3, 2, 1, go. Hello, hello, welcome back to Startup Health Now. If this is your first time joining us, a quick primer: this is the podcast where we celebrate the most innovative entrepreneurs in health and the moonshots they're working to achieve. I'm Nicole Clark, Startup Health senior writer. You're in for a treat this episode. Today I'm pleased to introduce you to two women whose ideas and visions about the future of health innovation carry colossal weight: Esther Dyson and Jane Metcalfe. Dyson is the executive founder of Wellville, a 10-year nonprofit that started in 2014, ends in 2024, and has the goal of helping five small communities create a sustainable environment that fosters health. She's a Swiss-born American journalist, businesswoman, and an investor and commentator in the health tech startup space. At Startup Health, we're lucky to have her as an adviser, investor, and friend. Dyson has vast perspective across many industries, including space travel — yep, the woman has trained to be a backup cosmonaut. But what Dyson is best known for is, shall we say, keeping it real. Her critiques of the investor, tech, and health worlds offer necessary counterpoints that keep the conversations and missions at a human level. She has a knack for translating macro ideas — ideas like long-term equitable well-being for all — and road maps for organizing societies for maximum health. Metcalfe is the creator and original publisher of Wired Magazine, the so-called Rolling Stone for technology. She and her partner Louis Rossetto, along with writers and leaders in the cyberpunk movement, declared a digital revolution in the '90s. Since then, they've offered dispatches from a future life. Through her work at Wired, Metcalfe turned what was once cult into culture. And these days she's at it again. As she says, she's all about revolution, and several years ago she declared the next one: the neobiological revolution. At Neo.Life, Metcalfe has created a platform for in-depth reporting and beautifully written stories about the people, companies, and ideas shaping our neobiological future. She's asking the questions we're all thinking, like: designer babies are here — what's the next edit? And would you eat CRISPR produce? I could go on about these two, but instead I'll let you listen in on their discussion from the 2020 Health Festival. It's Metcalfe interviewing Dyson, but really it sounds more like two friends who both happen to be brilliant talking about the big ideas shaping the future of humanity and their role in it. Enjoy. Did you guys see her jacket? Wait, stand up. She didn't dance all the way in without showing you that jacket. It's cool.
So this is... you're not usually known for your sartorial splendor, but...
Yeah, this is a Regina Holliday jacket. Regina Holliday is an artist who was married to a guy who ultimately died, but I think as in so many cases, the treatment was worse than the disease. So she now goes around and paints people's jackets after listening to their stories of their encounters with the healthcare system. And this is an interesting one because she actually did it after I had a benign breast lump that was big enough it needed to be removed, but it wasn't really that bad. Then two or three years later, I discovered — or I was being scoped regularly because I had Barrett's esophagus, which I discovered because I was training in space, training to go into space, and they give you pretty full workups. So I was being scoped every year, discovered I had cancer of the esophagus, and then the fun began. I actually have a piece about that called 'Second Opinion.' The first guy wanted to take out my esophagus and pull up my stomach tissue to replace the esophagus. And this is the point at which I said, you know, let's face it, I'm white and well-off and privileged, and I know David Agus, Steve Jobs' cancer doctor, so maybe I should get a second opinion. Even knowing that really just seems impolite.
That's a really good point. People are afraid to go around their doctor's back because they invest so much in the relationship and in the trust. And it's a vote of non-confidence, isn't it, to look for a second opinion.
Anyway, then the insurance wouldn't cover the expensive operation — sorry, they wouldn't cover the cheap operation at Memorial Sloan Kettering. They would cover the expensive one because that was one of their... that was in the group of people they would pay for. Which sort of shows again, it wasn't even the money, it was the inertia around 'well, these people are partners in Memorial Sloan Kettering is not...' and maybe there's a higher profit margin on the more expensive surgery.
Well, no, because they were my insurance company. I mean, they actually would have had to pay for it. It makes absolutely no sense except that they would have had to change their rules and blah blah blah.
So the agony you see on my jacket was absolutely justified.
I think people have some godlike faith in our doctors and medical system until they engage with it, and then they understand what a torrid mess it really is.
Yeah. So we've known each other a very long time. I think we probably met in 1992, not the '80s.
No, I didn't come to California till '91. Did you know me during the Electric Word days?
No, just... okay, sorry. And then we were on the board of the Electronic Frontier Foundation together. So we have 25, 26, 27 years of shared history in the tech space.
Yeah, so we can just tell jokes, you know, like number 13 and you laugh, right? Exactly. Old story. But what I'm curious about is, I think your breast biopsy was not that long ago, but you got interested in healthcare in what, 2004? What was your aha moment?
Okay, so I was running my tech industry newsletter and running a conference, and I went to Renaissance Weekend. They had this panel, like so many that they have at this particular event, with 13 speakers and three people in the audience. I was one of them. And it was an amazing bunch of people: an ER doctor, a nurse who was the kindest lady in the world, a couple of hospital administrators, a radiologist, a cardiologist, I don't know what. And they all talked about how hard it was to do their jobs in the face of a healthcare system that was misaligned, bad incentives, whatever. It was so sad and they were so nice. And I thought, wow, in my world, in the tech world, where are the VCs funding the startups with the solutions to these problems? Where are the new business models? Where are all the solutions? And I just thought, you know, this does need to change. So I started getting interested in healthcare. And that was interesting. The second thing that happened was I interviewed this guy called Charlie Silver. How many people know the website RealAge.com? Its business model is selling vitamin supplements. Its clever idea is you take a little quiz, not about your medical vitals but about your behavior: do you have a partner, do you have a dog, how much do you sleep? And it gives you your real age versus your chronological age. And he ended up selling it to Hearst and then to CareShare or somebody. But what was really interesting was who he sold his first company to: Jiffy Lube, who does oil changes. Juicy. And I thought, you know, okay, that's it: it's maintenance, not repair. And we need to do a better job of maintenance. So Charlie Silver was my patron saint in some weird way.
That's really great. Well, so what are the business models and disruption cycles in the tech industry that the healthcare industry needs to adopt?
Well, there's a bunch. I mean, one: every time I talk to some startup and they say, 'We've got this great software and it will revolutionize the workflow or it will connect this or that,' and I ask them, 'Well, do you know about VARs?' Anybody here know about VARs? V-A-R, what it stands for? Come on, there's one. Yeah, okay, there's a few. It stands for value-added reseller. And everybody in tech knows you don't just put the software out; you sell it to somebody who buys it, but then you go in and train the people who are going to use it, and you connect it to the stuff that's already there, and you add all this value that finally makes the product worth something. So the product can be replicated by pushing a button and saying 'copy,' but the value is added by actually putting it into use in some real world. And so many people in the health tech world don't get that: you need to prepare the soil into which you plant this thing for it to achieve its value. So yesterday I interviewed two CEOs, one from a company called Newtopia and another from a company called Kala Health, and in both cases they are investing in their own distribution system, their own way of touching the patient, helping the patient understand how to use the technology and so forth. That's a heavy load, that's a big lift.
And are they also investing in... I mean, what happens when the patient comes with their health thing to their doctor? So the question is scaling, right? And getting the healthcare system to accept whatever it is they're doing, and that's a long battle, isn't it?
Yeah. But that is the question. I mean, it seems like startups have two choices: either try and build it up themselves, which takes a lot of time and money, or partner with a big company, and then they lose that ability to get those instant feedback and innovation loops going.
