Name: Brainstorm Health 2024: Lessons from the Music Industry
Uploaded: 2024-05-24
Duration: 10 min 16 s
Description: D.A. Wallach, Recording Artist; Co-founder and General Partner, Time BioVentures

D.A. Wallach, Recording Artist; Co-founder and General Partner, Time BioVentures

Brainstorm Health 2024: Lessons from the Music Industry

Conferences

Well, thank you very much. It's great to be here following an actual death panel. And um as you heard in my introduction, I'm a bit of an odd duck. Um I run a biotech and health care venture fund in L A called Time Bio Ventures, but this was my previous life. And as you can tell from this photo, uh you should take everything I say today with a grain of salt. I want to talk a little bit about the parallels between the lessons we've learned in the music industry and what I perhaps see uh on the horizon for the healthcare sector. And when I was in college and got my first record deal, we entered the industry at a remarkable time when things were in total freefall. So what you see in this graph here is us, recorded music revenue over time starting from about 1970 the peak is the absolute bonanza of an era that the nineties were as the recorded music industry resold the entire history of music uh on compact discs, people were just rolling in cash. And when we got our first record deal in 2007 this freefall had been catalyzed by the advent of Napster and then youtube and with it, the erosion of consumer spending on recorded music. So you probably remember these record stores, they were progressively going out of business at this time. And a couple of years after we entered the industry, I had the good fortune of meeting the founders of Spotify. And when I saw their product, I was just completely blown away by the potential that I saw in it to get people paying for music. Again, it was such a compelling product that you could imagine consumers going from free music to something uh for which they would pay a monthly subscription. And that's exactly what happened. The old music supply chain was I think to a lot of folks at that time, clearly anachronistic and you'll remember these days, it was basically this very clunky intermediate system to get content to consumers. So you'd go into a brick and mortar record store and you'd sort of prostrate in front of Grand Wizard of music who would query their huge brain for all of the history of records. And they'd recommend to you just the perfect record to get in this example, the Jimi Hendrix experience. And that record typically would have come through one of just a few record labels like capital or Sony that were basically the sole distribution channel through which artists could get their content into their fan base. And Spotify succeeded by dramatically simplifying that connection between consumers and content. And it put all consumers on an equal footing such that they could access the same catalog of music globally for a very low monthly price. And here's the end of that story or at least up until today, what's happened with streaming, which is depicted in green here, consumers started to pay and revive the industry. Health care in some ways has the exact opposite problem, which is that we're spending too much and the amount that we're spending is growing too fast. And most of that spending is on our hospital centric business model. So as you can see from this breakdown of the 4.5 trillion we're spending in the US per year, something between 70 80% of it is basically going to human mediated health care services, be it in hospitals or brick and mortar clinics. And this model, as I see, it is really trapped in an 18th and 19th century factory paradigm where the concept is basically get a bunch of big brains into big buildings and you'll realize production efficiencies. And we have similar issues in education with large universities and in criminal justice. These are all a paradigms that originated in the 18th and 19th century and they're all in certain similar ways failing us today that fits into a supply chain. It might be a little bit of a stretch. But I think it's actually reminiscent of the music industry supply chain that I described previously. Instead of going into a record store, you go into a hospital or a clinic and you're seen by a physician who queries their huge brain which has been stuffed full of information, the whole corpus of medical knowledge. And they will try and identify for you the perfect intervention. And if that happens to be a drug as here, that drug will have come from one of a few large pharmaceutical companies like pfizer, which similar to the record labels are essentially now the distributors for those who really create new medicines, which are the small and mid size biotech companies. And so the question I want to raise is whether we should do to these and please forgive me when I was putting these together. I did not know that Johns Hopkins or CV S were sponsors of this great event. Nothing against either of them. I think they're fantastic organizations just a little bit dated. And so I wonder if we should do to these, what we did to these and if we do, what would the equivalent of Spotify even be, what would streaming medicine be? What I propose? Is that what we need to build? And this includes A I and a lot of the other technologies that people have been talking about today. And yesterday is a single global catalog containing all medical knowledge, all diagnostics, all interventions and all medical reasoning. Essentially the super A I of medicine in the cloud to which people can connect from anywhere in the world and connect to the exact same knowledge just like today. They connect to the same music catalog through Spotify or the same film and TV catalog through services like Netflix. My belief is that this type of knowledge centralization is actually the only way to make medicine modern and I would define modern medicine as evidence-based. I don't see why we should distinguish between medicine and evidence-based medicine. I don't think anyone goes to the hospital looking for non evidence based medicine. It should be personalized with validated algorithms that are universally applicable to patients. Uh everywhere in the world, it should always be up to date. So the standard of care that someone gets in Botswana should be exactly the same that they get in Los Angeles or New York. Uh We should be honest that if we're not giving people the same high quality care everywhere, we're doing that because they're poor, not because they deserve a different standard of care and it should be geography and income invariant again, the same medicine no matter where you are, no matter who you are with that type of centralization of knowledge. I believe we can actually decentralize the care itself. So on the one hand, centralize the information out of hospitals, sort of evaporated it into the cloud and then push down care into the community through decentralized delivery. And I've chosen the village people here, not because I think they should be your doctor, but just to make the point that perhaps people who today have different jobs even outside of health care in the future, when paired with this type of technology streaming medicine could end up being superior as a way of delivering care to even super doctors like house. And so I think in the future, we're going to marvel at the fact that you had to be a genius to be a doctor in the past. I actually think that's a moral imperative because lowering the barriers to medical competence is the only way that we can possibly scale up high quality care globally. What you see here is that the darker countries are those with a higher density of physicians per capita in the US. It's about three doctors per 1000 when you get into countries like Madagascar. Uh it's less than 1/10 of a doctor per 1000 people. So we're not going to fix that by manufacturing doctors in our current paradigm, it's just impossible. I would propose that maybe the doctor of the future is more like an accountant. It's a highly trained specialized person, but not necessarily someone who is educated for 15 or 20 years. And I think there are a million potential configurations of how those sorts of professionals could fit into something like streaming medicine to deliver better care. But this is just one kind of spitball idea. I came up with, imagine that patients get a voucher to spend on choosing a sort of primary care navigator and then hire this person. This is again like the sort of health care accountant character and they're paid directly by this voucher, not by insurance. So take primary care out of insurance, put them entirely on the side of the patient. And then this team, the patient, their care professional working with streaming medicine can navigate the system and choose the best products and services to cure them and then align cost savings with patients, let them capture the savings that they generate by navigating their own care in a thoughtful and cost effective way. Again, apologies to CVS and Johns Hopkins. But a couple of weeks ago, we learned Wal Mart is not going to save us. And I don't think that this is a particularly exciting future either. I would be shocked if 100 years from now, the way we're doing medicine is in minute clinics and huge buildings. And fortunately in my day job, we get to see amazing entrepreneurs coming up with all the little seeds of this future that I'm outline and we're not investors in all or even most of these companies, but I think they're really promising. And I would invite any of you who are working on this, who sort of believe in blowing up the system and starting from a blank sheet of paper to reach out to us. We're super excited to engage in entrepreneurs who are thinking really big and I appreciate your time. Thank you.