Digital health needs courageous investors -- and other lessons from the Khosla controversy

Reuters

Vinod Khosla, founder of Khosla Ventures, speaks during the Fortune Brainstorm Green conference in Dana Point, California April 13, 2010.

As expected, Vinod Khosla’s recent comments at Rock Health’s Health Innovation Summit have generated a lot of healthy discussion about health, as I wrote in my last post

It’s also clear from the resulting online dialog that there’s some basic confusion, as key points have become conflated or confused. 

As far as I can tell, no one disputes that healthcare requires significant innovation – that’s why digital health has attracted so much attention.   There are profound problems with how medicine is practiced, and huge opportunities for improvement, for radically rethinking how we do things.

I do worry that some technologists, including Khosla, have an excessively reductive view of medicine, and don’t adequately appreciate the essential humanity, nuance, and complexity that defines a physician’s role. 

Khosla claims that Google’s development of a driverless car is a challenge “two orders of magnitude more complex” than providing the right diagnosis.  To me, this highlights what I see as the underlying disconnect — the mischaracterization of the fundamental problem to be solved. 

Medicine isn’t (only) about inputting symptoms and receiving a diagnosis, it’s about trying to elicit symptoms, to understand why a patient is worried or concerned, to appreciate how a particular treatment approach is likely to work in the real world, to provide encouragement as a patient tries to deal with chronic illness. 

Doctors could and should do each of these things better (as I’ve discussed extensively in this space) – and digital health can, must, and ultimately will help. 

But I think – and I’ve seen, from both ends of the stethoscope — the role that doctors, at their best, can play in the integrated tasks of providing diagnosis, explanation, treatment recommendations, prognosis, understanding, support, guidance, and comfort. 

While some might prefer a less humanistic, more Spock-like approach to medicine – a computer algorithm (in Khosla’s parlance, Dr. A.) that can replace a doctor – most of us would prefer, and benefit from deeply compassionate physicians who are enabled by significantly improved health technologies; certainly this would describe my vision.

A related question is whether the healthcare innovations we need are more likely to come from those with deep experience in healthcare, or from outsiders (say, technologists) who can bring a fresh perspective.

In my last column, I argued that both are essential, but since tech VCs are comparatively flush these days, while traditional healthcare VCs are hurting, tech VCs such as Khosla are playing a disproportionate role in shaping how the space is evolving.  It’s outstanding that tech VCs are actively investing here, but it would be terrific, and I believe enormously helpful, for more investors with deep healthcare experience to join the fray as well.

Perhaps the single aspect of the recent online dialog that disturbed me the most was the critique of Khosla expressed by several readers of the wonderful Davis Liu piece (and in response to my last piece as well).  Some suggested that since Khosla’s results as a leading-edge cleantech investor have been spotty (most comments were less kind), why should we listen to him about health?

I thoroughly reject this – while many Silicon Valley VCs both became successful and remained successful by closely following the crowd, Khosla has demonstrated a remarkable willingness to explore new areas where the need is great, and where success is far from certain.  You know, the sort of boldness that VCs tend to advertise but less consistently exhibit. 

A key takeaway I had from the Rock Health Summit was that these are very early days for digital health; while the need for better solutions is very high, it’s not at all clear what will work, and how anyone will make any money in the process.  Not surprisingly, most of the investors represented were extremely early stage, and were involved because they were following their passion, rather than seasoned investors counting on a score. 

I understand the reluctance of investors to get involved at this point, but I also believe those who dare will be rewarded – they will have a chance to learn, first hand, what the issues are and where the opportunities lie, and will be optimally positioned so that when the space finally hits its inflection point, and everyone rushes in, they will already be there, deserved beneficiaries of the success they helped create.

 

 

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