The Future of Medicine: How AI Can Transform Healthcare for Billions (FII Panel) | EP #133

0:00Before we get started, I want to share with you the fact that they're incredible breakthroughs coming on the health span and longevity front. These technologies are enabling us to extend how long we live, how long we're healthy. The truth is a lot of the approaches are in fact cheap or even free. And I want to share this with you. I just wrote a book called Longevity Guidebook that outlines what I've been doing to reverse my biological age, what I've been doing to increase my health, my strength, my energy, and I want to make this available to my community at cost. So, longevityguidebook .com, you can get information or check out the link below.

0:35All right, let's jump into this episode. Our panel here today is titled How Can AI Democratize Health for the Next Billion? and to contextualize this, I'll simply say that given the development of AI and wearable sensor technology, there is no excuse for a world 10 years from now without a massive increase in health. There is no greater wealth in our health. every mother wants one thing for her children to be healthy. And I think that's the world that's more peaceful and more prosperous. What I'd like to do is ask each of our panelists to just take one minute and introduce themselves from the perspective in which they're here to speak about this.

1:31Each of them is bringing a very different, unique perspective on global democratization. Will, would you kick us off? Yeah, absolutely. Very happy to be here. Will Ahmed, I'm the founder and CEO of Woot. We build wearable technology to unlock human performance and improve health, combination of metrics like sleep and recovery and exercise and stress, a bunch of physiological measurements like heart rate and VO2 max and pulse socks, skin temperature. These are all the things that Woop is measuring. And as I think about the potential of continuous health monitoring and AI, you can imagine a future in which you have this 24, seven coach that's able to look at all of your data and really understand for you what you need right now.

2:25And that will include lifestyle decisions that will include diet, that'll include one you need to see a doctor or not. And I'm pretty optimistic that the future of health monitoring will make the world a much healthier place when coupled with AI. Thank you Will. I could agree more. Dr. Oz, what perspective do you come to us with? I have a fan of Peter Diamond, this if you follow what he's doing, you'll probably do well in life. But along the way, I realized that I've been a heart surgeon by training. And a bunch of what we knew was causing chronic illnesses amongst the people I was doing open heart surgery on could be avoided if they took some prophylactic measures.

3:06So to try to tell folks outside the ivory towers of Columbia University where I'm on the faculty how to do that, I started doing more media. So I hosted the Dr. Ashow which aired here in Saudi Arabia for its entire course of 13 seasons and 120 other countries that I learned a lot about people around the world so the challenges to health. Early in this process, I launched a show with my partner Oprah Winfrey. We started a Jeff Arnold, who is the founder of WebFD, and it was the biggest digital health platform in the United States. And we began to learn a lot about how to give people digital tools.

3:45The big lesson we learned is you want to give them rewards, which we'll talk about a bit more as we come along. Some of the rewards are informational, but oftentimes you just literally want to give them something, and it's especially evident with people in the working place. So Mohammed Zama Sharih, please stand. And moment as a pediatric surgeon, our partner here, but we launched just agreed with this with the National Council on Occupational Health to bring this sharecare platform to all 1 .2 million businesses in the kingdom. And the effort to get to more than 10 million workers and many more coming from other countries over the next few years is projected is to get them to be healthier.

4:22And I'll just give you one fact that by highlighting why that matters financially, we ran the numbers in the United States. If you can get the average person to retire not at 61, which is the average, but 64, that three -year difference, and that one -age cohort is worth a trillion dollars to the U .S. economy. That's enough to close the U .S. debt, which is one -third of all the debt we have in the world. It's also enough to make our social programs like Medicare and Social Security solvent. The same would be true here in Saudi Arabia. And this monograph, which the FII published, If you turn to page 60, this is a list of the attendees and what everyone is doing to stay healthy.

4:59So you can pick these up in different places, but in this list, you'll notice two things. There's common products like probiotics that are being used by a lot of people. But 20 % of the attendees are asking and taking maybe taking, but asking for metformin, which is a prescription drug. It's linked with longevity. So it's a very sophisticated group here that are looking for ways to biohack and even Spa hack. 30, 40 % are doing cold plunges and when sauna. So there's a lot of awareness of prevention. How do we activate that? AI would be the best way to customize. Amazing. Dr. Tenabom, please introduce yourself and your perspective on this.

5:37Thank you, Peter. Another huge fan of yours. And thank you for having me. I'm Jim Tenabom. I run Forsyth Capital. We're a $3 .5 billion healthcare focused venture fund. have a great interest in the intersection of AI and health care. In general, we believe that over the next decade, there's going to be profound impact in change that comes through the two coming together. There are two categories of things that we're looking for, things that are more readily integrated on top of the existing health care infrastructure. And one way of thinking about this is that we have right now a health care delivery system in the United States and globally, which has a very wide variation of standard of care.

6:21And AI methods are going to be able to narrow that variation so that we're able to deliver more uniform best practices across the patient population. We think that those are the types of things that are going to roll out over the course of the next five years. And then there are larger questions about given what we know now, how do we redesign healthcare delivery. And it's interesting here in Saudi. In fact, the government has been embarking on that exercise and and in the United States it's very hard to change the system that so really can convert and has been around for so long. So but nonetheless we have an interest in looking at a very long -term project of recreating of reimagining healthcare delivery in the United States, and hopefully over the next few years, we'll get involved with something substantial that focuses on that.

7:18So those are our interests. Thank you, Jim. Amir Ruben, please introduce yourself and your perspective here. Well, thank you, great to be here. I'm in the fan club of this entire row of people, so it's a privilege to be here. So my background is in healthcare innovation and delivery. I used to be the CEO at Stanford University's health system and then I was executive vice president at United Health Group, Big Fortune 5 company and then went to a start up one medical that reimagines the doctor's office and combined digital health and in -person care. We took it public and then we sold to Amazon last year.

7:54So if you're a US Amazon prime member, you could add one medical for nine bucks a month. You could get all you can eat on demand digital health. And then in 31 markets across the US in person care. and what I've seen kind of across my experience is how do you take this great innovation that all these amazing people have shared and how do you fit it into workflows of both kind of the demand side, the problem statements for consumers, and employers, and payers, and the supply side, physicians, clinicians, nurses, care coordinators. And so right now I run a venture firm called healthier capital and we're investing in health tech.

8:35This intersection of how do we take these great exciting technologies but yet fit them into the workflow of clinicians and I'll use an example from one medical as the kind of things we're looking for. So, and one medical, a consumer within a minute can have 24 -7 access to digital health, no copay, no deductible, no claims, and we charge the membership fee, nine bucks a month. So how did we not overwhelm our providers with unlimited demand? So we built our own technology and we first used natural language processing. Now some generative AI approaches that reads the emails based on the content, pulled it out of the physician inbox.

9:15We then staff a national 2417. Not all of them have to be physicians or even clinicians based on the content. Then we had a human in the loop, but then generative AI now helps draft the response. So we can take 50 % of the tasks off of a physician, yet then have one to two minute response for the consumers. So it's an example of how do you blend technology into services. But Peter, I want to throw it back to you. So I'll play moderator on this end. Okay. You have an unbelievable background and been a student and fan of you and the X -Prize. And I know you're a thought leader. Please share a little bit about how you're thinking about this and healthcare.

9:53Sure. I like studying how industries get massively disrupted. Right? So the PT's, the telephone lines around the world got disrupted when a service that was not ten times, a hundred times better came in and made getting a landline irrelevant, right? And so we see India with, you know, Ashambhani's 5G network just amazing. We saw Google come in and make libraries irrelevant. I'm interested in completely crushing, destroying, obliterating, and reinventing the healthcare industry. And I do think that we're going to get there relatively quickly. There's a point in which why would you ever go? There is a point in which AI is the best physician, period, right, where it's malpractice to diagnose without AI in the loop.

11:03There is a point in which the most of your data is collected on your body, in your clothes, in your car, in your bed, in your urinal, all the time, and that data is fed up to your AI that's monitoring you, not once a year for checkup, but continuously through your day and finding things at the very beginning. So, I'm interested in what countries are going to like reinvent healthcare and make US healthcare super jealous that we don't have that. Yeah. So I'm not interested in incrementalism. So I'm going to start with you, Mement. You have some fascinating data. How do you think about the rising billion?

11:56I'm going to not call it, you know, the bottom billion, the rising billion. And how this will support them. You mentioned AI and I share your belief yet. That's steady by the way in your panel when Jack Henry was describing sandboxing cues, large quantitative models. Thank you for that opportunity. Amirisk, you can moderate. I've watched from the best through the years, Dr. Oz. I'm trying to learn. But you've well done, then. I may award winning. Quality work. The big opportunity with AI, I think, is it's honest. Honest. Now, I asked if it's too remated. I'm sorry, not judgmental. No, it can be, it can make mistakes, obviously.

12:37You can hallucinate, but there's, I'll give you two examples. The one classy example that Jack Hittery shared with me years ago, when I was first trying to understand what this was, was pathology slides. So if I get a pathology slide in a Western country for prostate cancer, the pathologists will overeat cancer. They'll see there's more cancer than there really is. Why would they do that? They do because they're humans. They don't want to miss a cancer. So they'll say something is a more advanced tumor than it really is just in case, because they're not sure. Pathology slides read by AI, don't make that mistake, because they're just bluntly telling you what it is.

13:14So you do a great number of people have their prostate taken out. That's true in the West, it's also true in the East, but the more pervasive issue today is we have a little bit of a illness industrial complex. There's a lot of money spent to make us sick. Making foods that aren't good for us, subsidizing those foods, sometimes they're addictive foods. You know, we support, I think we probably put as much money into the back of subsidies in America as fruits and vegetables. You know, it's just not done in a way that objectively honest person would want, but these historical realities, why these were done.

13:46Am I blaming the people, it just is true that we're not doing our best. AI generated advice will have to tell you the truth. It doesn't fall prey to human failability, because it's kind of be kind, and an effort to be kind hurts you. Like a parent who loves you, but does the wrong thing by enabling behaviors. It also will take on special interest groups that maybe don't want you to do the right thing. And I think if you put those together, we have an opportunity, not just in the West, but also in the rising billion, to say honorably, your water is so poor, that you can't be healthy as healthy as you could, because you have arsenic levels, you know, 100 times more than they should be.

14:23So as a country, you need to do better job with water supply, I mean, basic stuff. It's not just curing polio, which would be nice also, but it actually starts to get into these issues that I expose pathology that otherwise we would ignore. Well, how many,

14:41come on, ask it, yeah. How many groups are in circulation? And what, you mentioned what you're measuring today, What would be your the next three or four things that you would love to be able to measure physiologically in the body? Where are you going? Well, when we first started, we looked at, well, we're some of the sort of more capable medical technologies out there. And how could we put those in a smaller form factor? And so initially it was the PSG machine, which is like the gold standard for sleep monitoring. It was the electrocardiogram, but in particular, to be able to measure heart rate variability, which is this fascinating lens and how your body is recovering.

15:23And it was actually the chest strap, which is the heart rate monitor from the 80s that athletes wear to train and being able to measure heart rate accurately during all sorts of different activities. Now, the good news is we've now been able to take those technologies and put them in a small form factor that has the same level of efficacy. And if I think about going forwards, all the new capabilities will probably go back to a similar place, which is just saying, what are all the different pieces of technology that you find in a hospital room, or that are off the shelf, you know, more cumbersome pieces of technology, that you'll be able to put in a much smaller form factor, much more affordable form factor, and democratize.

16:04I mean, just think about the fact, less than 1 % of humanity measured their sleep last night. Yeah, we know that sleep is essentially one of the most important things you can do for longevity, for performance, for really reversing all sorts of disease states and everything that could go wrong. And yet such a small percentage of society today is measuring it. So it's often asked, well, what more can we measure, what more can we measure? I think a good starting point is just getting a lot more people to be measuring their bodies because you can only really manage what you measure? Sure. I'm curious.

16:46Both of you have been in the medical system, investing in the medical arena. Is it, do we start from, from clean sheet and work up, or do you try and take the existing systems and, and improve them? Jim, how do you think about I mean, I like your categorization, the simplifying, but do you want to live, are you going to live long enough to send changes made? No, no, I mean, I hope spring's eternal. And I think, you know, venture capital, you start off with macro themes. The macro themes bring you to entrepreneurs, and the entrepreneurs bring you to investment opportunities. So the macro theme is to use AI to make care of delivery more uniform.

17:40Then the entrepreneurs on the ground that are delivering that have a spread of ways of going about it. I would say ironically, there's not a tight correlation between revenue growth and technology excellence. Can I ask on top of that? Do you think that doctors will change or medical systems will change? I don't believe so. I think they're so ingrained in how they do what they do, that to get people to actually change is almost impossible. Well, I think there's small change and large change. Okay. who's at risk and who can benefit from change? And in places where people go at risk and they can deliver, we're involved in a cancer care delivery company that's making some changes to the way the cancer cares delivered.

18:40Originally, we were hoping that they would be really heavy on the tech front. They've just been really heavy on the figuring out how to get doctors to accept various changes that are, and that are easy for them to accept. I mean, how long did it take for cardiologists to accept using AI to read an EKG? Right. I mean, it's like, step this go. Step this go. Just now, just now, we're getting doctors to allow AI to analyze acoustic sounds, which we're so bad at. Objectively, we're bad at here awful. Austin Flint murmurs. Please. Well, and I think it's a great question, Peter. I think the answer is both.

19:17And meaning, I think we're going to have innovation and continuous improvement from within in the ecosystem and sometimes we'll have disruptions from without, but if one is naive to how the ecosystem works, I like to say big healthcare always wins. And so, but I think also understanding the stakeholder needs. I actually was just with a kind of cancer, almost customer relationship management software company that's helping manage patients longitudinally and a lot of practices in community practices. is they don't have a the knowledge base and then the staff to manage kind of the symptoms and follow up on these immunotherapies.

19:58So they're not using the latest generation. So part of the answer there is, okay, and by the way, they're not getting paid for that time. But this panel is about the next billion. So let's take it there. So I think then the end on the next billion is, however, then there are some approaches that can leapfrog these things. And we're seeing this now in a lot of this generative AI. So I've looked at a number of companies now where a doctor and a patient consider cross from each other. And not only have the system do transcription, document what the doctor is saying, but also say, kind of do the differential diagnosis.

20:36I think it's this, I think it's that. It could be this, consider ordering these exams. And I think back to your other point, Peter, I think this could be an area like we saw cell phones in some parts of the world, leaf frog landlines, we could see the same here. We may have more regulatory burdens and more stuck in our current ways in the US. Actually, I've been spending some time with the Ministry of Health these last couple days here in the kingdom. And it's good to be the king. It is. And it's also, however, good to have a national viewpoint of regulation. We have pros and cons in the US from cities and counties and states, but in terms of having a uniform digital highway, in terms of having consistent standards, it's very hard to innovate in that.

21:24Can I put forward the thesis and get your feedback, which is the, I'm gonna compare the US against Africa in health. The US has such regulatory burden and such a disease -based industry, a sick care industry that shifting the battleship will be extraordinarily difficult. But take your favorite African nation where there is little, but there's 5G, there's smartphones, and with the proper creation of sensor technologies, we can have a roundup revolution using AI to democratize health. Just like in Africa, we saw the first cell phone -based currency exchanges using minutes, right, which is an innovation I still would love to have in the US.

22:24So do you imagine that we might see in five years time, and I'll remind you guys five years from now, I said this, that we have standards of healthcare improving in the rising billion at the mass level, not at the wealthiest, but at the general populace level. Well, I think the place that has the most likely for that type of scenario is actually here. Are you out of Saudi or UAE? Yeah. And they're already starting and they're doing planning and they're making an earnest effort and the arrow has just spent the last couple of days banging around the health care authority and you can make more comments.

23:03But I mean, you need a lot of factors. You need government that can actually be empowered to make change alignment, long -term thinking, money. And a lot of the factors are here. And I think one needs the right financial incentives. We can do it also in the US. I mean, the system is responding exactly as the financial incentives are. Absolutely. You get what you incentivize. So AI and healthcare, we all know where it's applied. Revenue cycle, building, collections, claims. That's where all the first money is to be made in AI and healthcare. And, you know, everything that Dr. Oz was talking about of digital pathology, digital radiology, it's there, but it's much, much slower.

23:53Why is it FDA -approval? Is it through CMS? Can you get build for it? How do you get reimbursed? But we've seen, for example, in Medicare for seniors in the U .S., we have 50 % of seniors now in Medicare HMOs, Medicare Advantage. Well, there is a financial incentives for the insurance companies, for the groups. And it's not a perfect model for our from it, but I think, to Jim's point, it takes leadership at the national level, at the country level. It then takes the right incentives. The entrepreneurs will come up with the ideas. But just a feed off that. I've been this audience maybe five times this year.

24:27Wow. So, and I, as you have been talking to these different miles, baby. Sorry. They got a finger flyer miles that we have not been able to use one day. But they don't need them to will. But I, what I've noticed here anyway is that the real winning game for health is going to come back down to the issues of making it easy to do the right thing. Sort of the blue zones approach. And there's probably a blue zones in the southern part of sorry, baby. But we know the other places where there are Blue Zones, Okinawa, Sardinia. They have done things that just every single day push you to walk a little more, which by the way, that by itself is probably the single biggest driver of longevity.

25:06The average American walks 4 ,000 feet steps a day. In Saudi Arabia, it's less because everyone's endorsed so often, and the optimal is, you know, well over 10, but let's just say seven. But that's just a basic example that will can monitor and keep track of. But I think those are the kinds of things that that ultimately will allow the extra billion people that we're talking about to rise up. And I spoke on Monday at the African summit, the same basic idea, the leapfrogging that have been mentioned is happening they're already with technologies and Orbis is a company that looks at retinal images and does AI evaluation to diagnose everything inside your brain but a lot of other metabolic illness as well.

25:44Again, we don't do that in most parts of the world but they just can screen a lot of people. But I think monitoring is the big part of it. What I'd like to do in our final eight minutes is give each of you two minutes to address that question How can AI democratize health for the next billion? I want to bring us back there Will Yeah, and just reflecting on the conversation here a lot of how At least I've thought about building whoop is very customer first or like you know individual first and it strikes me that we've talked a lot about you know different regulations and you know what doctors offices are going to do and we've almost looked at it more from the bureaucracy standpoint but I think that when you talk about a billion people it's going to come from the users first and you know we might be able to learn something from the education system right now so it wasn't like generative AI once the education system and said hey we're interested in rolling out you know large language models we're interested in you know, helping the students better understand how to write papers and answer questions.

26:53It was just like all of a sudden, every school around the world woke up to the fact that their students can now write a paper entirely from a large language model. And now every school is trying to figure out what the hell do we do with this new world? And they're changing way faster than they ever thought they were. And I think what we're going to see happen in healthcare is that level of disruption, where all of a sudden answers are going to be at the fingertips of individuals around the world. You know, there'll be someone wearing a wop and the AI layer that sits on top of that is going to tell them they're about to have a heart attack in 30 minutes.

27:29And guess what? They're not going to call their doctor and ask. They're just going to go to the ER, right? And all of a sudden, when these things start to happen in real time, the system is going to have to adapt rapidly. And I think what's so powerful about AI, as you're talking about, being people, is that the cost of that level of intelligence is gonna be so low that it's gonna be touching every individual. And so that's what's gonna push the system over. AmeriCorps, what are you next? Yeah, I think we can have a doctor in everybody's pocket. Exactly. And I think actually technology wise, that's here today, at least kind of a triage in diagnostic.

28:07I don't think - A doctor or a much better doctor in every part? Well, I still believe we need humanity and compassion and also - Do you not think that AI can be more empathic than a human? I think that most humans probably possibly, I do think - I think the data does show that, right? I think that's right and there's good data on that. But I think the key here is today there's a lot of barriers to access information. And even if you have great insurance or great resources, is even if your name's on the side of a building, I just visited somebody at Harvard, whose name's on the side of the building.