How to Explore If All Your Family Health Care Needs are Being Met with Robin Farmanfarmaian #6

Hello, everybody, this is David Goldsmith. And welcome to another edition of Redefining Tomorrow. Today we're going to be exploring how to make sure all your family health care needs are being met. And if there was anybody that I would like to have on the line for this is, it is Robin. And now, Robin, I'm looking at your name again and I'm saying I have said this name so many times.

Pharma, farmian, farm and farming.

Farm. Yeah. Okay, so you said it. Right. Robin and I met in San Francisco about 2014 at a group for an event. And since then we have connected on multiple levels. The reason Robin is, is on is she talks about, she's a speaker, she's an author, she does the consulting work. She's been an investor as well as a advisor. Several things that you would have in Silicon Valley to the healthcare patient empowerment system. She also does talk about things such as leadership and technology and sensors and all of the extras that come along with being a 25 year veteran of the Silicon Valley area. So welcome to the show, Robin.

I am so excited to talk to you. We always have a great time together.

We always do. So that's why you're here. Now, do you have an outline or some bullet points that we're going to be following for today?

Of course. Good.

Can you share them?

Absolutely. What we're going to be doing is talking about how to make sure all your health care needs for yourself and for your family are being met. And that is going to really drive three major points. Essentially it's going to be all around the shift from the hospital and clinic into the patient's home environment or office environment. Essentially healthcare, where you want it, how you want it and when you want it received.

Okay, so what are we going to talk about next?

So within that, we are going to talk about point of care, diagnostic devices and wearable tech.

Okay.

And we're also, yep. The, the actual in home physical care. So things like doctors and nurses that actually come to you for everything from flu shots to IV medications to clinical trials of chemotherapy.

Okay.

And, and we're going to close it out if we have time, talking a little bit about AI and voice technology. So essentially your Amazon Alexa being part of your health care team.

Okay. Okay. So Robin, teach me how I can make sure that my health care needs are being met. So teach me how.

And not just yours, but your grandparents, your parents and your children if you have children, and your grandchildren if you have grandchildren. Because each set of ivo, I've got.

Two kids, they're about 26 and 24, not about.

That's what they are.

And a wife and both my parents are still alive.

Okay. So yes. So each generation brings unique set of problems essentially to the board. And so different things are going to benefit different groups in better ways. And so when I'm teaching you these things, also think about them from your, your parents point of view and would this help them or would this help you monitor them right as they age and may need more and more care later on in life. So let's start with the shift from the hospital into the home with point of care diagnostics. Now we are seeing quite a large number of different technologies hit the market both in the consumer space and in the clinical space. So thinking about companies like Title Care and this one you're going to want to get, this is amazing. It's T y T o Care, Tyto Care and what it is, it's available in Best buy and for $300 you buy the platform. It comes with four medical devices. Now what you do, it's so cool. What you do is you call a physician over video and it's going to be through their app. So whatever smartphone you have, you call the physician. The physician appears by video and walks you through using these four medical devices either on yourself or somebody else who you're around now, whether that's your child or say your spouse. Now the four medical devices are temperature monitor, otoscope, which looks into your ear. So if your child has an earache, tongue depressor and blood pressure. Oh, I'm sorry. And stethoscope. And so each one of these devices hook onto a video camera. So when you use the otoscope, when you stick it in your child's ear, the doctor by video is seeing the camera feed and she can say things like move the otoscope a little bit to the left, move it a little bit to the right and she is able to diagnose by over video that way because these are clinical grade diagnostic devices.

So is just a simple quick question. Is this part of your, the health care insurance and all of that too or no.

So right now, I do not believe this is reimbursed by any of the big insurers. But it's only $300 for, for the actual entire set, first of all. But second of all, it is usually payable by things like your flexible spending account. So a lot of, you know, that's a thing in the United States where you can take part of your salary and put it away into medical expenses and not Pay taxes on that money and you have to use it up within the year. But that's a very specific thing, like an fsa. But the doctor's appointments. Yes, those depending on if you do it through the app or, you know, you could even just do it with your normal doctor. And if you're doing it with your normal doctor, your normal doctor is going to get paid for a telemedicine visit.

So do normal doctors have telemedicine?

Yes. So telemedicine is on a massive upswing. And worldwide it is expected to be about a $41 billion industry over the next two years. And then that is expected. I've seen some crazy numbers saying that's going to triple over the next like eight years. And so big, big companies like UnitedHealthcare. UnitedHealthcare is a Fortune 5 and it is the largest of the private payers in the United States. They are massively pushing telemedicine. So not only on their employers. Right. So they are not only educating their employers, but to anyone who is a patient of UnitedHealthcare, they email like one to four times a month saying, hey, how you feeling? Click here to see one of our Doctors on demand telemedicine partners. And we cover this by insurance. So not only are they covering it by insurance, but they are really marketing it and marketing it directly to patients. I know, Isn't that cool?

Have you used it? Just practice. Do you really use it?

Yes. Especially if you think about email is a form of telemedicine. Because all I'm doing is instead of going into my doctor's office, I email my doctor saying, hey, I need, you know, I'm not feeling well. I think my blood should get, you know, some blood tests done or I need a refill on my prescription. And then she emails back and sends in the prescription or writes the lab orders. And I've avoided going into the clinic. And that is definitely a form of telemedicine. In fact, so much so that Kaiser Permanente, which is a giant, you know, nonprofit here in the United States, a managed care organization, or really what's called a integrated care consortium. They, as of 2017, more than 50% of all of their clinic visits were done virtually. And in that statistic, they do count things like video calls and email.

Wow.

Yep. So I use it. I use it at least once a week. Like, I am constantly in contact with my doctors and if there is a problem, a lot of the time I will just either call them or just email them.

Now you. We haven't Spoken about your health in quite some time. But I, I think the numbers are that you've had like 60 surgeries.

No, six.

Six. Okay. You've had, you've had a lot that. So medicine is, is big to you. When did you shift to this telemedicine? How long? Is it something new? Is it something you've been doing for years?

So in terms of just coordinating everything with my physicians by email, I've been doing this, I want to say about four or five years. And before that it was a little bit spottier. But in the past four to five years, that's really when physicians have taken to it.

I don't know if you know, on the medical side, on the physician side, are these permanent? In many cases are like Kaiser and these companies hiring their own physicians to monitor these. Are they in the healthcare delivery system where they're getting, they're taking your care, primary care, your physician that you'd gone to and saying, no, no, you can use ours. Are they shifting that type of use case?

There is a lot of shifting going on. So let me give you some examples. One medical I use them, it's like a, a concierge type service almost for, I think it's $150 a year. I essentially get same day or next day appointments. My doctor is pretty much there for me whenever I need her and she's two blocks away. You do have to go into a physical office to get the physical exams. But I do most of my work with her over email. And if I do need to talk to someone 24 hours a day, seven days a week, they have a telemedicine hotline and it's usually staff stopped staffed by like RNs, nurses and things like that. And then the nurses then, because they're the ones who are really on the front lines a lot of the time. And the nurse can say, hey, you know, this looks like something you should go to the emergency room for. Or hey, this is something that you need to go see a doctor for. Or hey, here's, you know, rns can write prescriptions for certain things too, especially if it's something like antibiotics or you know, antihistamine or inhaler refill for your asthma.

Okay. So you go to the store, you buy this kit. You've got now medical grade tech in your home. You're doing this via video connection so that they can see, look and have, and have that feel. How is. I haven't heard this even though I knew it was out there. You're the first person I'm speaking to who's using this. How prevalent are the numbers in terms of when you meet people? How often do you run into people using this type of care?

Well, I talk about this on stage, so it's hard for me to tell because I actually change people's minds and have them start using it. So. And it's all over my books and my writing. So by the time I talk to people, they usually say, oh, Robin, I tried this because I heard you speak, or whatever it is. So I would have to actually look up hardcore numbers for that. But it is definitely on an upswing.

Yeah, just the thought, because it's it. My parents are in their 80s, 70s and 80s and they've not been advised to this type of service. And I'm thinking, okay, where's the disconnect? I can understand being. I can understand. Well, I have my two kids, 24 and 26, and I haven't heard about it for them. My wife has never mentioned it and I don't even know if our insurance companies ever mentioned it. So even though I'm in the tech field and I do a lot of tech work, it's surprising that I just. This is. It's just not as prevalent as I would think it would be based upon rising costs of insurance, at least in the States, but even in London and I live in Hong Kong. I don't know anybody in Hong Kong doing this now. Then again, I don't ask people how they take care of their health care.

There is that issue and with companies like UnitedHealthcare. And the reason I'm talking about them so much is not only have I been insured by them for about five or six years now, maybe five years, but I got to go in and give a 60 minute keynote to their C suite and some of their big employers. And so I really sat down with them and learned what they're doing. And I have so much respect for United, they blew me out of the water on how forward thinking they are with a lot of this. They are using their extensive amounts of data and they are picking out their severe chronic disease patients and they're spending the marketing dollars on them. Because if you only see a doctor once a year for a checkup, if that. Right. You're not an expensive patient. You don't have chronic diseases, you're not hospitalized, you're not on expensive medications. They don't need to tell you about this stuff because you're already really inexpensive. But patients like myself, I have Crohn's disease. No large intestines, 43 hospitalizations and six major surgeries. I am an extremely expensive patient for them. I'm on a medication called Remicade, which is a biologic IV infusion and I have to get it eight times a year. And when I was getting it at an academic medical center, it was costing $28,000 per infusion. And I switched it into the home with help from UnitedHealthcare actually. And it is now $2,500 in infusion over a five year period. That comes out to $1 million in billing differences for the exact same drug. So United is spending money on people like me getting the marketing dollars. They have a nurse call me once a month for free. So this is a nurse that is employed full time by UnitedHealthcare to just do this. She's been assigned to my case and, and she doesn't cost me any money. It just comes with my regular ppo. Like I just have a regular insurance company like insurance account. And she says things like, are you on the same medications? How are you feeling? Oh, and by the way, are you able to get to your doctor's appointment? Because if not, we're going to help you do that. And that's why you see companies like Uber and Lyft have giant health care departments now, because healthcare companies like UnitedHealthcare or if you have a doctor provider, they can call Uber using a landline or Lyft and then they can call the patient again using a landline and deploy this, the Uber Lyft, to the patient's home, brings them to the doctor's office and that is called an nemt, non emergency medical transport which is now being covered by Medicare. How cool is that?

So the. Yeah, it's really cool. The you gave one. Are there any other companies that are similar to Taito that are out there?

So the Apple iWatch you see this is now a clinical grade device with a single lead EKG monitor on it. The other company doing this is a live core, the cardia band. So there are two on the market doing this and what they do is they measure your ekg. Why you care about this is because of something called atrial fibrillation or afib. Now AFIB is silent, has no symptoms. You have no idea that you have afib. But if you do, you are five times more likely to have a stroke. So having this kind of a point of care, essentially a diagnostic, is fantastic. The other thing we're seeing is a lot of blood labs and urine analysis going into the home. There are at least 10 companies that I'm aware of that what you do is for $250, you go to cvs.com or their website. You order a lab kit by mail, $60 to $300 per test. They will do everything from cholesterol, blood glucose, liver function, thyroid function, cbc, platelet differential, even, you know, in case you have a really hot date next week or something like that. Though you're married, so you know, any of your friends have a hot date, just tell them they can get 10 of the STDs done this way as well. Yeah. And so the package comes to you in the mail, you prick the end of your finger, get some drops of blood into the little container, Bam, throw it back through the mail. And they use CLIA certified laboratories. So your doctor can take action on lab results coming from this. I know, right? Same thing with urine analysis. So the same, the way you get your urine analysis done. And this is, you know, especially important for kidney, kidney disease, pregnancy and urinary tract infections, UTIs, which is a leading cause of clinic visits. So instead you do the exact same test that you have in the clinic, which is you pee in a cup and you have a little dipstick that you dip inside and it changes color depending on the makeup of your urine. Right. The different proteins and sugars in it. Now, what has happened is that we can do it in the home now because of advancements in computer vision technology. Previously, if you were to try and take color, a picture of a color, upload that to the doctor, and the doctor would try to read the dipstick. Colors look different depending on lighting, what camera angles, and all of that. But computer vision technology, when you put this dipstick against a color pattern, backing is able to read it accurately. And so that's what the advancement is. And that's why now you can do urine analysis in the home as well.

Okay.

Were you writing all that down?

I'm writing it all down and I'm trying to. I'm. I'm looking at the. As you said, that the primary need is the, the patient that has expensive one expensive or continuous chronic disease. So, yeah, chronic disease. And.

But it's also fantastic if you have kids, say, under the age of 10. Because what is more fun than going to the emergency room at 2 o' clock in the morning on a weekend with a toddler screaming. Right. So this is also really good for if you are a busy parent and you have kids, because, I mean, your kids are in their 20s, so you've got grandkids coming on the horizon.

Yeah. So you. So theoretically, you could wake up in the morning, you have a child that's not maybe have an ear infection or something. You could then say, connect online. They can do a quick scoping. They could say, you need to see a doctor or let me prescribe to you the meds that we did before or.

Yep. Well, because this is, you know, like things like strep. There are certain things that are very easy to diagnose visually. Right. Because they've got telltale signs for a doctor or a nurse. So in that kind of case. Or an ear infection, especially if it's chronic ear infections, because the kids who get ear infections tend to get multiple ones. So, yeah, you can do that. Exactly that. And then get the antibiotics delivered by drone, which has actually already started happening here in the United States.

Who's delivering?

So Walgreens just partnered with ups, and as of two weeks ago, if you are in Virginia, Christiansburg, I think, or Christiansdom, something like that, they now, if you need band aids or whatever, you order from walgreens and with five within five to 10 minutes, it is sent to your house by drone.

Do they charge you any?

Not that I'm aware of, no.

Because I needed band aids the other day and what, what a pain. I went to the store. I didn't realize how many different versions of band aids there are. I, I, there were, there's got to be. I never really paid much attention. You always had enough band aids around someplace. It was like 30 different types. It's like, this is ridiculous. I just needed some band aids so it could be in for water for. Not for water. It has a chemical component to it. Does it have built in neosporine or some type of ointment? So it was really to be able to order and have it within 10 minutes would have been probably 30 minutes of savings.

40 minutes, you wouldn't have been overwhelmed. Because, like, when I order things from Instacart or Amazon or CVS or whatever online, I'm not overwhelmed by the choices. But when you go and try and face it in those big drugstores or just like the cereal aisle in a supermarket, you're just like, oh, my gosh, there's too many choices.

Oh, no, no. Cereal's a lot easier. I always go to the main. The ones that I like.

Frosted Flakes, you know, and Froot Loops. Is that what you're going for, David?

Well, when I was growing up, I would eat for breakfast a half a box of Captain Crunch. I couldn't do it every day because it ripped the inside of my mouth, but I would eat a half a box of cereal for breakfast. So, yes, I have my mainstays, but I don't have the same as I did then. But the bandages were amazing. It was a lot of different options. So. Cool. That's really cool. So we're seeing the drone tech connection to it, where we're seeing the ability to be able to. On demand, meaning a kid getting up in the morning and being sick, or you being sick in the morning so you could send the kid to work, I mean, to school immediately, or even if you personally aren't feeling well, you can get some diagnostic very quickly.

Exactly. The common causes, getting those common causes out of the clinic and back into the home so it doesn't inconvenience people anymore to get their healthcare done.

But if I was to go right now to a clinic or a hospital, I probably see a full clinic and a full hospital. So is it people are more people are saying they're getting sick, or is it that not enough people know? I wonder if you looked at the ma. The trajectories, I would probably say more people at least. Well, I would say more people. Globally, I think it's some. Over 30% of the Chinese are obese. From this. From. From China. I believe that there are the. I was just. I just spent two months in Luxembourg, a month, two and a half weeks in London, and I can't tell you that they look any healthier. And when I come to the States, I have that same challenge too. So are we getting more people going to the clinics and the hospitals, or are we not getting enough of this type of knowledge out there?

It's on. It's at the very beginning stages because if you think about it, people in general don't like change and they don't trust change and they don't trust health care because it's this big, unknown, terrifying thing for most people. And so I'm guessing most of this is happening both in the developing world, so places like Ghana and Rwanda. Then also the, you know, the, the coasts and the. In the. In the United States, all those places where there's lots of innovation happening. So Massachusetts, New Hampshire. I'm sorry, New York. And New York. California. Austin, Texas. Right. Chicago, Illinois, like all the ones that are along the edges of the country where there's just, you know, massive hubs of innovation. And so those are the first people who are willing to make this change because it's. It's scary.

I also think that the payment processing still is a challenge given the, what you said that you can pay it out of your, your flex, you could pay it out of certain places, but.

Not for everything, just certain things. So that was specifically around title care, but for just regular telemedicine that's reimbursed and wearable technology is reimbursed. So it depends on your health plan. But cms, Medicare, which as Medicare goes the entire industry has to go. It's I call private payer peer pressure because Medicare CMS sets the standard of care and they are now reimbursing for remote patient monitoring. So they reimburse for the doctor setting up the patient with the remote monitoring and that just might be giving them a lesson on how their Fitbit works. Right. Setting it up, doing the monitoring and then any type of communication that results from that monitoring is now all reimbursable.

My Menacare and Fitbit was just purchased yesterday.

$2.1 billion.

Yeah. Stocks stock swap on however they've done that. So yeah. Okay, if we any more on hospital, clinic or any point of care, diagnostic and wearability, where else can we go with this?

So we're also seeing. Oh you know what I do want to tell you about a story that I did about a year and a half ago is I moved a full on hospitalization into my home and now anyone can do it by using these hacks. So what I did is I, because I have no large intestine, when I get food poisoning or you know, a GI flu, those 24 hour GI flus that is extremely dangerous for me, I get dangerously dehydrated to the point where I will die if I don't get IV saline. And so last year it was like on a Friday night I was like, oh, I don't feel too good. And then Saturday morning by 7am I was like oh my gosh, if I do not go and get myself IV'd saline somewhere, usually the ER, I will die today. Like I already knew that. And so I said okay, well I don't want to go to a level one trauma center just to get something that any nurse first day out of nursing school can give me. And that's all I needed. So instead of calling an ambulance and going to Stanford ER and those prices which would be tens of thousands of dollars just to go through the ER to begin with. I used a company called IV Doc and they're in a lot of states here in the United States. There are other companies that are just like it as well. And I used an App and I ordered a nurse into my home within an hour. So this was like 7 or 8am on a Saturday morning. By 9am there was a nurse in my bedroom giving me 2 liters of saline, IV, mega doses of vitamins, IV and magnesium because I needed, you know, you lose electro. Electrolytes so mega dose of magnesium. And I did that for three or four days and the bill came out to under $2,000. Had I done that through the hospital, it would have been 20 to $100,000 because the hospital would have also ordered a huge number of tests that I wouldn't have needed. Like I would have gone in there presenting with stomach pain. I knew it was wrong, but I was also too weak to actually tell them and get my point across the way I would normally be able to do so. So I probably would have ended up with X rays or ultrasound or an MRI and you know, expedited lab results instead, you know. $250 for IV saline?

Yeah, that's. It's considerably cheaper than you would do the other way. And you can then talk with that nurse without having to worry about the other extraneous and get the thing solved instead of having to be legally response the hospital legally responsible to test you for all the other barriers.

Exactly. So I didn't waste anyone's time. Extremely important resources. Because anytime you go to an ER means somebody else might die. Right. Like because it is a level one trauma center. So at any point people with strokes, heart attack, things that seconds literally make a difference. And if they're, they're too busy because they're triaging me on all I need is IV saline and they're not going to listen to me. That's just a ridiculous use of resources and it could cause someone else to die. But secondly, anytime you go into emergency room, you are at risk for coming out significantly sicker then you went in. Now this is like the most widely known dirty little secret in health care. Right. Hospitals. It's just you do, they are contagious zones and someone who's like myself, who's immunosuppressed, I could come out with something that could literally kill me.

I worked growing up, I worked in emergency room, elderly ward, pediatrics and an emergency operating ward. So yeah, you could see that it's almost. You almost look around when you're working in these environments and you say the world doesn't know what actually goes on.

Yep, it's true.

It's. It's not what you think. I mean a volunteer or somebody might and I'M not saying this is the case. Be responsible for cleaning the room. Now, you've seen people at a restaurant, some people clean the table completely, make sure everything's covered. They go around the edges. Then you have other people who take the same rag from one place to another. They wipe a few things where the dirt is and the rest of the table is not wiped. Don't believe that your hospital stay is going to be any different. Even if there's standard procedures, if and if there's policy where things will be missed until we get robotics.

I would say not only that, but, you know, there's one flu strain this year and I can send you an article that I read on this. It actually takes four minutes of actively sanitizing it with like hand sanitizer for it to die. Yeah, because it's managed to. It's like if someone coughs on you and there's a little bit of mucus around it because the mucus with this particular virus strain dramatically improved. Just saves it, right? Saves, save the, saves the, the virus's life. And so if it's not dried out, it takes four minutes.

It's an interesting thought because one of the things, every so often I might have to take penicillin or some type of antibiotic. And I hate it because of my travels. Having worked in Sri Lanka, Bangladesh, India, India, all through Asia, having worked all through Europe and some Africa and some middle and all over the world, I, to some degree, as much as it's a bad way of looking at it, I like having my resistance and the antibiotics kills that. So to have something to go four minutes, that's an absurd amount.

And then no one will do that. And no hospital worker thinks to wipe something down for four minutes. And no one uses hand sanitizer for four straight minutes. That's the terrifying thing. And so that when you go on, you know, go into a hospital, it's everywhere, that type of viral or bacterial activity.

Okay, so anything else to add to either the point of care, diagnostics, anything more with the wearable? Wearables, Anything more with clinics and hospitals that you like?

Yes. So take it one step further that I hospitalize myself just getting IV saline. I also I mentioned earlier that I do my IV biologic drug which contains mouse protein in it. So it's actually a high risk drug. But we're also seeing vaccines as well as clinical trials going into the home. So two years in a row I've used Heal H E A L and it is on demand doctor or nurse in your house. And it can be for anything from a sore throat to you want your flu shot. So the past two years I've used them for my flu shot. I make an appointment, they come into my house right on time, five minutes later, they walk out, they give me my flu shot and it's zero copay, 100% covered by my insurance company. Now one step further, UPS is getting into the vaccine game. They have a medical delivery division called Markel and they want to start shipping vaccines to patients homes or to local UPS places and then deploy a nurse to administer the vaccine and then take that even one step further. Companies like Science 37, this is a startup and they just did a series C funding round and in this funding round was Sanofi. Sanofi is one of the largest of the big pharmas in the world. And so that tells you something right there. And Science 37, they do the same thing that they do that I do with my remicade which is they ship the medication to the patient's home in a temperature controlled environment. Patient puts it in the refrigerator, they deploy the nurse, the nurse mixes it on site just like a pharmacist does and then administers the IV over a period of time. They do this with both medical devices and pharmaceutical products. And then any of the doctor visits that you need to have will be done by video. I know. How cool is that?

Well, it's cool and it's, it, it's cool and at the same time there's a sad part about it and the same time there's a good part that it's cool because it's unbelievable. Tech. It's cool because UPS is just like, is transforming themselves. Just like they became the shipping and the, the shipper and the repair company for laptops and technology or for the distribution of socks and clothing. It's cool because they're getting into the medical side. So they're no longer a shipping company. They're also a, to some degree or a service oriented company. It's scary because a lot of people are doing, need a lot of help. And so this exists because so many people are sick. And I think we, you could have this challenge of being healthy and being sick and what is health care really? Is healthcare healthcare or is it really sick care? And healthcare is another different story. And so I've got several things running in my head simultaneously.

Which direction would you like to go?

Maybe we should, maybe we should call one of these people, see if they can give me something for it. What, from what I said, what jumps out at you.

So yes, you're right. We are practicing sick care, but from the time we're born, we're dying, aging in Silicon Valley. We look at it almost as a disease. Right. So yes, you're absolutely, you're correct. We're always playing catch up. Yeah, but let's see. Oh, go ahead.

No, it's just that we are playing catch up. But are we also causing. So that became. There's a causality. Are the GMOs the genetically modified products that we're eating? The. I was told, and I don't know how true this is. So this is maybe not real, but does the bread in Europe with the yeast or the way it's made is different than eating bread in the States? And I just a lot of challenges and here you're. We're coming up with so many solutions for the challenges that we may have created.

Oh, we. Well, I don't know, people. I mean, if you think about it, our longevity is significantly more than it was even 100 years ago. So what we have done is we have dramatically extended life and health and healthy lives. But yes, on the flip side, there's too much of a good thing. So we are through mass production of food as well as a lot of lifestyle and behaviors because we're not out there getting exercise constantly, because we're not foraging or hunting or setting things up. Technology has allowed us to be lazy. Yeah. So between those two things, they are really causing the biggest of the diseases. So heart disease is the biggest killer. Right. Things like lung cancer, most lung cancer is caused by smoking, which is a lifestyle choice. Hypertension and diabetes are lifestyle choices. These are not diseases that would exist if you worked out daily and ate a whole food. Very clean diet. But when you're talking about the bread, this is something I've actually been diving into recently. And about six months ago, I decided to cut out all preservatives and gums. Now, crazy enough, in the American food system, the mass produced food, whether it's yogurt or even just chocolate milk bread, any of the snacks, any, basically anything that adds creaminess, all has one of maybe 10 ingredients in it. And there are 10 ingredients that have really gone through the entire American food system. It's carrageenan, polysorbate 60 and 80. There are all the gums. So gaur gum, locust, bean gum. These are made in the lab using bacteria. And with the microbiome being a very big point of medical science right now, we don't know a lot about it, but we do know it is dramatically and intricately linked with healthcare of all kinds, whether that's diabetes, hypertension or even things like add. What if we just get rid of all of these preservatives and fillers? We know they wreak havoc with people's GI systems and if they're wrecking havoc with GI system, they're wrecking havoc with the microbiome and that in and of itself can cause a huge number of these diseases.

Yes. So are we the cause of our own need for the complex system? And so you've kind of. I don't know if there was an alternative and we might have had to go, we might have to go through this, but it's, that's what all of this tech and this capability and you're a, you're a case of someone who's got several different conditions. I don't know on a global scales there's any way to be able to differentiate between where the disease originated or how it originated in individuals, whether it was human made or not, whether it was pressure from work, pressure from meeting needs, pressure from or smoke or all the behavioral sides that contribute to our illnesses. So it's an interesting dilemma to listen to all these amazing things and at the same time being.

You should be scared. No, I'm just kidding.

Okay, so now you've gone over a lot of the in home care. Is there more to add to the in home physical?

So flu. Yeah. So the flu shots, the vaccines, the IVs. And one thing that's starting to go into the home is AI voice technology. Now this is interesting. There's something called a vocal biomarker. Being able to use somebody's tone of voice, the way they string words together, the speed of their talk over a period of time and how and those changes can be used as a data point in an overall diagnosis. So you get your blood pressure, you get your cholesterol and you get your voice imprint. Now there are a lot of companies working on this. One thing I do have to tell you is Amazon Alexa is now HIPAA compliant. It has over, last I heard, a thousand health apps I believe affiliated with it. And that was a few months ago. But companies like or hospital system like Mayo, Mayo Clinic last year published a white paper around a correlation between somebody's voice and coronary artery disease, which is the top five most expensive disease. So just in your home, doing your everyday lives, you can start to have things like Amazon Alexa record your voice and alert you or your healthcare professional when they think something is changing on your Voice so you can get it looked at whether that is a neurodegenerative disease, bipolar, any of the mental health disorders, or as I mentioned, things like heart disease and coronary artery disease. How cool is that?

It's cool. And at the same time, I don't know if you've seen the TedX talk where this one guy became very scared of AI and the reason he was is he was working on a project to differentiate between dogs and wolves. And they had done machine learning, I believe it was to be able to train the system. And they couldn't figure out why, when they would show a dog, it would call it a wolf. And they kept on looking and deciphering, trying to figure out where it came from. And they realized that even though the dog had a certain shape, had a certain snout, has certain eyes, had certain everything, the reason that the computer system, the AI was determining it was a wolf is because it didn't look at the dog. It looked at the snow in the background. Ah. So because wolves typically are shot with snow in the background. So if there was a dog with snow in the background, it must have been a wolf. So we. The AI side is really cool that it's got the capabilities. I had two questions come to mind in my head is one, out of all the companies that are being introduced into health tech and how many are failing, how many times are you giving your information to somebody, recording it, keeping it, maintaining it, with somebody, and then that company disappearing? And how does that happen to start over? Meaning that you've lost that data and you have to go to the other. And the other is, is there going, are we seeing misdiagnosis? Are we creating a hypochondriac type of environment? All my system's got to be watching. I've got to make sure I'm this. I've got to make sure I'm that. Is there a positive side? Well, not there's a positive. There is a positive side, but those.

Is there a negative side? Is there a, you know, a backlash?

Yeah, we. Are we. Or are we adapting? If you have Alexa, are you trying to make sure you eat better? Because you want to make sure that Alexa doesn't tell you you've got a heart condition?

Well, there is the fact, and that's been studied extensively in psychology, when somebody believes they are being observed, their behavior is different. Absolutely. Feedback loops work. Right. Secondly with the hypochondria. So, you know, most people who go through medical school gets what's called medical school syndrome because you get so ensconced in it. And so all of a sudden you're, you're learning about this rare disease and you're imagining everything that you feel is you have this disease and this happens to people who go to Harvard Medical School and Stanford Medical School. So yes, that is a very real possibility. Absolutely. And it will work with more.

And, and I, and I know I was pre med so I worked in all these, that's why I was doing all that. So I was very familiar that you'd look at something and say maybe I have that. I like that you said if you're being observed you'll change your behavior. But at the same time, if you're being observed, as we're seeing, that can cause chronic stress conditions and it can cause behavior where you try to circumvent it. So are we seeing a positive outcome because of the health tech where we're actually becoming healthier or are we not becoming healthier even though we have it and we're just adapting to it? And I don't know if that's an answer you have.

I don't that's an answer anybody has yet. Only because this is so new, it's not widely adopted yet really. It's the early adopters and a lot of people who are using things like wearable tech are the ones who were already doing healthy behaviors. So we need a few more years. And then you know, thinking about the fact that this is a three and a half trillion dollar industry in the United States alone, it's going to take a lot of data to really do do a study around that.

So what other types of tech are you seeing out there? It could be in that that are really cool. I'm not going to give you the direction. You probably have plenty of ideas. What other tech are you seeing that's kind of like wow, I never thought that was.

Oh, I grew up with, my dad was an MIT guy turned patent attorney and my mom was a physician. I think everything is possible. But we are seeing some other cool things going on with the voice technology though because it's expected by next year about 50% of all search is going to be done by voice. And the reason is, is because AI now has a 4.9% or lower error rate at understanding spoken English. If you are an American born English speaker, your error rate is about 4 to 5%. So AI is as good as human beings now at understanding spoken English and that's hitting healthcare in a lot of ways over the next year or two, including being able to help People who are disabled, right, if they are, if they have bad speech for some reason because their mouth is disabled or they've had surgery or something and they don't enunciate, you know, they have Parkinson's or some, you know, advanced disease. There are AI now that's being trained to understand people with disabilities. There is AI that is being trained to essentially do voice to speech and text, you know, text to voice, so that people who are blind can get around. Right. So there's some really cool things with that. Not only that, the hospital systems are starting to put AI speakers like Amazon, Alexa type speakers in the, in the hospital rooms for patients so patients can interact with their care team. They can interact with their room, so control the tv, control the curtains, as well as interact with their electronic medical record all by voice technology. This is fantastic for patients who can't sit up, you just had surgery and you can't reach the call button, but you can just, hey, hey, Alexa, call my nurse. That's a really big deal when you're a chronic disease patient or post surgical. I know, right?

Yes.

The voice thing, I did not realize how fast this was going to come. The reason also it's accelerated and we're going to see a huge difference over the next couple of years is because Amazon, Alexa has already distributed over 100 million devices and Google, because it's available in the Android phone, has already distributed over a billion devices that do voice technology and they are available in 30 different languages. And so this is going to happen fast. It's going to start really, you're going to start interacting with everything by using voice and in healthcare, that's a big deal.

I can see it happening in healthcare. I can't say everything because even though we have the capability to do a lot of these things, things by voice, we still don't. Meaning how many times do you type in? And maybe you don't, but I still type into the Google bar. And there are certain people who love to use voice and there are certain people who will text me and there are other people who only. And I, some, I often can't listen to the voice because I'm in an environment where I can't listen to the voice. So I'm not sure how quickly you'll have, will have that penetration, but I do believe that there will be continual capabilities of moving in that direction. So when you look at healthcare going forward, I mean, if, and I know you're not a futurist, but let's. What do you, what are some of Your thoughts going the next three?

Oh, so I am actually a futurist a lot. Everything I've been telling you is available now over the or over the next two years. But I did co found a company called the Organ Preservation alliance and we catalyzed breakthroughs in tissue engineering and cryopreservation in order to get rid of the transplant shortage in the world, but also to dramatically extend people's lives by switching out their organs when they started to age and curing disease, things like heart disease and like cirrhosis of the liver by just switching out the organ. And so I do know a lot about that world. We are looking at potentially being in we as a human race, not we as in a company, the human race. We are expecting to be in clinical trials in animals, animal studies within the next three to four years using tissue engineered vascularized organs like heart, lungs, kidneys and livers. In Israel they've already been able to 3D print a heart the size of a cherry, which is about the size of a rabbit's heart. In addition, there is a lot going on with ghost organs. So taking an existing organ, decellularizing it, but leaving the scaffolding and the outside of it in place and the vascular system in place, and then repopulating it using stem cells from adipose tissue, which is just fatty tissue from the recipient patient's stem cells and so like that. That is probably 10 years from human trial and less than 20 to the clinic.

How there's 7.5 billion people on this planet. How prevalent are these? Is this tech reaching the individuals who are $3 a day or less? What is it about five and a half billion people? How prevalent is the tech falling into these places and being able to be introduced at a cost effective way?

It totally depends what tech you're talking about. So the tissue engineering isn't even available in the first world yet. So you know the it's economies of scale in terms of some of this technology. The other stuff like especially things like drones. So in Rwanda and Ghana they've leapfrogged, essentially building an infrastructure of roads so they have cars instead. They're using drones and a company called Zipline with a, with it's the latest unicorn in the world of drones. They have an over $1.2 billion valuation. They've been in Ghana now for three years and they've done over 13,000 deliveries. And most of this has been for blood transfusions to save people's lives. But now they're doing over 160 different products they're all healthcare products that they, that they deliver by drone all over Ghana and now they've gone into Rwanda. So they're leapfrogging our abilities because we don't have that ability. We can't. If someone's dying in the middle of nowhere, Virginia and all they need is a blood transfusion, they're going to still die. Whereas the, the mom who needed the blood transfusion like this is a big killer and right after you give birth. So she's surviving in Ghana because we can get blood to her faster than we can get it to a remote part of say, like the mountains in Virginia. So they've leapfrogged us.

Why? Why, why, why can't.

Why? It's because of FAA regulations. So they have just, there's a, there's been a huge amount going on especially with Google Wing as well as UPS recently getting, getting classified as cargo flights. So they no longer need to be line of sight with the pilot. They can go. UPS specifically can carry over 55 pounds by autonomous drone. Now UPS doesn't have that capability because the FAA hasn't given it to them. They have drones that can do it, but the FAA hasn't given them permission for that yet. So it's purely regulations. Whereas in Ghana, they created with the government the world's first completely nationalized drone delivery system.

It's, it's an interesting, I don't know if you've ever been to Ghana. When you look at the countries around the world and you see the differences between what first world countries have and what some of these third world and I. And Third world's a very challenging word that we use people. I believe that India is considered a third world country in many respects, but yet they, they're thousands and thousands of years old in terms of growth. So it's more political challenges, I think than anything else that has caused them to stay where they are. It's amazing how some of these countries have been able to. The term leapfrog is always used, but they're able to accept a different form or different narrative to the way products and services and life can be lived as compared to what first world countries have accepted. It's just an amazing difference.

But this has been, oh, it's just all of these point of care diagnostics are, are accessible especially for clinics. So if you think about having something like a tidal care, but, but have that and the, you know, the one town clinic that's in the middle of Africa somewhere, right. So all of a sudden instead of having those Four expensive devices that are thousands of dollars or hundreds of dollars each. You get four of them for $300. So you can start outfitting some of these clinics as well. Companies like the Red Cross and things like that can be helpful there.

Yes, but that $300 service in the states, 300 for, for many of these other countries is a fortune. And so it's relatively thing.

But that's why I'm saying you can replace the expensive equipment that you would find in a first world doctor's office and you can replace it with the consumer clinical grade point of care. Diagnostics.

Yeah, absolutely. I was in Bangladesh. I was in Bangladesh and I put a pipe through my hand to the tendons. I was working in a factory in it, moving something and long story how it got there. But the care was kind of interesting. I won't even go into that. The way in which they approach medicine was very interesting. But they offered me six when I was done they gave me six drugs that I thought I should have and one was an anti ulcer drug. So maybe they thought I had challenges at home. I don't know that there were just random drugs that they had offered. I think the thing that was interesting to me about the drugs is that the drug was US$2, US$7, US$15 where that same drug in first world which often pays for third world, that drug would have been hundreds of dollars for the same. Sometimes thousands would have been for the same. Yes. For the same treatment. And so I don't know how we're going to be able to in, in future wise be able to balance that out because today some people are saying that the United States has or countries have people living like they're not third world completely but they're living hand to mouth even though they might have a higher income. How do we make this distribute? How do we make this care more accessible to the people of the world?

It's, I mean yeah, we start partnering with companies like the Red Cross or any of the other companies that go in. The Gates foundation does a huge amount in the, in the developing world world. Right. Bringing healthcare especially to the developing world. Anything that brings health care into the home brings it to a small clinic, like a small town clinic. Right. And can outfit it for much cheaper. And with a lot of the software. Right. AI software is pennies if as long as they already have a device they can get it for free a lot of the time.

What's the one thing that you would say in your history of the medical side with your care or Other care that you've just said that you could think back and say, oh my God, that is just beyond anything I've ever, ever, ever thought of. This is the most amazing. What would be that one thing?

Wow. See, just eradicating autoimmune disease. We just cannot figure that out. Right. And there's over 80 autoimmune diseases. So if someone came to me with a way to turn that off or to change the microbiome, that, that would blow my mind. But I think some of the microbiome stuff is already starting to blow my mind. The fact that we haven't taken it into account in medicine all the way up till now too.

So how about in your history, what's the one thing that stands out? Out of everything that you've been through, everything that you've seen, if you had to say, this is the one most amazing transformation, what would it have been?

Oh, the transformation of the. Shifting the biologic into my home. One thing I didn't mention is the first 16 years when I was getting it in the hospital, because I've been on the medication for 20 years now, it would take me eight days to recover. And that. That came out to over two months of recovery time a year just from the medication pulling it into my home. My recovery time went down to three days just by changing the patient environment. And the fact that we have not been taking the patient environment into account in healthcare most of my life is just mind blowing. And when I tell people that from stage pharma companies and doctors, their mouths drop open because they never think that a medication and the side effects are gonna look diff. Work differently depending on where the doc. Where the patient is when it's administered.

So let me give you a quick little story and then maybe you can react to it. In Silicon Valley, I was a head judge at a competition and one of the individuals stood up and he had this device which was like a test tube that could be stuck between the ribs, allowing a physician to be able to use tools to go right in to do heart surgery. And it sealed it on both ends so they could swap out tools. And it was an amazing tech. And the when they asked how much he could, the potential was it was like $800 million worth of sales that were the volume that they could reach maybe a billion. And there's some other companies who are doing security tech. And it was mainly security tech. So being able to access your files and accounts or protection, and that company was billions of dollars worth of capability. So what happened was the guy with the 800 million didn't win. And I looked to the person next to me and I said wait, wait, wait, wait. Are you telling me that security tech is more important now? Think about it. This person go into the hospital, they can have surgery, they can go home. And after most heart attack attacks or heart conditions that you have a stroke two weeks later. So these people can have their parents, their grandparents, their family live longer. They could go back to work, work and contribute to society. There were so many values that were so much stronger and yet everybody was more interested in a. But we can get a password protection to be able to get into our X, Y and Z or protect this. So there's a. I don't believe that people are looking at the implications of for example, home care or being home or being able to live with your family or have your grandfather around for another 10 years if things were done differently. I don't think that's looked at as much because there's no economic value to the corporation. But there's an economic or there's a social value to having a father raise or a mother raise their children which could be long lasting and completely different. I don't know if there's a way to equate that or be able to put a value that helps corporations see that number in a much better life.

Well, they have to have a long term relationship with you. And the problem with insurance here in the United States and especially even just employers and things like that companies is that health care works in one year increments here. Hospital contracts are on one year increments. Pharmacy benefit managers are one one year increments when they are, you know, pricing different drugs and doing the deals for drugs. And so no one has that long term view in mind. They only care about that short term. Okay. How do we reduce costs this year?

Yes. And that's. Those are the challenges we have in many different areas. We could probably talk for hours on that. Is there any last thing that you would like to teach me? Tell me that I should think about when it comes to all the things that go through your mind when it comes.

Yes. So always think outside the box, especially with your own healthcare. Because most of us, when we go inside of a hospital, we come out sicker. Right. Things happen. You need to be the CEO of your own healthcare team because if you are not, you are likely going to die. Right. Like or get sicker. And so you have to be willing to take control of your healthcare and look for different solutions. Right. Don't do if you're practicing your healthcare and receiving your healthcare the same way you did in 2015, then it's time for an upgrade.

And are the insurance companies a source to find some of these? So if you ask, they will tell.

You what they know about. Of course it's going, you know, these corporations, they're huge. So what, one nurse when you're talking to it, or one benefits manager when you're talking to them, may or may not be aware of everything. Right? So you have to do your research. Just like you wouldn't get your kitchen remodeled by just picking up the phone and calling one person and then walking away from the decision. You don't do, don't practice your healthcare that way either. Get, get at least three different sources of information that's high quality information and come up with your own plan with healthcare professionals of some kind helping you out and giving you advice.

Well, I guess that's, that's an important point because I think a lot of people would say, well, I'll do my kitchen myself. And I heard one statistic that plumbers love when people want to put in their own toilets, because they typically get called, once it's done, it's going to.

Cost you more.

And it's going to cost you more. And I've put in quite a few toilets, so I know that for some people it's very challenging. So in this case, it's finding the right resources. And I think it's an exploratory journey that hopefully there are companies out there helping to build methodologies or tools that will allow people to find what they need faster. The work is challenging, but it is.

For anything that you want to get done. I mean, how many people just buy one? You know, like, think about, oh, I need a new car, and then they just say, okay, this one. And they don't do any research into it. We research our house or apartment, we research our car, we research our prospective spouse, we research our kids, colleges or high schools or whatever it is. So why are you relying on that one? You know, your primary care doc, or you're just your insurance company to dictate how you do your health care.

I think we can leave it on that. So that was Robin. I knew we'd have a great time together. So I am so thankful that I ran into you the other day and said, come on, we've got to have you on the podcast. And we were able to make this happen so quickly. So thank you, thank you, thank you. You are, you are fantastic. Wealth of information and a refreshing way to look at some of the things given your knowledge but and not but and your history of having used these services, which I think adds another level of credibility to the commentary that you're adding.

Sure. Thank you. It was so much fun.

So I want to thank all of you who have downloaded or listened in. We hope, I hope, we hope that you've learned something today that'll make a difference in your life and the lives of others around you. So always remember, you can't fix yesterday. You can only create tomorrow. So let's work on creating a or redefining tomorrow. So love to connect with you if you're interested. Davidavidgoldsmith.com Instagram is Mr. DavidGoldsmith, Twitter, avidgoldsmith or LinkedIn, Facebook all over. What's one way to connect to you, Robin? What's one best way to go?

I am the only Robin Farm and Farmian in the entire universe. So you can find me on, you know, LinkedIn or just RobinFF.com. just Google me and you'll find me.

And that's the. Your name has always been one of those challenges that I've said. Okay. There's a lot of letters there, and I'm glad we made it past that point of the podcast. So love to connect with everybody. Thank you very much, and I'm David Goldsmith and thank you for listening.