Holiday Edition: Future Trends in Digital Health & AI (Daniel Kraft, Lucien Engelen, Zayna Khayat)

[00:00:00] Dear listeners, welcome to Faces of Digital Health, a podcast about digital health and how healthcare systems around the world adopt technology with me, Tjasa Zajc.

[00:00:14] In this special holiday edition of Faces of Digital Health, we're going to look at some of the trends in digital health in 2024, comment on them and reflect on the development of the field with three great speakers from the next slide.

[00:00:32] Netherlands, Canada and the US.

[00:00:35] You will hear from healthcare futurist and strategist Zayna Khayat, futurist and founder of NextNet Health Daniel Kraft, and digital health expert, CEO of Transform.Health Lucien Engelen.

[00:00:49] We covered digital health statistics in 2024, quote unquote sleeping topics that are about to be in the front line in the upcoming years,

[00:01:00] and patients as the key word in assessing the success of digital technologies in healthcare.

[00:01:09] Enjoy the show.

[00:01:10] And if you haven't yet, make sure to subscribe to the podcast wherever you listen to your shows.

[00:01:15] And also subscribe to our newsletter, which you can find at FODH.substack.com.

[00:01:22] That's FODH.substack.com.

[00:01:25] Now let's dive in.

[00:01:40] Hello, everyone, and welcome to this very special holiday edition of Faces of Digital Health.

[00:01:47] I am extremely happy to have the group of you guys here.

[00:01:51] So Zayna Khayat, the healthcare futurist.

[00:01:54] Daniel Kraft, also a healthcare futurist and the founder of NextNet Health.

[00:01:58] Lucien Engelen.

[00:02:00] Would you also say you're a healthcare futurist?

[00:02:02] You're just like a book of knowledge.

[00:02:05] He's a nowist.

[00:02:07] Oh.

[00:02:08] Nowist.

[00:02:09] Nowist.

[00:02:09] And we're here today to reflect a little bit on digital health in 2024 and where we're going in 2025.

[00:02:18] And maybe just to set the scene a little bit, I just want to highlight a few things that kind of stood out in the space for me.

[00:02:28] And then I'm going to ask you to do the same.

[00:02:30] So my three topics are the focus trends as presented by Rock Health.

[00:02:37] Going to obviously talk about the AI hype, adoption and regulation.

[00:02:41] And cybersecurity is one thing that's been on my mind this year.

[00:02:46] So investment wise, we're still waiting for the end result of how Q4 did.

[00:02:53] But based on the data from Gallant Growth Health, the investments have been rising compared to the 2023.

[00:03:02] But the number of deals is falling a little bit just because more investments have been going to later stage startups.

[00:03:09] And this is also interesting.

[00:03:12] So Rock Health created this maturity of market map where they are putting healthcare AI in the developing stage.

[00:03:20] We're moving from research to actual projects and practical implementations.

[00:03:25] Food as medicine is still a topic that is that keeps rising, especially in the US.

[00:03:30] I don't see that much of that in Europe.

[00:03:33] If we look at AI, there were 3.3 billion invested from January to October 2024, which is actually 36% of overall funding.

[00:03:45] And it's some people in the digital health space are saying that there's too much focus on just AI and not enough focus, maybe also on services in healthcare, because obviously technology is not going to solve everything.

[00:03:58] Hims and Medscape also put out an interesting survey results around the use of AI and adoption in practice.

[00:04:07] So doctors seem to be quite concerned about AI and the ethics dilemma.

[00:04:13] But what was really interesting is that basically, while the productivity increased according to this survey, the costs and the time that the clinicians spent didn't.

[00:04:24] In terms of AI, there's also a surge in the regulation space.

[00:04:29] New organizations are coming up to provide some sense of how AI is managed.

[00:04:35] CHI, the Coalition for Health AI, is planned to open two assurance labs, as by the end of 2024, and they're actually in discussions with OSCD to set something similar in Europe as well.

[00:04:46] So that's very interesting.

[00:04:48] I think another thing that really resonated in 2024 was the fact that for health, which we were all very excited about, the pods for self-assessment and medical exams basically closed in 2024.

[00:05:03] Cyber security, as I mentioned, is becoming increasingly problematic.

[00:05:07] In 2024, half the population in the US was potentially impacted by data breaches.

[00:05:15] The cyber security breaches are increasing.

[00:05:18] And what's interesting is that in the past, the attackers would just hold the data until they got ransoms.

[00:05:28] They are now actually also taking the data.

[00:05:32] So it's not just rocking it.

[00:05:34] They're actually taking it as well.

[00:05:35] An interesting research came out from the UK in terms of women's health.

[00:05:40] The reason I'm mentioning this is because the big issue in women's health is that we often say that we don't know much about the impact and consequences of lack of healthcare for women-specific issues.

[00:05:54] This UK research showed that every additional pound invested in obstetrics and gynecology could bring back 11 British pounds of ROI, which could translate into 319 million pounds in added gross value.

[00:06:13] So that's a few things that I thought really resonated with me.

[00:06:20] Who wants to start with any additional comments?

[00:06:23] Lucien, I was thinking we might want to start with you because a lot of this data is very US focused and you are based in Europe.

[00:06:30] What would you say resonated with us for the European space?

[00:06:37] First of all, thank you for having me and inviting us in this very special Christmas holiday setting.

[00:06:43] To your point, the thing that resonated to me when you were going through your slides is that we've been here before.

[00:06:50] In terms of when we, let's say 10, 50 years ago, all were bragging about digital health in the broader sense of it.

[00:06:58] We've seen numerous startups stepping up, failing, other ones trying it, reiterating again.

[00:07:05] Investors putting money in it, backing out of it.

[00:07:08] I think this is an ongoing process with every new development.

[00:07:12] I was particularly interested in the graph you showed about the concerns that not only physicians and others have.

[00:07:19] Same was also true in terms of digital health.

[00:07:21] And I think it's also the same will be true in every new development that hits the healthcare sector.

[00:07:29] That's not to say that there's always skepticism, but it's new.

[00:07:32] Everything new needs to be in balance.

[00:07:35] We need to have research.

[00:07:36] People would say there's no research about that.

[00:07:39] But let's be honest, in terms of digital health, in terms of AI, the first PhDs will start to graduate next year.

[00:07:47] It needs four or five years in the mix.

[00:07:50] So comparing that with old huge bodies of knowledge and science doesn't work out.

[00:07:56] But it's always a discussion stopper.

[00:08:00] That's the reason why I'm bringing that up.

[00:08:02] I think there's numerous new developments that are very promising.

[00:08:06] We will see some of them fail.

[00:08:09] We see some of them succeed.

[00:08:11] I think Forward is a good example.

[00:08:14] It's the first one to try on that scale.

[00:08:17] I've been following Amazon for more than a decade.

[00:08:21] When all those endeavors that they tried with Haven and other things failed, people would step up to me and say,

[00:08:27] hey, see, even Amazon can pull it off.

[00:08:30] They've looked behind the curtains.

[00:08:32] They now understand the industry.

[00:08:33] They now understand how to play with it.

[00:08:35] And they will come into this industry slash market fearfully.

[00:08:40] And they did.

[00:08:41] Will they fail with it?

[00:08:42] Sure enough.

[00:08:43] This is going to take a generation.

[00:08:45] And let me pause here for a second.

[00:08:48] Zaina and Daniel, feel free to pitch in whenever you feel like it.

[00:08:51] So just let me know.

[00:08:52] When it comes to AI, this is the graph that I forgot to attach in the short presentation earlier.

[00:08:58] And this is something that I am concerned about.

[00:09:01] Mostly the cost part.

[00:09:03] The fact that AI is either increasing costs or just keeping it the same.

[00:09:08] Only 21% of people said that they saw some sort of a decrease in cost.

[00:09:14] And staff hours.

[00:09:16] So staff hours, that was something that was the promise for clinicians.

[00:09:20] It was logical that the workload wouldn't decrease, but maybe the waiting times for patients would,

[00:09:27] because doctors would suddenly be able to screen more patients than earlier.

[00:09:31] Who wants to add some additional comments?

[00:09:35] Maybe Zaina or Daniel?

[00:09:37] I just take a bit of the long view.

[00:09:39] It's great to focus at the end of the year on what happened in 2024.

[00:09:42] But to take a bit more of the longer realm, Lucien already mentioned 10 years ago, there's often a lot of hype and hope.

[00:09:48] We're all living with digital health.

[00:09:50] Moore's Law, things getting smaller, cheaper in terms of compute.

[00:09:53] AI is somewhat on that exponential as well.

[00:09:57] Everyone knows Moore's Law, but I always love to remember Amara's Law,

[00:10:00] which means we often tend to overexpect what might happen in the next year or two.

[00:10:04] A little hyperinflation of expectations, but underappreciate what will happen in a decade.

[00:10:07] And with AI and digital, I think the hype cycle is emerging where a decade after IBM, Watson, et cetera,

[00:10:12] we're seeing AI hit the marketplace in real ways.

[00:10:15] Digital health, I promise, is starting to meet the clinical realm.

[00:10:18] Still a lot of fragmented pieces.

[00:10:20] And the big challenge is often the workflow piece.

[00:10:22] And there's so many fragmented systems, whether you're in Sur, Epic, or any other platform.

[00:10:29] These new tools, whether they're AI-enabled or digital health per se, which of course is blending,

[00:10:34] need to meet the clinician, consumer, and the patient where they are.

[00:10:36] So I'd often say it's the early days.

[00:10:38] And we look at these stats, it's interesting to look quarter to quarter,

[00:10:41] but I think sometimes to broaden the view and see where are we on this continuum,

[00:10:45] I think it's still early days.

[00:10:47] Dana?

[00:10:47] Maybe I'll just add, I think I'm pretty skeptical when these critiques of AI didn't do this miraculous

[00:10:54] thing or didn't do that.

[00:10:55] So reminder what technology does, it replaces labor wages.

[00:10:59] That's what technology does, right?

[00:11:01] Most agriculture industries are technology industries with a little bit of labor,

[00:11:05] unlike what it was even 50 years ago.

[00:11:08] And if a clinician that is using a very basic point solution like an AI scribe, which seems

[00:11:15] to be the flavor of the day in this last quarter, is saying that it's taking 20, 30 hours out

[00:11:21] of their week, which they call pajama time, right?

[00:11:24] The time they're at home in their pajamas because they can't get it done in the clinic.

[00:11:27] That is incredible productivity gain.

[00:11:30] I always say any technology in healthcare, as Dana said, whether it's a digital or any

[00:11:36] other tool that's replacing labor wage, what you free up is largely what I call gray dollars.

[00:11:42] You're not shutting beds.

[00:11:43] You're not closing clinics.

[00:11:44] You're not laying off people.

[00:11:46] You're freeing up capacity either to have a break and maybe see their kids or to spend a

[00:11:52] little bit more time or whatever you want to call it.

[00:11:54] Deeper medicine, as Eric Topol calls it.

[00:11:56] So I think that's what we have to always remember, why there's technology.

[00:11:59] The promise of AI is unlike other tech in healthcare that mostly freed up physical labor

[00:12:06] and some menial tasks like this ability to finally get at the cognitive, both gen AI from

[00:12:13] a communication and predictive AI from how you make decisions.

[00:12:17] 75% of all healthcare spend is labor.

[00:12:22] We're the most labor intensive industry in the world, more than any other sector, more

[00:12:27] than mining, more than construction.

[00:12:28] And we have not gotten at the labor structure.

[00:12:30] And that's to me what the promise is that any digital tool today has not been able to crack.

[00:12:36] Mm-hmm.

[00:12:36] To build on that, I also think that we need to take into our minds that when you start using

[00:12:43] these tools, it takes a while before getting adjusted, before it gets into your muscle memory,

[00:12:49] before you changed all the things that you've done.

[00:12:52] Just to give you one example, we started back in the days at Robert University Medical Center

[00:12:56] with continuously monitoring on ward.

[00:12:59] One of the things that was measured was the respiration rate.

[00:13:03] Prior to that, a nurse, and I'm making a bit of an exaggeration of it, looking to the patients

[00:13:08] and said, well, that's about 12.

[00:13:10] Then we started to measure it autonomously until they trusted it, until they became adjusted

[00:13:17] to it, until they managed to bring that into their everyday workflow.

[00:13:22] And that's where things start to kick in.

[00:13:24] Looking to these numbers, which are true.

[00:13:26] I do believe that all of them are generally correct, but give it some time.

[00:13:33] If you would shift today from Surin to Epic or from Epic to Surin, it takes you three to

[00:13:39] four years to get everything up and running.

[00:13:42] Now, all of a sudden, we think that AI is as magical as the term.

[00:13:46] All of a sudden, with a magic wand, solves everything within a Fortnite, which is not true.

[00:13:53] It raises the issue now.

[00:13:54] We've got these technologies, these tools.

[00:13:56] It's almost more of a field of implementation science.

[00:14:01] How long does it take for something to be discovered or out there, whether it's voice-to-text

[00:14:05] or a new wearable where the data flow can track blood pressure and get into the EMR, and

[00:14:10] connecting those dots into the workflow and align the incentives to use these tools.

[00:14:15] That's often the larger gap.

[00:14:16] We need more folks doing design thinking, human psychology, and change management on top of

[00:14:19] all the technology advancements.

[00:14:22] That's a really great point because implementation is probably, some say 60, some say 80% of the

[00:14:29] success.

[00:14:29] I'd say 90 at least.

[00:14:31] 90.

[00:14:31] And I think that's something similar that we also see in the European health data space,

[00:14:38] Lucien.

[00:14:38] I was reminded on that when both you and Daniel were talking about we are maybe too impatient

[00:14:45] sometimes with technology.

[00:14:47] And I think that's the situation with EHDS.

[00:14:50] Everybody is expecting that now because legislation is here, it's just going to work.

[00:14:55] A lot of projects have already been happening in the last decade to support the efforts and

[00:15:00] figure out the how.

[00:15:01] Now the key focus is on really figuring out how can we align based on standards.

[00:15:06] Different countries have different state of digital maturity.

[00:15:10] Those that have things digitized are faced with legacy systems.

[00:15:14] Those that don't need to find funding to start digitizing.

[00:15:17] Patience is one word that I'm getting from this whole discussion.

[00:15:21] But let's talk about excitement.

[00:15:24] What excites you at the moment in the digital health space?

[00:15:27] Are there any things that you saw that you were impressed by?

[00:15:31] Daniel, you usually have tens of slides of solutions that are really impressive.

[00:15:38] What's standing out for you or keeping you thinking at the moment?

[00:15:43] Daniel, everyone in the digital space often used to get stuck on wearables and otherables.

[00:15:47] I think now we're entering this era of multimodal health.

[00:15:50] Of course, AI is this wrapper on it.

[00:15:52] Your digital exhaust, your omics, your socio, all these new biomarkers that are emerging from

[00:15:56] voices of biomarker to some of the amazing data out from the UK Biobank on proteomics,

[00:16:02] et cetera.

[00:16:03] So I think what's most exciting is now starting to connect a lot of those dots and the systems,

[00:16:08] whether it's your Apple HealthKit to the EMRs or starting to take in some of the data to

[00:16:12] emerge.

[00:16:13] I think we'll see the next year to be almost the years of the digital twin where we're

[00:16:16] starting to connect some of the data to true actionable insights and still need the design

[00:16:21] thinking and the implementation science so folks will trust it and use it.

[00:16:24] It's still the super convergence of tools and technologies.

[00:16:26] And they're starting to connect more than they used to be in their sort of siloed past.

[00:16:30] And I'll just add on that.

[00:16:31] I think another theme is no more point solutions, whether that's a wearable that has its own

[00:16:36] charging device, its own app, its own interface, so multimodal data.

[00:16:41] But I'd say even in AI, right?

[00:16:43] I don't get that excited when you open with the startup slide.

[00:16:46] I don't think we have a supply problem in the future of health.

[00:16:49] There's a lot of great stuff out there.

[00:16:51] As we said, it's how does it integrate and implement?

[00:16:54] And then a lot of the AI have been point solutions, right?

[00:16:56] When I look at, I'm in Canada, all the AI companies are proliferating.

[00:17:00] They're like one piece of a hundred things a clinician does in their life.

[00:17:04] And they're building a company out of it.

[00:17:06] In my view, I'm like, you're not a company.

[00:17:08] You're not even a product.

[00:17:09] You're a feature that should be on Epic or Cerner or whatever.

[00:17:14] That's another theme linked to this multimodal theme of integrated care from the human labor

[00:17:18] side.

[00:17:19] What I've been seeing a lot, and I love Daniel and Lucien, you're probably way closer, but

[00:17:22] as a futurist, I'm looking at signals all the time.

[00:17:24] Multi-agent AI is the platform.

[00:17:28] You'll have a lot of things behind the scenes, agent to agent, sorting stuff out, never involving

[00:17:32] the human across a clinical pathway or a clinician's office.

[00:17:36] And then sometimes the agent will interact with the patient or the clinician or the administrator.

[00:17:41] That's how I've been seeing things start to develop, which I think is pretty new.

[00:17:45] I've seen in the last few months at scale.

[00:17:47] What do you guys think?

[00:17:49] So I had agents.

[00:17:50] I almost think, yes, agent to agent piece, but nor this agentic health where I think we're

[00:17:54] already seeing the early versions of these where each of us will have our own, I call it

[00:17:58] generative health.

[00:17:58] The agent that matches you, your age, culture, language, personality, incentive structure,

[00:18:03] workflow issues, whether you're a consumer patient or clinician.

[00:18:06] And they're going to start to blend all these multimodal agents and make it much more accessible.

[00:18:10] Already, we can go to Dr. GPT and put in your labs and your x-rays and your clinic notes

[00:18:16] and empower the consumer or the clinician.

[00:18:19] And so these agents, I think, are going to get more sophisticated.

[00:18:22] Already, Lucien, a year ago, was way ahead of turning himself into his own AI avatar.

[00:18:25] And now you can go on synesthesia.ai and do that in two minutes.

[00:18:29] So these things are getting democratized.

[00:18:31] There's a lot of Marpoint solutions.

[00:18:33] No one wants to log in to find different wearables or apps.

[00:18:35] The agent component will start to hopefully make those more touchable.

[00:18:39] Still all the challenges of regulation, ethics, and who pays for them.

[00:18:43] But a tremendous opportunity to put the dots together.

[00:18:47] What gets me the most excited is a different approach.

[00:18:51] Technology now, for the first time, is giving us the ability to get in front of the problem.

[00:18:56] As Daniel and others often say, it's not healthcare, it's sick care.

[00:19:00] We wait until there is a problem and then pull out 1.5 million to get the best treatment out there.

[00:19:07] But I think technology, including it, is giving us the opportunity to get more in front of the problem than ever before.

[00:19:14] Because I don't think adding more healthcare to the mix is going to solve the problem.

[00:19:20] It's adding more health.

[00:19:21] In the Netherlands, for the past five years, the application rate for nursing school dropped 41%.

[00:19:28] Last year, minus 20%.

[00:19:30] By no means, just this is an example, we will have the number of people needed to cope with the demographic issues that we're facing.

[00:19:39] When we utilize all that data and early signals from your watch, your phone, your environment, smart cities, your sewage, all combined, gives us, I think, for the first time an opportunity.

[00:19:54] If that convergence Daniel mentioned, and if those agents Zena mentioned, start to interact and connect with each other, we will be able to make sure that we're there at the moment in time before somebody gets sick.

[00:20:09] And I think that's not only way cheaper, but it's also preventing people from having a life event that they need to recover from and maybe even need to step down from their work.

[00:20:21] Just to also look into the economic aspect on that.

[00:20:24] And the reason for mentioning it like that is that for...

[00:20:27] And this didn't happen to me only since the last year and a half.

[00:20:33] As opposed to talking to elder men in city halls that are responsible for health and social and well-being,

[00:20:40] I find myself now talking to the elder men of economic affairs and businesses.

[00:20:46] Because they now understand that investing in healthcare, and you showed one of the slides about women's health,

[00:20:52] every dollar put into health is going to deliver ROI up to nine times in general.

[00:20:58] Every quarter of a dollar put into digital health, as the WHO stated, is going to create 200 million less deaths and up to $199 billion of economic growth.

[00:21:14] These things now, we've always tried to address it from a healthcare perspective.

[00:21:22] And now business and society is getting into the mix as well.

[00:21:27] And we all know what happened with prevention.

[00:21:29] It always was, there's nobody paying for it.

[00:21:32] Guess what?

[00:21:33] That's starting to work now.

[00:21:34] Technology is the big lever into it, I think.

[00:21:37] And to your point about switching from sick care to healthcare,

[00:21:40] one of the things we've seen in 2024 is going to continue to accelerate our lot of consumer devices.

[00:21:44] The Apple Watch, the Aura, the Whoop, all have a bit of that early.

[00:21:47] I always talked about the check engine light for the body, the vitals, one of the Apple Watch as a health tracker.

[00:21:52] It'll look at your sleep data, your resting heart rate, and give you that early warning.

[00:21:56] Hey, you might be a bit off.

[00:21:57] Maybe you've got a pending COVID or flu.

[00:21:59] Give you that proactive element.

[00:22:01] And that's the beginning stages of integrating that to everyone's life that will then hopefully move the needle to prevention,

[00:22:07] proactive detection, and finding things, as Lucien says, the plumber's problem before the leaks start.

[00:22:12] I'll just add on that.

[00:22:14] Just why we're so optimistic from what we see is, of course, the speed of computing power,

[00:22:19] more as well, the pace at which we're doing things is getting democratized.

[00:22:22] It's a move to prevent you from getting sick versus treat sickness.

[00:22:25] There's a whole new set of actors on the scene.

[00:22:28] So Lucien reflected on Amazon and Apple.

[00:22:30] But all of our travels, we're meeting banks, we're meeting libraries, we're meeting pension funds.

[00:22:36] These new entities are coming and Spotify's founder is trying to get into one of these kind of longevity science data companies.

[00:22:44] Lucien talks about a lot.

[00:22:45] The beauty of that is if you look at the tech stack of medicine today, it's been pharma, devices, or medtech, and health IT, Epic, Cerner.

[00:22:54] So it was contained to a few players who could have the capital structure and the way to do what they do,

[00:22:59] and no one else could really participate.

[00:23:00] And we had to finance that R&D by buying those products and services.

[00:23:05] These other agents are developing solutions outside of healthcare, and the R&D is being amortized across every sector they're upending.

[00:23:14] So I'll just give one example.

[00:23:15] At South by Southwest, there was a whole session, I think, Warner Music, a big TV studio, Apple with their VR, and one of the big video game companies.

[00:23:25] I didn't realize video games is a bigger industry than all of the other, hey, with an industry's combined.

[00:23:31] So like you think about all these new actors coming in that already, as Daniel said, they know how to delight a customer.

[00:23:37] They know how to do design.

[00:23:39] And they've got a capital structure that's going to allow them to move very fast.

[00:23:44] I just think that's another converging point of why we're pretty optimistic.

[00:23:47] On that point exactly, I invested in a company called Deep Well Therapeutics.

[00:23:52] They are doing medicinal media, blending video games and medical device and mental health.

[00:23:57] They just got an FDA clearance for their SDK to embed these sorts of tools and all sorts of video games and media for VR.

[00:24:03] How do you get someone engaged in their health?

[00:24:04] Sometimes it's by playing a video game, and then the AI can optimize that for the individual.

[00:24:08] We've seen digital therapeutics for ADHD in that space as well that are FDA cleared.

[00:24:13] Lots of new ways to engage folks on the health side, not just the sick care side.

[00:24:17] What I see happening right now is this.

[00:24:20] We all talked about personalized medicine, which was in the mix for ages and billions of dollars went into that bucket.

[00:24:28] We now also have the opportunity to create with AI and data more that personalized health care aspect.

[00:24:34] The first one is the disease.

[00:24:36] The second one is the whole human.

[00:24:38] The third part that's kicking in now is that personalized health aspect, where you will get a different cash receipt at your supermarket based on the things that your system knows that are beneficial for you and be cheaper for you and made more expensive for me, for instance.

[00:24:55] So I think that is going to push the boundary in a totally different way than we've ever seen before on TML.

[00:25:02] So I want to go back in terms of the positive expectations, because I keep thinking about the barriers to success.

[00:25:13] Is there a topic that you see that's not discussed or understood enough?

[00:25:19] I'll give you an example.

[00:25:21] We know that mental health is at the forefront also of the delivery.

[00:25:25] There's like tons of solutions and startups that are promising faster diagnostics.

[00:25:31] But actually in mental health, the challenge isn't, diagnostics is a challenge, but the challenge is also the supply of clinicians, psychologists, psychotherapists that then actually talk to people.

[00:25:43] One topic I'm curious about is the connection between police and healthcare.

[00:25:49] I spoke with a representative of One London.

[00:25:53] It's a project for digitizing the whole London.

[00:25:56] He said, my son, it works in the police.

[00:25:58] And I don't know how many calls, like a huge percentage of the calls and interventions that they need to do is actually connected to mental health.

[00:26:07] In many cases, we don't have that deep understanding of the problems.

[00:26:12] What do you see is not understood well enough or is not discussed enough?

[00:26:17] Is there anything that comes to mind?

[00:26:20] Go ahead, Danny.

[00:26:21] I love the mental health space.

[00:26:23] And certainly police and other first responders need to be more engaged in that.

[00:26:27] And maybe digital tools can identify who you're coming up against, analyze their presence from video to voice and give folks proactive warning.

[00:26:35] In an area I think Lucy and I are both interested in is what's the future of the workforce with all these new AI tools which are exploding and digital platforms?

[00:26:42] How do you select the next generation of medical students or nursing students or pharmacists or nurses?

[00:26:47] How do you educate them?

[00:26:48] What do they need to learn, whether it's in digital mental health or integrating AI into their intensive care unit, multimodal data?

[00:26:55] Who do we pick and how do we get them engaged?

[00:26:58] And where do we shift our human resources?

[00:27:00] And what are the economics of that and the regulatory elements?

[00:27:03] Because I think we're entering this new age, but of course regulatory reimbursement and the medical school curriculum are quite lagging.

[00:27:10] Yeah.

[00:27:10] And the nursing school curriculum and physiotherapy.

[00:27:13] I would agree that's a big one that it's just weird.

[00:27:16] It's this big elephant yet is it is the thing because 75% of health care is labor.

[00:27:21] And I think treating illnesses like mental health with talk therapy as the biggest lever plus drugs.

[00:27:27] We're going to look back and be like, that's what we did.

[00:27:29] We're going to have a whole other set of tools based on our discussion.

[00:27:32] I'll just give you my top five list of the sleeper topics that are coming.

[00:27:36] So I think you mentioned obesity.

[00:27:37] I think because of what's going on in the States with the GLP ones, Topol is constantly putting articles.

[00:27:42] It's also affecting Alzheimer's and cancer because our metabolism could be the root cause of a lot of illness.

[00:27:48] And Daniel's profiled a lot of that at his conference.

[00:27:51] We're just getting started on this massive clinical trial of making a dent in obesity and what's going to happen and all the products and solutions that are going to come around the pill.

[00:28:01] Sleep is going to have a renaissance soon.

[00:28:03] Women, as you said, in a whole new way.

[00:28:06] Dental and oral health.

[00:28:08] Maria Filipova and her team in the U.S. have been a leader.

[00:28:11] I think the last one, and I'd love Daniel and Lucien if it's coming on your radar, is just kind of carbon in health.

[00:28:17] All this AI eats a ton of energy.

[00:28:19] We're starting to see, and Manish Juneja in the U.K. and others are starting to say,

[00:28:24] this new calculus of the cost benefit of an AI solution isn't just a quadruple aim,

[00:28:30] but there's this carbon cost that could actually tip the scale.

[00:28:34] Accreditation being linked to net zero is starting to come.

[00:28:37] I just wonder, guys, is it two years from now that it's going to be mainstream or what?

[00:28:41] This idea now of connecting health to planetary health and our impact,

[00:28:44] and I think there's a statistic that the healthcare industry,

[00:28:46] writ large, is like the sixth largest polluter on the planet.

[00:28:49] Think of everything from the waste from an OR to the computational cost of AI for your chatbots.

[00:28:54] So I think that's an important area to integrate into our knowledge set.

[00:28:59] I think it was already three, four years ago that we, together with the Robert University Medical Center

[00:29:04] and Maastricht University Medical Center in Deloitte, calculated that during the pandemic,

[00:29:09] we've saved as much as 3.4 million tons of carbon dioxide by now bringing people back and forth into the hospitals.

[00:29:16] They said all those servers need energy as well.

[00:29:19] Correct.

[00:29:20] But also the server companies are building sustainable systems powered by renewable energy.

[00:29:28] It costs less and less energy.

[00:29:30] I'm not sure if you heard the news about this new supercomputer that was launched yesterday at Google, the Willow.

[00:29:37] That's as big as an adapter or a charger of my laptop.

[00:29:42] And of course, it needs a lot of energy.

[00:29:44] Also, this guy, Harmo Neven, who runs that AI quantum lab over at Google said,

[00:29:50] now we're going into the doubling of Moore's law, by the way, Daniel.

[00:29:55] So it's one of the things he mentioned in his talk about that.

[00:29:59] Carbon is going to be a huge factor.

[00:30:01] The problem, however, and that goes to your police statement, it's a different bucket.

[00:30:06] It comes from a different place.

[00:30:08] It's somebody else's money.

[00:30:09] So we're not able, just like prevention to say, on a macro level, it plays out.

[00:30:15] But we need to take some money from somebody else and put it into this bucket.

[00:30:20] And that's not going to happen because every industry has his own immune system.

[00:30:26] What we see happening now in the Netherlands with mental health and police, we're now putting it into a different bucket.

[00:30:33] When somebody is running astray on the street, then we say, that's healthcare's problem.

[00:30:37] Or that's the municipality's problem.

[00:30:40] Or that's police's problem.

[00:30:42] We need to, I would say, be educated about that.

[00:30:46] But we need to look at it from a more holistical perspective or at a macro level, as opposed to an individual.

[00:30:52] Can you elaborate a little bit on that example from the Netherlands?

[00:30:56] Does that mean that, because the way that I understood it is as if instead of collaborating more,

[00:31:03] it's just like shifting the problem from one sector to another, which is definitely not what we want to see after.

[00:31:11] And I don't think it's exclusive for the Netherlands.

[00:31:14] I think this is what's been done always.

[00:31:15] This is the bucket of internal affairs and mental health or the GP that needs to step up to it.

[00:31:21] We've done that always.

[00:31:23] Nowadays, it's more like we're closing off the discussion.

[00:31:27] At one end, we don't want to collaborate.

[00:31:29] We want to share data and knowledge, making sure that we understand the problem better.

[00:31:35] But then we say, somebody needs to pay for that.

[00:31:38] And that's the thing that keeps getting back and forth.

[00:31:41] One topic that was in the background of many of the answers that you provided was the human factor in educating people, the human factor in prevention.

[00:31:52] You can have great prevention programs, data and technology to help people understand what they should do.

[00:31:58] But that is far from making it possible for people to actually do that.

[00:32:03] The environment is the key factor in behavioral health.

[00:32:06] Do you bike to work or do you live in a place where you have to drive every day?

[00:32:10] How do you see that issue?

[00:32:13] The fact that the human element and what people will be willing to do is really strong.

[00:32:21] And that goes to adoption and implementation of technology.

[00:32:25] It goes to personalized health.

[00:32:28] It goes to prevention.

[00:32:31] Yeah.

[00:32:31] So it drives a lot of things, even carbon emissions or if we would say global warming.

[00:32:37] We know about it.

[00:32:38] Do people really care?

[00:32:42] Some people do.

[00:32:42] But on the global level, we obviously don't care enough because we're in this trajectory of I'm important.

[00:32:49] My development is important.

[00:32:50] I only care about myself type of a thing.

[00:32:53] So where are your thoughts in that sense?

[00:32:57] I mean, big level and high level, you get what you incentivize.

[00:33:01] People act in their own self-interest.

[00:33:03] They need to think in healthcare design in those elements of delight or the pathways to walk to work or the better design of the cafeteria.

[00:33:10] So you have the healthy food up front, not the starches or the user interfaces and all these digital tools and AI to match your type of digital twin.

[00:33:18] So I think it needs bringing the designers, the change management folks to align those incentives, which is sometimes the hardest part.

[00:33:25] We know behavior change is super hard.

[00:33:26] But when you can sometimes get someone hooked in to their badges or their points or to the human connection or having someone to hold them accountable, that can make a big difference.

[00:33:34] And that's not high tech.

[00:33:35] That's often smart design thinking.

[00:33:37] Everything from how you build your physical space or a city to the UI on your wearable.

[00:33:41] But it also goes to corporate responsibility, Daniel, in this example about supermarkets.

[00:33:51] Knowing that healthy food is about 40% more expensive than unhealthy food, what's the corporate responsibility of a supermarket chain?

[00:34:00] To offer affordable food for people that need it.

[00:34:03] And the one thing that I see happening now in my discussions with supermarkets as I created that program that's called Health Meats Retail is that at first they were reluctant to step into it.

[00:34:14] And now gradually, due to partially the fact that within four years vegetarian food become a thing for them, they didn't see that coming in that breath and that speed.

[00:34:24] I now try to scare them a bit also to say, you've seen this happening with climate.

[00:34:29] You also will see this happening within your supermarket.

[00:34:32] That also brings me to the point where I said in my keynotes, I think there will be a Greta for health.

[00:34:37] That not only will be talking about that carbon footprint, but also demanding that you as a company no longer deliver food that's unhealthy in your canteens and stuff like that.

[00:34:50] That also will be able to really down drill that and make you move into that direction.

[00:34:57] So not only as an employer, but also as a supermarket and as a provider for food and other things.

[00:35:04] Here in the U.S., I think we have a huge lobby for the cheese lobby, for example.

[00:35:08] And so the school lunches, which are the biggest fast food chain in the U.S., have too much cheese and the kids get obese and have diabetes.

[00:35:14] So back to the supermarket all the way down to at government level.

[00:35:17] We're going to see a big shift in early 2025, make America healthy again.

[00:35:22] God forbid we have RFK Jr. as our star for health care.

[00:35:26] But at least some of what he said is about shifting things more to health rather than sick care.

[00:35:30] There may also be pressure on how you change clinicians in their payment models to pay more for cognitive, less than for procedural.

[00:35:37] So some balancing might happen.

[00:35:38] Politics plays a role.

[00:35:40] So I just joined the board of Nourish, which is a national in Canada nonprofit for food and medicine to catalyze.

[00:35:46] So I'm getting way more exposure to this area than I ever did before.

[00:35:49] And I think, Daniel, who did you have at NextMed last year?

[00:35:51] She was incredible.

[00:35:53] Nora.

[00:35:54] Nora, the CEO of Eat Real, makes the point about so much of our health is driven by our bad eating habits.

[00:35:59] So just one thing, Lucien, maybe you've seen this.

[00:36:01] I saw that big supermarkets have an area called the health food aisle.

[00:36:05] It's like, what?

[00:36:07] That's food.

[00:36:08] It's food like substances or edible chemistry.

[00:36:14] It's not food, right?

[00:36:15] By the biological definition.

[00:36:17] The other area is part of my work at Nourish.

[00:36:20] I've been looking at in the States, these food deserts.

[00:36:23] So areas where there's no economic sense for a Kroger or who are your other big chains in the U.S. to set up because of their pricing and volumes.

[00:36:33] Food deserts and health care deserts tend to overlap geographically.

[00:36:37] So there's also not good services.

[00:36:39] And then the feds will set up programs like the Supplemental Nutrition Assistance Program, SNAP, the old food stamps.

[00:36:46] So then Amazon could come to town and set up basically a grocery store without a physical footprint where you order in the basket that SNAP will pay for.

[00:36:56] It's only the good food that government should be financing.

[00:37:00] And then it's delivered to your door.

[00:37:01] And so I'm finding, again, these new players, a dollar tree, I think.

[00:37:06] There's 14,000 of them, I believe, Daniel, in the United States.

[00:37:10] 10,000 of them are in food deserts.

[00:37:13] The food-like substances they offer are not foods.

[00:37:15] So they're starting to have a different role in closing that gap of health and food deserts.

[00:37:21] I just think lots of neat solutions on the ground.

[00:37:23] No tech.

[00:37:24] It's policy.

[00:37:26] It's incentives.

[00:37:27] And I think it's new agents coming on the scene.

[00:37:29] In the Netherlands, for the past four years, there was a commission trying to identify the definition of vegetables and the fruits.

[00:37:38] Because they want to detox vegetables and fruits.

[00:37:42] But the tomato soup or tomato soup, whatever, lobby says,

[00:37:46] the minute you want to detox a tomato, me as producing tomato soup also wants to have that detoxed.

[00:37:55] So that's an insane kind of thing that's happening.

[00:37:58] Then we said, wait a minute, government.

[00:38:00] Maybe you should talk only about non-processed vegetables and non-processed fruits.

[00:38:05] And then came in the genetically modified kind of lobby that said, wait a minute, then we want to start that as well.

[00:38:11] So this is a wicked problem.

[00:38:13] I think this might be the next wicked problem to get in front of the plumber issue that we might have to tackle.

[00:38:19] So to conclude, in the last part of the discussion, we mentioned incentives a lot.

[00:38:28] So incentives either what drives people to behave healthy or what drives the industries to act responsibly and for the good of the population and not for profits.

[00:38:42] So what would your advice be to legislators and decision makers in terms of policy designs,

[00:38:49] which is basically what you need will be in to create change oftentimes just because you want to do good.

[00:38:59] That doesn't mean that you will, because if you work in the industry, you will to put profits for it.

[00:39:04] I think one of the challenges with legislators, I think there's one PhD in Congress in the United States.

[00:39:09] There's a few quasi MDs in the Senate.

[00:39:11] How do you educate the legislators, the government folks who are going to set these policies?

[00:39:15] Part of what we try to do at NextMed Health is bring the regulators in to see to see where the fuck is going

[00:39:19] so that they can create the digital health regulatory platform, software as a medical device.

[00:39:24] We need some of that thinking in convergence of education, whether it's on AI, digital or low-cost OMIC.

[00:39:30] So they're legislating and driving policies that match the next decade, not five years before.

[00:39:36] And I think that's happening everywhere.

[00:39:38] We're seeing tons of policy innovation, new methods of policymaking,

[00:39:42] a lot more futurism built into policy models.

[00:39:47] Because by default, policy is long-range planning.

[00:39:50] It is looking out.

[00:39:52] When the policy got decided that we're going to pay for children to go to school from kindergarten to grade 8,

[00:39:56] that doesn't return anything for 30 years.

[00:39:59] But we knew to do it, vaccination, fluoridation,

[00:40:03] although those two things might go away soon in some countries.

[00:40:06] I'm not as concerned personally about policy.

[00:40:09] It's never as fast as you want it to be.

[00:40:12] If anything, the current that scares me is just this unleveled playing field of information.

[00:40:19] So whether it's an asymmetry of good evidence-based information and average,

[00:40:25] then let alone disinformation where various agents on purpose are changing the discourse,

[00:40:31] that gets a little bit difficult to process because you can't regulate out of that.

[00:40:36] The playing field's not the same.

[00:40:38] My personal view is I think it's some of what went on in the U.S. election,

[00:40:41] where it was two different games.

[00:40:44] And I don't know the answers to that, but of all the millions of things on the list of us healthcare people,

[00:40:48] that's not one we're tackling systematically.

[00:40:53] Lucien?

[00:40:54] The only thing I want to add is that if you think the government will prelude the market in terms of legislation,

[00:41:00] you will be disappointed.

[00:41:02] Yeah.

[00:41:03] And please, let's not expect from the government to do so.

[00:41:06] Let's expect from the government that based on best practices, based on science,

[00:41:13] based on the needs that we as society need to get in place,

[00:41:17] that they fix that.

[00:41:18] Based on good principles, guidelines, and ethics.

[00:41:21] Let's not get disappointed about the things that we know that is going to disappoint us.

[00:41:25] And let's try to fix it from the way that we can do it.

[00:41:28] And I'm hopeful.

[00:41:29] Let's also be honest.

[00:41:30] I think technology is going, like we've seen in many other industries,

[00:41:34] how technology changed not only the equation, but also a power shift towards the end user.

[00:41:42] And the end user, meaning the patient or the citizen, often not included in the debate.

[00:41:51] They're not at the negotiation tables between insurers and institutes.

[00:41:57] So maybe that is going to change as well.

[00:41:59] We will see what the future brings.

[00:42:03] Just one very quick question for Daniel.

[00:42:05] So in December, NextMed was supposed to happen, but it's moved to the end of March.

[00:42:13] Anything you can share in terms of what's going to be covered?

[00:42:16] What kind of topics are going to impress the audience?

[00:42:20] Thanks.

[00:42:21] You're all going to be at NextMed Health at nextmed.health.

[00:42:24] It's going to be March 30th to April 2nd in the spring,

[00:42:26] thanks to some unexpected renovations at the Hotel Dell.

[00:42:30] I think the theme is still back to the sort of super convergence realm.

[00:42:33] How are we going to think about taking these new magical tools

[00:42:36] and connecting the dots into the future?

[00:42:39] So we've got what's now, but how do we go from now to next?

[00:42:42] And whether it's medical education or innovating AI

[00:42:45] or who regulates or pays for things.

[00:42:47] And the magic is in NextMed Health is it's not any one field

[00:42:50] is bringing folks from the clinicians and patients to the regulators,

[00:42:53] to the startups to see and connect the dots.

[00:42:56] So I'm excited to have you there and encourage other folks to join us at NextMed.

[00:43:00] Thank you everyone and have lovely holidays and good 2020 fall.

[00:43:05] Happy holidays.

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