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To Add is Expected, To Subtract is Design

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By KIM BELLARD

A couple years ago I wrote about how healthcare should take customer experience guru Dan Gingiss’s advice: do simple better.  Now new research illustrates why this is so hard: when it comes to trying to make improvements, people would rather add than subtract. 

That, in a nutshell, may help explain why our healthcare system is such a mess.

The research, from University of Virginia researchers, made the cover of last week’s Nature, under the catchy title Less Is More.  Subjects were given several opportunities to suggest changes to something, such as a Lego set-up, a geometric design, an essay or even a travel itinerary.  The authors found: “Here we show that people systematically default to searching for additive transformations, and consequently overlook subtractive transformations.”

In the Lego picture here, for example, when asked how to strengthen the upper platform, most people wanted to add new columns, instead of simply removing the existing column.  The researchers note: “The subtractive solution is more efficient, but you only notice it if you don’t jump to an additive conclusion.”

Giving cognitive nudges – like explicitly mentioning the option of deleting something – improved the likelihood that people would come up with subtractive options, but increasing cognitive load (through additional tasks) decreased it.  Co-author Benjamin Converse said:    

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Some Discord Could Be Good for Health Care

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By KIM BELLARD

By the time you read this, Microsoft may have already struck a deal with the messaging service Discord.  VentureBeat reported two weeks ago that Discord was in an “exclusive acquisition discussion” with an interested party, for a deal that could reach at least $10b.  Bloomberg and  The Wall Street Journal each quickly revealed that the interested party was Microsoft (and also confirmed the likely price). 

Me, I’m wishing that a healthcare company – hey, TelaDoc and UnitedHealth Group, I’m looking at you! – was in the mix. 

Let’s back up.  If you are not a gamer, you may not know about Discord.  It was launched in 2015, primarily as a community for gamers.  Originally it focused on texting/chat, but has widened its capabilities to include audio and video.  The Verge described it: “Discord is a great mix of Slack messaging and Zoom video, combined together with a unique ability to just drop into audio calls freely.”

Zoom meets Slack meets Clubhouse.

As you might infer from the potential asking price, Discord has done quite well.  It has over 140 million monthly users, and, despite having no advertising and offering a free service, generated $130 million in revenues last year (through its “enhanced Discord experience” subscription service Nitro).  OK, it still isn’t profitable, but a December funding round gave it a $7b valuation.

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We Are the Ever Given

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By KIM BELLARD

The Ever Given is free! 

Admit it: you’ve been following the story about the huge container ship stuck in the Suez Canal.  It’s about the size of the Empire State building laid flat, and somehow ended up blocking one of the busiest waterways in the world. 

As serious as this was for global shipping and all of us who depend on it, much hilarity ensued.  Memes exploded, using this as a metaphor for almost everything, healthcare included.  Once there started to be hope for getting the Ever Given free, people started new memes that it should be “put back.” 

Well, I’m a sucker for a funny meme and a good metaphor too.  Our healthcare system is that canal, and we’re the unfortunate ship.  Only it doesn’t look like we’re getting unstuck anytime soon.

The Ever Given got stuck a week ago.  It is one of the world’s largest container ships, but high winds, poor visibility (due to a dust storm), and, perhaps, human error caused things to go sidewise, literally.  It got stuck on the banks.  Over 300 other ships have been blocked as a result; alternative routes add several thousand miles to the trip, making it a tough choice between waiting/hoping and rerouting. 

The Suez Canal carries about 10% of worldwide maritime traffic, worth as much as $10b daily.  It has been around since 1869 – far longer than the similarly important Panama Canal – and has been widened/deepened several times since.  Ships keep getting bigger and bigger, carrying more and more cargo, as globalization has created boom times for shipping (or, rather, shipping created boom times for globalization). 

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THCB Gang Episode 48, Friday March 26

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This week (for one week only) #THCB Gang was on Friday. Matthew Holt (@boltyboy) was joined by regulars medical historian Mike Magee (@drmikemagee), Fard Johnmar (@fardj), from digital health consultancy Enspektos, THCB regular writer Kim Bellard (@kimbbellard), and employer health expert Jennifer Benz (@jenbenz). Sadly Casey Quinlan was ill and couldn’t join last minute.

It was an extraordinary week, especially in terms of digital health investment. We talked a bit about that and a lot more about high deductible health plans, whether the filibuster will be busted, and what that might mean for Medicare for all. A wide ranging and big picture conversation!

The video is below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels. 

Nanoparticles On My Mind

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By KIM BELLARD

Nanoparticles are everywhere!  By that I mean, of course, that there seems to be a lot of news about them lately, particularly in regard to health and healthcare.   But, of course, literally they could be anywhere and everywhere, which helps account for their potential, and their potential danger.

Let’s start with one of the more startling developments: a team at the University of Miami’s College of Engineering, led by Professor Sakhrat Khizroev, believes it has figured out a way to use nanoparticles to “talk” to the brain without wires or implants.  They use “a novel class of ultrafine units called magnetoelectric nanoparticles (MENPs)” to penetrate the blood-brain barrier. 

“Once the MENPs are inside the brain and positioned next to neurons, we can stimulate them with an external magnetic field, and they in turn produce an electric field we can speak to, without having to use wires,” Professor Khizroev explained.  A special magnetic helmet would communicate with the MENPs, in real-time. 

Other efforts, such as Elon Musk’s Neuralink, have been looking at using implants to achieve the brain-computer interface, but Dr. Khizroev is skeptical of this kind of approach:

Other efforts have used external instruments like microelectrodes to try to solve the mysteries of the brain, but because of its complexity and difficulty in accessing, such methods can only go so far.  There are 80 billion neurons in the human brain, so imagine how difficult it would be to attach 80 billion microelectrodes to access every single neuron. The only way to truly tap in is wirelessly—through nanotechnology.

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Roblox and Healthcare’s Metaverse

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By KIM BELLARD

As neither a gamer nor the parent of a gamer, I’ve been proud that I’ve stayed even mildly in touch with the cultural phenomenon that gaming is.  I’ve written about, for example, the Metaverse, Fortnight, and e-sports.  Still, I somehow managed to be completely oblivious to the existence of Roblox, until they went public this week and was valued at $45b, larger than Electronic Arts (which I had heard of). 

Once again, I think there are lessons for healthcare.

P.J. McNealy, CEO of Digital World Research, described Roblox to NPR as: “Minecraft meets Nintendo, which meets Lego and mobile phones enable a whole bunch of it.”  Whatever the metaphor, Roblox is booming.  It was valued at $4b a year ago, but the pandemic was very, very good for it. 

Half of America children use Roblox.  Two thirds of its users are 16 and younger, and most of them were spending lots of time at home last year.  It is now estimated to have 37 million unique daily users, spending some 30 billion hours on the site last year.  It is available in 180 countries, in 11 languages.

What makes Roblox particularly unique is that it is not a game developer; it is a platform where users develop the “experiences”.  Roblox describes its mission thusly:

Roblox’s mission is to bring the world together through play.  We enable anyone to imagine, create, and have fun with friends as they explore millions of immersive 3D experiences, all built by a global community of developers.

It claims 8 million developers have created 20 million experiences — and that it paid over $300 million to them.  The games are free but users can buy and spend an in-game virtual currency (Robux), which can be exchanged for actual money (Roblox shares 30% of the revenue with developers).  At least one developer made over $1 million in a single year; over 1200 made at least $10,000, with over 300 making over $100,000. 

Mr.  McNealy believes the IPO will allow Roblox significant expansion:

This money will either give them an opportunity to build more content for the for the platform or to go to adjacent platforms like music or partnering with Spotify or movie service.  That’s where this is going to go.

CEO and co-founder David Baszucki isn’t content with the younger market, wondering: “So how do we make it possible for Roblox to connect with everyone in the world?”  Alex Hicks, cofounder of Roblox studio Red Manta, sees such potential, telling Polygon: “Lots of kids already know what Roblox is, but they’re just scratching the surface with the older audience.” 

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Your Health Data May Be a NFT

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By KIM BELLARD

I must admit, after I wrote about digital currency last week, I did not expect to be writing about crypto anytime soon. Then I heard about “non-fungible tokens” (NFTs) and got a sense of the hype they were causing — how I could I resist?

There may even be a connection to health care. 

You may have seen the Nyan Cat (pictured below), which is not new; it turns 10 in April.   What is new is that last month its creator “sold” it.  You may be thinking, wait, the GIF is everywhere, anyone can download it, so in what sense could he “sell” it?   

That’s where NFTs come in.  As you may know, “fungible” means that two things can be interchanged; one dollar is just like any other dollar, one bitcoin is like any other bitcoin, one electron is like any other electron.  Non-fungible, then, means the item in question is unique, and this is where the “token” comes in.  Basically, NFTs use digital certificates via blockchain to mark that something is one-of-a-kind, a claim of digital ownership.

Nadya Ivanova, chief operating officer of research firm L’Atelier explained NFTs to The Wall Street Journal:

Think of it like a digital passport that comes with an asset.  They allow for this trust and authenticity to be established in a way that we haven’t been able to do before, whether it’s with physical assets or digital assets.

Artists have been using NFTs for a few years now, and auction house Christie’s is auctioning off the “First Purely Digital NFT-Based Work of Art Ever Offered by a Major Auction House,” featuring the digital artist Beeple (aka Mike Winklemann).  Christie’s promises:

…the buyer receives the artwork file containing a digital signature from the artist and all vital details including time of creation, edition size and a record of any prior sales. These details are permanently attached to the artwork, providing an enduring guarantee of value. 

NFTs have gone beyond art.  The NBA is all over this, with NBA Top Shot selling highlight clips; one of Lebron dunking just went for $200,000.  Maverick’s owner Mark Cuban is a big proponent.  “The tech is real,” he told CNBC. “The impact is real, and permanent.” 

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THCB Gang Episode 45, Thursday March 4, 1pm PT – 4pm ET

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Joining me, Matthew Holt (@boltyboy), on this week’s THCB Gang will be THCB regular writer Kim Bellard (@kimbbellard), medical historian Mike Magee (@drmikemagee),  policy & tech expert Vince Kuraitis (@VinceKuraitis),  patient safety expert and all around wit Michael Millenson (@MLMillenson), and consumer expert and current President of the Medical Board of California, Denise Pines.

Vaccines at warp speed, some “Neanderthal” state governors opening up, but also a pandemic bill passes the house with some health policy implications. Plus lots of fun and games in the world of digital health and startup health plans. We should have something to discuss!

You can see the video below live and the audio will be on our podcast channel (Apple/Spotify) from Friday

Wanna Buy Some Bitcoin

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By KIM BELLARD

To healthcare organizations, digital currency is the thing you’re forced to deal with when your systems are held for ransomware.  To the rest of the world, it’s increasingly starting to look like the future.

Tesla caused somewhat of a stir last month when it disclosed that it had bought $1.5b of bitcoin.  It also said it would start accepting bitcoin payments for its cars.  CEO Elon Musk added to the furor, saying: “I do at this point think bitcoin is a good thing. I’m late to the party, but I am a supporter of bitcoin.” 

Most of us are late to the digital currency party. 

Bitcoin’s market cap hit $1 trillion in mid-February, although it now hovers just over $900b, with Ethereum another almost $200b.  Tesla is making more money from its bitcoin investment than from its core businesses.  In the scheme of global financial markets, digital currencies are still small, but are not something any CFO should be ignoring.  

Tesla is not the only major company accepting digital currencies; Overstock, Starbucks and Twitch do, as three wildly different examples.  Twitter is thinking about paying vendors or even employees with bitcoin.  Facebook expects to launch its own cryptocurrency this year. 

I’m not aware, though, of any major healthcare companies accepting or paying with digital currencies.  No Tesla-type breakthroughs in healthcare. 

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THCB Gang Episode 43, Thursday Feb 18, 1pm PT – 4pm ET

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THCB Gang was broadcast live on Thurs Feb 18

Joining me, Matthew Holt (@boltyboy) were THCB regular writer Kim Bellard (@kimbbellard), patient advocates Grace Cordovano (@GraceCordovano) and Robin Farmanfarmaian (@Robinff3), newly-minted VC Marcus Whitney @marcuswhitney, and medical historian Mike Magee @drmikemagee.

We touched on the impact of the extremes of global warming on health! And in a pandemic nonetheless!. Plus the wild world of SPACs, more funding for mental health, and the sausage making of health care’s place in the upcoming stimulus bill. But I’m not sure the group is ready for the big policy move that the pandemic may give us the opportunity to pursue! A great conversation nonetheless.

The video is below but if you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

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