Thrilling Three 2016

December 22, 2016


2016 will be recorded as the year of the “surprise” – a year that illustrated more than any in recent memory our inability to predict the outcome of near-term events, a real failure to move beyond “big data” into clear and precise “insights.”  To not just “know the numbers” but to truly understand what data trends and population sentiments are “actually telling us.”

This year will also prove to be one that reinforced the resilience and agility of markets and the entrepreneurs that make them possible.  A historic year enabled by the adaptive and creative – a chapter that often reminded us of the importance of playing for the long game, to commit to bold new possibilities that are only made possible, by those who have “the gift (and grit) of giving.”

Over the course of every year, I build and curate a list of the most remarkable advances


encountered, then boil them all down to what I call my “thrilling three” – the three most thought-provoking ideas, products or trends I encountered across the year. Though diverse, each has caused me to pause and say, “Really? Wow, that’s impactful – that could change everything!”

In 2015, we highlighted SQZ’s approach to simplify and speed the development of personalized cell-therapies.  One year later, with a half-a-billion dollar pharma deal in-hand, SQZ has focused on a product to enlist a cancer patient’s own B cells to recruit the immunologic troops to build an anti-tumor army.  B cells are a class of immune cells which have been notoriously difficult to genetically manipulate, but SQZ’s microchip may crack the code.

In 2015, we again focused our attention on end-of-life care and in this case innovation, by creating for the first-time real incentives (CPT® codes) for physicians to schedule advanced care planning conversations with their patients, well before those conversations become strained by acute treatment decisions.  However, as with all things new and unfamiliar, “implementation of the new codes has prompted a barrage of questions from family physicians concerned about applying them correctly,” according to the leadership of the American Association of Family Physicians.  Nonetheless, this is a wonderful signal that primary care physicians are acting on this opportunity to help their patients prepare in advance and new guidance has resulted.

Lastly, in 2015 we zoomed in on the microbial world to highlight new microbiome-based diagnostics and treatments that are emerging.  2016 was a year of exciting progress, but there were some surprising setbacks for the microbiome.  In the setting of diagnostics, encouraging progress has been made in helping to understand the role of the microbiome as treatment-response modifiers, with particular attention in the setting of oncology care.  In contrast, the most advanced microbome-based treatment, in this case for recurrent C. diff infections, came up short in its first randomized Phase 2 trial – an event that sent the whole field looking for the explanations and jiggering even newer approaches. Either way, our personal microbiome’s are destined to become a new “vital sign.”

So for 2016 here they are:

Blockchain – In biology the history of everything is written in DNA – chromosomes faithfully copied with each and every cell division as a written diary of every cell and all the lives that preceded them.  As a result of extraordinary advances in memory storage technology and cryptography, our digital worlds have evolved to something similar.  Welcome to blockchain.  For those who have not followed this, simply said a blockchain is a secure digital identity that can be created and associated with any asset – physical or virtual.  Most often talked about in the context of Bitcoin or other related online currencies, a blockchain can be built and used to tag immutably to anything.  And like DNA in biology, all new events bring with them the full history of every event that preceded it.  Well beyond virtual currency, blockchain will rewrite the rules of many modern conventions (and industries) because as in biology a central tenant of progress is trust and, with blockchain, the securitization of trust has been revolutionized.

Iodine – All products have features and limitations.  But very few rely on our personal biology, except for perhaps golf clubs, to activate these features in order to obtain benefits.  But with medical products, this is precisely what is required.  Enter Iodine, a new platform with which patients can carefully track precisely how their medications are performing and catalogue what might be the negative attributes of the medicines.  Given the difficulty we all have keeping this type of longitudinal information organized and useful, platforms like Iodine and the data sets that will thus emerge is the beginning of new tools that will transform how real-world evidence is captured and translated to enable treatment personalization and more patient-centric decision making.

Affectiva – Across a world filled with diverse languages, ethnicities and cultures, we truly share just one thing – our innate emotions.  Like instincts in other species, our emotions are hard-coded in us and then reinforced in early pediatric development.  It is our emotions that make us truly human and without even saying a word, we have a profound ability to read the emotions of others simply by looking at facial expressions.  First developed by Paul Ekman in the 70’s and then updated in 2007, the FACS (Facial Action Coding System) details the facial expressions (facial muscular reflexes) co-incident with each emotion.  Fast forward to today, Affectiva has automated the FACS coding system and can rapidly capture diverse emotional states in response to cueing prompts or just on the fly using personal computers or cell phone cameras.  The ability to capture these deep insights is the beginning of a new era in personal and population analytics.

Next up, reflections and forecasts derived from the annual “pilgrimage” called the J.P. Morgan Healthcare Conference.

End of Year Reflection

“We have the capacity to think several centuries into the future.  Start the task, even if it will not be fulfilled in your lifetime.  This generation has a responsibility to reshape the world … So we must ask ourselves about how we lead our life, and in the service of what exactly are we using what ever talents we may have? … To check our motivation, we must ask:

Is it just for me, or for others?

For the benefit of the few, or the many?

For now or for the future?”

–His Holiness, the Dalai Lama