll realize production
03:49 efficiencies.
03:51 And we have similar issues in education
03:54 with large universities and in criminal justice.
03:57 These are all paradigms that originated
04:01 in the 18th and 19th century, and they're
04:03 all in certain similar ways failing us today.
04:07 That fits into a supply chain.
04:10 It might be a little bit of a stretch,
04:11 but I think it's actually reminiscent of the music
04:14 industry supply chain that I described previously.
04:17 Instead of going into a record store,
04:18 you go into a hospital or a clinic,
04:20 and you're seen by a physician who
04:22 queries their huge brain, which has
04:23 been stuffed full of information,
04:26 the whole corpus of medical knowledge.
04:28 And they will try and identify for you
04:30 the perfect intervention.
04:32 And if that happens to be a drug, as here,
04:35 that drug will have come from one
04:36 of a few large pharmaceutical companies,
04:38 like Pfizer, which, similar to the record labels,
04:41 are essentially now the distributors for those who
04:44 really create new medicines, which
04:46 are the small and mid-sized biotech companies.
04:50 And so the question I want to raise
04:52 is whether we should do to these--
04:54 and please forgive me.
04:56 When I was putting these together,
04:57 I did not know that Johns Hopkins or CVS
05:01 were sponsors of this great event.
05:04 Nothing against either of them.
05:05 I think they're fantastic organizations, just a little
05:08 bit dated.
05:09 And so I wonder if we should do to these what we did to these.
05:13 And if we do, what would the equivalent of Spotify even be?
05:19 What would streaming medicine be?
05:23 What I'd propose is that what we need to build--
05:26 and this includes AI and a lot of the other technologies
05:29 that people have been talking about today and yesterday--
05:33 is a single global catalog containing
05:37 all medical knowledge, all diagnostics, all interventions,
05:42 and all medical reasoning.
05:44 Essentially, the super AI of medicine
05:47 in the cloud to which people can connect
05:50 from anywhere in the world and connect
05:52 to the exact same knowledge.
05:54 Just like today, they connect to the same music catalog
05:57 through Spotify or the same film and TV catalog
06:00 through services like Netflix.
06:03 My belief is that this type of knowledge centralization
06:07 is actually the only way to make medicine modern.
06:11 And I would define modern medicine as evidence-based.
06:15 I don't see why we should distinguish between medicine
06:17 and evidence-based medicine.
06:18 I don't think anyone goes to the hospital looking
06:20 for non-evidence-based medicine.
06:23 It should be personalized with validated algorithms
06:26 that are universally applicable to patients
06:29 everywhere in the world.
06:31 It should always be up to date.
06:32 So the standard of care that someone gets in Botswana
06:35 should be exactly the same that they get
06:38 in Los Angeles or New York.
06:40 We should be honest that if we're not
06:42 giving people the same high-quality care everywhere,
06:44 we're doing that because they're poor,
06:46 not because they deserve a different standard of care.
06:49 And it should be geography and income invariant.
06:52 Again, the same medicine no matter where you are,
06:54 no matter who you are.
06:56 With that type of centralization of knowledge,
07:00 I believe we can actually decentralize the care itself.
07:03 So on the one hand, centralize the information out
07:05 of hospitals, sort of evaporated into the cloud,
07:09 and then push down care into the community
07:11 through decentralized delivery.
07:13 And I've chosen the village people here,
07:16 not because I think they should be your doctor,
07:19 but just to make the point that perhaps people who today have
07:23 different jobs, even outside of health care, in the future,
07:26 when paired with this type of technology, streaming medicine,
07:29 could end up being superior as a way of delivering care
07:33 to even super doctors like House.
07:35 And so I think in the future, we're
07:37 going to marvel at the fact that you had to be a genius
07:40 to be a doctor in the past.
07:42 I actually think that's a moral imperative,
07:45 because lowering the barriers to medical competence
07:48 is the only way that we can possibly scale up
07:52 high quality care globally.
07:53 What you see here is that the darker countries
07:55 are those with a higher density of physicians per capita.
07:59 In the US, it's about three doctors per 1,000.
08:01 When you get into countries like Madagascar,
08:04 it's less than a tenth of a doctor per 1,000 people.
08:09 So we're not going to fix that by manufacturing doctors
08:13 in our current paradigm.
08:14 It's just impossible.
08:17 I would propose that maybe the doctor of the future
08:20 is more like an accountant.
08:22 It's a highly trained, specialized person,
08:24 but not necessarily someone who was
08:26 educated for 15 or 20 years.
08:29 And I think there are a million potential configurations
08:33 of how those sorts of professionals
08:35 could fit into something like streaming medicine
08:37 to deliver better care.
08:38 But this is just one kind of spitball-y idea I came up with.
08:42 Imagine that patients get a voucher
08:44 to spend on choosing a sort of primary care navigator,
08:48 and then hire this person.
08:50 This is, again, like the sort of health care accountant
08:52 character.
08:53 And they're paid directly by this voucher, not by insurance.
08:56 So take primary care out of insurance,
08:58 put them entirely on the side of the patient.
09:01 And then this team--
09:02 the patient, their care professional--
09:06 working with streaming medicine can navigate the system
09:09 and choose the best products and services to cure them.
09:13 And then align cost savings with patients.
09:16 Let them capture the savings that they
09:18 generate by navigating their own care in a thoughtful and cost
09:23 effective way.
09:24 Again, apologies to CVS and Johns Hopkins.
09:27 But a couple of weeks ago, we learned
09:29 Walmart is not going to save us.
09:31 And I don't think that this is a particularly exciting future
09:35 either.
09:35 I would be shocked if 100 years from now,
09:38 the way we're doing medicine is in minute clinics
09:40 and huge buildings.
09:41 And fortunately, in my day job, we
09:43 get to see amazing entrepreneurs coming up
09:46 with all the little seeds of this future
09:49 that I'm outlining.
09:50 And we're not investors in all or even most
09:52 of these companies.
09:53 But I think they're really promising.
09:55 And I would invite any of you who
09:57 are working on this who sort of believe in blowing up
09:59 the system and starting from a blank sheet of paper
10:01 to reach out to us.
10:02 We're super excited to engage in entrepreneurs
10:04 who are thinking really big.
10:06 And I appreciate your time.
10:07 Thank you.
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