Healthy Optimism, May 31


A scientist walks into a healthcare company…

In case it’s not clear by my bio and the material I choose to cover here on Healthy Optimism, I like the life sciences. I’m, um, not actually a healthcare guy. I mean, it’s headed that direction but my background is basic research. Cell biology. Intestinal physiology. And a hint of microbiology. I’m nerdy enough that, during my time in lab, I developed an attachment — a friendship, almost — with a couple of of high-end microscopes. Come to think of it that’s probably not nerdy, just socially maladjusted. Whatever.

Point is, I’m coming at this health and healthcare thing from a very different perspective than a lot of people in the business, including my colleagues. And being a scientist in a healthcare town, which Nashville definitely is, part of that perspective is shaped by the discovery of a strange but somewhat understandable line that’s artificially dividing two groups.

The line has been drawn between the life sciences and healthcare. On one side, anchoring the edge you have basic academic research. Molecular biology and the stuff I did. Further in you have pharma, small molecules, biologics, and genomics. Right near the center are medical devices and diagnostics. On the other side out at the edge you’ve got the business and finance of healthcare, including payers. Health IT and the infrastructure underlying the whole system, like EHRs, probably fits just a little closer in. Then there’s health tech and consumer devices, followed by the data analytics that personalized medicine relies on closest to the center line. Or something like that. I’m still figuring out exactly where it sits, which is part of the problem. It’s arbitrary.

The thing is, when you quit looking at “healthcare” and “life sciences” and instead look at the sub categories like “molecular biology” and “personalized medicine” and “genomics” and “diagnostics,” the line starts looking blurry at best, pointless at worst. If we don’t figure out that this whole thing is a (very long) continuum and not separate categories, we’re going to miss out on some crazy cool innovation in the future. Biology and silicone are coming together faster than anyone anticipated, and we have to figure out how to integrate the pieces to make it accessible and sustainable.

Caveats before going further.

First, yes, there are distinctions between “healthcare” and “life sciences” when you look at the extremes. Nobody would conflate the work I did in grad school on mouse intestinal cells with the work people do figuring out the financial modeling behind insurance plans.

Second, yes, there are — as Jumpstart Foundry CEO Vic Gatto has patiently explained to me on multiple occasions —solid business/VC reasons for drawing a line. Funding a health tech startups, or even a diagnostics company, is a very different proposition than putting money behind a team working on a biologic.

Aside from those caveats, though (fully admitting the handwaving that’s going on right here to just brush them off), the distinction between life sciences and healthcare is becoming burdensome and obsolete. The two industries are merging, largely because of the molecular revolution and its aftermath. We still don’t really understand how genetic information, including RNA as well as DNA, not to mention environmental and other triggers, lead to physiological changes. I mean, in some cases we do, but the field is still in its infancy. But what we do know is changing medicine. We can profile tumors to determine whether a given patient might respond better to one drug over another. We are starting to understand how the presence (or absence) of bacteria in our bodies is correlated with, if not causative of, everything from GI issues to obesity to neurological conditions. Diagnostics and a lot of medical devices are also rooted in molecular and cellular processes, whether or not they’re listed on the product fact sheet.

What ends up happening is that our molecular understanding of human biology informs and helps interpret the expanse of health data being collected, and vice versa, crossing over whatever line still exists.

This all seems obvious on paper, but in practice it seems like scientists and healthcare industry insiders don’t always know what to do with each other. Part of it is a failure by scientists to clearly explain how basic academic research leads in the long (and sometimes short) term to advances in human health. Part of it is due to the massive amount of energy the healthcare industry has to spend these days trying to figure out how to make the numbers work. There’s so much focus on the business of healthcare that it’s easy to forget about the science behind health.

Not sure if I’m communicating these thoughts well, even though this is a problem I spend a lot of time thinking about. It’s encouraging, though, to see progress. For all the handwringing around Theranos (of which I have taken part to an almost obsessive extent), it offers a good look at the merging of Silicon Valley, biology, and healthcare. Mistakes (or worse) were made, so let’s take the lessons and move on. Synthetic biology is moving fast, bringing engineering principles to biology to design molecular solutions to all kinds of problems that include issues of health. Diagnostics and medical devices are integrating new information from the scientific community and are being implemented in ways that are improving healthcare delivery — i.e., making the business of healthcare better.

I’m excited because here at Health:Further we’re working hard to figure out where that line is, why it exists, and how it can be removed. Our new partnership with Life Science Tennessee is both an indication of this commitment and a major part of the solution. We want more scientists at Health:Further to 1) talk about how their work affects human health and 2) learn about the realities of our health system. Or to flip it around, we want traditional healthcare types at Health:Further to 1) talk about the business of healthcare (an issue idealistic scientists can forget) and 2) learn more about innovation taking place at the molecular level that will change their businesses.

As we constantly say around here, “building the ideal future of health is going to take all of us.” It’s natural and necessary to draw some lines, we all need to define the terms and put constraints in place. Still, there’s no reason not to move the lines, adjust the constraints, to include as many relevant perspectives as possible. Especially when those lines don’t make sense anymore.