Technology and the unintended consequences of disruption

I have to apologize right from the beginning because I don't have puppies or kids to start my presentation. Thank you, Tiffany. But I do want to start with something that I was really excited about. If you go back a few years, that was my first laptop. Who remembers when they got their first laptop? Right? That was a big day for a lot of us. Well, for me, it was 1989, and the Compaq LTE had just come out. Or it was just coming out, I pre-ordered it. So I was one of the first people to get it. At the time I was living in Dallas. I was so excited. I could actually take this with me on an airplane. Because prior to that we had this big lunchbox. That was the closest thing we had to a portable computer. I get on an airplane and people would walk up and down the aisles asking me, what's it like being able to work on an airplane? Because I would just take it out of my briefcase— back then we had briefcases— take it out of my briefcase, flip it open on the tray, I started working, wondering who was watching me. I didn't know it was a big deal. Since then, technology has come out at a faster and faster accelerating pace over the years, to the point where a new computer doesn't come out almost weekly now. We're wondering what's going on. Or if we have a cell phone that's 8 or 9 months old, we're thinking to ourselves, are we using something that's obsolete? It's just hard to keep up. Well, it's really impossible to keep up. But every once in a while something comes out that changes the world in some dramatic way that we don't see coming. It creates disruption. And I want to give you an example. And these disruptions are typically unintended consequences of the popularity and impact of our tasks. So the example is, I started traveling to India in 2009. And I did that because we were setting up a software development offshore organization. And I got to India, of course, my eyes Because it is so different from the United States, as far from the United States visually and the patterns of life, the colors, the culture that you can get from the US. In addition to that— is this flickering? Yeah. Okay. Okay, got it. In addition to that, the traffic is way different, and I don't know if you can see, These are rickshaws, the motorized rickshaws, which they call autos or tuk-tuks depending on where you are, but I'll call them rickshaws. That's all you can see through the windshield, except right over here, if you look really carefully, there's a car in the middle of these rickshaws. So literally typical traffic in Mumbai or Pune, which is where I went to set up this office, which is about a 5-hour drive from Mumbai, 3 of those hours through traffic like this. It was just a sea of these things. This was a picture through a windshield in 2009. And in 2010, this picture kind of gives you an idea of what the traffic is really like and the mix of cars and motorcycles and these 3-wheeled rickshaws, these motorized rickshaws. So for the next 6 years, I traveled to India 8 or 9 times, and this was pretty much what the scene was like. Then I took a sabbatical for about 18 months and came back And I saw there was something different. And at first I wasn't sure what it was, but I could tell it had dramatically changed. And then it hit me. All these rickshaws were gone. What happened to them? This is only an 18-month period. There were millions of these. You can see some of them here. They're still there, but they're just— it's now flipped. Instead of 28 of these rickshaws to every car, it's now 20 cars to every rickshaw. So my mind is trying to make conclusions. It must be government regulation because these are all 2-stroke motor vehicles and they were a huge cause of pollution in the rise of pollution problems in India. So I thought it must be government legislation, but I didn't want to believe it. So I go to the office and I ask Shalaka, who is the director in our development team, I said, Shalaka, what happened to all the rickshaws? And she said, What's Uber? I said, Uber. She says, yeah, they— Uber came to India and they won't approve rickshaws for Uber driving cars. I had to wrap my head around that idea. So in 2009, when they— it's the first year I went to India, it's also the first year that Uber started this limo combination with a mobile app that leverages GPS in 7 years completely displaced a class of vehicles halfway around the world, which means they displaced the manufacturers, they displaced the drivers, but they created new opportunities for people who could afford to drive cars that were Uber-supported cars. This is what I mean by unintended consequences of disruption, because I wasn't there, but in 2008, when the founders of Uber were sitting in their garage coming up with this idea, I don't think that they were thinking to themselves, haha, we can eradicate rickshaws in Southeast Asia. Oh, did I mess up? No. Oh, right at the punchline too. We could eradicate all the rickshaws in Southeast Asia. It's just not how people think they're starting entrepreneurs are starting a company. But when something becomes this impactful, things happen that they have no idea about. Now there are things in the world that are predictable trends and movements. We can see things coming. For example, for years my friends and I could see that all this proliferation of these Yeah. We all saw that. We all saw the fact that when digital cameras came out on the scene, that they were getting higher pixels, they were getting cheaper and smaller and more available to everybody. That film eventually would go away. Everybody from Kodak saw that, that digital media would— people would be getting their information that way, right? And so eventually the newsprint companies that didn't embrace digital technology would eventually be displaced. And we've seen massive consolidation in that industry, which is still going on today. And with the discovery of vaccines and their tremendous effectiveness and then the political and social will that followed and the campaigns behind it, we would eventually see the eradication of diseases like smallpox, polio, and rubella. So I believe we called that eradicated around the 2000— around 2000. However, most disruption comes at us in ways that that we don't expect, and it makes it feel like we're standing on ground that is shaky and unstable because we can't predict— like the drivers in India couldn't predict that one day this app would come to India and would completely destroy their industry within just such a short period of time, right? So even though my friends and I all predicted that phones would eventually be a single device, we would get rid of all these and have devices that we have. None of us could see the iPhone coming. So I remember when— I don't remember if any of you remember when Steve Jobs first presented the iPhone just before it was first launched, and how odd it seemed, at least to me. And I think of myself as being pretty open-minded and usually being able to abstract the value of something when I see it. But I saw that and I thought, Who would that matter? Who would care about this? What happened to the bottom? So I went to the bottom side and pushed all of the photos. But 6 months later, I kept hearing all this buzz, and I thought, you know, I have to get one. And I got one, and within a couple of weeks, I couldn't imagine how I could live without it. This will blow your mind. I found this last week. If you have an iPhone, original iPhone, iPhone in a box that's worth a lot of money. That's the one— there are several like this on eBay. So this is the mark of a truly iconic disruptive product. It's only 12 years ago that it was launched, and it's already an extremely valuable collector's item. So who could have seen these products Facebook, Twitter, Instagram, Snapchat, Airbnb, Tinder, Bitcoin, Amazon Alexa, Tesla. And who would have imagined that all this stuff would be running in something called the cloud? It's— we're getting used to this concept now, but just 2 years ago, 3 years ago, all I ever heard about is once the cloud. What is a cloud? How do I know if I'm in the cloud? Well, it's really foggy. And that the use of these products and the proliferation of them would give rise to a generation, millennials and especially Generation Z, who would see the world so differently from how we see the world. This extreme concept of work-life balance—not just work-life balance, but extreme work-life balance—the idea that you should be able to work from anywhere, right? Not only anywhere, but any country, and do the same job. This idea that employers have to see the problem on a daily basis to attract and engage millennials and convince them somehow that the idea. The idea of a career that lasts more than 2 years is a good thing, right? And that, that same generation, because of the way they get information, would be susceptible to, uh, would be susceptible to information that is less than credible, which would then usher in things back in, things like measles. How did this happen? Well, it's not because of the data. There's no question about the effectiveness of vaccines around the world. If you're vaccinated, if your population is vaccinated, they don't get these diseases. If they're not, they get them. So it must be related to this idea that you guys actually did too good a job. You got rid of the disease, you got rid of the conversation, because when there's no disease, you can stop talking about it. When they stop talking about it, political will starts to die, social will isn't really there, people forget why it mattered so much, and then they're, they're lacking the galvanization to be the defense, to have defenses against new information. Coming in, that critical thinking part of the brain starts to go to sleep. So the idea in my mind is it's like the lid is on the jar. Once they— even if you take that lid off the jar, you can't convince people to look up. This comes from a metaphor from a book that is a favorite metaphor of mine. The book is The Secret Life of Bees. So I don't know, has anybody read The Secret Have you ever Life of Bees? read The Secret Life of Bees? Okay, a few of you. Well, the protagonist in this book is a little girl. She is sleeping in her bedroom at night, she hears all these bees in the wall, but she can't convince anybody that there's really bees in her wall. So she captures some of these bees in a jar to prove to her parents that they really— she really does have a problem with bees. And she keeps the bees in the jar for a couple days, but she starts to feel bad. I don't want to ruin the life of these bees. So she decides to let them go, and she takes the lid off the jar, and they don't fly out. They kept bumping into this lid, and they learned where the lid was, and so they learned how to fly just below it. And she leaves the lid off overnight, and they still don't leave the jar. So until she gives those bees a different perspective, they don't fly out. That's a great story. Pushing things aside. So I liken this metaphor to this idea that when people get an idea in their mind and they feel any survival around that idea, then to convince them that there is— that idea doesn't really exist is really difficult, or that threat that they feel. So it always boils down to some survival, either survival, uh, protecting your ideas, or survival You're going to put yourself in some kind of a danger that's perceived. So in this case, this is perceived danger when she takes the lid off the jar, the bees still won't fly out. What makes this even worse is this idea of social media and physics, which is an oxymoron, right? It's either social media or it's physics. But this is how people are getting their information today, especially these newer generations, from YouTube, from Daily Show, from Twitter, from Instagram, from all of these non-credible or less than credible sources depending on whose quality they are. And the news that gets people's attention is the things that scare them, right? this is just natural. There's this concept that most people hear, who's heard of Maslow's Law? Most people. So this idea, it's a hierarchy, Maslow's hierarchy of needs. So it's this pyramid that defines the most basic needs at the bottom, eating and drinking, right? And staying warm and shelter. And then above that, right above that, are security, And security and safety. That's right above the most basic needs. So things on social media that scare people and get reinforced because then they get shared and other people start talking about it, and then you see it 2 or 3 or 4 times, you start to believe it, then that's appealing to that second layer of that pyramid. The things above it are hope. Growth and actualization and all the things that just don't matter if you feel like your survival is at risk. Now, we don't have this problem in country— third world countries, most third world countries where they are surrounded by disease. And it's not uncommon to hear stories of a parent walking with their child 10 or 15 miles to stand in a line for hours to get vaccinated. Why? Because they're surrounded by death and disease. This is real and visceral to them. It's immediate. There's no information that's going to come in to say, well, vaccines are dangerous, because nothing can be more dangerous than what they're living with, right? They're highly galvanized against false information. So one of the problems we have in our world is that we don't have any built-in mechanisms system once we do our jobs really well. Let me highlight this by making an example and comparing it with seat belts. Seat belts are just another prophylactic, right? Just like you take vaccines to prevent you from disease and injury and death, you wear seat belts to protect you from potential injury and death in an auto accident. Okay, in the '60s, mid-'60s, Congress passed a law, all vehicles have to have seatbelts. But they didn't pass the laws, uh, it was state by state before seatbelt laws were required. You have to wear them. That took years. But in the early '70s, there were a couple of critical studies about the dangers of not wearing seatbelts, the efficacy of wearing them, and how it reduces death and reduces serious injury. And what's interesting is it doesn't compare to how effective vaccines are at reducing death and injury and disease, but it does— it is dramatic. So now the law that I remember— I don't know if any of you remember right when the seatbelt laws were first implemented, but I remember feeling resistance, like the government's getting into my life in ways I feel like they shouldn't. I should be able to You get in my car and drive. If I don't want to wear a seatbelt, I don't have to. But I didn't want the fine more than I didn't want to have to wear the seatbelt, so I said, whatever, I'll wear a seatbelt. But then the news started to shift. Where the news used to be, might be something like, 10-car pileup, 10 people dead, right? That's what the news would say. But after the seatbelt laws were passed, we started to hear a distinction That is where you'd hear, 10-car pileup, 7 people injured, 3 dead, 2 people were thrown from their car because they weren't wearing seat belts. You'd hear this over and over again. And then we would see movies with the dramatic music and a bunch of teenagers in a car having fun, and they're in the back seat not wearing seat belts. You know an accident's about to come, right? And half those kids are going to die, and the other half's lives are going to be destroyed. Over and over again, we kept getting the self-reinforcing stuff that's just built in to the point where I can't remember the last time I ever thought about not wearing a seatbelt. I immediately feel unsafe. I remember maybe 20 years ago, I had somebody get in the car that didn't want to wear a seatbelt. I told them, I'm not going anywhere until you put your seatbelt on. But I can't even remember the last time that happened because it's so ingrained. Our consciousness. We feel so at risk not wearing it that— and that's just because of this built-in reinforcement. I don't, I don't know how you duplicate something similar in public health, but we need to find some way to do something like that, right? Okay, so now what happens when we do get an outbreak? Well, all of a sudden that whole reinforcement engine starts back up again, right? So we have this measles outbreak. The news says measles, and then they say the people that are getting them weren't vaccinated, kind of like people that died from car accidents weren't wearing seat belts. And what happens? New York passes a law almost overnight. I don't know how many people— how many people have heard of this, about New York's law? Well, I just heard about it last week. It was passed amazingly quickly. That now it's illegal not to get vaccinated with a $1,000 fine if you're found to not have your vaccinations. All primarily because of this news, it's scare, and all of a sudden social will, political will, and things happen. And I hate to sound like I'm a fearmonger, actually, in preparing for this presentation, I was always like, everything's— you have to motivate people with positive things, right? That's how you do it. And as I'm doing this presentation, I'm thinking, oh my God, I have to scare people. That's what I have to do to get them motivated. That's way more powerful. But in this case, that's what you have to do. Here in Arizona, where prior to this outbreak we just loosened our laws, amazingly enough, this was the whole NLA's critical thinking where you're great, you can't start a We just loosened our laws. So now it's a religious or a philosophical concept that you don't have to prove that your kids are vaccinated when they go to school. How is that even possible? Okay, so it all boils down to this: if, if it gets deeply enough in our psyche that it's a threat, And it's reinforced often enough, it sticks. So I want to do a little experiment here to kind of prove this point. I'm going to show you guys 4 pictures, and each picture has a number, and I'm going to call out the numbers, and you tell me which one gives you— makes you react the strongest, where you have the strongest kind of internal reaction to it. Okay. Okay, give me a 2. Image 2, image 3, and image 4. Okay, so for those of you who couldn't see everywhere, image 2 had 3. 3. And 4 probably had a little bit more than image 3, or maybe they were tied, 2 and 3. For 1, I think nobody— did anybody raise their hand for 1? Okay, there was a hand for 1. And 4 had much fewer. And we're all data people, right? Because we live by data. Data tells us what we should be afraid of and what we shouldn't be afraid of, right? The things that should matter to us, or maybe it should, Let's look at the data. So this is opioids, it's the yellow. I should actually just call out the colors. Opioid is the yellow, right? And we all know that this is a critical problem right now, but what's making it critical isn't the number of deaths, at least in my opinion. What's getting all the attention is the rise, is the steep rise, which is scary because Because we don't know where that rise is going to end, and the news picks up on that, social media picks up on that. But if we were at some flat steady state near that number for a few years, people would just think that's, that's the way they are, and it probably wouldn't get the same level of attention. By the way, I think half of that— maybe you can correct me because you guys know the numbers— I believe half of that is from prescription opioids, roughly, right? So So, so that goes across demographics. This is not a particular segment of the population other than somebody who has pain. And I really understand how easy this is, uh, how addictive these drugs are. When I was in 2000, I had back surgery, and my doctor— thank God he was really good— he told me, he gave me OxyContin, which is the worst of these, right? And he said, this is highly addictive. Do not take it more than 2 or 2 and a half weeks at the max. He said, and then wean yourself off it because it'll be uncomfortable. And I'm thinking, how painful could it be? So, and I was a lot of pain from the surgery, so I wasn't going to question him. I was taking the OxyContin. At the end of that 2 and a half weeks, this is before any I didn't know anything about this. I said, you know, I'm just gonna go cold turkey. I don't need to get off this. I was miserable for 5 days. I couldn't believe it. And if he hadn't scared the heck out of me on how addictive this is and how hard it would be to get off, I might have started taking some again just to try to reduce the discomfort. But I didn't. So I get it. I really understand how easy it And is to get addicted. there, by the way, anybody interested in stories about how there's physician groups— you probably know this— that actually are responsible for this? Not all, but there are certain ones. I have a story about that. Yeah, you can ask me later. Okay, so that'll go to— so that should be the scariest, right? And that one was That is also tied to terrorism. Then we have vehicle deaths and— oh, I'm sorry, then we have gun deaths. We can see that gun deaths are on the rise, uh, not dramatically, but they are definitely leading up. Uh, there's all kinds of politics and concerns around guns, and it's a complicated issue, but it should be something that scares us. No. Then we have vehicular deaths, and they've actually gone down, right? We don't worry about Hence, we only had a couple people maybe that had been in car accidents or had somebody that they knew that was in one, or maybe not. Maybe they just have good common sense to be afraid of something that weighs thousands of pounds and goes 60 miles an hour. Then we have terrorism, which doesn't even get off the bottom line of the chart at this scale. In fact, time we see it getting up is 9/11. And even then it's a blip compared to the others. By the way, this goes through 2017, so it doesn't include Vegas, which would have been a fractional blip to what 9/11 was. But this is dominating our social media, our news, you know, credible news sources, and our political conversation, election Questions over running loss on that issue, not on the others. Because this— because there's 3 things that matter with data, and without understanding this, then you can't really understand the power of that data. Those 3 things are story, story, and story. Brené Brown, who's a fantastic speaker on the public speaking circuit, says, if you can't measure it, it doesn't exist. And I think that's true. But more importantly, if you don't have a compelling story about it, the data doesn't matter. So you have all these other things. And by the way, that chart didn't have the biggies like heart disease and cancer and things like that. But terrorism— just think of this number. Any one of those those other things, you have 2,000 to 3,000 times the opportunity to die from any of those other 3, let alone all of them, than you do from ever being in a terrorist attack. And this is not limited to the US. When I was in India in 2017, that was the worst year for British terrorism. There was a parliamentary Terrorists acted 4— I believe there were 4 total that year. It was a bad year. Whenever I was done with work, if it wasn't too late, I'd go up to the concierge level at the Marriott. And the concierge level towards the top of a hotel is like an expat community. It's a lounge with a bar. You have people from all around the world that are on extended stays, like weeks and weeks, 4 weeks, 8 weeks. And so they're looking connect with other people. So you end up making friends, right? So I had all these friends from New Zealand, Australia, the UK that I would see every 18 months or whatever. So I was leaving the next day to go home, but I was going to stop in London for 2 days on my way home just to go visit London. And so I mentioned this, and the 2 guys from the UK said, be careful. And I didn't know what they were talking about, but I just felt like meeting them, so I said, be careful of what? They said, Well, haven't you been watching the news? And I said, the news? He said, all the terrorism. I said, okay, how many people die every year? Because this has been bothering me for a while already at that point. He said, how many people die every year from car accidents in the UK? They're not telling you to be careful when you get into a taxi. And I said, or how many people even die— I didn't realize this when I was saying this, but I looked it up later— I said, how many people die just crossing the street? street in the UK as compared to how many people died from terrorism this year. Well, later on they said, yeah, yeah, we get your point, but, but they had a lot of trouble letting it go even though they realized how silly that argument was. Well, I looked it up later that same year. There were 32 terrorists, uh, people that died from terrorism from those 4 terrorist attacks combined. 300 people died crossing the street in the weekend. 3,500 serious injuries for pedestrians. I didn't bother looking at cars because who cares, right? Like, we made the point already. All right, so I'm going to switch gears here a bit. I think I've beaten that drum about story and fear and its power to change our view of things, right? I'm just curious, the people that raise their hands for terrorism— by the way, no matter what group I ask, I either get that many or I get a majority that pick the terrorists. And that group can be like— I did this over the weekend, and the group I picked were, were 4 doctors, and 3 of the 4 picked the terrorist picture. So it doesn't matter. I think that's a good point. It's just so prevalent. Everybody's picking that. Okay, so how many people that picked terrorism still think that should be the scariest thing, or the thing that you should react to the strongest because it has the biggest chance of really making you, you know, affecting your lives? So if you still think that terrorism is the one you react strongly, raise your hand. It's okay if you do. Okay, that's fair. And I'm not saying it's right or wrong, I'm just curious. I want to talk about it just out of curiosity. I'm not trying to convince you. Maybe you have a story, maybe you have a story behind it, but I'm curious. Okay, thank you for being honest to share. Okay, so now I want to change gears a little bit. So the future of disruption, I believe most that is going— the really consequential disruption that we may not see coming is going to come from things related to big data. And many of these may be related to products that were created and then the data that follows that. So I'm going to talk about 2 products that I'm involved with. Well, one, the first one I'm involved from the data side. What's the name of the product? The second one is part of my company that we were talking about and how the potential consequences or unintended consequences of mobilizing. And I'm bringing them up because I think they make cool stories, not just because I'm trying to promote my products. And you'll see what I mean. The first one has to do with bones. So what is it we really know About bones. You ask an orthopedic surgeon, they'll say, I know a lot about bones. Do they really? They do know what their favorite tools are to use on bones. They're a hammer, a drill, and a saw. And these are 3 technologies that have not changed perceptibly in, what, 30 years, 60 years, 90 years? I have no idea. 100 years. Hammers, it's pretty much the same for hundreds of years, probably. Saw, same thing. Drill, maybe it's a little— they haven't changed. So, um, for this, there's a friend of mine who's an anesthesiologist, and he sat through all of these orthopedic surgeries because he does a lot of anesthesia for outpatient surgery, and he came up with this brilliant idea about 8 years ago, and then many Prototypes and FDA approvals, and so on coming on the market this year. He's going to reinvent the drill, and in doing that, he's also going to reinvent the saw. This is the first massive technical breakthrough these two instruments in a hundred years. Somebody else will have to hand have to reinvent the hammer at some point. All right. So let's talk about what a surgeon does with it, and I apologize. This is a little bit too much, but they drill into bones, right? And when they drill into the bone, they will drill through it because they have to, usually in a repair, because they have to put screws in that go all the way through both sides of the bone to fix it, and they plunge. So they have 2 choices when they're drilling. They either burn or they plunge because they either go in really slow to prevent Plunging, but then the bone heats up and they burn it, which then causes the fixation, the screws, to fail. Or if they go through at the speed to prevent that, then they are at risk for plunging. Okay, audience participation. How many people think that surgeons plunge between 0 and 30% of the time? I'm going to give you several choices. Raise your hand. 30 to 60% of the time? 60 to 90% of the time? 90 to 99% of the time? Do I have any hands up? How about 100% of the time? 100% of the time. In several studies done with groups between 10 and 50 orthopedic surgeons, They plunged 100% of the time. The smallest plunge, and it was only one surgeon that did it, and this was a test on many different bones that these surgeons were drilling through, trying not to plunge, uh, plunged 4 millimeters. That was the least, but the range was 5 millimeters to 30 millimeters, and the average was 8.2 millimeters. So you're thinking a millimeter, that's not very much, right? It's a little thing. Well, the space between the skull and the brain ranges between 7 millimeters and 0.4 millimeters, depending on where you're drilling in. So now, when they drill into the brain, they actually— into the skull, they actually have a stop because they know the thickness, approximate thickness of the skull. So, in another anonymous study of neurosurgeons, 60% of them admitted to having plunged into the brain at least one time with catastrophic results. And several of those surgeons admitted— this was an anonymous study— that they plunged through the same brain multiple times. They're probably in an emergency sort of situation. So this is a problem. In every other part of the body, pretty much, there is no gap between the bone and the ligament or the tendon or the cartilage or the muscle or the nerve on the other side. So orthopedic surgery causes new damage that wasn't there when— before they started, sometimes affecting the recovery rate of that surgery, or often affecting it. And The failure rate, and they waste a ton of parts, about 30% of the screws that range between $100 and several thousand dollars depending on what surgery it is, they waste 30% of that because the screw strips and they have to throw it away or the bone strips. They can't try to screw it into another spot or because of the failure to fix it. So this is a big problem, right? And the surgeries take longer and they A lot of these fixations fail anywhere from, you know, depending on the type of surgery, you know, might be 10 to 30% of the repairs actually fail and you have to go in for a second surgery because the screws come out or the, or the, or they, or sometimes they screw in too far and it causes nerve damage, whatever the reasons. It's a real problem. Notice it's taking 2 hands for the surgeon to do this. One is holding back the drill guide, which protects The skin. The skin, and the other's holding the drill. By the way, that drill, when I said it really hasn't changed much, when I was in my mid-20s, I went skiing and I fell, and I tore this ligament in my thumb. So I went to a hand surgeon who was recommended as a really good hand surgeon, and he said, you have to come back, it's torn, we need to pin it, and we need to put it in a cast for 6 weeks so that it will cast I can't see him. So he said, fine. So I go back the next day and I sit down and there's a tray. The nurse comes in, takes the cloth off the tray, and there's a black and decked drill, a pair of pliers, and a steel shaft with a little drill bit on the end. And I— then the doctor walks in right after that and I look at him and I said, please tell me the department just got this. And he said, you know what they say, He says, what? He goes, nobody does it better than Black Decker. He starts dancing. He starts dancing and singing Black Decker to the table. Then he said, well, I could have bought a surgical drill for $1,000, but $39.95 and it comes with a lifetime guarantee. He's thinking he's being funny. I'm thinking I need to get the hell out of there. Excuse me. I don't know what the reaction was. So, uh, but he actually did a great job, and luckily he did not have to drill all the way through the second bone. He needed to drill into it to fix it. I didn't have the plunge issue that most people do, but that's how little these things have changed. So that was the Smart Drill. The Smart Drill combines the, um, that guide and skinning protector with The drill itself and puts it on a separate motor and puts sensors in the drill bit so that it can actually measure all the torque and all the speed, and it measures everything. It knows exactly where it is inside the bone and the length of the drill. You can see a surgeon here using it. They don't need 2 hands now. So the second hand in this case is free to just sit there floating in the air, but they could be using it for something constructive. And the amount of data that it's capturing so they can see. So in this picture, the peaks are the walls, and the middle is the marrow, so that it knows that it can figure out the density of that bone, the brittleness, when, where the bone ends, and it stops as soon as it's through. And it, you know, it goes through the bone an average of half a millimeter at the end. And the most that they've measured is 1 millimeter. So this changes that. Not only does it change the drilling, but it knows exactly how much torque now to put into the screw and what screw— the length of the screw needs to be, the thread pitch that they need to use on it, whether it's a locking screw or not, all this stuff. And out of 100 screws used in surgical trials, only 1 screw had to be changed. Instead of the normal 30%. And that one screw was the very first one. The inventor was worried about his product, and he was the one doing it. He was afraid, and so he didn't trust the numbers. Otherwise, it would have been 100%. So it eliminates the waste problem, shortens the surgery, we respect $100 a minute time in the OR, the patient's recovery. You know, the numbers on this, but it's obvious. Recovery will be faster, better. Once they have those numbers, they'll get public anyway. This is going to change everything. And then they're going to fix an oscillating saw on the end of this. So they drill some— if they've got a soft robot, they drill a couple pilot holes so that they can see the gap in different places, which then models the curve. Now they take the oscillating saw and it knows to cut through at that curve without affecting any tissue behind it. So you just reinvented 2 of the instruments used the most by orthopedic surgeons, etc. Of course they have another one. That's only a small part of the benefit for the world. Yeah, it's very important for surgeons, but take this data that it's collecting on the surgery and identify the problem. to marry that with the patient's medical history. And if the DNA, uh, if the DNA profile is available for that, for that patient, marry it with that. And do this 100, 200, 300, 500,000 times, and all of a sudden you know things about bodies you could have never known. Like, maybe you find out that, uh, Hispanics with a certain Genetic profile that happen to live in the Southwest or happen to have a certain type of lifestyle or take a certain medication or something that over time causes— reduces osteoporosis in women who would normally be susceptible than other women. You might learn things like that. You might learn things related to people getting cancer or learn things that would be We might learn things about other systems in the body because, because this data now is a— gives us insight to something we never had insight to before, all because now we're measuring the torque on somebody's bone and tying that to the movement of the throat. Okay, so this next one that I'm going to talk about is This is a story that I've been heavily involved with because it's a company that I'm partnered in. We started 7 years ago, or 6 years, 7 years ago, trying to build a social network for physicians with the idea that they could freely exchange medical records between each other by requesting access to patient records in the practicing physicians in the ER. So I could say, could I see this patient's record? And the other physician would just have to say, sure you can. And now I could pull it from the ER. I wouldn't have to wait for somebody in their office to send it to me, which I see as one of the biggest problems we have in healthcare today. Well, we ran headfirst into meaningful use of HIPAA and this constant And the EMR company is building Chinese walls around their problems. We even had an EMR company, one of the biggest ones, after we started pulling data from it, they encrypted the physician records so that we couldn't see it anymore. So now I think that company was fined a lot of money because they did that. But this is still a huge problem. And as a result, somebody goes to a urologist, then they go to An oncologist because they found they have cancer, and then they end up at a radiation oncologist to get treated. And each of those steps, even though they're part of the same health information exchange, at each of those steps they go— they have to request records for tests and studies that have already been done, and they can't get them in a timely manner. So they just order the same test again. 2 times. 3 times, 4 times, because they don't have free access to that record and the patient doesn't have free access to those records. Okay. We ran into— we said this is too big a problem for us to solve. I didn't have any EHR company that could stop us from being affected, and so we abandoned that and took a different approach. We said let's, let's just collect and aggregate data, at least start this way. Make a business out of it. And we'll focus on one group that has very few EMR software systems that represent 90% of that group. And because my partner is an aesthetic surgeon, we picked— and we have a good relationship with the Aesthetic Surgery Association— we picked that. We partnered with another company that develops an IoT device, the Internet of Things device, For those of you who don't know that term. And we send that device out to the doctor's office, they plug it into their network, which gives us access to their EMR database. We pull back 15 years of history, and then from that point on, we just pull back history. The doctor gets this intelligence dashboard where they can look at their practice and compare it to an aggregate of other practices in their area, and they can say, oh, I'm charging too much for this, not enough for that. I'm not really marketing this procedure, but these other guys are all marketing a different procedure. Now they now have a real business view of their business compared to their peers. They did never have that before. As a result of this, we now have 250 data providers here in the last 2 years. In the next 6 to 9 months, this should grow to between 350 and 400. We have contracts now with major, uh, A manufacturers of products that have never had visibility on how their products are used in these, uh, by the surgeons. But more importantly than this, the association said, hey, now that you've got access to this data, we've got problems with certain types of implants that cause cancer, and we think it's because of this, but we don't— we need to track that. Let's, let's kind of register into this. Because as anybody who's ever dealt with physician registries, you know, patient registries, you know, they're a pain because it's all anecdotal information. You have to track the patient over a period of time and report. And by adding a mobile app and building some framework components in there now, we can create a registry, or the association can, whenever they've got a concern and they want to track patients. Then the doctor after surgery puts in some Quick values, and if the system spots a trigger keyword like sarcoma and it pops up, this patient might be appropriate for this registry. Do you want to register them? Yes. The patient's registered, and now the system follows that patient every time they go for a follow-up visit to the doctor, and every time— and on a periodic basis, the patient or the doctor will just get questionnaires on the app. Security questions, not any of the demographic information, because most patients— it just makes it really easy. And now companies finding this who are selling off-label products— off-label, for those who don't know, means it's a product that's approved for one thing, but it's like mesh that's used for fixing hernias, and now a physician wants to use it for breast implants as a mesh For, uh, for being able to have a better outcome, but it's not FDA approved for that. But now the FDA wants it approved because they're having the 2 drugs help. And so now they're doing a retrospective study and reaching out to us, and we're finding out that we're getting involved in clinical studies because they can reach back to the data and we can make adjustments in our queries and pull new data back. And now all of a sudden they've got a 3-year, 4-year retrospective study overnight. And then I don't know if any of you heard about— how many people heard about this big concern that came up with breast implant health or disease or condition that the FDA got concerned about? They convened 5 weeks ago a 2-day panel. Raise your hand if you've heard of this. Okay, well, there's these huge patient advocacy groups that are driven by women who have had breast implants and then all kinds of long-term health problems, many of them having those implants removed. And I'm not saying they're right or wrong. I'm sure, I'm sure there's something that their experiences were resulting in, but I just, you know, know what it is, but— and it doesn't happen to everybody. It happens to a certain segment of the population. We don't know exactly what the segment is, but there were Facebook groups with like 70,000 people on it, patient advocacy groups, and they were making a big deal about it. Of course, social media drives a lot of things. The FDA got very concerned because of this public outcry. That's what they call it. They convened a panel. They invited all the medical associations in. to present all the manufacturers and products related to this to present. We were swept in with our association with a couple other companies. And during that, you know, this was concerns over that, as you can see. It was, it was all over the news. If you happen to watch the news these days. And this is my partner presenting at the FDA. So we ended up presenting along with all of these other companies. We were presenting our data, and 7 of those companies were presenting our data, talking about our product, and you were mentioned over 16 times during those 2 days. Again, 4 weeks before we got invited to this, we didn't even know this was a thing. So this idea of unintended consequences from something that's disruptive— we had no idea what we were doing. Was disruptive, and it turns out to be disruptive on a pretty big level. And after, and now we are an implantable device surveillance platform, not a business aggregation, business intelligence system. It's the same thing; it's just it's story, story, story, story, right? So the FDA approaches us because they think it's great what we're doing. The patient advocacy groups think it's great what we're doing. And I'm somewhere in the middle of something. I'm sorry. I'm sorry. I'm sorry. But HIPAA and meaningful use are sore spots for me because I bumped my head with that issue for several years. So I want to ask you, what is the difference between medical history and financial history? How many people think that your financial How many people think your financial history is more personal to you than your medical history? Well, I do. A few people. Okay, so then I'm assuming everybody— I'm going to ask you, raise your hand. How many people think your medical history is more personal to you than your financial history? Okay, it depends on who you ask. I don't know if it's 50/50, but a lot of people feel that way. Now imagine if there If there were no credit unions in existence yet, and somebody wanted to start one today, what would be the chance that that would be possible given privacy concerns and regulation that's in place right now? Who thinks that would be possible? Anybody? No. No, I don't think it would be. But because credit unions have existed since the late 1800s, 1800s, they became a part of our financial and economic DNA, so that when regulation and privacy issues came up, those regulations and issues were all crafted around this ability to be able to go get a financial record from the credit unions, not to the exclusion of them. But think about it, which is more important? You're at a bank, you're trying You're trying to to get a loan, but you don't have all your financial history there. I mean, you get the whole history of your finances up to a certain point when they look at your credit history, and now you're crippled if you can't get the loan. Versus you're in the hospital and you're unconscious and there's nobody there that can hold— and you need that medical history. Which is more important? One's life and death, and one's a house you're not going to get. So medical history Needs to happen. Unfortunately, HIPAA came in my mind about 15 years too soon, and meaningful use had the right idea but got off on the wrong foot because what meaningful use was all about was interoperability of data. So the incentive should have been that, not getting doctors to get on electronic systems. But that's me pontificating, and you guys don't care about that. The point is is that there is an opportunity right now because HIMSS has talked about interoperability as the new buzzword instead of meaningful use. And SPC has a vision for taking what they've got and expanding it to broader kinds of health records, which I think you're going to learn about over the next few days about where they're headed with that. And there are very few companies in a unique position to actually make this happen. And so people in this room are at a very rare opportunity to really make a big difference because you guys are partners, you're the thought leaders, you're the influencers that can help make this— bring this conversation about so that whatever is standing in the way I think that will slowly dissolve as the value of having a healthcare highway is professed in a broad way. You know, people are afraid enough of not having it. I hate to be a fearmonger, but people are afraid enough of what the cost of healthcare is and the risk to people of not having it. If that drug gets good enough, maybe we'll see this finally change. Thank you. So let's end— and I want to end this on the idea that let's make this happen. Let's help SDC see, realize their vision, because you guys are the ones, and me and everybody else in the country, and eventually the world, benefit from this highway being created. I'm David Hirschfeld, and I'm honored I'm very privileged to have the chance to share my ideas about disruptive technologies and their unintended consequences. Thank you. Thank you.