 He's in a digital health space and yeah, with that I'm like a welcome to you. So, welcome. Thank you for your attendance, your participation. It's a fascinating and very exciting topic which I do spend quite a bit of time trying to share so people understand what's happening in healthcare and it's a revolution. So, thanks to Biology for elegantly setting us up really in terms of reminding us of some of the key issues that we see in healthcare as well as of course starting to allude to some of the things that are happening in healthcare. I think he gave you a number of trends, nanotechnology for example, robotics which are in themselves topics that should be covered in separate sessions such as this one. Today I'm only going to look at what was commonly called a digital health but I would generally try to refer it to data driven health. What I mean by that is that the advent of digitization, mobile devices, et cetera is creating a greater amount of data which we can start making a lot of sense with as far as our health is concerned. Who's familiar with the term digital health or data driven health for example? Is there something you'd be reading about? Is there something you're familiar with? Just give me a show of hands quickly, just give me a field. Good, so I won't be teaching too many people something they already know. But this is a highly exciting topic. There was far too much tech on the previous slide. I'm basically healthcare. I've worked in Medtech, I've worked in functional company, I've consulted them, I've done banking to them as well and about three years ago I stepped out of the corporate industry and I set up Propel which is a small venture platform focused on seed funding or promising health tech and of course the minute we invest we also spend time advising in order to improve the chances of making a substantial amount of money later on with the large corporate size to acquire the little stuff. It's a very exciting space. Everybody seems to think that the US is where it's all happening. It's a fair conclusion based on everything we can see but we shouldn't underestimate what's happening in Asia. There are a lot of startups in the digital health space in Asia. I'm personally starting to try and do a bit of an official count of this and I think the ones I found, I found 250 so far, startups in digital health. So I'm ignoring biotech, ignoring people making new limbs, space makers, etc. It's just literally data to different healthcare solutions. So healthcare is changing dramatically. I think you're probably reading a lot of that in the press if you're going along and reading things. I think the Economist launches a quarterly summary on science every three or four months. The last quarterly update, I think 80% of the articles were on healthcare revolution and what's happening in healthcare. The biggest disruption that I'm seeing is in digital and it's the same reason or rationale that we're seeing a disruption in other areas of business such as financial services where fintech is making a big impact, for example, or commerce. Largely because it's getting cheaper and cheaper to start up a business and it's getting cheaper and cheaper to set up a solution. Usually we need one coder and a willing customer and you've got a business which in healthcare has always been an issue. Because the barrier to entry in healthcare has always been one of the cost and you saw what it cost to deliver a new drug. You can move away from that and start creating solutions that are much much cheaper and suddenly you get a much higher adoption from people like you and I on a day-to-day basis. Technology therefore is driving that paradigm and it's disrupting pretty much every single arena of life that we will have in front of us. So whether you're a parent, you start thinking hard about the education focus of your children going forwards. Whether you're looking for a job and you start thinking hard about what you're getting that focus on in terms of developing as a profession. So a lot of jobs that we know now are disappearing because of digital impact and technology impact. It represents a fantastic opportunity for emerging markets about in Asia. If markets such as Indonesia, Vietnam, Myanmar which have a serious chronic issue in terms of delivering healthcare the number of specialists per 10,000 population is woefully low. The number of hospitals with the right equipment is woefully low. If but the contrary to those countries is that they also have very high prevalence of disease. The highest rates of diabetes are in Asia and are in those very countries. India had a 10% prevalence of diabetes. Less than 1% turn up to actually get a consultation gives you a flavor of the sheer time bomb so to speak that is occurring in those countries as far as healthcare. As diabetes is not going away, in fact it's getting worse because the rates of obesity are getting worse around the world. Now technology will help try and leave for a while. What I mean by that is that if India, Indonesia and Vietnam insist on trying to build a healthcare system like all the OECD countries around the world in the same way through the same steps it will take 300 years roughly speaking to get to the same level you've got in the UK, Australia or the US. They can't afford to do that, not with the population the way it is, the growth of that population and the disease in that population. Why it represents a fantastic opportunity, we'll come back to that. Finally, the whole of that paradigm shift which I think was described as moving away from disease treatment to wellness or prevention means that we're starting to see some significant new opportunities as it relates to new players in the market and I'll touch upon that. The number of FTSE 500 companies focused on healthcare has gone up by 76% in the last 2, 3 years and the Google is one for example and you've probably all read about Calico, Project X they are investing a ton of money in the future of health. So hopefully that is something that echoes with you the stuff you've read or certainly something else that's exciting. So what is digital health? There are a number of other words used for it so for example you might have heard of mHealth mobile health, e-patient, quantified self these are all terms that are banded around they all kind of come together on the same heading which is digital health. What is digital health? It really is this sort of conversion of the digital revolution that we're all experiencing with health and it's driven by things such as wireless devices, sensors, improved battery life etc. and I'll come back to that just to give you a flavour of what it is there's a neat little diagram there that you'll find at Nuvium which is N-U-V-I-U-M which kind of sums up all of the various elements of the ecosystem that makes up digital health. It's not a new topic so it didn't appear yesterday the economists were all writing about it back in 2009 anyone heard of Clayton Christensen some of you have so he's pretty much a godfather of innovation he wrote the Innovators Dioma for example and he coined the phrase precision medicine I think that was used back in 2008 so this is not new since some people got ahead of the game in relation to understanding this but if you look at Google searches for the word digital health that was taken in March, late March of 2015 up 103% week on week so you can see the trend in terms of the number of people who search in this topic because there's novelty and in fact it appears in an awful lot of documentation that you're reading they're financial times, economists straight times, etc and then of course there are other publications so they're financial times we're talking about CES is everyone familiar with all CESs? The Big Las Vegas show where all consumer electronics launch their new products once a year it's the biggest festival with all consumer electronics well, digital health startups and products is the fastest growing category of that show obviously no one's interested in washing machines they much more interested in having to wash these days but all of the other devices behind it so it's a huge growth the other thing is J.B. Morgan is the biggest financial conference for healthcare in the world it takes place once a year in the US and sponsored by J.B. Morgan the big investment bank digital health didn't really feature in that it was all about biotech and medtech now digital health is about one third of the entire program of events and conferences so it gives you an idea of what's happening in the last few years okay so let's go back but I actually gave us an idea of old health care and some of the trends and the issues with CED etc and I think it was a natural way of trying to summarize what's happening to help us with that contrast or that shift that's there and I think insurance is a great question to raise because it gives you a great flavour of what that looks like so let's continue with that for a minute before we come back let me come back to you in relation to insurance have you bought insurance? so give me very quickly a summary of what that process was in terms of buying insurance don't think about the process of buying insurance what information did you get asked for in relation to providing that insurance and what to you therefore do you think is missing? so I think the process was basically that my family knew someone who sold insurance never recommended me because there was a trustee person a family friend then we had a conversation which talked very much about what kind of insurance we needed for someone who had joined the work boss for example the major components were if you died if you were ill then there were other kind of things like saving links and financial products a lot of control and my conversation during that process was that there was fucking problematic control so I hated every part of it because I couldn't get a straight table or excel comparing various programs of love super paid I just think something that paid something if I die tomorrow and I think something that if I didn't die at least I could pay for the first 30 days I don't care I had to google very hard to figure out whether it was a good idea to do something called early stage catastrophic which means that somehow you figure out that you have kidney cancer really early I found out that screening was a terrible idea if I bought insurance for cancer because if I wanted to discreet myself for cancer and I found out that cancer at early stage was preventable then insurance wouldn't pay me out so technically it would make more sense for myself to not discreet myself and end up with terminal stage cancer and then at least get an insurance payout at that point so the interesting thing about all this apart from the dreadful experience which is pretty standard with financial services companies is that you got to ask a bunch of questions some information it wasn't particularly relevant to you in your case and you got a product that you did or did not feel was kind of shaped for you and it kind of also demonstrates really confusion in the industry in terms of what they should be selling you and actually it's kind of a less tweaky existing product with something that's fancy rather radically rethinking the whole product but what is interesting about insurance at the moment and I'm familiar with some of you are with the business of selling insurance but apart from the bit that is going to someone and telling you what insurance they will collect a bunch of data from you which is a precinct script all of that gets compared to a bunch of actuarial tables which are frankly speaking the law of average so they will take human beings at a certain age certain gender and that was an average score and they could pay to the average score whether you are high risk or low risk which is good news if you are high risk category because presumably you will be getting better value insurance but it's not exactly good news if you're well athletic not a cash potato and taking care of yourself you can say well why am I paying for the risk that somebody else creates for example so that's one experience anyone care to share their experience of seeing the doctor recently no? I can't look at this in the audience even better even better so let me paraphrase visits to the doctor these days usually one only way to see the doctor when something's happened something hurts or you don't quite understand something happening in your body and therefore you go and see the doctor so you waited for the trigger to start with which is something's not right so you've gone to see the doctor in a waiting room for quite some time until this will turn to see the doctor then you go and see the doctor roughly speaking how long has the doctor got to consult with you 5 minutes you're lucky but it's good for 5 I like that and what happens in those 5 minutes that's at the end what happens during the 5 minutes before you get a few dumb questions asked don't you because now the doctor's into hypothesis generation mode and trying to deduce what might be wrong with you based on what his or her experiences and what answers they're getting from you so it's an instant in time a bunch of questions that are pretty much influenced by the experiences that that doctor themselves and their experience versus what you've reported as being your symptoms and if you're lucky you end up with the right outcome because it's a simple thing and they recognize it immediately but if it's complex then it starts getting quite tricky and in Singapore they didn't get referred to somebody else because it's a single model and you tend to deal with your general practitioner for quite a bit longer so that's not particularly satisfactory either knowing that if not an exact science medicine's never been an exact science and we should all contend ourselves and knowing that a general practitioner is not an expert at every single topic it's impossible so they know a little bit about a few topics and they do their best to carry out their function and make references where they can to actually get the answer where they don't know the answer for the studious ones I'm looking at other stakeholders in the world such as for example the government and how they deal with it but really what to say and to reflect the point by Lugin made which is it's a highly fragmented area of our everyday lives in terms of the information that exists but that information is absolutely critical so they didn't better healthcare and so it would be great if we could actually try and change that in terms of being able to try and connect those dots being able to refer to other pieces of information so this is where this is why there are people on on records such as Koshler the guy who founded some microsystems Eric Topol renowned cardiologist etc who reads and reads the materials to you this fundamental shift in the delivery of healthcare driven by digitization by mobile devices sensors etc and the reason they're talking about this is because what you're finding with digitization is that the individual stakeholders that we've spoken about although we already talked about that one and that one at the moment are generating their own information in their own way in a much easier way so who's wearing a Fitbit or a dual bone or something that's all two or three is a room it's surprising how few it is still minding somebody who bought it and gave up three months afterwards because you only got step to date but that's fine, that's understandable we're helping the ecosystem learn how to do things better but we are nevertheless generating data about ourselves which in the short term helps us and we'll come back to that but in the long term you can imagine where some of the information will help your conversations with your doctor and imagine a doctor's surgery in 10-15 years time what will happen is that your phone or a device that you're wearing has recorded a ton of information what sleep you've had what you've been eating what sort of stress levels you've been facing etc and so in the future you'll come into the doctor's surgery because something's slightly wrong with you and there'll be an automatic uploading that information into the doctor's computer and an automatic reference point to other people in the same sort of demographics shown the same symptoms in order to be able to try and do an automated diagnostic so as you can see you're starting to move towards a way of delivering primary health care that's going to be much more efficient in the way it's done and therefore theoretically helping your physician who's spent 7 years training actually deliver what they would like to do which is consulting with you around your wellness rather than trying to rush you through a far better process to find out how they correct your problem so you can see where this is going in terms of starting to see an ecosystem that's starting to change and it's starting to get rewarded in the future but you'll get rewarded by making sure that you stay well rather than by correcting what's wrong with you and so all of that data generated goes up into an information cloud I'm trying to be as generic as possible but what I'm trying to explain is that it all goes into a central or a way of aggregating data so that you end up with a much better way of referencing the issues in a much better way of diagnosing etc so it's a very powerful paradigm shift going on and one that's going to make a significant difference in the way in which we experience health care in the next 10, 15, 20 years and that's just digital so if we haven't talked about regenerative medicine, nanotechnology and all the other things that will make fascinating topics for other meetings so just in case you thought that this digital health thing was just starting out and was kind of a a new phenomena etc this is just in US this is a sheer number of startups about 18 months, 2 years ago last time we did the audit in the US so as you can see you've got every single stakeholder representative insurance, patients, physicians the big pharmacist and all the time you've got every single element of the value chain of health care from finding a doctor to paying your bills to actually trying to get some health care via phone what you've seen there is essentially what I would describe and we'll come back to some of those essentially what I would describe as the third industrial revolution the Hamish some of you read about the second industrial revolution which started in Europe but it started as a cottage industry people started buying weaving machines etc in their own little backyards and started creating more efficient products slowly over the years starting aggregating to bigger, bigger corporates we will see the same in this this will start consolidating and it's already starting to consolidate and I'll touch about that towards the end in terms of giving you a flavour of who among the big guys are starting to take a position with the digital health so what we'll focus on here and you'll have to guide me on how much time we put into things because there's an awful lot of information here but I'm conscious it's Sunday afternoon but what we will do is spend some time looking at this big data itself we've all heard of the term big data I assume so we'll talk about it in the context of health care we'll talk about wearables and sensors because I think there's a notion generally with people's heads that it's something you wear around your wrist I would like to show you where we can go beyond that but it's all about business models I think some of you are familiar with the term essentially what I'm talking about is how the industry fundamentally changes as a result of this technology shift and then I'll talk about funding because of course the greatest testament or demonstration of how an ecosystem is evolving is to follow the money and of course there's something very close to what I do on a day-to-day business but just showing you some of the trades both in the US but also in Asia and we'll give you a flavour of where digital health is going I was going to talk about regulations but we'll probably run out of time so we'll figure out how we get the information because it is actually quite an interesting impact Who's heard of 23andMe? Who knows what happened to 23andMe last year? Yeah, what did happen to 23andMe last year? Well, basically we got some issues with the FDA and the idea to withdraw the health management from one end of the country Yeah, okay That's why that topic is massively important Digital health is in that grey zone and in some cases like a jaw bone wrist wearable it doesn't require regulations because you just count the steps but when the device is starting to interpret that data and give you a guidance on your health then it requires regulations but it's a new area so you can imagine every single regulatory environment is running around trying to figure out how to regulate it The US have released their guidelines the European Union is kind of thinking about it and the rest of the world is watching what the other two are doing Anyway, come back to that I think this is a very powerful quote since we started with quotes I thought Gary was quotes Thomas Goetz who's well known if you go to Ted Med or Ted Talks you'll find Thomas turns up quite regularly He's of the opinion that as you can see the healthcare is not a science problem it's really an information problem and his greatest case study is when you go for a annual checkup and the data comes back and usually you go to about seven or eight forms of A4 covered in data none of us know what to do with the data if you're lucky the doctor will be through some of it but it's an awful lot of Greek really if you pardon the expression his opinion doesn't have to be that data should be it's your data it's about you therefore that data should be represented in a way that you can understand and take a decision at the moment if you ask your doctor the data which you're theoretically right to do so you wouldn't know what to do with that data because most of it's got a complete doubly good time and so he's of the opinion that should change and so if you go to TET and find this talk you're finding that's fascinating but big data just to refresh everyone is really about four four V's and as you can imagine there are a great number of varieties of sources of data coming through we with our wearables and our phones are starting to create a new class of data but you can just imagine in a healthcare volume the sheer level of different types of data that exist ranging from an x-ray through to an electronic health record with a doctor's surgery all of that force is very distinct nothing talks to each other, it's all very distinct and so you then you get to the amount of data it's grown incredibly fast bear in mind I think I looked at the data last year I think 90% of all data generated in the world was generated in the last two years so that gives you a feeling of there's just a sheer amount and a sheer velocity of data being created in the world and therefore creating that opportunity that's there going forward now the important thing of course is the quality of that data and so a lot of the new business models that you're coming through are helping us be able to deal with those four V's in an adequate way six areas I'll cover in terms of big data that's really to some of them less so the first one is genomics presumably everybody's heard of genomics sequencing the genome we'll talk about it in a little while data analytics as you would imagine with all this data someone's going to make a lot of money analysing it in this particular and therefore making sense of it public awareness now that we have access to this data we have access to devices it's a lot easier for us to be able to and then that with a better understanding of for example the spread of the flu bug around the country supporting providers so how do we use that data to help clinical trials for example I'll talk about that in a short while self-care, how do we help ourselves with all that data and finally of course the ecosystem how do we start bringing those data together to make some sense of that data I'll dive into those separately in a minute so genomics and beyond so this is a famous 23andMe 23andMe, 99 bucks you send your DNA in, you analyse it and they send you back some of your DNA sequence it's not a full sequence and from that you can start paying an understanding of the predisposition you have in relation to certain diseases I think a last count of looking at their data 800,000 people have used 23andMe and they have encroached the FDA they did get told to stop doing what they were doing that's been changed, they now regain FDA approval for certain diseases and so they're back in business as far as the healthcare environment is concerned and so much so back in business that they signed a $60 million deal with Roche Big Drug Firm a few months ago we had to look at that data on an anonymised basis to start looking at disease patterns and how they could potentially affect cancer which is Roche's primary focus area and I'll come back as to why that's happening Roche in a minute but there's a few other ideas there in terms of the key some of the better known names there I won't dive into each one of them I'm sure that you can google the and find out a bit more but they're fairly well known players days of analytics sorry so in terms of the analytics or the actual sequencing itself I'm glad to see the challenge of the sequencing the analytics is fairly simple the actual interpretation data gives you some interpretation for you to use it's something that's really easy to do it's really just software so a lot of SaaS models are coming up for you to use others adopt or as a private individual the full sequencing is possible Illumina is a better known of those players in our space they were the CEO Illumina was at Ntech Singapore earlier this year talking about what they were doing I think Balaji touched on it the challenge is cost so when Clinton launched precision medicine in terms of DNA sequencing not what Obama just did but what Clinton was doing back in 2006 I think it was I may have a date wrong I think it was something like 3.5 million dollars which means apart from academic research no one could afford it Moore's law has more or less determined that to sequence a genome can be as little now as about a thousand bucks now let's be realistic a thousand bucks as long as you bought the $3 million machine that does the sequencing behind so it's really a volume game so until we get more laboratories only more of those machines can help before you get full sequencing so to answer your question I think the 23 of me is an adequate half way house to sequence your genome and get a better understanding of it if you want to go to the step level the next level up it's going to cost you a great deal of money transitions already getting into this will charge you about a couple of thousand dollars for the sequencing but it's another 45,000 dollars to help you interpret and take the right decisions and give you a little consulting in relation to your DNA samples I'm familiar with this company and I'm getting 70 incorporated with the CEO of the GeoPreventor with the DNA analysis of all sorts of sequences there are many out there some of them are very focused on certain diseases some of them are more broad in what they do I don't claim to know them all yet I do try and keep up to date with what's new so the data analytics we'll pick on Practice Fusion because it's one of the better known ones that has raised quite a significant amount of funding over the last few years Practice Fusion basically has created a free health record software for doctors and clinics to use they were initially only in the US they've now launched in the UK but their principle is following if we give you the software free and you get into it rather than bits of paper then you'll be able to get more information out of it but at the same time if you get more and more surgery or more and more physician practices doing it can you start aggregating that data then you can start getting a lot more insight so what you're starting to see is things that are broadly called social medicine in other words physicians being able to talk to each other around I've seen this symptom here's a photograph can you help me with where you've seen this before so creating a great deal more power at a physician level around understanding data interpreting data and therefore supporting diagnostic it doesn't do diagnosis it just provides data inside to doctors beyond just the sample of patients they see on a day-to-day basis which is of course a very small sample versus the whole population but it's very successful it's starting to get used by a great deal of physicians in the US who are getting benefit from that I won't go into detail with those some fantastic bits of analysis out there around the reduction in health costs from using health records for eliminating errors being aware of what drugs a patient is actually allergic to and not describing that so you can start we'll go back and we'll look at cost savings in a minute but it's just the electrification where the right service of health records would save billions of dollars in the US alone although it will be significant so let's practice fusion but I'll always look at the other the scene of health is the other way it's quite well known as well so public awareness in other words how do you create greater awareness in the populations as a whole so if you remember my piece of information about India where 10% of people have got diabetes but less than 1% turn up for consultation they're not interested all because they've decided it's going to die and all get diabetes it is entirely because they're not aware that diabetes even exists if you're a rural farmer in India you've probably got a GSM phone in your pocket rather than a smartphone it's highly likely you've never heard of diabetes so a symptom manifests itself like a heightened heart rate or your eyesight's dying to vary a little bit they're not necessarily going to attribute that to diabetes so it's an interesting free one so health map and sick weather you can download and play with sick weather works on the basis of twitter information about disease and builds patterns based on that health map I forget what that input is but you can download and play with it Sproxil is an interesting one did you know that in Cambodia over 50% of anti-malarial drugs are fakes over 50% so you can imagine how people are being poisoned thinking that they're taking anti-malarial drugs what's criminal really about that is that everyone's got a phone pretty much in Cambodia so it must be simple to try and help someone who's just been given a drug packet that looks like the real thing to actually validate whether they've got the right packet at hand Sproxil is one of those companies that's doing that now so the drug pack as manufactured by the drug firm is issued with a unique number and therefore when you get the pack as Joe average in which he's been to the pharmacist you can then send that number to a central phone up by SMS literally within 5-10 seconds you get a response back as to whether it's a real pack or whether it's to be handed back to the pharmacist to get another one so a really cheap way of eliminating counterfeit drug or certainly limiting the risk of someone poisoning themselves as a counterfeit drug support provider so clinical and non-clinical intelligence so all of that data that I talked about in relation to the big data of course it's massively powerful in relation to helping the medical profession provide a better diagnosis and managing your health or helping you manage your health much better in the future there's a couple that I'll touch on IBM Watson is that something that you're familiar with well certainly it's famous because I think Watson beat the Jeopardy Champions I think that's his moment of fame the thing to know about IBM Watson it'll consume 200 volumes of medical research every 3 seconds in terms of just digitising it which means that he can very quickly get through all of the medical research out there and start helping better cross-reference and you know matching of the data you're seeing at an individual patient level with what's happening in the bigger, wider world so you can imagine once you've got all that in there and you start with a critical trial data from big pharma companies and you start adding all the health records from patients etc the sheer power of IBM Watson in relation to helping with diagnosis particularly for rare diseases for example so what we're starting to see is some of the larger hospitals in the US trying how they're supporting diagnosis with IBM Watson one of the ones, big teaching hospital Flatiron is a case of leveraging data from patients and genomic data in relation to treatment of oncology their strap launch is really cute is software as a drug it kind of says it already which is how do you use software to solve a problem rather than administrating a chemical who here is familiar with Angelina Jolie everyone knows right thank you to the next stage who knows what she is famous as a wrong term but well known from her relation to her health one two three four we'll pick on somebody else lady behind Bellagy, what do you know about that double mastectomy she was at risk she did that very recently certainly a couple of years ago she had a double mastectomy do you know what triggered her decision beyond family history correct she did a full genome sequence and there's a little protein called BRAC2 which is there determinants as to whether you are predisposed or not doesn't mean you've got it, doesn't mean you're predisposed she did that test it came up as you're predisposed she didn't mix that in, of course it was the family history I think she lost her arms and her mother to breast cancer so the probability went through the roof she was concerned and she was going to take no risks so that's why she had the operation but it's a clear it's one of the most high profile uses of say gene sequencing but it gives you a flavour of what the insight is starting to get on health as an individual is concerned and so flight iron is trying to use that purely on oncology in terms of how to use all that data to try and really help not only the industry that manufactures solutions but also the patients in terms of how they manage it but you can imagine how insurance are getting in there to come back to the case around being screened for insurance purposes earlier on it's really, really powerful and we'll talk test on that a little bit later on one of the things that's growing out in front of this is clinical trials biology shows some numbers which are a little out of date, it's a 2005 so I think you can safely say that generating a new drug that we get from the pharmacy is probably close to about two to two and a half billion dollars now one new drug, now in that number are two big variables, one it's a total cost to get to that drug so you can imagine a number of drugs that killed along the way that were deemed unsafe or literally weren't going to give any results so that's all of it together so it's kind of loaded towards one product but that's how you pay for your business to run the other course is a clinical trial there are three clinical trials in the development of the drug phase one is it actually comes out of the lab which is trying to figure out when this thing works phase two we'll have to put it in a very small number of samples just to continue testing that it works and then if you get through all those days you go to phase three which is let's get a sample of patients and we'll administer the drug on a blind basis and some people will get it some people don't get it and then those to get it aren't being told etc basically it's completely random the FDA requires that that's usually between 5,000 and 10,000 people so as they get a large enough sample to be able to understand one of the adverse events of that drug and therefore to determine that it's sufficiently safe to be able to administer so it goes beyond just testing the efficacy of the product when it's administered to the patient now 10,000 patients over a period of time is in hell of a lot of money to run so that's a huge drive in the cost of the drug now that trial comes to an end more or less when it's determined by the protocol of that particular trial which usually works with when it's time to hand the document to the FDA to get approval beyond that point there's no further trial data however once the drug is approved and it's administered to everybody because you know every cancer patient suddenly gets administered there's an awful lot more data there that's not being collected so where devices come into play is to be able to start collecting that data so there was a recent Apple event about a month ago where they announced two things one was the Apple watch so I'll take that off the table what was the other thing they announced Spot on, Research Kit anyone look that up and figure out what that was so Research Kit is essentially an open source bit of software that allows patients essentially to own the phone or the device to collect data about themselves and of course how they go into the disease so suddenly you're going from a sample of 5 to 10,000 people for one drug trial to the drug is in the market or not it's still in trial the sample is millions and it's a fraction of the cost so you no longer need to get that patient to come in once a month for the blood test and then you go see the nurse etc you can see where the cost is coming but that needs to happen by exception rather than by everybody going through in case we have to catch something out so all of that data means that you can start managing a disease in a much more effective way which is why I think it's quite a cute slogan which is the software of the drug so that's essentially big data from that perspective support self care so that is really how you and I as individuals with a disease can manage our own disease using our device I've deliberately put a heel in there because there's a single pool start up which is doing very well in that very space but I'll talk about glucose today and why I'll talk about glucose because metronic, who's heard of metronic? probably top 2 or top 3 metronic firms in the world is that right for speaking right I think that's basically recently bought Metronic just put $15 million of funding into glucose last month what does glucose do? glucose enables any diabetic who's using a device to test their glucose levels to interact with their phone and so the phone will start collecting of course lifestyle data you'll put in your own dietary data in there it'll read your glucose levels because it does it by interacting with that device that you're using and it will then start making certain calculations that you would normally do as diabetic patients such as for example how much insulin I should be administering to myself it also automatically sends that data up to your physician so your physician can keep an eye on some of the data and be able to alert you whether there are certain things that are outside the norm so the glucose applications enabling diabetic patients who are on insulin that all diabetic patients essentially to be able to manage their disease in a much more efficient way these days without that they're picking their finger, getting blood putting on a piece of paper, figuring out what the level is and then working out according to a table what insulin should be administered it's very painful to manage diabetes very painful some of the others you can look up as you speed there is a need of course for all of that data to land on the same platform because otherwise it remains that fragmented data that I should be talking about earlier on this afternoon I'll pick on a I'll pick on a couple this is the kind of the first out of the box Qualcomm Life or Qualcomm is a very large tech company they have a fund called Qualcomm Life they established a platform called 2Net which is open source and allows a lot of the devices to start feeding that information into one cloud essentially so you can then reuse that data but the new kid on the block is a health kid which all of you have got if you own I guess iPhone 5S and beyond Tony IOS IOS 8 brought that out I had a recent meeting with the CEO of one of the insurance companies that I mentioned and we were talking about health kit and he was talking about this data collection and I said to him oh I see you've got an iPhone 5S I said do you know that that's collecting your data he looked at me blankly so I said well pass me your phone hand the phone over and I tap the health kit but this thing is sprung up did a couple of things to show the dashboard that shows steps and walking distance and this graph for the last six months was there he looked scared and I said listen that's what's happening you just switch that off if you want to switch that off but the phone is actually tracking that data for you and so and that's the health kit doing that and that gives us inputs but the accelerometer the chip on the phone is already collecting that information health kit is a beautiful way of bringing all information together most of us have used health kit that are probably limited to our weight potentially our heart rate depending on what machine you've used and no doubt your steps and distance walk most of the other information that you could collect is not on there yet it sits with your doctor at some stage it will become available for you to use going forward it's interesting to see therefore to come back to the point that I made earlier on around new entrances to health care you know Apple a long time ago decided they'd done music, they'd done video quite a tough media they were moving into new areas the car, the home and health, they're doing health in a big way okay saving was just to give you a flavour so you saw an awful lot of applications that I mentioned and I tried to describe what some of them are doing but all I had to say this is McKinsey data there's a report out there about digital health and value you'll find this graph in it but they're approximate and McKinsey does say very clearly that their estimates based on not really knowing what all of the extent of innovation will be in the future so they're basing it on what they know so I essentially say that this number could be a lot bigger but it's interesting to look at the US because the US is the biggest spender in the world on health care 18%, 18% of GDP in the US has spent on health care versus an average of about 11% in the European Union so it gives you a flavour of just how much they're spending and they're spending that kind of money because there's no uniform single one player in it it's a lot of stakeholders largely because the US system works on a number of procedures done rather than an outcome but hopefully somebody decided to see how that greater level of data means you can start moving towards an outcome rather than just doing procedures so I talked about how you can accelerate R&D clinical trials briefly see if you have a flavour I talked about how you can manage disease a little bit, we'll go back to that of course there's obviously reduced rates I was talking about that earlier in terms of having a better understanding of someone's health records when they turn up a hospital in an emergency which you might stop some of the errors that are going on insurance companies are starting to look at working out how they can change payments for rewarding certain actions for example around wellness and diet the idea being you're reducing costs further down the road because to your point your question earlier on an insurance company has a vested interest in trying to help you drive that because again it reduced acclaims might have an impact on policies so this is a very interesting graph it's simple but it gives you a very strong flavour typically speaking what are the drivers all of them sit on what I would describe as that data driven health care element that I was talking about and you know resulting in a substantial amount of money saving so you can see why Obama went on record about three weeks ago roughly speaking saying the precision medicine was a key focus area for the US going forward and they are a leader in that without that they don't understand out there and give it a seal of approval in terms of we're going to put some money, we're going to drive this through so wearables talked about that a little bit so any questions on big data and the impact that's having on health care how is the quality of the data true if you have one billion people having it at home and everyone enters it differently if I feel well she doesn't feel well in the same way how is it it's an extra question one that is occupying the minds of a lot of people who are looking at data or data driven health care as a way forward and the precision of sensors is getting better for example there are ways of de-dumping data these days there are ways of comparison of data to eliminating outliers and normally let's say in terms of patterns etc it's definitely not or a long way from perfect but they're getting much smarter trying to improve the data integrity that's coming through and the data sources and validating the data sources before they're allowed into the ecosystem that's collecting data it is a concern at the moment that my French about shit in equals shit out so you've got to be careful when you put in the system if you want some decent results if you do some decent what do you think we'll start to see that from insurance companies for example there's a very long question yeah I mean it's again it's an important question to me because all of these words as long as behaviour change we as an individual need to take great ownership of our health and therefore what's pushing the early doctors will do anything the first time and they'll like it or not like it but it's the rest of that bell curve of people that you need to bring on more as you come through I guess something that we'll be doing by proof of the pudding people will start seeing it at the value of it sorry millennials which discounts quite a few of us in the room but millennials do that every day anyway they expect to get the odds out of their telephone but you're right I think payors, governments or insurance companies etc will start in their ways of trying to drive behaviour towards an outcome that's much competitive much more look at your data, empower yourself and do the decisions you take for your health employers as well for example employers recognise that I think I saw some data the other day that if someone's BMI which is the weight to body high ratio calculator to tell you whether you're a virgin or obese I think for a male certainly in the year 2029 you're at a 40% higher risk of being an absenteeist stroke taking sick leave etc how good that correlation is I'm not sure but the data showed certainly there was a likely correlation in 2002 in the US that's a heavy driver an employer in the US will spend an average of $7000 come ahead on insurance costs there's a big difference to the UK or Singapore in the US I'll be into this and try to understand how they can reduce their claims and improve the performance of the employees etc while at the same time making it fun Singapore government is doing a lot of that they have an act we earn points every time we do steps etc seeing health is paying a ton of money on that with some degree of success but again moving the population towards that will take time given the impact of open source technology in the commercial IT world does that going to have an impact on health care in big data in terms of what the proliferation of new applications etc so you showed so many companies doing so many different things and I just couldn't help but think am I going to lock all my data up in a proprietary system like that what is the robust who owns that data yeah so you own the data and that's the way it should go I think when you'll see and it's my own hypothesis there but you'll see something more likely to be walleted because there's two of that data by the party providing with the health analysis or support that kind of stuff going on so you'll see the end of that data so we're not going to see any equivalent to I don't know Linux something as successful as Linux in the world of health care software why Linux is an operating system I know there's data which you own and in software they were unable to serve so not for the software will we see a lot of open source health startups you are I mean for example a research kit by Apple is open source so there will be people out there companies out there generating open source software to enable the rest of the profession and the rest of the industry to start building from that and that's one of the drivers I suspect in getting better outcomes from that data that is also sort of the MI Bio which is kind of developing but it's still quite expensive like an open PCR machine right now it's still $500 and then getting to use that you can amplify your DNA analyzing that reading that you're going to need a lot of knowledge there are still some ways to go but yeah absolutely no it's just very much a nice space and we're seeing the beginning of of the revolution so where are more sensitive devices I like this quote if we're not deliberately I'm pissed off just about every single doctor in the world until they read the actual article he written where he wasn't saying that he doesn't want to lose their jobs he was just saying that what a doctor does now will change and so if you talk to doctors who look at this seriously they know that the way in which they engage is substantially going forward and it's good news for doctors you spend seven years training you want to do what doctors want to do rather than just gather data and churn it through a computer but a lot of the way in which they look at you and engage with you will be driven by the information that you're bringing to the table you know I'll come back to the case then but at the moment cardiovascular patients hypertension patients usually what happens is that you have no risk of missing your life until you are at risk in other words you've been diagnosed with hypertension it's kind of neither in between really it's zero or one, it's very binary now some of you in the room and actually no one put their hand up with it but some of the people around Singapore I've seen have got heart rate monitors on their wrist so it's a little bit smaller for one called the surge which has a heart rate monitor on there the Apple Watch has got one et cetera now, those particular devices measure your heart rate on an interval basis and therefore theoretically I haven't seen any software application that does that yet but it should be coming you can start measuring your at-risk heart rate in other words when you're sleeping over a period of time which means that as your hypertension problem rises so will your heart rate rise and so now you're going to start seeing a trend that says I'm increasing at-risk and you can do something about it like change my diet, go for exercise and so on and so you really take action early enough to reduce your risk of getting hypertension or certainly delaying the onset of hypertension which delays the crucial life quality but also delays all the cost that might come on to actually treat your hypertension going forward of course drug firms don't like the idea of this but you should certainly implore that and take ownership of that as soon as you can particularly as you get older so where it is there's a common understanding I think that a wearable is something you stick on your wrist and largely because of course everything we've seen so far has been fit-pissed, your bones misfeeds and my garments for example etc so there's a lot of those things around and they will usually warn on your wrist and so I would just put them in the category of the activity tracker on the left but the reason I bring this slide is because in fact the whole world of biosensing wearables and the emphasis on biosensing because it is literally trying to convert a biological element be it external or internal into a data output that you can start using for something else and we're starting to see a plethora of other types coming through so the smart watch obviously is one that you guys are familiar with I think Apples made enough noise with it at the launch of his watch I think it was a Friday pre-orders last Friday pre-orders and so we'll see what comes out of that the beauty of that of course all of the applications that we know exist on our phone and it just stops appearing on the watch and being much more powerful in terms of being able to take regular heart rate data but then there's the other three categories which are often not mentioned or forgotten about smart clothing anyone heard of Apples not for sale in Singapore yet just launched in the US Apples has been in usage actually quite some time that was professional sports teams for most professional sports teams if you look at them when they're playing now they're shirts so I was watching the Rugby Six Nations this year most of their shirts have got some sort of bulb at the back of the pod at the back of the neck below the collar behind the player's head that's collating a massive data on that player and so essentially what's happening now in sport is that you've got telematics that normally you find in your car which tells you what you're doing is now telling the doctor team doctor and the team tactician what is happening in their team in terms of speed in terms of movement that guy is starting to trail leg in other words he's injured do we take him off etc so the whole management of teams is radically changing at the moment because of things like Athos which is measuring muscle usage as well as heart rate so it's sports changing but Athos is now starting to be available for you and I Joe Average to buy it ain't cheap but sorry yes they're also wearing impact sets yeah so they're doing a trial in the US with American football helmets you have to be right a rugby too now which is good, it's good to see certainly, there was a recent interesting article a couple of months ago I think a fairly promising American football player decided to quit his career didn't he he was very worried about concussion issues he had so it's quite interesting to see how that's changing people's behavior because of their own future matches and tattoos we'll come back to one of those it's a company called MC10 which is developing a little tattoo that will get literally painted onto your skin and we'll start doing things like just measuring heart rate perspiration, salt content your environment data etc and we'll have a much longer lasting battery life than your average iPhone and so that will just be stuck on and we'll go I'll talk about another one in a minute called Zio and in gestibles and smart influence it says what it says really we'll decide to see devices your swallowing devices that are taught with your phone so progest is ok, it's important that's been developed to take alongside your medicine and so if you're a patient taking a lot of medicine because you've got a chronic disease such as diabetes or cardiovascular or oncology or cancer that particular device will help you understand the effectiveness of the product how you've taken it, whether you've taken it whether you're supposed to have taken it and of course a wealth of data to help the industry improve treatment in terms of sharing data as opposed to your disease and the drugs you're taking so that's really wearables as we are known now there will be new ventures going on but largely speaking there is what is biosensing wearables when people talk about biosensing wearables why is it important I think some of you, if you've used them will identify with what I've got on my slide but it's important because it's creating real time it's not when you're going to see the doctor and you give them information it's not when you're doing your annual checkout once a year it's real time and it's pretty much every day every minute, every second of your life it's measuring physiological parameters very easily so in other words you, your behaviour every day etc but of course it's able to start relating to what's going on around you in your environment because it's easy to collect weather data where you've been in terms of location plane versus a benzene factory to take an extreme case but all these things of course are starting to build a much more 2D or 3D picture about you as a person and why you may be ill and of course finally it's allowing you to start analysing some of these trends for yourself certainly I get a lot out of this watch when I'm doing training for trifle because it gives me a lot more data about how efficient I am with my running and my swimming etc I think most of you are aware of the whole ecosystem of the wearable you're collecting the data it goes into the cloud and then you get feedback either on versus your own goals or versus a bunch of people you're competing with which is got this piece here I've got the health care label here to give you a flavour of what I mean by the feedback results in terms of you're getting the information visibly to look at so you can look at training for example am I doing 10,000 steps a day or is it once a week and I do 10,000 steps and if so what do I do about changing that and of course the community the peer pressure is incredibly powerful behavioural change tool the people you know it becomes incredibly competitive who's actually hitting their targets on a week by week basis when I was 71 my mother went trekking in the power last month wanted to know her distance she would be walking every day so I bought her a Fitbit the outcome of that is now she's competing with everyone else in the family in relation to the number of steps so it's amusing but you can see what it creates by the way of that behaviour so in terms of behavioural change I'm going to get to this later but what are we starting to see I mean is that starting to are these tools needed on health and this type of thing it's an interesting question because I've had that question before I was trying to find one data point that I actually kind of demonstrated that and I found one about a month ago because the CEO of Weight Watchers was on a record recently announcing his results which weren't very good and he has attributed it to this particular metric the fact that people are now able to measure their own exercise behaviour lifestyle that's called it that means a lot of people who generally rely on Weight Watchers and Weight Watcher clubs to drive their lifestyle around weight and now starting to rely more on this to take even more empowerment from the data they're getting and so whether right or not Weight Watchers as the CEO is it the impact on his revenue on the fact that wearables are starting to change people's behaviour as to how they manage their weight it's quite interesting data point anyway you would think they might have thought about as Weight Watchers getting into this kind of business you thought yeah but it was a classic case of Kodak the year before the year before he laughed at it saying it was a fact but so did all the Swiss watchmakers who are now of course doing U-turns now that the Apple Watchers have been launched so it's interesting to see right now but it's a classic case of industry repeating the same mistakes over and over again in terms of their future okay so biosensors two categories really in my head there's this one here that you guys are all familiar with the misfit jaw bone wittings basis I think biology has got a basis I think on interest that's the bit everybody knows this boy here will probably wreck the revenue models of all of these guys but that shadowed it out shadowed it out so what you'll see is what Nike announced last year yes sorry because a lot of the business models for these guys misfit jaw bone etc is the hardware that they sold with on your wrist yeah and a lot of them have been quite skewed in the way in which they aesthetically built these things to fill your wrist jaw bone was the first one that had a few problems it now works quite well and it's quite itch kind of thing you got one more done misfit then designed one that was with a battery the battery ran out in six months rather than every week and it was waterproof you've got on your wrist and they look like a jewel etc so that's how they were selling it they were collecting data and it was kind of more sold because of what you were looking at in the store on the shelf now Apple's device coming out which will be copied by a series of others that are going forwards more or less negates that because now in one watch you've got time you've got phone an accelerometer HR monitor etc so what you'll see is what Nike's done it was Nike last year I think Nike said right we're not doing the fuel ban anymore can that we're just doing software so Nike's smart enough to recognize the fact that the hardware side will just be in the consumer side will just be taken out by the large players like Apple so what Apple's done is legitimize the space because I think the Apple watch sold out in the US and China within the hour of launching on Friday the $17,000 Apple watch sold out in one hour I don't know how many there were but it sold out in one hour incredible so that's why I think that a lot of these guys start changing their business models starting to address it then there's this space which is often unheard of or certainly unexplored unless you really start looking at it but it's the way in which wearables or biosensors are starting to change the way in which medicine is being delivered by nurses by doctors by surgeons, etc on a day-to-day basis and I'll look at a couple of those but I put up there some of the more common names for you to sort of spend some time looking at in your time but I mentioned the tattoo earlier on and I mentioned the pillage swallow earlier on we'll look at a couple more in a minute so in relation to the wellness side as I called it here's the famous Apple watch launched on Friday the garment is the one I wore which does give a regular information around the efficiency of your running for example the oscillation of your body as you're running etc so it's getting really quite clever in terms of what it tells you and some of the key metrics that top athletes have had for years now and used to actually improve their own performance is now enabling Kiwis like myself to actually try and do something about being better at what they do this is the Athos so I mentioned earlier on as you can see it's either the bottoms and tops but these little grey dots here are the little sensors that are measuring your muscle performance as you're exercising so it'll start helping you with recovery rates for example it'll start helping you around how your muscle is working better than another in relation to some of the weight training you're doing and of course as I described professional teams who start managing that they're much better and then LUMO which is a completely radical change from that helps people with posture issues Scoliosis has been the extreme version of that there are people who are long before that who visit their osteopath or their chiropractor on a regular basis largely because they're sitting at their desk stressed out on a keyboard, hunched over a keyboard which is extremely bad for you the human body was not designed to do but this thing will help you it will gently vibrate to remind you that you're sitting in a really bad posture you should do something about it so this is just a very minute sample of all the ones you've seen but it does take you away from the stuff you're wearing with your wrist and show you some of the other things that are arriving in consumer space that are going to make quite a difference in the way in which you do sport for those of you who are adopters certainly the rest of you then at some stage in the next few years you'll find it the only thing you can buy in a store will probably we're going to medical side diagnostic chronic and monitoring so a live call one hit is a single channel ECG so I can measure my heart rate just by holding my phone between my fingers and it's 125 bucks to buy all I need is an iPhone I can send the whole I get the full trace of my phone and I can send it to my doctor this was one email and it is so cheap that the Apollo hospital group in India assigned a deal with these guys to launch that particular device in their hospitals more at the surgery primary care level to enable doctors to do ECG tracking of their patients rather than buying the general electric machine or the philip's machine that's thousands of dollars now you could probably say the general electric machine is far more accurate in terms of what it does it's probably a 26 channel ECG etc but as a starting point, an indicating starting point while you're talking to the patient you just give them the phone and let them hold them between their fingers and they'll give you that information your ECG trace within 30 seconds sitting on the back of an iPhone 5 passing around then you've got Xeo Xeo basically is what I was describing by way of hypertension treatment so you basically wear it as a blaster stick it on your chest battery lasts I think about 14 days 21 days something and it will trace your heart behaviour over a long period of time but on a regular basis as well so if you are at risk usually for patients who are at risk then your physician can prescribe this to you it's on a small trial basis in the US at the moment for you to actually go on your everyday life everyday way of life and wear the patch on your chest and collect data that you can then provide to your physician or your professional cardiologist you can start making some informed decisions about you rather than just a measurement so they can't really do when you come into the surgery so it's very very powerful all of these are apart from a Q all of these are over the April so you can start seeing them peering in surgeries in the US there's no reason why they shouldn't appear in Asia and certain countries that are looking for ways of delivering better health care at a price point you know this will start replacing the stethoscope which was invented in 181916 it's largely everyday type of performance in terms of diet deficiencies you know you're taking the right level of zinc inputs etc so at the moment it is limited to what you and I would want to know out of it but that's deliberately designed that way what we're trying to do is get great attraction with consumers but it will go much more in depth in relation to being a much more I'm trying to think of the right word now I've come back to a bit you know a inner box on the desk physician type analytical tool probably what's the Star Trek term for it the tricorder it's kind of a mini tricorder that's its destination which there's a competition for is there a tricorder competition? there is, yeah which I think was awarded last year I forget and the tricorder did not win it it was another player that won it I forget the tricorder is technically the the joe average tricorder that's one of the more successful Kickstarter campaigns they've had endless issues getting it right they've gone through it they end up modifying the parts in it which meant that all their data was no longer FDA approval so Star Trek legal trials all over again this is a story I always relate to all that health care startup entrepreneurs I work with in terms of it ain't that simple to get one of these things out in the market okay it's going to do is European and it's my little symbol there it's not all US there are other inventions however the sad story is that he couldn't get funding in Europe because he's got more funding than he needed to go to that's the nature of things that lead the US to where the money is we'll look at it in a minute okay the most powerful biosensing wearable is your phone so before you rush out by Fitbit or Misfit or whatever if you've got yourself an Android 5, 6 or an iPhone 6 or 5 you've already got all that it's built in your phone so don't waste your money literally it is the most powerful because we pretty much all own one in the room we take it everywhere we go it's full of the sensors that track every day and therefore we can end up with information on sleep activity, lifestyle habits just from the one phone and then of course you start tagging on to that the new open source software that Apple's released and you literally have an incredibly powerful biosensing wearable to which you can apply a whole bunch of apps to analyze that data and that's where it's going so the watch will only add to that so you'll be able to literally everywhere you go whether you're asleep or awake okay just very quickly on adoption at the moment adoption is reasonably low that's a fairly big number I know but it's reasonably low and reason for it are the number of barriers you've got standing in the way that you would expect and that's usually the sort of barriers you would expect when you're looking at new technologies lack of awareness the data is not valuable I think someone may be coming over here on around collecting this data but don't get anything out of it that is a constant approach that everybody has for the wearables you can buy at the moment but I think based on what we see with the Apple launch etc that we are seeing a massive shift to adoption people are starting to use these things a lot more be a lot more aware of the possible but also at the same time be able to get a lot more of that data so I think this is going on the data but it basically has a prediction that we'll move to a quadrupling of the value of that market so you pretty much a massive pickup adoption purchase of wearables going forward but I mean wearables in the sense that I was talking to you here not just a thing to stick on your wrist okay I'll stop there are there any questions on that are there any buy-sensing it's very variable from country to country it's a single bore which tends to be very gadget savvy and friendly, you see a lot more in the UK I was surprised at how low penetration was at this stage it's still seen as a gimmick probably less than that to be honest with you probably less yeah but most of what we can buy at the moment is that stuff on your wrist the other stuff I talked about I'm literally trying to come to the market now I thought so so for instance in terms of the biological the technology can be really fast but some of these will change then some of the what? the biological relevance so the things that you can actually measure and whether what you're measuring actually relates to something how much is the product so I think if I answer any question the limitation, the handbrake is twofold one is the sensors to be small enough to be able to place in the device that doesn't get in the way of your everyday life the other is battery life these things run out of battery very quickly so until we figure out how to put longer batteries in small spaces we're going to continue to use some very limited usage of some of these things so what I'm saying is that the biological side of it because you're using sensors to protect stuff it's either already a known sensor for certain readouts like mucosa or something but beyond that that's just acceleration but beyond that for diseases or other when science understands disease there's not really much limitation beyond the hardware being useful let's say where science doesn't understand because of course there's a great deal of research you should take place before there's any useful application of a sensor the biggest handbrake is the the doctor there, the behaviour but in terms of biology it's really the miniaturisation of stuff that already exists in a hospital or a doctor-surgeon in terms of built measures in fact like MCM for example protects the whole set some parameters in a lot kind of changes in that because the level of order in the line I think it should start to improve now it's a good example of how miniaturisation is coming into play but it's not ready for launch yet so they're still doing trials ok, healthcare landscape is shifting as a result of this what I mean by that, I'm talking about the big industrial players, big med tags the GSGAs, there's no fees in this world largely because spending is inefficient or non-existent depending on whether you're dealing with Myanmar whether you're dealing with the US policies are changing to reflect all of this most of the material markets don't afford their healthcare bill anymore there's an increasing focus now on outcome rather than just doing tests new business models are therefore starting to take shape I should change this, which we've talked about a bit earlier on at the beginning of these slides and I talked to you about the number of new entrants in healthcare from other industries that are coming through some examples I won't dive too much but I'll keep an eye on a couple there so health insurance is changing radically in terms of the way in which it is being administered consumed and administered and we talked about it a little bit earlier on in the US there's a big vertical keys a very large IPO last year in Asia we've got our own, it's called Connection Asia a very successful lady ex-mercer has launched a business a closed series of funding this year $8 million raised from 3-4 VCs so that's quite a powerful one in electronic health records we've talked about practice fusion earlier on there's a little Singapore company called Our Health Mate that's something similar PRACTO or as others as well but just to let you know, it's time to give you a flavour that Asia is not being left by it's doing its own thing as well just looking at business models very quickly what I was trying to do there is to help you understand where we're seeing traction on the B2B model so business to business model versus the business to consumer model what's interesting to see is that generally most of the business models we're seeing so I'm not talking about wearable devices anymore I'm talking about businesses as a whole that are dealing with digital medical information business out of it they're seeing great deal more traction with business to business application the consumer is generally very fickle if you look at the adoption of Fitbit for example generally that was a spike usage for about 2-3 months and then it starts dropping right off so unless you find them a reason to actually get the owner to re-engage their Fitbit the end of that curve tends to be the Fitbit it gets parked in the drawer and never used again so there's still some way to go before we start seeing a valuable consistent, sustainable revenue model from consumer digital health so most of the stuff that we use is free it's not making any money for anyone however on the business to business to start to see a great deal more so some of the things I showed you are wrong practice fusion resolvable approaches are making a lot of their money largely because they're selling a service to the industry as a whole as opposed to selling it to a large drug for post launch data for drugs this is my cheeky little go at the industry I call it rebooting the life science industry I talked about clinical trial data and how that was changing now that everybody's got a phone in their hand just really quickly talk about pharmacogenomics here to your flavour most drug firms design a drug by finding a molecule entity that looks exciting and then try and apply it to various diseases so they find a connection to they end up with a potential product then take down the trial phase a bit here to miss usually there's a whole industry now of screening agencies you give them the molecule they go screening and the entire database to work out what it applies to but as you can see it's immense you know you could end up a few weeks down the road finding that molecule doesn't actually do anything and it gets parked and you go to the next molecule etc and so you end up with products that a lot of good ideas that don't make it through and so you end up with some of these products only being applicable to some people as other people I give you an example the most common treatment for diabetes is metformin I think it's something like to 20 percent of patients to whom metformin is described have absolutely no effect on them at all because it's not designed for they're not the right genotype for a particular product so where we're seeing a big change in drug design is the example I gave you of 23 a meteor you deal with rush what rush is doing is using the data to understand a particular profile of a patient with a specific disease and then to understand what protein is broken in the DNA chain of that patient they then work out what drug is actually a molecule needs to be administered to actually change that protein defect and correct it so it's much more precise we're starting to see that coming through on some new drugs because generally in the oncology drugs they're heading for immunotherapy where it's targeting the cancerous cell directly rather than the usual chemotherapy approach which involves the entire body but that's where drug research is going so an example in the UK 23 a meteor talked about it wrong with rush and Pfizer do your deal so rush did a deal that was no price did disclose but rush and genetic did a 60 million deal with 23 a meteor in the UK NHS which is a national health service has a thing called genome England which is a new database they've created where the 100,000 patients with a rare disease have been uploaded into it and these guys among 12 others I think I think it's 12 others but these guys are leveraging this data on a pro bono basis to understand how they can define better treatments for the patient to have a rare disease the moment there is no treatment so they're using the genome sequence to understand what protein is to be dealt with and how they actually try and correct that protein so you can see in your head is no doubt the radical change in R&B going on at the moment from you know pretty much an average approach to very precise targeting of disease that's why Clayton criticism referred to the precision medicine phenomena there's now going to be about you rather than the other 10,000 people looking at it yep I talked about very quickly so I won't spend too much time on that but it gives you a flavour of how that's changing I can simply quote this example most countries with a central pay-off such as the government will take a drug firm through an approval process to get reimbursed now in the past it used to be quite easy because it was all about finding a solution but now of course that's why because a government is currently setting forward the treatment how many of you, if anybody followed the Gilead saga the last year they released a revolutionary product the Hepatitis C but it's a thousand dollars a pill so the cost is exorbitant but people have obviously been described it because it's a miraculous drug but it's working out people to the fact that you know it's more of an outcome than it has to be about treatment it's quite interesting where J&J tried to get approval of the UK for a drug that was treated on average 35,000 dollars a per annum initially we're told they weren't going to get approval because the government of the UK which has an agency that obsesses this stuff said we can't see sufficient benefit in this product therefore we're not going to reimburse it what J&J said is that we're not going to charge the patients until they've actually seen the benefit so that got it approved immediately because we'll only pay when there's a benefit so what's interesting is that the data you're starting to collect from some of these applications that are sitting on your phone is starting to create that data that demonstrates the benefit on a sample of millions of people at a time rather than a few thousand at a time so the examples here are Elin is a Singapore based company Rika is a Singapore based company this one I've talked about already is a research scale but we're starting to see some interesting midsize companies coming out of Singapore that are actually deriving quite a decent business model from that new phenomenon going on in the clinical trials okay, any questions on that I'll try to sort of touch on how it's changing industry we could talk about insurance to plan out our own for example but it's changing a whole bunch of things okay, funding I just wanted to touch on a few points in relation to funding to give you a flavour of what's happening because that gives you an indicator of where investors think things are happening in terms of trends and therefore how you can improve that so there's certainly some themes coming out of it which I'll talk about in two seconds Virgin Capital in 2014 doubled what it was invested in 2013 which doubled what was invested in 2011 so in terms of venture funding in healthcare it's the fastest growing area of healthcare getting money at the moment way more than biotech way more than mid-tech so growing number of technology investors which means that basically Google moving in, Apple moving in and of course big pharma companies and big mid-tech companies are too a large number of M&A deals so I can see some of the big players acquiring the little startups and just give you a flavour last count it's seven and a half hours around the world it's a startup it's a big ecosystem so that's the trend so you see digital health dwarfing the other two and it's only dwarfing funding as a whole in VC that's the trend year on year 14, double, 30, it's doubled in 10 there's some key trends there's some analytics and big data going from there to there to now number one healthcare consumer engagement so what you and I use on a day-to-day basis number one, number one, number two the fastest growing area at the moment is telemetry being able to reach a doctor from remote without having to go and visit he or she in their surgery for example I'll skip that that's too small for you to read but I just wanted to show you the number of M&A deals in digital health now worth about 20 billion back to Dickinson Neutronic, AstraZeneca Weight Watchers and here you've got Facebook so you've got all sorts of deals going on with the big guys coming into digital health space just to give you a flavor Roche did a deal a couple of weeks ago as well they're all coming into play which is that, consolidation I was talking to you about in the beginning and that big map of startup big change I was wondering would they ever wake up when I was in the industry but certainly starting to see a major wake up I know your company is waking up as well yeah alright I'll just give you a quick flavor of Asia I talked about that briefly the 199, 200 startups that I last counted and then just give you an idea of trends in terms of where the bulk of them are versus so big data is quite small at the moment in Asia that is but consumer health and wellness in other words apps that you and I can download and use quite a few Asian startups in that space it's a very big deal there's millions of dollars invested and the stage in which they're invested and who Singapore Singapore and Singapore again so India, China and Singapore are the growth zones for digital health startup funding in China and India is a massive business case 1.3 billion people in Singapore the principal driver I think is the regulatory intellectual property of the legal framework that's making it much more friendly for startups to come here rather than sitting in Vietnam or Indonesia for example or probably still there is loads more information but I'm conscious of this anything that makes sense any questions I think earlier you mentioned about this company and Singapore startup doing electronic health records but the thing is for you to even collect data on electronic health records the hospitals must be willing to open up their EMR systems I mean so this is something that has to involve all the institutions in Singapore both public and private so how do all this companies try to navigate this so largely they provide the free they largely provide software for free so that's the attraction for the clinic they will take the software for free and use it and then of course the startup works out different ways of monetising that Singapore is a peculiar case, the government is rolling out a platform for all medical centres hospitals, doctors etc the electronic health records I think Accenture is the consulting firm that's actually doing the top technology for them I think they're on 30% of all physicians I have now digitised their patient records so I think broadly speaking MOH will tell you that it's going well I think people will tell you it's going slowly but it's happening the US has got something similar going on at the moment as well there is a bit of push and pull going on so the private sector is giving things free to actually be able to do other things with it but the government is starting to take a broader interest and try to be much more efficient in terms of way healthcare administered by getting better insights of the data if the government is really throwing out an electronic health record system then how are these startups cocky against what the government is like well there are two ways of looking at it one, so our HealthMate is doing a fair bit of business outside of Singapore they're based here but they're doing this outside of Singapore where there aren't the governments that are doing this particular options and in Singapore the government's system is pretty much a repository of information so it gives you the key areas of information in terms of database doesn't really do too many analytics and they diagnose of sport so that's why you're starting to see them move into a better way that you can derive from that data to help clinics be more efficient so when a patient comes in how do you triage that patient more rapidly to major case to doctor minor case to nurse result sorry the data at the moment it's your physician owner Singapore is owned by the physician but the overseas is owned by the patient physician yeah it's a cultural thing in Asian countries the doctors keep yeah I mean in Asia and Singapore but what about let's say in the EU or in the US it's still very much held by the healthcare organization to which you're aligned to or connected to so essentially your physician is the only person that has access to that data you should have access as individuals as your data but you don't actually have access to this data that's one of the things that needs to change over time in Singapore currently who owns my data like some data with the doctor who actually owns it your physician I mean I don't know that for in terms of legal perspective in terms of who's accountable for it then your physician is here PDPA kind of starting to move the most the patient owns the data trying to the mechanism is still run the patient is not ready so it's going to be a while before that she becomes available to you because there's a lot of these startups about selling using the data providing free to another company so I don't see there's any regard to who owns it well a lot of that data you're talking about is completely anonymized anyway and aggregated so once it gets anonymized it's okay no no no it's certainly Singapore and the UK I think there's some very strict protocols to who can access and how etc we're talking about your medical data held by your physician or your hospital it's a different story of Fitbit data Fitbit is selling your data to every marketing company analytics company you can possibly hear the money hopefully you'll be that linchpin and you will be starting to bring it together in one place so theoretically you'll be the only person that has this ability of all of those data points in one place well a while away from that but I'm just painting a picture of where it's going where I think it's going so what are the remaining high unsolved problems so this is what people are addressing right now but I don't quite understand what are okay let's say I want to get into the space where are the largest unsolved problems if I'm usually honest with that I wouldn't be telling you the unmet medical need in Asia is massive so the US is dealing with one problem which is how they would use their costs before you're seeing in Asia it's some sort of thing it's starting with how do you create awareness in the population that there is a diameter to change your lifestyle so there are some massive medical needs which are obvious the challenges have you actually to change I think when you mentioned lifestyle I think with the two parts of the equation when is the food when is the physical activity so I think the wearables kind of covered it in the physical activity side but maybe the food is not so much an individual middle of food I don't know if that sounds tricky there the challenge with technology and food at the moment it's really hard for the technology to look at your food and say hey that's what's in there it's changing some couple of interesting devices out there actually seem to be able to do that better but at the moment it requires you to enter the information yourself which is the pain I don't know about you guys but I gave up doing that after about a week I just got fed up typing every single thing I was consuming into my phone and so immediately the diet thing fell out of the equation so it told me how many calories I was burning but it wasn't telling me how many calories I was consuming and if a diabetic is useless it doesn't make any difference it's about carbs so you can see the more complicated lifestyle is a bit broader than that it's more than just activity so if you're a taxi driver and all you do is sit behind a car steering wheel that is an issue to your lifestyle theoretically a taxi driver should stop every hour and walk around the block they don't obviously they can stop just having a cigarette but that is a massive impact on our individual lifestyle so every government is looking at it very closely they are looking at it carefully because it's obviously understanding first what you can make a difference in versus what private enterprise can make a difference in it's all taxpayer money they're looking at it from a perspective of what can they borrow from somewhere else rather than invent themselves there is obviously all the legal rails you decided to address in some countries like the UK or Europe generally it's a previously challenged that you need to get over getting people comfortable with the fact that it's actually for their benefit rather than big brother looking at their health records for example so it's classic government moving slowly Singapore government is certainly one of the more proactive let's say precociously we want to call it governments out there in terms of what they're looking at UK is doing a reasonable job Obama is on record in the US that's where we're going so quite a lot government level regulations but there's a lot of information there for you governments is going to have to play a massive role in this and so you've got huge difficulty in the OECD government that's trying to find ways of being more efficient and you've got the developing market trying to find ways of delivering better health care because of substantial underinvestment for many years that's what we've been carrying on so they've had a lot of really reactive I want you to call them reactive at the moment I know a lot of them are watching to figure out what they do and training forwards where they think they can get traction a lot of this and I think someone dealt with it earlier on for example is why are we not seeing change in the government, why is it that wellness is not you've got to remember that government's decision makers are politicians politicians are elected for a short period of time and so a lot of decisions should be taken but actually don't affect what's happening now in their term, won't be taken necessarily because it'll be someone else's advantage not mine, so you've got that short termism that's also standing in the way of getting some real strategic policies taking place there's an interesting healthy tension between industry, government in terms of trying to push the agenda what are some negative implications that you guys perceive going on in these areas in terms of more data that's becoming available if you're making the wrong choices if you're not healthy in terms of business activities there are risks to this if that's what I'm referring to how will employers deal with the information they've got how will insurers deal with the information they've got could insurers actually have access to that data they're worried well how many hypochondriacs are going to create out of this so there's a lot of risk to it without that we've got to be careful we don't let the risk get in the way of what is essentially a radical change for healthcare and a benefit to all of us in the long term and there will be teasing issues there will be data hacks there was a massive one in the US last year a big insurance company got hacked into they hadn't encrypted any data records so of course they got hacked into so we'll all have to learn but data privacy, it's a mess guys anyone who's using Google or LinkedIn or Facebook you said goodbye to your privacy a long time ago I wonder what about so we're going to start with more small how you guys are going to talk about the rising cost of developing drugs I think they actually call it the euro swap because it's the opposite of what was going to cost of developing drugs is going higher and higher so is it going to be care about the and so forth you're going to afford the best drugs for us if you're poor and living in bad conditions you have to be a serious group what's that going to happen no but I think like any innovation there's a barrage of entry which means that wealth of people will be able to afford it for less well advantaged people but you need a certain amount of that to be able to create the volume or the industrialization of that particular technology to be able to bring its price point down so like any innovation generally it's the people who are well off who get the benefit first they eventually dribble down to the rest of of the population at the bottom of the pyramid you know it's up to NGOs, governments you know those kind of stakeholders to try and expedite the reduction of price point so one of the interesting phenomena we're seeing in a moment is why we're broadly called frugal innovation so the example of this thing for example suddenly now Apollo hospitals is in a position to do single channel STG with any single patient in India for the price of 125 bucks well it doesn't include the first sorry but most doctors got a Samsung phone anyway so it's not creating necessarily creating a prohibitive price point actually you could see it a bit of the other way in relation to the technology allowing a much lower price point for the delivery of healthcare therefore rural villages etc to afford some of the technology companies work with an Indian company doing a prenatal scanner India and Indonesia have missed millennial development goals for infant mortality year on year on year after year two reasons for that or key drivers for that one is newborn when you go back home mum is busy doing cleaning washing, food cooking and handling the newborn baby so you can see the disease traffic in the house usually it has been very successful in trying to reduce that sanitation issue for example reducing the size of the soap bar a rather large expensive one to actually a small one they can afford every day a major issue for a lot of farmers for example and creating awareness through telephone, SMS campaigns radio campaigns etc another one of course is the fact that there aren't enough obsguining in India and so a mother will generally end up in the rural area giving birth of that and even obsguining being available and usually it's a midwife who's half qualified or not qualified so if it's a straightforward birth it's not an issue, it happens it gets complicated in breach and those kind of things you need some tools to be able to define whether it's time to do the inception and some of those tools are all prohibitively expensive or require quite a lot of level of training to be able to use them so this particular start working with is to find a device that actually works with the phone and so not only do they reduce the price when you can clean it you can do the prenatal scan much every single village can afford one but at the same time the data is interpreting on the screen on the phone that a nurse or a half they call them they have a yellow name they come back to me can look at the screen and define whether it's green or red as to whether there's a risk here and therefore do they need to then go to the telemetry mode and talk to the obsguining back in Delhi because if you ask the Dale what's going to come to your village they'll come or only three weeks time from now of course it's far too late just to give you an example of where it's not necessarily prohibitively expensive it's actually reducing the price point any other question? in that case your round of applause to continue we'll actually go to Hans Cafe which is at the National Library Board across the street National Library we'll probably need about 15 minutes something like that to wrap up here we'll go across the street if you want and I'll talk about these things and yeah, next one in about a couple months so thank you everybody thanks a lot