1. 2014 | BREAKTHROUGHS IN HEALTH & WELLNESS
01/ WHAT IS A BREAKTHROUGH
IN HEALTH?
Remembering the Human As the
Basis for Patient-Centric Care
PAGE 06
02/ CAN THE INDIVIDUAL IMPACT
CARE?
DIY Innovation in Health
PAGE 14
03/ HOW CAN DATA TRANSFORM
HEALTHCARE?
Artificial Intelligence for Health-
care Innovation
PAGE 16
A SELECTION OF INQUIRIES,
HISTORIES, SPECULATIONS
AND PERSPECTIVES ON
HEALTHCARE INNOVATION
RE/THINKCARE

2. INTRODUCTION
—
UNEXPECTED BREAKTHROUGHS ARE TRANSFORMING
THE HEALTH AND WELLNESS WORLDS. WHERE WILL THE NEXT
ONE OCCUR?
A heady mix of demographics, technology, social media, the eco-
nomics of austerity, spiraling costs and the seemingly limitless
possibilities of scientific advances conspire to make the fields of
health, wellness and care among the most complicated and pressing
challenges of our times. The pace of these changes is simultaneously
glacial and meteoric depending on where one looks, with the
different players – governments, insurers, doctors, scientists,
patients, startups and many others – all moving at different, often
incompatible speeds.
Other relevant cultural shifts are also at work in the health and
wellness space. Shifting foundations of health knowledge and
authority have democratized the relationships between patients and
doctors as well as massively expanded the spectrum of health
practitioners available to us. Now, many of us have a family doctor
(and many of us don’t), but we also see a naturopath, a massage
therapist, a trainer, a life coach, an osteopath and myriad others.
That is all in addition to “Dr. Google” and the newly available data of
“the quantified self” which are increasingly weighing into our health
queries and decision-making. The boundaries of technology and medi-
cine are increasingly blurry.
When most people think about breakthroughs in this domain, they
are naturally drawn into the world of cures and scientific discover-
ies. But because of strict FDA guidelines, the heyday of blockbuster
drug discoveries is behind us. So if our perception of health break-
throughs is wrong, where are breakthroughs in health and wellness
occurring? In this special feature, we offer a selection of perspectives
that highlight many potential sources of transformation. Through
an exploration of the drivers of change in today’s health landscape,
what we actually see is a more fundamental redrawing of the lines
around who is at the center of care, and who will be involved in
delivering it. From big data to little garages, from automation to
personalization, there has never been so much potential to drive the
next breakthrough in health as there is today. //
re/think care
writers
—
01
patrick glinski
02
marc lafleur Ph.D
03
dustin johnston-jewell
& peter jones Ph.D
04
james aita
05
hesam masoumi
06
marina andreazi
07
steven bisch M.D.
& alex yurek
08
fiona hughes M.D.
09
reynald fleury
designer
—
01
julie do
re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.

3. re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.
A SHORT
HISTORY OF
BREAK-
THROUGHS
IN HEALTH-
CARE
—
01
patrick glinski
Every time we visit a hospital, talk to a doctor
or even clean a wound, we’re utilizing the
breakthroughs of health’s past. With so much
focus on advanced science and progressive
social policy today, it’s easy to take for
granted that the world once saw disease as a
punishment inflicted by the gods. Thankfully,
brave innovators throughout the history
of healthcare have developed theories,
disciplines and innovations that continue to
be pervasive in today’s health practice.
THE HIPPOCRATIC CORPUS
—
• A PAGE OF THE HIPPOCRATIC CORPUS, A COLLECTION
OF AROUND 60 EARLY ANCIENT GREEK MEDICAL WORKS.
• ASSOCIATED WITH THE PRACTICE OF HIPPOCRATES,
THE FOUNDER OF MEDICINE AS A RATIONAL SCIENCE.
RELEVANCE
Hippocrates may be the most important figure in healthcare. Born in 460 BCE,
Hippocrates can be credited with the insight that a person’s lifestyle can affect
disease, for identifying subjective symptoms and objective signs as reactions of
the body to disease, and defining the role of the physician as a facilitator of
natural processes. Hippocrates, through his practice and the readings of the
Hippocratic Corpus, ushered in an era of rational science. His approach to
medicine, and his Hippocratic Oath, represent the foundation of practice and
ethics in care today.
PRACTICE, POLICY, PHILOSOPHY.
BREAKTHROUGHS CAN COME IN MANY FORMS.
HERE IS A CURATED SELECTION THAT CONTINUE
TO IMPACT OUR HEALTH TODAY.
THE MICROSCOPE
—
• AN EVOLUTION OF THE LENS BUT A BREAKTHROUGH
SCIENTIFIC TECHNOLOGY.
• INVENTED SOMEWHERE BETWEEN THE 1200s AND LATE
1500s TO ASSIST WITH SIGHT, AND ADOPTED WIDELY IN
THE MID-1600s FOR SCIENTIFIC PURPOSES.
• ALLOWS FOR THE ANALYSIS OF BIOLOGICAL STRUCTURES.
RELEVANCE
There is a hidden world beneath ours that is far too small for the naked human
eye to see. At a time when science and mythology were coming to a head, the
microscope facilitated the discovery of bacteria, viruses, cells and more. While
many incremental developments likely resulted in the microscope, a spectacle-
maker named Zacharias Janssen is often considered the inventor of the first
compound microscope. Discovered after combining multiple lenses while trying
to develop new ways of assisting people with poor sight, there isn’t a high school
science class today without one.
01 TRIAGE
—
• A TOY SOLDIER FROM NAPOLEON’S IMPERIAL GUARD.
• THIS ARMY WAS SUPPORTED BY SURGEON-IN-CHIEF
BARON DOMINIQUE JEAN LARREY, CREDITED AS THE
CREATOR OF TRIAGED CARE.
RELEVANCE
It’s hard to imagine that care was once first-in first-out. Baron
Larrey changed all that, introducing the concept of sorting soldiers
into immediate, urgent and non-urgent cases in warfare situations.
The breakthrough of triage changed how care was done in
mass-casualty situations, and continues to be an important
philosophy in today’s care system. Triage allows healthcare
practitioners to see the most urgent cases first.
CLEANLINESS
—
• A BAR OF CARBOLIC ACID SOAP, REPRESENTING
THE INTRODUCTION OF THE ANTISEPTIC INTO SURGICAL
PROCESSES.
RELEVANCE
Indeed, soap was once a breakthrough. The introduction of cleanliness
principles in the operating room is one of the most important developments in
modern medicine. Hot on the heels of the discovery of Germ Theory, in the
mid-1800s Joseph Lister introduced the idea of sterility in the operating room,
highlighting the use of carbolic acid to clean hands, treat wounds and sterilize
surgical tools. The resulting drop in infection rates ushered in a practice that
still lives on today. “Scrubbing in” is now an essential part of OR procedure.
BEDSIDE TEACHING
—
• A HOSPITAL BED, REPRESENTING THE VALUE OF
BEDSIDE TEACHING INTRODUCED BY WILLIAM OSLER.
• HIS BREAKTHROUGH APPROACH TO THE EDUCATION
OF NEW DOCTORS, AND HIS SYSTEM OF RESIDENCY IN
TEACHING HOSPITALS, REMAINS IN PLACE TODAY.
RELEVANCE
Given the hands-on nature of medicine, it’s hard to imagine that
the concept of residency only gained popularity as of 1900. Classic
medical training before then focused on lectures, as opposed to
offering opportunities for practical experience. William Osler is
credited for introducing the breakthrough of bedside teaching, or
bringing medical students into the ward as an applied learning
opportunity. As a result of this breakthrough in medical teaching,
doctors gain real world experience with the diagnostic, mechanical
and empathetic responsibilities of healthcare practitioners.
THE HYPODERMIC NEEDLE
—
• AN EARLY SYRINGE, AROUND SINCE BEFORE 120 CE.
• MODERNIZED FOR THE DELIVERY OF MEDICINE IN SMALL
DOSES THROUGH THE INTRODUCTION OF THE HYPODER-
MIC NEEDLE.
RELEVANCE
It’s easy to take for granted the flu shots we get today and forget that a series
of medical breakthroughs led to the idea of injections. Prior to the 1850s,
medication either needed to be taken orally, or required an incision (which
was not so helpful, since the concept of sterility hadn’t been fully adopted).
But with the introduction of medicines like opiates that were effective in
small doses, the medical community, led by Alexander Wood and Dr. Charles
Hunter, ushered in the era of the modern glass syringe used to administer
localized anesthesia.
THE STETHESCOPE
—
• THE STETHOSCOPE, INVENTED IN THE EARLY 1800s, IS AN
ACOUSTIC DEVICE ORIGINALLY BASED ON THE EAR TRUMPET.
• DESIGN USED TO LISTEN TO THE INTERNAL WORKINGS OF
THE BODY.
RELEVANCE
The stethoscope may be the breakthrough most synonymous with our
image of a doctor. Remarkably, prior to the introduction of the stethoscope,
there were no non-lethal ways of understanding what was happening within
the body other than placing one’s ear to the body – a process called
ausculation. Lacking in precision, many believe that the impracticalities of
this procedure resulted in symptoms being understood independently as
opposed to being seen as part of a related system. René Laennec’s invention
of the stethoscope changed all of that, giving doctors the ability to better
understand the inner workings of the body without visible symptoms. //
THE COWPOX VIRUS
—
• A PETRI DISH CONTAINING THE COWPOX VIRUS.
DURING THE LATE 1700s, A BREAKTHROUGH OCCURRED
WHEN IT WAS DISCOVERED THAT EXPOSURE TO COWPOX
PROVIDED IMMUNITY AGAINST SMALLPOX.
RELEVANCE
Today, we regularly receive vaccinations from birth for everything
from Hepatitis B to Influenza. Back in the 1700s, the concept of
vaccination was just starting to take shape. After identifying that
people previously exposed to the cowpox virus developed immunity to
smallpox, Edward Jenner discovered the breakthrough of vaccination
(vacca being Latin for cow) by exposing his gardener’s 8-year-old son
to the virus and then exposing him to smallpox six weeks later. Jenner
is viewed by many as the father of immunology thanks to his break-
through, which initiated the modern era of medicine.

4. 02
marc lafleur Ph.D
WHAT IS A BREAKTHROUGH
IN HEALTH?
REMEMBERING THE HUMAN AS THE BASIS FOR
PATIENT-CENTRIC CARE
—
re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.
01
As a medical anthropologist, my job is to
listen to people’s experiences of disease and
illness, to try to make sense of what they
tell me so that better solutions can be
designed that acknowledge the complexity
of these events. No matter how often I hear
them, patients’ stories are always compel-
ling, always alive with the difficulties,
challenges and rawness of their sickness.
These stories are electric with an energy
that sees them skip and jump between
seemingly unrelated moments, times,
places, events, emotions and horizons that
unite the physiological with the all the
other exigencies and aspects – good and
bad – of lives lived.
This dichotomy routinely catches me
in the crossfire. I recently reflected on this
as I tried to explain to someone in a
clinical setting what patients had told me
about a specific treatment. He was unable
to reconcile that patients were relieved and
thankful for the treatment they were
getting, which represented a huge step
forward from what had been previously
available to them in terms of both outcome
and quality of life, while at the same time
describing a distrust of the treatment and a
desire to wean themselves off the medica-
tion. To me, these contradictions made
perfect sense – they spoke to the complexi-
ties of what it means to be human and sick.
But to my interlocutor, these two statements
were irreconcilable, and for him, like so
many others, were only evidence that people
are unreliable and, ultimately, irrelevant
narrators of their health and wellbeing. As
such, the chasm widens between the ways
that we experience disease and the ways
that we are treated for it.
WHAT, THEN, DOES THE NOTION OF A
BREAKTHROUGH MEAN IN THIS CONTEXT?
02
We live in a world awash in technology and
the technological mindset; this is especially
true in the world of healthcare. Evolutions
in patient care tend to be considered
through the lenses of science and technol-
ogy. Western biomedicine itself can easily
be conceptualized as a discipline with more
in common ontologically with engineering
than it does with what we perceive as the
more so-called “human” disciplines.
Medicine became a professionalized and
institutionalized entity around the same
time – not incidentally – that the Industrial
Revolution was reshaping the tools
available to us, the ways that we work and
even how we think about work. Since the
19th century, medicine and the practice of
caring for the health and wellbeing of
others have increasingly turned towards
technology and a technological ethos to
solve the increasingly complex problems
that we face.
With this perspective in mind, what do
we imagine when we think of break-
throughs? We consider ourselves to be a
culture of doers, and from garages to
university laboratories to high-tech
corporate campuses the characterization
of breakthroughs tends – at least in the
popular imagination – to take on a particu-
lar bias. Specifically, we tend to think of
breakthroughs in a technical sense – an
approach, a solution, an invention, a new
technique, a new tool – that “solves” a
problem. In the healthcare space we are
particularly prone to thinking of break-
throughs as embedded in new pharmacol-
ogy and in the applications of new technolo-
gies such as MRI or robotics. To be sure,
these sectors represent crucially important
areas of research and development for the
sector and have offered incredible advances
in patient care and outcomes. Yet, a consis-
tent contradiction manifests: as technology
offers us increasingly sophisticated solu-
tions to solve specific health problems,
patients routinely express doubts, hesitation
and dissatisfaction with their care and their
continued engagement with the healthcare
system. What accounts for this divergence?
In many ways it is a story as old as
medicine itself. The practice of medicine,
at least as we conceptualize it in the West,
seems to divorce our body and its various
symptoms from the rest of who we are. We
enter the disease experience as a whole
person and upon diagnosis we are reduced,
sometimes violently, to a set of clinical
statements, test results, imagery and a
complex numerology of risk calculations
and percentage-based possible outcomes.
Ironically, this intense focus on the
biological as an instrumentalized land-
scape has, in many ways, been at the root
of Western biomedicine’s success in the
understanding of disease and the elabora-
tion of new medicines and treatments. Yet
it has also led to the disaffection that
patients continue to express about their
treatment experiences.
If we are not inclined to dismiss them
out of hand, what are we to make of the
ways in which people explain their dis-
eases, the connections they make between
disease and other non-biological aspects of
their interior worlds and the social rela-
tions in which they exist?
These are attempts to find meaning in
disease and the ways that we experience
and narrate unwellness. These experiences
are always both physical and emotional,
inside our bodies and out in the world. In
other words, disease is never contained
only in our bodies. While it may show up in
an MRI or a biopsy, it also lives in the ways
that we tell ourselves and others about it.
Disease does not respect the boundaries we
use to try to contain and limit it. It is not
exclusively physical or internal.
In medical anthropology we distin-
guish between disease on the one hand,
and illness on the other. Disease speaks to
the biological definition and evidence of
disease while illness speaks to the social
experience of disease, the ways in which
disease cascades through one’s body and
permeates one’s experience of the world,
reshaping relationships, perceptions and
meaning as it goes. Ultimately, while
disease is relatively straightforward to
treat, illness is not.
03
I would suggest that many of the break-
throughs still to be realized in the health-
care space concern not the application of
new scientifically and technologically-
informed tools and solutions to disease.
Rather, it is an understanding of the
cultural and human needs and challenges
that accompany and complicate disease
experiences and the ways that we seek out,
adhere to and ultimately live through our
interactions with the health care system.
Over a hundred years ago, the great
physician Sir William Osler spoke of the
importance of – for lack of a better word
– the bedside manner of doctors. He
realized that in order for doctors and
patients to interact profitably and effec-
tively, they must approach each other as
people first, recognizing human frailty
and creating a relationship built on
empathy rather than expertise. The recent
efforts towards patient-centric care are
the hopeful signs of a budding under-
standing of this, but more needs to be
done. The transformations of the health-
care system as increasingly specialized,
and technocentricity will continue to
challenge and complicate the efforts to
recognize patients as more than the
accumulation of their symptoms. That
said, the seeds of breakthrough exist all
across the health landscape – most
importantly in the voices of patients
themselves. //
SINCE THE 19TH
CENTURY, MEDICINE
AND THE PRACTICE OF CARING FOR
THE HEALTH AND WELLBEING OF
OTHERS HAVE INCREASINGLY TURNED
TOWARDS TECHNOLOGY AND A TECH-
NOLOGICAL ETHOS TO SOLVE THE
INCREASINGLY COMPLEX PROBLEMS
THAT WE FACE.

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03
03
dustin johnston-jewell & peter jones Ph.D
CAN DESIGN THINKING BE THE
SOURCE OF OUR NEXT BREAKTHROUGH
IN HEALTH?
—
Q&A
DJJ: WHATROLEDOYOUTHINKEXPERIENCE
ANDSERVICEDESIGNPLAYSFORBOTH
PATIENTANDHEALTHCAREPRACTITIONER?
PJ: Everyone uses information to answer
healthcare and care questions for themselves
or their families, but I think the higher
impact is going to be for designers to move
more deliberately and more strategically into
clinical practices and large healthcare
institutions and start to teach what we learn.
It’s important to realize that no one is a
patient all the time and people who are
suffering from a condition or are going
through healthcare treatments don’t think of
themselves as users.
We are almost at the point where the
experience design around the usage of
information will be greatly enhanced, as we
get very large databases. This will enable
healthseekers to answer more complicated
questions about their own health conditions,
and the possible steps they can take to obtain
better health.
As for service design, there are so many
touch-points throughout the patient journey,
but designers today wouldn’t touch more than
one or two. They think service design is about
improving the experience that their client has
access to. Their client has just a slice of time, a
slice of the overall experience. Nobody can
even think about the end-to-end right now,
and that’s a huge opportunity for the future.
That’s really where design thinkers can
come in and understand the complete
journeys of the individual experience in
healthcare and healthseeking, while realizing
that healthcare is a series of services. Today
these services are provided in a supply side
approach by healthcare organizations and by
the systems and policies that they are part of,
which is massively complex. Yet, there is no
good way to integrate all the different points
for coordination of care for the patient’s
entire journey.
PETER JONES’S BOOK, DESIGN FOR CARE, IS THE
ACCUMULATION OF FIVE YEARS OF RESEARCH, EXAMINING
THE IMPACT OF DESIGN THINKING AND SERVICE DESIGN AS
A PROFESSIONAL COMPETENCY: EXAMINING HOW IT CAN BE
INTEGRATED INTO NEW HEALTHCARE PRACTICES, HEALTH-
CARE EDUCATION AND ACROSS THE SPECTRUM OF HEALTH-
CARE APPLICATION AREAS.
—
DJJ
Dustin Johnston-Jewell,
innovation strategist at
IC Toronto
PJ
Peter Jones, Ph.D.,
author of Design for Care,
founder of Redesign and
associate professor of the
Strategic Foresight and
Innovation program at
OCADU.
DJJ: HOW DOES FORESIGHT COME INTO
PLAY FOR THE FUTURE OF HEALTHCARE?
PJ: Foresight needs to be pushed by vendors
as well in order to plan for the near-term
future. Policy may have used foresight, but
hospitals, practices and vendors have hardly
used foresight at all. There has been a rise of
innovation centers within hospitals, but they
are usually staffed by process improvement
people who are very analytical. They are very
good at driving down costs, but foresight takes
a different angle. In foresight we create future
value by identifying desirable end states, and
creating scenarios and pathways to achieve
those end states. This may be more expensive
now, but it creates greater value.
Healthcare is a very scientific, evidence-
based, traditionally-managed field with
hyper-educated people who already know
everything. They don’t think they need
designers because they figure it can’t be that
hard. A fair number of doctors are becoming
innovators. As analytical thinkers, however,
they can’t get it all. Healthcare needs synthe-
sists, foresight and long-range thinkers, and it
needs to accept more imaginative presentation
of proposals for structure and function. In
this, designers need to be integrators. //

6. re/think care ©
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04
WILL WE BE WEARING
THE NEXT BREAKTHROUGH
IN HEALTH?
—
04
james aita
It’s practically a daily occurrence on
technology blogs: the announcement of
some new product component or wear-
able design that will somehow provide
insight into a little-known world.
This year’s Consumer Electronics
Show was dominated by the unveiling of
gadgets that strapped sensors to people’s
bodies, and with the impending release of
Google Glass, we can be sure to witness a
wave of new products that will enlighten
us to the unknowns of our environment.
One central theme that continues to
surface in these new wearable technologies
is the revolution of personal health.
In a world where societal pressures
seem to constantly promote poor health
and diet decisions, and care is becoming
both increasingly expensive and inacces-
sible, there is a growing appetite for the
individual to gain insight into their body
and take control of their health more easily
and economically. But with all these new
technological developments, it can be
difficult to keep up and make sense of it all.
Activity monitors like the Jawbone Up
and Nike+ Fuelband use accelerometers
and GPS to give wearers feedback on their
caloric burn and sleep patterns. Google
has paved the way for smartglasses
technology, which already has an army of
competitors building in cameras, pico
projectors and a variety of other smart
components into fashionable eyewear –
allowing our experience of the world
around us to be captured and analyzed by
the internet and a host of apps.
Heart rate monitors and pulse oxim-
eters are nothing new, but they are
currently being refined and combined to
operate in smaller forms for wearability,
while software applications like Apple’s
Siri and DailyBurn’s MealSnap allow
people to share their life experiences with
robust internet-based analytics to gain
valuable information.
But this merely scratches the surface.
The real promise of this confluence of
personal health-applicable technology
comes with innovations that are just barely
emerging. Dave Aspery, founder of the
Bulletproof Executive, describes wear-
ables’ potential as boundless: infiltrating
your Google calendar and your phone’s
GPS to supply an algorithm that could be
key to performing better, lowering stress
levels, even extending your life.
Google recently announced smart
contact lenses that use biofluidic sensors
to track glucose levels through tears. This
opens a whole new door into plausibly
monitoring factors such as vitamins,
thyroid hormones, allergen antibodies,
histamine and adrenaline within the body
by implantable wireless sensors developed
by institutions like Rensselaer and MIT.
New core temperature sensors developed
at a university in Berlin, which, added to
the developments in heart rate variability,
pulse oximetry and EMG muscle sensors,
can give valuable feedback for both fitness
and stress – key for disease management
and prevention.
Companies like Samsung, Apple and
Intel among others are furiously acquiring
healthcare experts and engineers special-
izing in these sensor technologies to help
build their next generation of wearable
devices, with the smartwatch being the
primary product to host all these gizmos.
Graham Palmer, Country Manager for
Intel Canada, explains: “Technology in
this wearable category gives you new
capabilities that just weren’t available
previously. We have crossed the economic
and technological barriers that have
prevented this type of technology from
becoming truly pervasive.” Intel just
purchased wearable company Basis
Science, Inc. for a reported $100 million.
But all of this technology is of little
use without tangible benefits; it is the
heightened integration that wearables
afford to the user that has the potential to
generate true value. For example, the
insights that wearables provide to our
unconscious actions and thoughts could
broaden our scope of stress management
through enlightening us to factors that
were previously unknown. Going beyond
the mere regurgitation of data, wearables
could also compile methods and techniques
tailored to its user’s lifestyle and habits.
They could act as proof for changes the user
has already taken the initiative to act upon,
such as diet. Aesthetically, wearables also
offer an outlet for users’ self-expression. As
Palmer puts it, “[Fashion] will be a big part
KNOWING HOW YOU
DID YESTERDAY
CREATES A PATH
FOR CONSCIOUSLY
DECIDING HOW
TO CHANGE YOUR
BEHAVIOR.
of the conversation – how people feel about
wearing these things publically, and the
statements those make about them.”
Of course, this innovation doesn’t
come without risks. Wearables can already
transmit information about where we are
and what we’re doing. You can even tell if
someone is having sex. Privacy and
security are two very controversial and
very important concerns – ones that the
technology giants are actively addressing.
Aspery notes the necessary legal ramifica-
tions: “I would be the first to support a bill
of rights that says you own your biometric
data, you own the data about what’s going
on inside your body and you can license it
or unlicense it to anyone who wants rights
to it.” Palmer supports the prioritization of
privacy and security from the tech-
developers’ perspective, comparing the
trustworthiness of a wearable device as a
sixth sense akin to sight or sound.
Wearable technologies promise a
window to a world of information that
never existed before. Our bodies have
always been somewhat of a mystery and in
many ways difficult to control. Making
visible what goes on inside us can drive a
revolution – a renaissance in the way we
take control of our bodies and take
ownership of our health. And it’s coming
sooner than you think. //

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05
hesam masoumi
BREAKING THROUGH FAST IN A SLOW INDUSTRY
WHAT IS THE NEXT STEP IN
THE EVOLUTION OF PHARMA?
—
For the pharmaceutical industry, the big question at the moment is: how far beyond
the pill is the industry willing and capable to realistically go? The further the aim
beyond the pill, the higher the level of resistance seems to be in the industry, both
culturally and structurally. There is something fundamentally disruptive about the
idea of being a pharma company that doesn’t just sell compounds. There is nothing
impossible about it, but the structural and cultural hurdles will cause major disrup-
tions from within once the industry is ready to take that next step.
PRESCRIPTION FOR SUCCESS
THE OPPORTUNITY AHEAD
Even with all of the barriers and chal-
lenges, there are plenty of opportunities
for pharma to get beyond the pill.
Whether it’s a focus on technology-enabled
solutions that cross over to digital health, or
predictive analytics with patient data at an
individual and aggregate level, perhaps even
becoming an end-to-end integrated care
provider, the opportunities and permuta-
tions are infinite. But in order to be
successful in this space, the industry must
make a fundamental strategic decision:
what is the purpose of innovation at the
organization and across disease areas? Does
going beyond the pill mean finding alterna-
tive sources of revenue that contribute to
better patient outcomes, or is it merely
supplementary to heighten the effectiveness
of the compound? The answers to these
questions will have a profound effect on how
pharma companies organize to seize the
opportunities ahead, with implications for
the types of innovation activities, where
innovation lies within the organization,
what kind of skills to develop, which (if any)
startups to acquire, whom to partner with,
where to lobby to change the rules, and
ultimately where to create value.
Many pharma companies have found
barriers to innovation due to the lack of
clarity on why innovation and break-
through has become a real topic of debate.
Organizations like Merck Global Health
Innovation Fund have been very deliberate
about buying and investing where there is a
high propensity to disrupt beyond the pill,
with a primary focus on IT platforms and
technology-enabled solutions. Their
investments include ventures such as
Health Sense, a predictive analytics
platform and Welldoc, the first FDA-ap-
proved mobile prescription therapy. Some
are considering more experimental
opportunities, looking at the potential of
personalized medicine and creating new
value in DNA economics, which, while still
close to the pill, takes a different perspec-
tive relating to patient outcomes. Others
are considering the possibility of providing
medicine as a service, which is much closer
to the core capabilities of the industry, with
a focus on adherence and access.
BEYOND CHEMISTRY
PHARMA FUTURES
Despite the inherent unpredictability of
the future, what is certain is that a
significant, disruptive change is brewing
for an industry that has mainly preferred
to remain on the safe side.
Pharma must decide whether to organize
and plan for the future, or merely ride out
the current state and be a victim of the
approaching shake-up. Pharma companies
need to ask themselves: what kind of
organization do they want to be in ten,
twenty, or even fifty years? There are a
number of model companies in other
industries that, when faced with a
comparable scenario, have lived on to
serve as examples. Exemplary is IBM’s
successful shift from PCs to an IT and
business services organization, which led
to a complete sell-off of their PC business
units. Imagine a world where a pharma-
ceutical company completely sells off its
pill-producing functions. There are also
other less dramatic examples, like Nike’s
subtle shift from an apparel-heavy
company to an athletic performance
provider fueled by digital platforms.
Any breakthrough innovation for
pharma beyond the pill will require a
tectonic shift in how the business is
designed and organized for delivery of
value. This includes rethinking culture,
the approach and definition of strategy,
the use of extensive methods of design and
following through on implementation, the
right people, skills and partners, and most
importantly a purpose with a clear
direction forward on why to innovate
beyond the pill – and what it means for
the future of the organization. //
THE FURTHER THE AIM
BEYOND THE PILL, THE
HIGHER THE LEVEL OF
RESISTANCE SEEMS TO
BE IN THE INDUSTRY,
BOTH CULTURALLY AND
STRUCTURALLY.credit
DrJean-BaptisteLabrune

8. YOU CAN’T DO PERSON-
ALIZED MEDICINE
UNLESS YOU ANALYZE
BIG DATA. YOU CAN’T
ANALYZE BIG DATA
UNLESS YOU USE ARTI-
FICIAL INTELLIGENCE.
06
It is the future’s most important technology, and it’s real. Machines and robots guided
by artificial intelligence are now able to learn, reason, plan, communicate and perceive as
well as move and manipulate objects. These versatile and groundbreaking capabilities
have been applied to many markets, and AI-guided machines can now play soccer, answer
customer service calls and even beat the world’s best players at Jeopardy!
In addition to training AIs to carry out traditionally human roles, companies are
leveraging artificial intelligence’s unprecedented capabilities to tackle some of healthcare’s
most wicked problems. Jeopardy-playing computer “Watson,” created by IBM in 2013,
now conducts cancer research, consolidating incredible amounts of molecular, genomic
and clinical data. Assay Healthcare Solutions developed software that applies a formula to
do nurse scheduling, and staffing according to trends in patient demands derived from
collections of past and current information.
AI’s potential in the healthcare industry caught the attention of venture capitalist and
Silicon Valley visionary Carl Berg, who founded his company, also called Berg, along with
Mitch Gray and Niven Narain, inventor of the company’s patented Interrogative Biology
Platform. Combining an ambitious entrepreneurial vision with excitingly powerful
bio-intelligence technology, this biopharmaceutical company intends to revolutionize
healthcare. For Narain, Berg’s president and CTO, this goal is quite straightforward: “We
simply have to go back to the biology and identify the core elements that are different in
the individuals with a disease compared to healthy ones.”
AR·TI·FI·CIAL
IN·TEL·LI·GENCE
NOUN
1.THETHEORYANDDEVELOPMENT
OFCOMPUTERSYSTEMSABLETO
PERFORMTASKSTHATNORMALLY
REQUIREHUMANINTELLIGENCE.
Though Narain makes it sound simple,
identifying patterns in thousands of samples
is actually extremely complex. One person’s
biological sample can yield over 14 trillion
data points, between proteins, metabolism,
lipids, genetics and medical records. That is
where the artificial intelligence used in
Berg’s Interrogative Biology Platform comes
in. “We crunch all of this data and interro-
gate it so it can tell us exactly what is
relevant for this particular disease,” said
Narain. The output will look like hubs on an
airline map – indicators called biomarkers
and drug targets on the relevant metabo-
lytes, proteins and genes that will then serve
to guide the discovery process.
Focusing on cancer, metabolic dis-
eases, CNS disease and inflammatory
disorders, the resulting biomarkers and
drug targets can be applied both to
diagnostics and to therapeutics, turning
big data into actionable data.
Berg has recently partnered with the
Department of Defense, a high-incidence
population for prostate cancer. Berg’s
Interrogative Biology platform can predict
the individuals who will have the most
difficult forms of prostate cancer and
therefore would benefit from aggressive
treatments. Such predictability of treatment
response represents early signs of personal-
ized medicine and the potential for a leaner,
more efficient healthcare system.
According to Joe Andreazi, one of
Berg’s senior scientists, artificial intelligence
is the key factor that has made this innova-
tion possible. “Berg is at the forefront of the
push towards personalized medicine. You
can’t do personalized medicine unless you
analyze big data. You can’t analyze big data
unless you use artificial intelligence.”
With drugs in advanced phases of
clinical trials, Berg also aims to challenge
the traditional chemical approach to
therapeutics, which currently takes 12-14
years and can cost over 1.3 billion dollars.
Letting the data take the lead in identifying
patterns in disease mechanisms makes the
drug discovery process unbiased and
innovative. “On a basic level, we are disrup-
tive because we approach problems differ-
ently. We start with tissue samples to see
what is happening in the system, as opposed
to a hypothesis or what has been published
in the literature,” says Narain. In this
process, the data will generate drug targets
and the specific protein that should be
used for an individual patient. This
strategy is particularly exciting because
protein drugs, which supplement proteins
that are already present in the body,
typically have no side effects and no
toxicity, circumventing one of the pharma-
ceutical industry’s biggest hurdles.
Definite challenges still lie ahead for a
company with the lofty goal of revolution-
izing healthcare. From a diagnostics
perspective, turning the discoveries into
actionable tests is an exciting prospect.
According to Andreazi, “We may know the
biomarkers, but developing a clinical test to
measure it on a large scale can be difficult
since many of them are in low abundance in
the metabolism.”
Berg’s founders clearly understand
that in order to reduce cost and increase
efficacy, medicine will need to move toward
a more personalized model. Unlocking the
unprecedented capabilities of AI through
bio-intelligence has the potential to
address some of healthcare’s most perplex-
ing issues, and could truly change the way
that diseases are treated by physicians,
reimbursed by insurance companies and
understood by the government. This is
certainly much more exciting than a
soccer-playing robot. This is the future of
healthcare. //
re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.
HOW CAN DATA
TRANSFORM HEALTH-
CARE?
—
06
marina andreazi

9. re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.
WITHOUT KNOWLEDGE
OF HOW NEW CONCEPTS
DISSEMINATE THROUGH-
OUT HEALTHCARE, THE
INDIVIDUAL PATH-TO-
MARKET IS CHALLENGING
AT BEST.
CAN THE INDIVIDUAL
IMPACT CARE?
—
07
steven bisch M.D.
& alex yurek
For years, individuals have been shaping
their own care based on their unique
circumstances. Parkinson’s patients
have been suspending rope from their
ceilings in place of saskapoles or leaving
a visual trail of Kleenex boxes rather
than decals, creating micro-innovations
that are driven by their specific needs to
improve quality of life. However, these
innovations often remain isolated to
their homes.
The path for individuals to affect
care across the healthcare ecosystem is
fraught with difficulty. The path to
change is complex, expensive and
requires many allies across the industry.
These barriers are in place with good
reason – they work to prevent harm to
the patient; however, without knowledge
of how new concepts disseminate
throughout healthcare, the individual
path-to-market is challenging at best.
PHYSICIANS AS GATEKEEPERS
—
The gatekeeper for many innovations is the
physician; when they consider the imple-
mentation of new procedures, he or she will
be understandably cautious due to two
main concepts that underpin medical
practice, safety and efficacy. The concept of
“primum non noncere” or “first, do no
harm,” is as old as medicine itself, and
states that above all else, the physician is
never to knowingly put a patient at undue
risk by their action or inaction.
The physician must act as this gate-
keeper because the risk and litigation that
surrounds medicine ultimately falls on
them. For this reason, new medications,
procedures and technologies are adopted
only very slowly. Even the oldest technolo-
gies with previous widespread use are
abandoned for other “safer” options – most
notably, the use of forceps for assisted
vaginal delivery. Even in experienced
hands, forceps, when used improperly, can
cause significant harm to a mother and her
child. The cautious physician will be very
aware of this fact when deciding to chance
the life of the patient and the baby with a
new device over a proven alternative.
To illustrate the liabilities that exist,
gynaecology has been in the media spot-
light as of late with the ubiquitous reports
of lawsuits based on vaginal mesh tech-
nologies having caused chronic pain that
was not foreseen in initial marketing. In
order to streamline approval processes for
new devices, the FDA approved the new
meshes not based on rigorous testing for
safety, but based on how similar the new
devices were to previous versions. Under-
standably, physicians are therefore very
hesitant to stray from their comfort zone
when new innovations come to market.
THE BURDEN OF PROOF
—
The concept of evidence-based medicine is
a relatively new idea in medical practice,
whereby statistically significant evidence of
value is required prior to the implementa-
tion of a new technology – and it repre-
sents another hurdle for the individual
innovator. Given the scarcity of resources
both in private and public medical prac-
tice, innovations must be proven by
statistically significant clinical trial to be
“better” than what is currently used to
physicians, payers and policymakers alike.
For the individual innovator, large, multi-
center trials would be impossible without
the involvement of outside partners.
LIGHT AT THE END OF THE TUNNEL
—
The path-to-market that has been painted
is narrow, but there are innovations that
have made it through the noise and have
begun to affect the delivery of care. In
2013, there was one standout medical
device breakthrough that made it all the
way from a car mechanic’s garage and
into the halls of medical device compa-
nies and conferences with the WHO:
after watching a YouTube video on how to
extract a wine cork that was stuck inside
of a bottle, Jorge Odon began to develop a
device that would help extract a baby
from the birth canal.
After meeting with a local obstetrician
and further refining his device, Mr. Odon
was able to demonstrate it to the chief of
obstetrics at a major hospital, who intro-
duced the device to the WHO’s chief
coordinator for improving maternal and
perinatal health. He declared the idea to
be fantastic and arranged for it to be
tested in the USA.
Nearly six years after Mr. Odon’s
moment of inspiration, the device is slated
to be manufactured and sold around the
globe. The cost of manufacturing the
device is expected to be less than $50,
making it accessible to patients in the
developing world, and it has the potential
to save the lives of mothers and children in
these countries.
The Odon device illustrates that indi-
viduals can make an impact on care. With
patience, guidance and advocacy by industry
leaders, innovations can spread across the
healthcare ecosystem to change the way that
care is delivered around the globe. //
RIGHT >
The Odon Device

10. re/think care ©
copyright 2014 idea couture inc., idea couture llc and idea couture ltd.
09
reynald fleury
HOW CAN WE ENSURE
SAFETY IN THE FACE OF
CHANGE?
—
09
MEDICINES – compounds or preparations
used for the treatment or prevention of
disease – are perhaps as old as mankind,
and the ways that we ensure their quality,
safety and efficacy has evolved over time.
Yet it is evident that even in the digital age
of health apps and other digital therapies,
we are facing some age-old quandaries
between breakthrough therapies and prop-
er regulation.
MITHRIDATE – the mythical remedy with as
many as 65 ingredients created by Mithra-
dates VI Eupator of Pontus in the first
century BCE – was one of the most
complex, highly sought-after drugs of the
Middle Ages and Renaissance. It wasn’t
until 1540 in England that the manufac-
ture of medicines needed to be supervised;
in this case, by four inspectors appointed
under the Apothecary, Wares, Drugs and
Stuffs Act. The inflection point for phar-
maceutical inspection may have been the
Salerno Medical Edict, issued by Frederick
II of Sicily in 1280, which required apoth-
ecaries always to prepare remedies in the
same way.
Regulation of medicines only became
possible after the breakthroughs in chemis-
try, physiology and pharmacology of the
nineteenth century; this formed a solid
foundation for modern medical research to
build upon, particularly gaining momentum
after 1945. Until 1956, the focus was
predominantly on quality control. There
was some attention paid to safety and
efficacy, but it was sporadic; there was not
yet any consistent systematic attempt to
define and evaluate intrinsic safety and
efficacy of new medicines.
Today, healthcare professionals and
consumers have started to enter the eHealth
(electronic health) era, in which the Quanti-
fied Self movement, mHealth (mobile health)
and wearable technology will play a much
larger role in healthcare. Already, the internet
and social media are a key piece of the
prescription journey for both patients and
physicians: from “Google it” at the symptom-
atic level to “I love it” at the patient advocacy
side. After only few a decades – with eHealth
dating back to the end of the last century, and
Epocrates (a suite of point-of-care medical
apps) having been launched in November
1999 – the Federal Drug Administration
drafted mobile medical app regulations in
2011 and published its final guidelines for the
regulation of mobile medical apps in 2013. It
focuses on a small subset of medical apps
“that present a greater risk to patients if they
do not work as intended.”
08CAN ADVERSITY HELP
HEALING?
—
08
fiona hughes M.D.
“THAT WHICH DOESN’T KILL YOU…”
Whether we tend toward iconic philoso-
pher Friedrich Nietzche, who preached
psychological toughness in Twilight of the
Idols, or pop singer Kelly Clarkson’s
“Stronger,” which professes emotional
toughness upon ending a relationship, the
take-away from both is much the same:
difficult experiences in life toughen people
up, making them stronger and better able
to manage subsequent problems.
We know this. Every parent tells us
this when we’re young. But is this lesson on
the benefits of life’s challenges one that we
can apply to our understanding of health
and illness? Could a new way of thinking
about health and dealing with illness be
informed by the idea of resilience, one that
slows our tendency to pop pills in favor of
learning to cope?
We don’t have to look far for evidence
that we are having difficulty keeping it –
our health – together. Absences at work
due to stress are on the increase. According
to the World Health Organization, stress is
one of the biggest health challenges of this
century, and by 2020 half of all sick leaves
will be attributed to stress.
The economic consequences of lost
productivity due to stress are staggering,
and so is the amount of money spent on
drugs. While there’s no medication yet
that targets stress directly, changes made
last year to the DSM-5, the influential
handbook of psychiatry, mean that
feelings of worry, sadness, or distraction
can be medicated.
Taking prescription drugs aimed at
correcting biochemical ‘imbalances’ is one
way of avoiding stress. Preventing and
focusing on the elimination of disease-
causing factors is another. The prevention
approach emphasizes avoiding stressors
proven to negatively affect health and
linked to all sorts of issues such as sleep
disturbances, depression, weight gain,
depressed immune system and higher risk
for coronary artery disease.
Helpful as these management ap-
proaches can sometimes be, a deeper
breakthrough in perspective requires that
we focus on building resilience and on
learning to cope with stress. Informed by
Nietzsche (or Kelly Clarkson), this is the
realization that although life isn’t easy, we
are potentially stronger – even healthier –
after facing challenging experiences.
Resilience, the buzzword of the
moment, is defined as positive develop-
ment despite adversity and is being applied
today in many fields, especially economics
and psychology. This concept of resilience
in a psycho-social context was developed in
part by Aaron Antonovsky, an American-
Israeli medical sociologist. In interviews
with Israeli women, Antonovsky found that
some of the healthiest were concentration
camp survivors.
Based on this research, Antonovsky
identified the origins of health in per-
sonal components that serve to make a
person more resilient: manageability and
meaningfulness. In other words, being
able to make sense of our experiences
and learning to manage our lives makes
us healthier.
Rather than working to free our-
selves from stress, we build resilience by
shifting our attention to learning from
the stresses and strains of life. Handling
conflict and navigating adversity are
skills that can be developed and nur-
tured. We can learn to concentrate and to
be less anxious. We can work on being
calm and weathering the storm, emerg-
ing stronger when we do. Orientation
toward problems and developing capaci-
ties to solve them requires that we master
managing pressure, stress and health in
spite of hardship.
So far we have established the
improvement of psychological health after
adversity, but what about physical health?
Are we also healthier after an illness? The
answer depends on whether we can find
the time and energy to fight it.
One measure of a robust and strong
immune system is the ability to quickly and
correctly respond to illness. To develop
immunity, first we need to get sick; the
process of getting sick and then recovering
is how the immune system learns. This way
it is better to fight an illness if we can.
When given the chance to activate our own
resistance, the process of meeting the
foreign element – the disease – makes the
immune system stronger.
The breakthrough here is concep-
tual and ontological. But making the
breakthrough would fundamentally
reorient some of the ways we structure
healthcare. The path to increased
physical and psychological endurance is
to understand that health and illness
exist on a spectrum rather than as two
opposite states of being. It is then that
we begin to realize that we can train our
immune system and that we are stron-
ger after an illness, just as we are after a
crisis. To frame and understand health
as the ability to change, we need to pay
attention to illness and adversity as the
beginning of a healing process. //
Given the complexities and regulatory
barriers, actualizing the full value of digital
therapy remains challenging. Unintended
collisions between breakthrough technolo-
gies and their more slow-moving regulators
will inevitably lead to market disruptions or
delays. The central question for now with
regard to digital therapy regulation is
similar to that of drugs in the past: who is in
the position to make decisions about when
to use the digital therapies, which digital
therapies to use, how to use them and how
to weigh their potential benefits against
risks. Simple and accurate self-diagnoses
and prescribable digital therapies are well
on their way, but the reluctance on the part
of app developers to make themselves liable
in a still-untested field – where regulation is
struggling to catch up with innovation –
threatens to slow this potentially transfor-
mative breakthrough. //