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

Before we get started, I want to share with you the fact that there are incredible breakthroughs coming on the health span and longevity front. These technologies are enabling us to extend how long we live, how long we're healthy.

The truth is, a lot of the.

Approaches are, in fact, cheap or even free. And I want to share this with you. I just wrote a book called Longevity Guidebook that outlines what I've been doing to reverse my biological age, what I've been doing to increase my health, my strength, my energy, and. And I want to make this available to my community at cost. So longevityguidebook.com, you can get information or check out the link below. All right, let's jump into this episode.

Our panel here today is titled How Can AI Democratize Health for the Next Billion? And to contextualize this, I'll simply say that given the the development of AI and wearable sensor technology, there is no excuse for a world ten years from now without a massive increase in health. There is no greater wealth than our health. Every mother wants one thing for her children to be healthy, and I think that's a world that's more peaceful and more prosperous. What I'd like to do is ask each of our panelists to just take one minute and introduce themselves from the perspective in which they're here to speak about this. Each of them is bringing a very different, unique perspective on global democratization. Will, would you kick us off?

Yeah, absolutely. Very happy to be here. Will Ahmed. I'm the founder and CEO of whoop. We build wearable technology to unlock human performance and improve health. Combination of metrics like sleep and recovery and exercise and stress, a bunch of physiological measurements like heart rate and VO2 max and pulse ox, skin temperature. These are all the things that WHOOP is measuring. And as I think about the potential of continuous health monitoring and AI, you can imagine a future in which you have this 247 coach that's able to look at all of your data and really understand for you what you need right now. And that will include lifestyle decisions, that will include diet, that will include when you need to see a doctor or not. And I'm pretty optimistic that the future of health monitoring will make the world a much healthier place when coupled with AI.

Thank you, Will. I couldn't agree more. Dr. Oz, what perspective do you come to us with?

I'm a fan of Peter Diamandis. If you follow what he's doing, you'll probably do well in life. But along the way, I realized that I'm a heart Surgeon by training, and much of what we knew was causing chronic illnesses amongst the people I was doing open heart surgery on could be avoided if they took some prophylactic measures. So to tried to tell folks outside the ivory towers of Columbia University, where I'm on the faculty, how to do that. I started doing more media. So I hosted the Dr. Oz show, which aired here in Saudi Arabia for its entire course of 13 seasons and then 120 other countries. And I learned a lot about how people around the world saw the challenges to health. Early in this process, I launched a show with my partner Oprah Winfrey. We started a company called sharecare that was run by Jeff Arnold, who is the founder of WebMD. And it was the biggest digital health platform in the United States. And we began to learn a lot about how to give people digital tools. The big lesson we learned is you want to give them rewards, which we'll talk about a bit more as we come along. Some of the rewards are informational, but oftentimes you just literally want to give them something. And it's especially evident with people in the working place. So Mohamed Zamashari, please stand. Mohammed is a pediatric surgeon, our partner here. But we launched and just agreed with this with the National Council on Occupational Health to bring this Sharecare platform to all 1.2 million businesses in the Kingdom. And in the effort to get to more than 10 million workers and many more coming from other countries over the next few years is projected is to get them to be healthier. And I'll just give you one fact that might highlight why that matters financially. We ran the numbers in the United States. If you can get the average person to retire not at 61, which is the average, but 64, that three year difference in that one age cohort is worth a trillion dollars to the US economy. That's enough to close the US debt, which is one third of all the debt we have in the world. It's also enough to make our social programs like Medicare and Social Security solvent. The same would be true here in Saudi Arabia. And this monograph which the FII put published, if you turn to page 60, this is a list of the attendees and what everyone is doing to stay healthy. So you can pick these up, you know, in different places. But in this list you'll notice two things. There's common products like probiotics that are being used by a lot of people. But. But 20% of the attendees are asking and taking, maybe taking, but asking for metformin, which is a prescription drug. It's linked with longevity. So it's a very sophisticated group here that are looking for ways to biohack and even spa hack. 30, 40% are doing cold plunges and sauna. So there's a lot of awareness of prevention. How do we activate that? AI would be the best way to customize.

Amazing. Dr. Tannenbaum, please introduce yourself and your perspective on this. Thank you.

Peter, another huge fan of yours and thank you for having me. I'm Jim Tenenbaum, I run Foresight Capital. We're a three and a half billion dollar healthcare focused venture fund, have a great interest in the intersection of AI and healthcare in general. We believe that over the next decade there's going to be profound impact and change that comes through the two coming together. There are two categories of things that we're looking for, things that are more readily integrated on top of the existing healthcare infrastructure. And one way of thinking about this is that we have right now a healthcare delivery delivery system in the United States and globally which has a very wide variation of standard of care and AI methods are going to be able to narrow that variation so that we're able to deliver more uniform best practices across patient population. And we think that those are the types of things that are going to roll out over the course of the next five years. And then there are larger questions about, about given what we know now, how do we redesign healthcare delivery? And it's interesting here in Saudi, in fact, the government has been embarking on that exercise and in the United States it's very hard to change a system that's so encumbered and has been around for so long. But nonetheless we have an interest in looking at a very long term project of reducing, recreating and reimagining healthcare delivery in the United States. And hopefully over the next few years we'll get involved with something substantial that focuses on that. So those are our interests.

Thank you. Thank you, Jim. Amir Rubin, please introduce yourself and your perspective here.

Well, thank you. Great to be here. I'm in the fan club of this entire row of people, so it's a privilege to be here. So my background is in health, healthcare, innovation and delivery. I used to be the CEO at Stanford University's Health System and then I was Executive vice president at UnitedHealth Group, big Fortune 5 company and then went to a startup, One Medical, that reimagined the doctor's office and combined digital health and in person care. We took it public and then we sold to Amazon last year. So if you're a US Amazon prime member, you could add one medical for nine bucks a month. You could get all you can eat on demand digital health. And then in 31 markets across the US in person care. And what I've seen kind of across my experience is how do you take this great innovation that all these amazing people have shared and how do you fit it into workflows of both kind of the demand side, the problem statements for consumers and employers and payers and the supply side, physicians, clinicians, nurses, care coordinators. And so right now I run a venture firm called Healthier Capital and we're investing in health tech. This intersection of how do we take these great exciting technologies but yet fit them into the workflow of clinicians? And I'll use an example from one medical as the kind of things we're looking for. So at One Medical, a consumer within a minute can have 24, 7 access to digital health. No copay, no deductible, no claims. And we charged a membership fee nine bucks a month. So how did we not overwhelm our providers with unlimited demand? So we built our own technology and we first used natural language processing. Now some generative AI approaches that reads the emails based on the content, pulled it out of the physician inbox. We then staff a national 24. 7 team. Not all of them have to be physicians or even clinicians based on the content. Then we had a human in the loop. But then generative AI now helps draft the response. So we can take 50% of the tasks off of a physician, yet then have one to two minute response for the consumer. It's an example of how do you blend technology into services. But Peter, I want to throw it back to you so I'll play moderator on this end. You have an unbelievable background and been a student and fan of you and xprize and I know you're a thought leader. Please share a little bit about how you're thinking about this in healthcare.

Sure.

I like studying how industries get massively disrupted. Right. So the ptts, the telephone lines around the world got disrupted when a service that was not 10 times 100 times better came in and made getting a landline irrelevant. Right. And so we see India with Gesh Ambani's 5G network. Just amazing. We saw Google come in and make libraries irrelevant. I'm interested in completely crushing, destroying, obliterating and reinventing the health care industry. And I do think that we're going to get there relatively quickly. There's a point at which why would you ever go. There is a point at which AI is the best Physician. Period. Right. Where it's malpractice to diagnose without AI in the loop. There is a point at which most of your data is collected on your body, in your clothes, in your car, in your bed, in your urinal, all the time. And that data is fed up to your AI that's monitoring you not once a year for a checkup, but continuously through your day and finding things at the very beginning. So I'm interested in what countries are going to reinvent healthcare and make us healthcare super jealous that we don't have that. Yeah. So I'm not interested in incrementalism. So I'm going to start with you, Mehmet. You have some fascinating data. How do you think about the rising billion? I'm going to not call it the bottom billion, the rising billion, and how this will support them.

You mentioned AI and I share your belief that study, by the way, in your panel when Jack Henry was describing Sandbox EQ's large quantitative model.

Thank you for that opportunity.

Amir, you should moderate.

I've watched from the best through the years. Dr. Oz. So I'm trying to learn.

But well done then. Emmy award winning quality work. The big, the big opportunity with AI I think is it's honest.

Honest.

Now I asked if noted. I'm sorry.

Not. Not judgmental.

No, it can be. It can make mistakes, obviously it can hallucinate. But there's give you. I'll give you two examples. The one classic example that Jack Hidary shared with me years ago when I was first trying to understand what this was, was pathology slides. So if I get a pathology slide in a western country for prostate cancer, the pathologists will overread cancer. They'll see there's more cancer than there really is. Why would they do that? They do because they're humans. They don't want to miss a cancer. So they'll say something is a more advanced tumor than it really is, just in case because they're not sure. Pathology slides read by AI don't make that mistake because they're just bluntly telling you what it is. So the right number of people have their prostates taken out. That's true in the West. It's also true in the East. But the more pervasive issue today is we have a little bit of a illness industrial complex. There's a lot of money spent to make us sick, making foods that aren't good for us, subsidizing those foods. Sometimes they're addictive foods. You know, we support. I think we probably put as much money into tobacco subsidies in America as. As fruits and vegetables. You know, it's just not done in a way that objectively honest person would want. But these are historical realities why these were done. I'm not blaming the people. It just is true that we're not doing our best. AI generated advice will have to tell you the truth. It doesn't fall prey to human failability because it's kind. To be kind in an effort to be kind hurts you like a parent who loves you but does the wrong thing by enabling behaviors. It also will take on special interest groups that maybe don't want you to do the right thing. And I think if you put those together, we have an opportunity, not just in the west, but also in the rising billion to say honorably, your water is so poor that you can't be healthy, as healthy as you could, because you have arsenic levels 100 times more than they should be. So as a country, you need to do a better job with water supply. I mean, basic stuff. It's not just curing polio, which would be nice also, but it actually starts to get into these issues that expose pathology that otherwise we would ignore.

Will, how many. Excuse me.

Can I ask it?

Yeah. How many hoops are in circulation? And what you mentioned, what you're measuring.

Today.

What would be the next three or four things that you would love to be able to measure physiologically in the body? Where are you going?

Well, when we first started, whoop, we looked at what were some of the more capable medical technologies out there, and how could we put those in a smaller form factor? And so initially it was the PSG machine, which is like the gold standard for sleep monitoring. It was the electrocardiogram. But in particular, to be able to measure heart rate variability, which is this fascinating lens into how your body's recovering. And it was actually the chest strap, which is the heart rate monitor from the 80s that athletes wear to train and being able to measure heart rate accurately during all sorts of different activities. Now, the good news is we've now been able to take those technologies and put them in a small form factor that has the same level of efficacy. And if I think about going forwards, all the new capabilities will probably go back to a similar place, which is just saying, what are all the different pieces of technology that you find in a hospital room or that are off the shelf, you know, more cumbersome pieces of technology that you'll be able to put in a much smaller form factor, much more affordable form factor and democratize. I mean, Just think about the fact less than 1% of humanity measured their sleep last night. Yet we know that sleep is essentially one of the most important things you can do for longevity, for performance, for really reversing all sorts of disease states and everything that could go wrong. And yet such a small percentage of society today is measuring it. So it's often asked, well, what more can we measure? What more can we measure? I think a good starting point is just getting a lot more people to be measuring their bodies because you can only really manage what you measure.

Sure. I'm curious. Both of you have been in the medical system, investing in the medical arena. Do we start from clean sheet and work up, or do you try and take the existing systems and. And improve them? Jim, how do you think about that? I mean, I like your categorization to simplify. But do you, do you want to live? Are you going to live long enough to see changes made?

No. No. I mean, I hope. Hope springs eternal, you know, and I think, you know, you know, in venture capital, you start off with, with macro themes. The macro themes bring you to entrepreneurs and the entrepreneurs bring you new investment opportunities. So the macro theme is to use AI to make care of delivery more uniform. Then the entrepreneurs on the ground that are delivering that have a spread of ways of going about it. I would say, ironically, there's not a tight correlation between revenue growth and technology excellence.

Can I, can I ask, on top.

Of that, do you think that doctors will change or medical systems will change? I. I don't believe so. I think it's. They're so ingrained in how they do what they do that to get people to actually change is almost impossible.

Well, I think there's small change and large change.

Okay.

And there's who's at risk and who can benefit from change. And in places where people go at risk and they can deliver, we're involved in a cancer care delivery company that's making some changes to the way that cancer care is delivered. Originally, we were hoping that they would be really heavy on the tech front. They've just been really heavy on the figuring out how to get doctors to accept various changes that are, and, you know, that are easy for them to accept.

I mean, how long did it take for cardiologists to accept using AI to read an ekg, Right. I mean, stethoscope.

Stethoscope. Just now. Just now we're getting doctors to allow AI to analyze acoustic sounds, which we're so bad at objectively. We're bad at hearing Austin Flint murmurs Please.

Well, and I think it's a great question, Peter. I think the answer is both and meaning I think we're going to have innovation and continuous improvement from within the ecosystem and sometimes we'll have disruptions from without. But if one is naive to how the ecosystem works, I like to say big healthcare always wins. But I think also understanding the stakeholder needs. I actually was just with a kind of cancer almost customer relationship management software company that's helping manage patients longitudinally and a lot of practices in community practices they don't have a, the knowledge base and then the staff to manage kind of the symptoms and follow up on, on these immunotherapies. So they're not using the latest generation. So part of the answer there is okay, and by the way they're not getting paid for that time.

But this panel is about the next billion. So let's take it there.

So I think then the end on the next billion is however, then there are some approaches that can leapfrog these things and we're seeing this now in a lot of this generative AI. So I've looked at a number of companies now where a doctor and a patient can sit across from each other and not only have the system do transcription document what the doctor is saying, but also say kind of do the differential diagnosis. I think it's this, I think it's that it could be this. Consider ordering these exams. And I think back to your other point, Peter. I think this could be an area like we saw cell phones in some parts of the world leapfrog landlines. We could see the same here. We may have more regulatory burdens and more stuck in our current ways in the US Actually I've been spending some time with the Ministry of Health these last couple days here in the kingdom and it's good to be the king. It is. And it's also however good to have a national viewpoint of regulation. We have pros and cons in the US from cities and counties and states. But in terms of having a uniform digital highway, in terms of for having consistent standards, it's very hard to innovate in that.

Can I put forward the thesis and get your feedback which is the I'm going to compare the US against Africa in health. The US has such regulatory burden and such a disease based industry, sick care industry, that shifting the battleship will be extraordinarily difficult. But pick your favorite African nation where there is little but there's 5G, there's smartphones and with the proper creation of sensor technologies we can Have a ground up revolution using AI to democratize health. Just like in Africa we saw the first cell phone based currency exchanges using minutes. Right. Which is an innovation I still would love to have in the US So do you imagine that we might see in five years time and I'll remind you guys five years from now I said this, that we have standards of healthcare improving in the rising billion at the mass level, not at the wealthiest but at the general populist level. Well.

I think the place that has the most likely for that type of scenario is actually here, the Saudi or uae.

Yeah.

And they're already starting and they're doing planning and they're making an earnest effort and Mirror has just spent the last couple days banging around the healthcare authority here and he can make more comments. But I mean you need a lot of factors, you need government that can actually be empowered to make change, alignment, long term thinking, money. And a lot of the factors are.

Here and I think one needs the right financial incentives. We can do it also in the us I mean the system is responding exactly as the financial incentives are.

Absolutely. You get what you incentivize.

So AI and healthcare, we all know where it's supplied revenue cycle, billing, collections, claims, that's where all the first monies to be made in AI and health care. And you know everything that Dr. Oz was talking about of digital pathology and digital radiology, it's there, but it's much, much slower. Why is it FDA approval? Is it through cms? Can you get billed for it? How do you get reimbursed? But we've seen for example in Medicare for seniors in the U.S. we have 50% of seniors now in Medicare, HMOs, Medicare Advantage. Well there is a financial incentives for the insurance companies, for the groups and it's not a perfect model, far from it. But I think to Jim's point it takes leadership at the national level, at the country level, it then takes the right incentives. The entrepreneurs will come up with the ideas.

But just to feed off that, I've been to Saudi Arabia five times this year.

Wow.

So. And I as you have been talking to. Flyer miles, baby, sorry the artificial flyer miles that we have not been able to use. One day they'll donate him to Will. But what I've noticed here anyway is that the real winning game for health is going to come back down to the issues of making it easy to do the right thing. Sort of the blue zones approach. And there's probably a blue zones in the southern part of Saudi Arabia. But you know the other places where there are blue zones, Okinawa, Sardinia, they have done things that just every single day push you to walk a little more. Which, by the way, that by itself is probably the single biggest driver of longevity. The average American walks 4,000ft steps a day. In Saudi Arabia, it's less because everyone's indoors so often, and the optimal is well over 10, but let's just say seven. But that's just a basic example that we can monitor and keep track of. But I think those are the kinds of things that ultimately will allow the extra billion people that we're talking about to rise up. And I spoke on Monday at the African Summit, same basic idea. The leapfrogging that Amir mentioned is happening there already with technologies. And Orbis is a company that looks at retinal images and does AI evaluation to diagnose everything inside your brain, but a lot of other metabolic illnesses as well. Again, we don't do that in most parts of the world, but they just can screen a lot of people. But I think monitoring is a big part of it.

What I'd like to do in our final eight minutes is give each of you two minutes to address that question. How can AI democratize health for the next billion? I want to bring us back there.

Will.

Yeah. And just reflecting on the conversation here, a lot of how at least I've thought about building Whoop is very customer first or like, you know, individual first. And it strikes me that we've talked a lot about, you know, different regulations and, you know, what doctor's offices are going to do. And we've almost looked at it more from a bureaucracy standpoint. But I think that when you talk about a billion people, it's going to come from the users first. And, you know, we might be able to learn something from the education system right now. So it wasn't like generative AI went to the education system and said, hey, we're interested in rolling out, you know, large language models. We're interested in, you know, helping the students better understand how to write papers and answer questions. It was just like all of a sudden, every school around the world woke up to the fact that their students can now write a paper entirely from a large language model. And now every school is trying to figure out, what the hell do we do with this new world? And they're changing way faster than they ever thought they would. And I think what we're gonna see happen in healthcare is that level of disruption where all of a sudden answers are gonna be at the fingertips of individuals around the world, there'll be someone wearing a whoop. And the AI layer that sits on top of that is going to tell them they're about to have a heart attack in 30 minutes. And guess what? They're not going to call their doctor and ask. They're just going to go to the er, Right. And all of a sudden, when these things start to happen in real time, the system is going to have to adapt rapidly. And I think what's so powerful about AI as you talk about a billion people, is that the cost of that level of intelligence is going to be so low that it's going to be touching every individual. And so that's what's going to push the system over.

Amir, going to you next.

Yeah, I think we can have a doctor in everybody's pocket.

Exactly.

And I think actually, technology wise, that's here today, at least kind of a triage and diagnostic.

A doctor or a much better doctor.

Well, I still believe we need humanity and compassion. And also, do you not think that.

AI can be more empathic than a human?

I think that most humans probably, possibly. I do think.

I think the data does show that, right?

I think that's right. And there's good data on that. But I think the key here is today there's a lot of barriers to access information. And even if you have great insurance or great resources, even if your name's on the side of a building, I just visited somebody at Harvard whose name's on the side of the building. I said, how long does it take you to get an appointment? He said, well, I saw a nurse practitioner in 10 days, and his name's on one of the buildings. So, you know, everybody wants that immediate access and service. And so those initial questions, I think we could have assessed. And I think, to Will's good point, I was just visiting with the Red Crescent team, the ambulance, EMS services here, and they've now got kind of remote telemetry. You can measure EEG in the fields or so you could get stroke protocol going or door to balloon time faster, but if it was on your whoop, I could get that even faster. So that's, I think, all very doable. The integration into the existing ecosystem is where it'll fall. But I agree with what Will said. If we could put it in the hands of consumers, of people, they'll have that information. And I think the technology's here and it's available. And so I'm very excited about that.

Wonderful Dr. Tanenbaum.

So, I mean, I agree with the line that everybody's going down doctor In a pocket concept is already here and now. But the problem is it's hard to get a person to trust an AI to deliver their care. You know, the whole.

Dr. Do you think that's generational?

Over time it will be. However, I was going to a slightly different place, which is that I think that the places where it will likely get adopted more readily is where the doctors are accepting of the AI with the patient. And I think there's economic alignment in places that are capitated where, for example, you have six months of waiting and you can effectively make a much more streamlined system because now it's augmented effectively, but still doctors in loop.

Do you think, Jim, that physicians will spend a quarter million or a half a million dollars going through medical school if they're playing second fiddle to an AI that a nurse practitioner could easily.

Well, I don't think there's any, I don't think there's any decrease in, in acceptance rates at, you know, high top various medical schools. It's still impossible to get into medical school. So there's a great deal of interest in it. I think the role of a physician, and this is actually something I've been interested in philanthropically, you know, is going to change and evolve. It has to.

What's your vision?

My vision is more of a business, a business man, woman, you know, sort of objective. What's the best, you know, sort of processes for me to adopt in order to be able to deliver measurably the best care the least expensively.

So more of a health coach and, or consultant.

Could be, could be. Although the AI could power up the doctor too. I mean, you're talking about the last mile, you know, and the last mile could come in a bunch of different ways. I mean, it could be on your cell phone, if that's the way you like. The last mile. It could be delivered to you by a nurse practitioner, you know, as well, if you want the human interaction. But I, I think that in general, physicians that, that adopt these tools are going to be advantaged and they're going to be advantaged in various systems better than others. But I think capitation is, you know, kind of one place where, you know, they, if there's a fixed pot, they can do something more efficient. They can share more in that pot.

Dr. Oz, take us home, please. On, on the topic, I think you.

You teach people how to treat you. That's true in our personal lives. It's going to be true in the medical care system. It has not historically been the case because there was a asymmetric advantage to physicians because they had domain expertise. The word doctor don't mean doctor a teacher. We're supposed to be teachers, not orderers. And I do think the economics of medicine have always been driven to making more money for the people who are providing the care. But the people who deserve more value, who will ultimately use AI to drive it for the extra billion entering the system are the employers, the governments, the people who need the productivity of people. Just being very pragmatic about this. If I'm running a business and my employees are present presenteeism, they're there, but they're not really at full speed. Or they're not there because various health ailments, that's a problem. It's why we focus so hard in the US on employee and occupational health. That's why we're working with the National Council of Occupational Health here with this big program. It's mission critical for the Saudis to have a workforce that is healthy because they don't have enough people to do the work. And it's going to be that way. I think for the billion people as they come into the system, they're going to want to have jobs and stay in those jobs and earn money and build wealth for themselves and have a confidence for the future and therefore consume it runs the whole cycle. We've never thought of health care as that. Health care is always seen as a drain on the economy.

Right.

$4 trillion coming out of the economy as opposed to generating a lot of value for the nations that have high quality health care. So keeping clean water, avoiding communicable diseases, making sure that you've got folks that are able to get basic preventive care so they all can live with a health span that that's, you know, the way they want to live until they're at least 85 is something that's valuable. But I do have aspirations that will go even higher than that. I think 120, which you've mentioned, maybe longer. But that think of how much value there is to someone who's 75 years old, who's learned all that, who can offer back because they've been kept healthy. The only way to keep the system honest is a smarter arbitrary. And AI is the only thing in my lifetime that's sitting close to doing that. So it's going to allow all these transformations to happen. And without AI, and there's a lot of arguments about the good or the bad. AI is not going to be the problem. It's people who use AI who aren't good.

I'm going to. We're out of time. Do a survey of the four of you real quick. Here's the question. When will it be malpractice to diagnose a patient without AI in the loop? Your answer, within five years. Within 10 years. Within 20 years or never. I'm going to start with you.

I would say within five years.

Within five years.

One year.

Within one year.

Within one year. Some of these complicated diagnoses. Why would you not just search it? It's right there.

Amazing. Jim.

I would say less than five for sure.

Yeah.

I would say practically within five years. When the legal system evolves is a different question. Peter, how would you answer it and how would you.

I'm like, I'm going to push it hard as I can, as soon as I can.

20 minutes.

I think within five years is my answer.

Let's give it up for our amazing panel, everybody.

Thank you. Let's get a team photo.