WEBVTT 00:00:05.008 --> 00:00:08.688 Hi, I'm Paul Verschure and together with my colleague, Fernand van Siemens, 00:00:08.828 --> 00:00:12.828 we are speaking today with Alexander Neuken about the role of collaboration 00:00:12.828 --> 00:00:15.028 in the emerging area of digital health. 00:00:15.548 --> 00:00:19.488 As partner and head of the life sciences sector in strategy and transactions 00:00:19.488 --> 00:00:23.648 at Ernst & Young, Alexander leads mergers and acquisitions in pharmaceutical, 00:00:24.088 --> 00:00:25.728 consumer health, and medtech areas. 00:00:27.288 --> 00:00:32.208 We're meeting for the second time now, Alex Neuken. and 00:00:32.208 --> 00:00:35.168 now in the follow-up discussion from our first 00:00:35.168 --> 00:00:37.928 interview we would like to look at a bit more 00:00:37.928 --> 00:00:43.168 detail at the question of of digital health developments in digital health and 00:00:43.168 --> 00:00:48.888 what it really means for the notions and questions around collaboration so so 00:00:48.888 --> 00:00:54.368 alex maybe you can situate a little bit that discussion by saying why why digital 00:00:54.368 --> 00:00:56.308 health is an important topic for you 00:00:56.388 --> 00:01:00.028 and also in your professional activities? 00:01:02.028 --> 00:01:11.288 We are generating a ton of data points every day in hospitals, 00:01:11.488 --> 00:01:16.248 at doctors, in our daily lives that are completely lost. 00:01:16.388 --> 00:01:22.708 They are only individually used for each individual patient, if at all, if at max. 00:01:22.708 --> 00:01:32.808 So, and then they are basically lost because they come, they basically are used 00:01:32.808 --> 00:01:35.528 for a direct interaction between patient and doctor. 00:01:35.708 --> 00:01:40.988 So, I have this and that symptom, I took this and that medication or did this 00:01:40.988 --> 00:01:43.748 and that workout and now this and that hurts. 00:01:43.748 --> 00:01:53.848 This type of information is in an aggregated way very valuable because it allows us to draw. 00:01:55.908 --> 00:02:02.648 Conclusions on certain patterns or development paths for diseases where it's 00:02:02.648 --> 00:02:07.088 far too late to start when this is developed. 00:02:07.488 --> 00:02:11.148 Take diabetes, for example, and the use of sugar. 00:02:12.088 --> 00:02:13.448 If you have. 00:02:15.100 --> 00:02:19.380 Much earlier feedback on your lifestyle and what it means to your health. 00:02:20.400 --> 00:02:27.400 And if you get aggregated data from millions of patients in the world and can 00:02:27.400 --> 00:02:35.100 make more accurate predictions about what behavior is driving which outcomes, 00:02:35.260 --> 00:02:37.080 in theory, we all We all know of that. 00:02:37.240 --> 00:02:45.440 But if you basically live through your life and get pointers and alarm signals 00:02:45.440 --> 00:02:50.100 or warning signals already at a time when you can still do something about it, 00:02:50.180 --> 00:02:51.460 it's much more efficient. 00:02:51.760 --> 00:02:57.640 And also many diseases like Alzheimer's, et cetera, we don't really know the genesis of those. 00:02:57.760 --> 00:03:02.560 We don't know the drivers and triggers. The more data we can collect, 00:03:02.820 --> 00:03:04.400 aggregate, and analyze, 00:03:04.840 --> 00:03:13.540 the better we will get a view on what's actually causing the disease, 00:03:13.840 --> 00:03:19.020 what's the trajectory, what might be early warning signals that you should take 00:03:19.020 --> 00:03:25.460 serious, and on which basis you should consult a doctor or something like that. 00:03:25.460 --> 00:03:31.740 That's one area of connectivity that will create value for the wider community. 00:03:33.200 --> 00:03:44.900 The other area is we have extremely high infrastructure costs for keeping people 00:03:44.900 --> 00:03:49.360 into settings that are built out of brick and mortar. 00:03:49.360 --> 00:03:59.820 So, hospitals, intensive care units, and then all sorts of rehab infrastructures. 00:04:01.800 --> 00:04:09.120 The issue is our system is at a point where we are no longer going to be able 00:04:09.120 --> 00:04:12.600 to afford all of this expensive infrastructure. 00:04:15.181 --> 00:04:19.841 One way to reduce costs is to put people back in their home setting where they 00:04:19.841 --> 00:04:31.241 want to live anyway much more favorably than sitting basically in a bunker somewhere 00:04:31.241 --> 00:04:34.001 and being monitored all the time. 00:04:34.141 --> 00:04:38.541 If you do that with digital tools. 00:04:39.741 --> 00:04:45.341 You enable them to be in their home setting and have the right monitoring of 00:04:45.341 --> 00:04:53.641 their rehab, of their evolution, of their disease, and allow them to go back to a more normal life. 00:04:53.881 --> 00:05:00.341 So that's another area where I think digital health is creating big, big opportunities. 00:05:00.801 --> 00:05:04.461 And then another area is on the diagnostic side. 00:05:04.461 --> 00:05:15.981 If you go to a single doctor with your pain and ask for a diagnosis, 00:05:16.481 --> 00:05:19.981 you may or may not get the right answer. 00:05:19.981 --> 00:05:24.121 There's a lot of potential for human error, 00:05:24.281 --> 00:05:34.301 and maybe not the best-suited person is looking at what has been taken as a 00:05:34.301 --> 00:05:36.101 picture, monitored, or whatever. 00:05:36.661 --> 00:05:41.461 With connected telehealth solutions, 00:05:42.021 --> 00:05:50.201 you can more easily consult the best experts in the the world do much of the 00:05:50.201 --> 00:05:55.281 diagnosis remotely who are not doing anything else but looking at. 00:05:56.181 --> 00:06:00.861 And based on an algorithm that selects the cases that are relevant so you basically 00:06:00.861 --> 00:06:07.181 have a monitoring tool already that basically filters out out of thousand cases 00:06:07.181 --> 00:06:11.021 the five or ten that that really need a doctor to look at. 00:06:11.681 --> 00:06:21.161 Out of the 1,995 are probably standard and can be very easily recognized by a machine. 00:06:21.341 --> 00:06:26.661 And the five where really an expert needs to look at, this can be a Chinese doctor or a U.S. doctor. 00:06:30.541 --> 00:06:33.781 However, he is looking at those. And he's not doing anything else but looking 00:06:33.781 --> 00:06:35.561 at these pictures so that he has comparability. 00:06:36.061 --> 00:06:41.681 And that's his day job. He's being paid for this." That's telehealth. 00:06:41.881 --> 00:06:46.601 That's the opportunity to get the best opinion and the most accurate analysis 00:06:46.601 --> 00:06:48.561 of what the doctor can see. 00:06:51.461 --> 00:06:56.661 Those are three areas, just to exemplify it, where I see value created for the 00:06:56.661 --> 00:06:59.441 patient, for the community by reducing costs, 00:06:59.681 --> 00:07:07.021 for the development of the medical knowledge to address stress disease as better. 00:07:07.281 --> 00:07:12.021 Right. So Alex, there's a little connectivity issue. I don't know if you noticed. 00:07:14.803 --> 00:07:19.303 No, I didn't. I could always hear and see myself very well. 00:07:19.783 --> 00:07:24.823 I don't know if you could. Do you have connectivity hiccups? Yes, a little bit. 00:07:26.523 --> 00:07:29.663 Alexander's voice doesn't get through. 00:07:31.223 --> 00:07:37.723 Okay, fine. But Alex, if there's something on your side you know you can do, but okay. 00:07:38.403 --> 00:07:44.763 We move on. Okay, so there's three areas, right? It's basically big data on the one hand. 00:07:44.883 --> 00:07:50.403 Then we have at-home treatment and diagnostics telehealth. 00:07:50.683 --> 00:07:55.943 So this is also a little bit, if you want, the ambition and dream of digital health. 00:07:56.063 --> 00:08:01.783 But for each of these three, do you have actual examples where this dream has 00:08:01.783 --> 00:08:04.623 been realized in a substantial way? 00:08:08.003 --> 00:08:16.323 Yeah, I think in each field. Field, this is already something that's not just 00:08:16.323 --> 00:08:19.323 kind of 10 years out thinking. 00:08:20.063 --> 00:08:30.763 This is already existing. So in telemedicine, for example, or telediagnostics, such tool exists. 00:08:32.243 --> 00:08:39.683 So there are players who do this. It's just not yet fully established practice. 00:08:39.683 --> 00:08:41.763 There are some hurdles to take. 00:08:41.903 --> 00:08:48.443 Number one is, first of all, the hurdle of we do what we are used to. 00:08:48.643 --> 00:09:00.683 So technology advancement is not coming through if doctors are not willing to adapt and innovate, 00:09:01.463 --> 00:09:06.823 the way they deal with their patients or they do their business. 00:09:08.160 --> 00:09:12.700 Call it business, it is somewhat a passion, probably also, or there needs to 00:09:12.700 --> 00:09:14.260 be, otherwise it's not successful. 00:09:14.480 --> 00:09:25.940 But anyway, the other aspect is that in COVID, we saw a boost in telehealth, 00:09:27.160 --> 00:09:33.500 in the sense that there has been many more applications or many more treatments 00:09:33.500 --> 00:09:42.120 being done remotely, prescriptions being made remotely, and things like that. 00:09:42.300 --> 00:09:49.260 So there was an increase, I don't recall the number, but it was clearly more 00:09:49.260 --> 00:09:50.840 than double-digit growth. 00:09:51.120 --> 00:10:00.920 So probably more than 100% type of growth in that area. So I don't want to point 00:10:00.920 --> 00:10:05.040 to specific names in terms of this is the single company that is doing it. 00:10:05.340 --> 00:10:10.520 But if you look at the collaboration that, 00:10:10.640 --> 00:10:15.520 for example, J&J and Apple have on the applications of the Apple Watch, 00:10:15.620 --> 00:10:23.260 that you can actually get medical grade information out of your watch and use 00:10:23.260 --> 00:10:28.500 that for your monitoring is one example. There are more than that. 00:10:28.640 --> 00:10:34.880 If you take the da Vinci robot for surgery treatments. 00:10:35.560 --> 00:10:40.380 The doctor can sit anywhere in the world and treat you on the robot, 00:10:40.640 --> 00:10:46.840 in particular for very complex and complicated operations where you cannot bring 00:10:46.840 --> 00:10:48.020 the patient to the doctor. 00:10:48.020 --> 00:10:56.560 This is a very interesting way to get the patient treated with really laser-sharp accuracy. 00:10:59.240 --> 00:11:08.180 I've seen this tool myself. I looked at a DaVinci, and it was demonstrated how 00:11:08.180 --> 00:11:10.180 it operates. It's really fascinating. 00:11:10.520 --> 00:11:13.760 You can really millimeter precisely make cuts and everything, 00:11:13.880 --> 00:11:15.780 so it's really super sharp. 00:11:18.918 --> 00:11:23.458 No, I can't hear you. I actually know the DaVinci very well. I've also used it. 00:11:25.978 --> 00:11:30.198 So we have this development of digital health. It's also, if you want, 00:11:30.338 --> 00:11:35.778 disrupting the current organization of how health is provided. 00:11:36.218 --> 00:11:41.258 So how does that change? I mean, does it bring in new stakeholders in the process? 00:11:41.378 --> 00:11:47.858 And how are these stakeholders in the end, if you want, motivated to participate in that process? 00:11:48.918 --> 00:11:57.918 Yeah, of course. And this is clearly at the frontier of innovation and also 00:11:57.918 --> 00:11:59.558 at the frontier of sectors. 00:11:59.898 --> 00:12:06.418 So there is the sharp distinction between health care and tech that's getting blurry. 00:12:06.718 --> 00:12:09.598 So there are new players entering the health universe. 00:12:09.958 --> 00:12:17.778 You saw Amazon and Google entering the space, Apple being interested in the space. 00:12:17.778 --> 00:12:25.298 So the tech players, Microsoft, having a lot of life science activity, 00:12:25.658 --> 00:12:36.198 really genuinely interested in the space and developing their business case for it. 00:12:36.198 --> 00:12:39.638 So you have lots of players that 00:12:39.638 --> 00:12:42.398 you would not naturally associate in the first 00:12:42.398 --> 00:12:45.898 place with health and the health sector are coming 00:12:45.898 --> 00:12:49.118 into into play and they want to play in this 00:12:49.118 --> 00:12:56.658 field big time so that's clearly a shift the classic farmer players play their 00:12:56.658 --> 00:13:04.018 role they are interested in in particular in particular when it comes to new 00:13:04.018 --> 00:13:07.778 payment or reimbursement models for their drugs, 00:13:07.918 --> 00:13:14.698 if you are outcome based paid by the insurance. So if your drug is really only. 00:13:15.740 --> 00:13:20.960 Reimbursed when it helps the patient, you need to have tools to monitor the 00:13:20.960 --> 00:13:27.460 patient health and confirm that robustly to the payer organization. 00:13:28.080 --> 00:13:34.200 So you need to demonstrate that this medication prolonged the life of the patient. 00:13:34.620 --> 00:13:39.160 I mean, it's easy to prove if it cured 00:13:39.380 --> 00:13:42.820 the patient but in many cases cancer treatments 00:13:42.820 --> 00:13:45.600 are not a cure but just a life 00:13:45.600 --> 00:13:48.360 prolongation and how do 00:13:48.360 --> 00:13:51.220 you monitor that and how do you prove that your 00:13:51.220 --> 00:13:58.900 drug was the cause for that and yeah these kind of questions but then so let's 00:13:58.900 --> 00:14:03.660 then zoom in for instance in some sense you want to change medical practice 00:14:03.660 --> 00:14:09.040 and that means you have to overcome the habits that now are in place in terms 00:14:09.040 --> 00:14:10.060 of treatment guidelines, 00:14:10.380 --> 00:14:12.900 the training of medical staff, and so on, 00:14:13.560 --> 00:14:19.980 which might give you an inertia in actually managing this reorientation towards digital health. 00:14:20.080 --> 00:14:24.160 So how do you get that community on board in this process? 00:14:26.687 --> 00:14:32.327 It's all about education and the right incentives. 00:14:33.087 --> 00:14:35.847 It's easy to say, it's hard to be done. 00:14:36.207 --> 00:14:42.927 So education starts in a medical, in a med school and in the practice year, et cetera. 00:14:43.267 --> 00:14:49.987 And doctors usually do as they are trained. They even use the devices they are trained on. 00:14:50.087 --> 00:14:54.687 That's why med tech players are very keen on getting medical students using 00:14:54.687 --> 00:14:59.227 their innovations because that's then how you start the life cycle of the product 00:14:59.227 --> 00:15:04.327 because until their retirement, they probably stick to that device in doing their treatments. 00:15:04.807 --> 00:15:09.227 At least that was the case in the past. So this one theme, 00:15:09.607 --> 00:15:18.547 how to break into this, the medical education and how do you train doctors that 00:15:18.547 --> 00:15:20.727 are already practicing and active, 00:15:20.727 --> 00:15:26.407 so beyond their initial training to change the direction. 00:15:26.707 --> 00:15:29.847 That's one thing. The other thing is the incentives. 00:15:30.267 --> 00:15:34.627 And they're clearly monetary incentives that also count. 00:15:35.147 --> 00:15:38.787 If you are basically, as a medical practice. 00:15:39.627 --> 00:15:50.027 Getting benefits from these tools that directly translate into profitability of the practice, 00:15:50.027 --> 00:15:52.827 this then it clearly is an incentive that is very 00:15:52.827 --> 00:15:55.947 strong but now on the 00:15:55.947 --> 00:15:59.047 other hand so when we spoke last time about collaboration 00:15:59.047 --> 00:16:05.407 in your broader business environment you emphasize very much this notion of 00:16:05.407 --> 00:16:12.087 goals and and motivation um but in some sense now you seem to emphasize more 00:16:12.087 --> 00:16:16.607 this idea of okay let's bring up a new generation because the current one is 00:16:16.607 --> 00:16:18.507 actually already lost for this purpose. 00:16:18.747 --> 00:16:22.987 So is goal setting then not anymore an option? 00:16:24.027 --> 00:16:25.307 It is. 00:16:26.427 --> 00:16:33.867 The goal should be for anyone in the medical profession to treat the patient 00:16:33.867 --> 00:16:40.927 in the best possible way and ideally cure his disease or prevent him from getting the disease. 00:16:41.187 --> 00:16:48.407 So So that's part of the purpose of the medical profession. 00:16:48.687 --> 00:16:57.127 So anything that can be brought under that definition of the purpose of what 00:16:57.127 --> 00:17:00.967 we are doing should be already considered. 00:17:00.967 --> 00:17:11.067 And then I think the next step is really to get alignment between the goal of 00:17:11.067 --> 00:17:14.167 making the patient's life a better one and, 00:17:15.794 --> 00:17:26.494 with what the doctor is actually permitted and incentivized to do from all the environment around it, 00:17:26.574 --> 00:17:35.114 be it is it too burdensome and complicated on the data protection side to actually get into this. 00:17:35.254 --> 00:17:45.474 There are no lawyers. They are scared of this heavy lifting on the legal side. 00:17:46.474 --> 00:17:51.634 Then the easiness of use, so there 00:17:51.634 --> 00:17:55.874 are no technicians, they don't really necessarily understand the device, 00:17:56.694 --> 00:18:01.994 or the technology or the software, what it actually does and how reliable it is. 00:18:02.634 --> 00:18:08.054 I think that is one other element where you need to get their buy-in. 00:18:08.174 --> 00:18:14.374 So make their life as easy as possible and make it for them as beneficial as 00:18:14.374 --> 00:18:17.714 possible. I think that's the other element. 00:18:18.274 --> 00:18:24.174 And so, first of all, it needs to have proven positive impact on the treatment. 00:18:24.274 --> 00:18:30.454 Second, it needs to be beneficial and easy to use and beneficial to their… But 00:18:30.454 --> 00:18:33.434 you're saying for those stakeholders in the medical profession, 00:18:33.734 --> 00:18:42.094 this idea of higher quality of care would still be a relevant component in getting 00:18:42.094 --> 00:18:44.294 their buy-in? It's a component. 00:18:44.754 --> 00:18:47.994 I think it is. I truly believe 00:18:47.994 --> 00:18:59.394 that that's the majority of the medical profession is genuinely willing to improve 00:18:59.394 --> 00:19:05.374 the lives of their patients and better the outcome of their treatment. Okay. 00:19:06.954 --> 00:19:13.874 Absolutely no doubt about that but it also needs to be made easy and be facilitated 00:19:13.874 --> 00:19:21.654 by the organization or the system because what we too often have is scarcity of resources, 00:19:22.954 --> 00:19:31.454 constraints in terms of um yeah of of willingness to support this type of innovation 00:19:31.454 --> 00:19:36.394 because it's not regarded as valuable by the reimbursement system. 00:19:36.594 --> 00:19:38.974 They are not getting paid for it. Why should they do it? 00:19:40.414 --> 00:19:43.614 These are all blockers and obstacles. 00:19:44.234 --> 00:19:50.514 Yeah. But now the other side, also another stakeholder group you mentioned, are now the patients. 00:19:51.054 --> 00:19:55.474 As opposed to going to the hospital, you want them to stay at home, 00:19:55.554 --> 00:20:01.934 and now they get interfaced to interventions and monitoring and diagnostics through technology. 00:20:02.434 --> 00:20:06.094 So how do you get them to go along with that? 00:20:06.214 --> 00:20:10.254 Because they might say, well, I prefer to speak with a human being directly 00:20:10.254 --> 00:20:11.834 physically at the hospital. 00:20:13.074 --> 00:20:18.174 Yeah, and that's interesting to see that we had this COVID effect. 00:20:18.454 --> 00:20:26.234 So people did not want to see a doctor physically, but they wanted to get medical advice. 00:20:26.954 --> 00:20:35.494 And here the solution came in. And this is a little bit like with Amazon shopping or other things. 00:20:35.914 --> 00:20:39.794 Once you're getting used to it and you see this is, oh, this is easy. 00:20:39.894 --> 00:20:43.814 I just click on a few buttons and then I get next day my delivery. 00:20:44.674 --> 00:20:48.034 The same applies to other things in life. 00:20:48.154 --> 00:20:55.234 So people will not go back to their previous behaviors, sitting in a waiting 00:20:55.234 --> 00:21:01.694 room at the doctors for two hours in order to get an appointment but rather do it online and. 00:21:02.674 --> 00:21:05.994 Get it more easily with less burden you 00:21:05.994 --> 00:21:10.174 don't need to drive through the city you're not sitting in a room with all sorts 00:21:10.174 --> 00:21:15.214 of coughing and sniffing people who are severely ill and you get more sick out 00:21:15.214 --> 00:21:20.334 of this waiting room than you entered it that's not what people want and if 00:21:20.334 --> 00:21:22.874 they recognize the easiness of the interaction. 00:21:23.214 --> 00:21:28.774 And like we do now have a picture of them and not just talking to a machine. 00:21:29.254 --> 00:21:34.894 I think that people will learn to use it and appreciate it. 00:21:35.734 --> 00:21:43.134 But there's a very central question then of trust, right? 00:21:43.254 --> 00:21:49.894 So how do you then instill trust in that end user, In this case, 00:21:49.934 --> 00:21:57.614 the patient in that new pipeline of communication with the provision of healthcare. 00:22:00.167 --> 00:22:05.687 Yeah, I think, I mean, first of all, and that's balancing maybe a little bit 00:22:05.687 --> 00:22:13.607 my statement from before, you need to have the proper regulation in place that protects data. 00:22:13.787 --> 00:22:21.567 And you need to trust that this regulation is not only on paper, 00:22:21.627 --> 00:22:25.987 but also the practice, the lived practice, right? 00:22:26.047 --> 00:22:31.187 So that's number one. You need to have trust in the system that it's not being 00:22:31.187 --> 00:22:37.967 abused, it's not being hacked, it's safe, your data is at a safe spot, things like that. 00:22:38.207 --> 00:22:48.907 So that's clearly a prerequisite to give your data. 00:22:48.907 --> 00:22:58.727 And then the second point is that people are willing to contribute to medical development. 00:22:59.107 --> 00:23:07.067 So I think a lot get hooked up with the fact that they are not only providing 00:23:07.067 --> 00:23:11.047 their own data, but this is for a higher good. 00:23:11.127 --> 00:23:15.907 So there is medical advancement that's being enabled through that. 00:23:16.727 --> 00:23:22.787 And second, the they are getting something back on the long term, 00:23:22.867 --> 00:23:26.747 they that's, that's a little bit the quid pro quo. 00:23:26.867 --> 00:23:32.947 So if I get my data points, if I'm a diabetic, for example, I give I share my 00:23:32.947 --> 00:23:39.147 data points on my disease development, maybe in four or five years time. 00:23:40.524 --> 00:23:47.024 This aggregated data of millions of diabetes patients and their life cycle in 00:23:47.024 --> 00:23:52.024 terms of disease development may have positive impact on how I'm going to be 00:23:52.024 --> 00:23:55.084 treated because we are much smarter around the disease. 00:23:55.084 --> 00:24:03.584 And we have much better predictability of next steps and intervene more early 00:24:03.584 --> 00:24:07.964 than we usually do because normally when we intervene today, 00:24:08.184 --> 00:24:10.844 it's simply too late to fix it. 00:24:11.004 --> 00:24:16.404 So you can just kind of try to keep the status quo, which is already an advanced disease state. 00:24:17.044 --> 00:24:20.144 However, if you talk about trust, 00:24:20.464 --> 00:24:23.244 it will move also not so 00:24:23.244 --> 00:24:26.304 much towards words do i trust the person with 00:24:26.304 --> 00:24:29.224 my data but more do i trust what 00:24:29.224 --> 00:24:34.624 now this machine is telling me to do yeah that's the other thing but interestingly 00:24:34.624 --> 00:24:43.164 um i have the feeling that this is people need guidance in particular in territory 00:24:43.164 --> 00:24:46.864 where they don't know what to do so in particular when they They are ill, 00:24:47.004 --> 00:24:50.084 and they are looking for guidance. 00:24:50.584 --> 00:24:56.584 And the doctor is usually a trusted person, but my sense is, 00:24:56.784 --> 00:25:02.204 and I might be wrong, I haven't basically had personally the experience, 00:25:02.324 --> 00:25:08.444 but my sense is that people are also taking orders from a computer if it tells 00:25:08.444 --> 00:25:10.904 them this is now the right thing to do. 00:25:13.044 --> 00:25:14.684 For example, there are... 00:25:16.047 --> 00:25:30.307 Digital health apps that you use for side effects on diseases that can tell you you're vomiting, 00:25:30.447 --> 00:25:32.867 so you need to take this or that. 00:25:33.447 --> 00:25:35.207 That's possible. 00:25:36.247 --> 00:25:39.967 That's a simple algorithm that sits behind it and that exists. 00:25:41.167 --> 00:25:44.267 So people would actually follow that. 00:25:46.047 --> 00:25:50.027 Well, sure. I mean, humans would do that. But if you talk about digital health, 00:25:50.167 --> 00:25:54.627 also as you mentioned earlier, this might become more and more a central component 00:25:54.627 --> 00:25:56.547 that we have some AI system, 00:25:57.487 --> 00:26:03.527 that in the end just will guide your intervention and will tell you what to do. 00:26:04.107 --> 00:26:09.367 And it might not be one-on-one matched anymore to a human, a human expert. 00:26:10.167 --> 00:26:15.487 So that would very much, of course, raise the challenge. But how do you then 00:26:15.487 --> 00:26:19.087 assure that that end user has trust? 00:26:19.587 --> 00:26:24.207 Like, look at the discussion we have now around the COVID vaccination, 00:26:24.687 --> 00:26:30.807 where actually the hesitancy about vaccination is surprisingly high. 00:26:31.667 --> 00:26:37.227 So, if we already, and it's also very easily manipulated, apparently, 00:26:37.327 --> 00:26:44.967 because we only have to hear one story about a 0.001 percentage risk for blood 00:26:44.967 --> 00:26:48.027 clots, and there goes one third of your population, 00:26:48.167 --> 00:26:51.447 even in educated populations like Germany. 00:26:51.447 --> 00:26:55.667 So trust, now, if you want to advance this digital health agenda, 00:26:56.007 --> 00:27:04.407 do you believe that instilling trust can actually be managed in a coordinated and rational way? 00:27:07.994 --> 00:27:11.054 Um yeah it's a good it's a good question i 00:27:11.054 --> 00:27:14.134 think um it's very 00:27:14.134 --> 00:27:17.594 situational right so if you are if you 00:27:17.594 --> 00:27:20.654 have cancer and you know that your options 00:27:20.654 --> 00:27:23.594 are you don't do anything and live for 00:27:23.594 --> 00:27:29.494 another two months or you at least try alternatives um you're probably in a 00:27:29.494 --> 00:27:32.134 different situation and have 00:27:32.134 --> 00:27:41.054 a higher willingness to try whatever hands come to you to try to pick it. 00:27:41.134 --> 00:27:48.374 If you are in your normal life, not ill or at least not diagnosed with anything 00:27:48.374 --> 00:27:54.254 and have your habits and your kind of lifestyle and et cetera, 00:27:54.474 --> 00:27:59.494 you probably don't listen to someone who's telling you you should not smoke 00:27:59.494 --> 00:28:01.394 or you should not drink or you should not whatever, 00:28:02.514 --> 00:28:07.594 because simply it's pleasure, it's fun and you don't yeah, 00:28:08.574 --> 00:28:10.554 you don't think of the end. 00:28:11.714 --> 00:28:15.414 But once you've got the cancer, once you've got your liver disease or whatever 00:28:15.414 --> 00:28:20.234 it is, then you start, oh whoops, I need to change something and I need help 00:28:20.234 --> 00:28:23.574 and I trust now whoever is telling me what I should do. 00:28:24.474 --> 00:28:30.274 The expert. Right. I believe that for me, complex With complex technologies, 00:28:30.634 --> 00:28:34.974 we have certification schemes and ISO standards and whatever. 00:28:35.214 --> 00:28:40.414 So would you think that would be sufficient to assure trust? 00:28:40.674 --> 00:28:44.914 If we say, okay, here you have an AI system, it will tell you what to do, 00:28:45.034 --> 00:28:49.654 and it is certified by the European Medicine Authority. 00:28:51.454 --> 00:28:57.234 I don't think that is the stamp of trust that makes the difference. 00:28:57.514 --> 00:29:06.234 Okay. It lives with the examples, the use cases, the conviction that others 00:29:06.234 --> 00:29:11.454 are using it, that I know they have good experience with it. Let me try it too. 00:29:11.654 --> 00:29:15.754 I think that you need these examples. You need to bring it to life. 00:29:15.894 --> 00:29:18.794 Trust cannot be imposed by a stamp. 00:29:19.574 --> 00:29:23.234 Okay. But still, that's what we do with many complex technologies, 00:29:23.674 --> 00:29:26.714 right? Airplanes get certified. Yeah. 00:29:28.014 --> 00:29:34.074 Yeah, but I'm not saying we should not certify things. 00:29:34.174 --> 00:29:39.194 I think we need standards and they can be implemented with this level of certification, 00:29:39.334 --> 00:29:42.094 but that itself does not create trust. 00:29:42.434 --> 00:29:47.214 Sure. Okay. So it's a necessary condition, but it's not sufficient. 00:29:47.394 --> 00:29:56.054 So what would be sufficient then? What would be the magic transition to assure trust? Sure. 00:29:57.914 --> 00:30:05.134 I think a big is understanding. So you need to find a convincing and. 00:30:08.864 --> 00:30:15.204 A transparent way of showcasing the benefits versus the downsides. 00:30:15.404 --> 00:30:21.464 I think if people get the feeling you are hiding something or you are just kind 00:30:21.464 --> 00:30:28.584 of showing the shiny side and not making clear what the whole picture looks like, 00:30:29.744 --> 00:30:30.924 people don't want to... 00:30:30.924 --> 00:30:35.624 I mean, you see this in this vaccinations topic that you raised. 00:30:35.624 --> 00:30:42.664 Number one is the single bad message that kills or at least makes people uncertain. 00:30:43.144 --> 00:30:45.664 So I don't want to get a blood clot. 00:30:47.164 --> 00:30:50.064 I don't have COVID right now. Why should I? 00:30:51.024 --> 00:30:57.124 The risk is high perceived, even if it's not high statistically. 00:30:58.024 --> 00:31:04.384 But if you are the one getting it, you probably say, why did I then get into 00:31:04.384 --> 00:31:06.924 this? So I think that's one thing. 00:31:07.404 --> 00:31:18.744 And the other one is that if people have the feeling they are pushed in a direction 00:31:18.744 --> 00:31:22.204 without the proper explanation, 00:31:22.764 --> 00:31:24.744 then it's causing resistance. 00:31:24.744 --> 00:31:34.264 That's a little bit the strange animals of Querdenker in Germany, 00:31:34.504 --> 00:31:41.724 and they probably exist everywhere in the world, who are all about being manipulated. 00:31:42.784 --> 00:31:46.464 So if you start thinking, okay, someone is trying to manipulate me here, 00:31:46.804 --> 00:31:50.524 then they are creating resistance as well. 00:31:50.624 --> 00:31:53.364 Right. Very obscure arguments, to be honest. 00:31:53.504 --> 00:31:57.204 But obscure arguments seem to work. 00:31:58.224 --> 00:32:03.924 So the other possible source to instill trust in those end users, 00:32:04.024 --> 00:32:06.904 as you say, might be evidence, knowledge. 00:32:07.824 --> 00:32:12.464 But do you believe that is sufficiently developed in all these domains? 00:32:12.464 --> 00:32:17.864 Because there, of course, the risk might be that evidence as such is very opaque 00:32:17.864 --> 00:32:21.724 for a non-informed outsider. 00:32:22.104 --> 00:32:27.184 So here I am, now I have cancer, I get some complicated immune therapy. 00:32:27.924 --> 00:32:32.504 Okay, it will take me ages to figure out what that really means. 00:32:34.624 --> 00:32:39.884 And that is also then the role of the expert in today's system that I talk to 00:32:39.884 --> 00:32:44.124 my doctor because my doctor knows, so I don't need to know, but I trust my doctor. 00:32:44.124 --> 00:32:53.184 So if we remove that authority from the delivery of healthcare and replace that with technology, 00:32:53.564 --> 00:33:02.964 how then do we find an alternative to that authority that tells us what to do? 00:33:04.183 --> 00:33:07.843 Because in some sense, what's interesting, our traditional healthcare system 00:33:07.843 --> 00:33:12.423 has reduced collaboration by making the patient really a patient that means 00:33:12.423 --> 00:33:16.323 disempowered, lack of autonomy, you're told what to do. 00:33:16.683 --> 00:33:21.243 But if we move to digital health, we also are actually proposing a different 00:33:21.243 --> 00:33:25.523 kind of system where the end user, the patient, is more empowered, 00:33:25.743 --> 00:33:28.543 autonomous, and an agent in the whole system. 00:33:28.543 --> 00:33:35.183 So that requires also quite a cultural change in how we deliver healthcare. 00:33:35.443 --> 00:33:40.863 Is it really realistic in most of the societies that we live in? 00:33:41.303 --> 00:33:44.463 I think it is realistic to some degree. 00:33:44.583 --> 00:33:53.683 I think the issue is that you need options to be able to make a decision as a patient. 00:33:53.683 --> 00:34:01.243 If you are with a deadly disease at your stadium where doctors tell you you 00:34:01.243 --> 00:34:05.123 have six months to live, I think you are running out of options, right? 00:34:05.203 --> 00:34:10.783 So you take what you get and you are very much relying on the person because 00:34:10.783 --> 00:34:12.503 you don't have oversight. 00:34:12.663 --> 00:34:18.363 You cannot make a judgment call yourself. You don't have anything to base your 00:34:18.363 --> 00:34:25.043 judgment on except for maybe a stomach feeling. But you don't understand the treatment. 00:34:25.223 --> 00:34:28.423 You don't understand the options anyway. 00:34:28.643 --> 00:34:31.623 So you need to get a steer. 00:34:31.823 --> 00:34:36.283 Otherwise, you're not doing the right thing. So the increased autonomy is maybe 00:34:36.283 --> 00:34:41.843 more for the preventative space where you have the options to continue your 00:34:41.843 --> 00:34:43.643 disastrous lifestyle or change it. 00:34:44.363 --> 00:34:50.883 Change your habits, stop smoking, stop drinking, stop whatever is detrimental to your health. 00:34:51.343 --> 00:35:01.223 And find alternatives to have a life that is satisfying and gives enough pleasures as well. 00:35:01.583 --> 00:35:09.443 This is interesting because the transition to a healthcare that's more preventive than reactive, 00:35:09.703 --> 00:35:14.903 and that's also what you're describing now, indeed requires more agency of that 00:35:14.903 --> 00:35:17.623 patient to say, look, I'm part of this broader society, 00:35:17.983 --> 00:35:23.983 and I want to be a productive member of this society without becoming a burden 00:35:23.983 --> 00:35:26.883 to myself, my family, and society. 00:35:27.403 --> 00:35:30.483 But that, of course, requires a very different mindset. 00:35:31.063 --> 00:35:38.263 And the question now is, are we educating people sufficiently to also step into that boat? 00:35:39.742 --> 00:35:45.762 I think this is a process that takes time. It's looking back at the environmental 00:35:45.762 --> 00:35:51.762 movement and how people think today about the environment versus how they thought 00:35:51.762 --> 00:35:54.662 maybe 20 years ago has shifted dramatically. 00:35:55.242 --> 00:36:01.262 And I think the same is going to happen when it comes to health and their own behaviors. 00:36:01.622 --> 00:36:06.282 I think this is nothing that you can generate overnight. 00:36:06.282 --> 00:36:11.922 Night sure but then will we achieve this point on time before our health care system collapses. 00:36:12.682 --> 00:36:15.582 Yeah good question i don't know um i felt 00:36:15.582 --> 00:36:19.162 this always uh at the brink of collapse exactly so 00:36:19.162 --> 00:36:25.262 surviving somehow because we are subsidizing it uh out of the tax uh income 00:36:25.262 --> 00:36:33.382 etc so sure the level of services um there are different ways to do it so right 00:36:33.382 --> 00:36:38.602 but but now we have different moving parts in this now and one of them we haven't really highlighted yet, 00:36:39.302 --> 00:36:42.362 and that's the tech companies right for 00:36:42.362 --> 00:36:45.942 tech companies these are new markets and it 00:36:45.942 --> 00:36:51.862 might have been adolescence it might have been group x in society oh no health 00:36:51.862 --> 00:36:58.702 is a great market for us right so so then do you think that the issues we just 00:36:58.702 --> 00:37:04.642 discussed about about goals patient quality quality of life and health, trust, 00:37:04.942 --> 00:37:12.562 are then also goals that these stakeholders easily relate to or also sincerely relate to. 00:37:14.671 --> 00:37:20.491 Yeah, I think, I mean, why not? Yeah, it's not, I mean, ultimately everyone 00:37:20.491 --> 00:37:22.571 who is, they are all businesses. 00:37:22.631 --> 00:37:25.471 Yeah, they are trying to generate revenues. 00:37:26.511 --> 00:37:31.731 I don't blame anyone for doing that. Even someone who is a doctor or running 00:37:31.731 --> 00:37:34.631 a hospital is ultimately somewhat a business. 00:37:34.891 --> 00:37:39.771 I understand that, Alex, but take Facebook, right? 00:37:39.911 --> 00:37:43.851 Yeah. If Facebook would give me health advice, I would really be very concerned 00:37:43.851 --> 00:37:49.831 because we know, actually, Facebook is in full-out assault on health, 00:37:50.071 --> 00:37:54.391 certainly on mental health in our society, in order to drive revenue because, 00:37:54.491 --> 00:37:55.711 in the end, they're an advertisement company. 00:37:56.371 --> 00:38:03.151 Right? So it's okay. This is then a dilemma we got to work with because they 00:38:03.151 --> 00:38:08.511 have proven to be unreliable and they have proven to be really undercutting 00:38:08.511 --> 00:38:10.711 and eroding the foundations of our society. 00:38:11.111 --> 00:38:17.091 And now, in some sense, we want to bring them into a domain that is very central 00:38:17.091 --> 00:38:19.911 to our individual and collective well-being. 00:38:19.911 --> 00:38:23.551 Yeah i think um first 00:38:23.551 --> 00:38:28.171 of all i haven't seen any initiative on the health side from facebook yet i 00:38:28.171 --> 00:38:34.071 can't comment on that um but i would not cut all the tech companies over the 00:38:34.071 --> 00:38:42.391 same uh over the same judgment or i don't know if i'm expressing that correctly but um. 00:38:47.031 --> 00:38:54.011 There is a lot of good that anyone who has access to data, 00:38:54.171 --> 00:39:02.131 to health data of patients or whatever it is, and using that in the right way can contribute. 00:39:02.591 --> 00:39:07.931 And I don't really care if it's coming from Google, which is also an advertising 00:39:07.931 --> 00:39:14.331 company to some degree, or if it's coming from something that's been built from scratch. 00:39:14.611 --> 00:39:20.531 But if you look at the pattern that people are using, 00:39:21.571 --> 00:39:26.011 or the search words they are using when they look for health advice, 00:39:26.151 --> 00:39:30.751 etc., I think there's a lot of information that we can gain from it. 00:39:30.771 --> 00:39:34.111 You're not getting the right answer from Google. That's not what I'm saying. 00:39:34.691 --> 00:39:39.251 So don't Google if you're sick. That's making it worse. but. 00:39:42.353 --> 00:39:47.133 There is a lot of information that we can gain from what people are looking 00:39:47.133 --> 00:39:48.833 for when they have a certain disease. 00:39:49.033 --> 00:39:50.973 I think that's super helpful. 00:39:51.353 --> 00:39:54.833 Sure, but if that information is with Google or Facebook, you're never going 00:39:54.833 --> 00:39:56.713 to get it unless you pay for it. 00:39:56.793 --> 00:40:00.313 It's more the other way around, right? We know Google has been shipping a lot 00:40:00.313 --> 00:40:07.093 of NHS data from the UK to its own servers, not accessible by anyone else anymore. 00:40:07.093 --> 00:40:11.753 I was more reacting to this point that you say, well, all these big tech companies, 00:40:12.013 --> 00:40:13.513 in the end, it's all about revenue. 00:40:13.833 --> 00:40:16.193 So as long as they optimize revenue by delivering healthcare, 00:40:16.613 --> 00:40:18.593 it will probably be okay. 00:40:19.393 --> 00:40:23.013 And at least that's how I took your answer. And that's why I wanted to push 00:40:23.013 --> 00:40:27.073 back or challenge that a little bit by saying, well, this has not always worked 00:40:27.073 --> 00:40:29.993 out so well, right? because they make sure of you. 00:40:30.233 --> 00:40:37.173 I mean, it's not for sure if they are basically just taking data and store it 00:40:37.173 --> 00:40:40.893 somewhere where it's no longer accessible, then something went terribly wrong. 00:40:41.173 --> 00:40:46.673 I wonder who made the contracts under which they do it or why you're not suing 00:40:46.673 --> 00:40:50.753 them until they basically no longer exist. 00:40:51.273 --> 00:40:57.893 But, you know, I don't know anyone else who has the cap 00:40:58.253 --> 00:41:01.273 capability the reach and the breadth to to 00:41:01.273 --> 00:41:06.413 you you wouldn't start it from scratch now or who should start it is you do 00:41:06.413 --> 00:41:09.693 you think the government should do it i doubt it that they are doing a better 00:41:09.693 --> 00:41:15.393 job in that so but there there lays an interesting challenge right because we 00:41:15.393 --> 00:41:20.773 do know we have to bring in technology to advance this it's absolutely necessary, 00:41:21.253 --> 00:41:24.453 but for that goals and trust 00:41:24.453 --> 00:41:27.513 has to be aligned and also 00:41:27.513 --> 00:41:30.433 developed and okay what's the longer path 00:41:30.433 --> 00:41:36.333 here or what's the shorter path here and you could also in one scenario could 00:41:36.333 --> 00:41:42.273 be either a conglomerate of more european companies as as a fresh entry of course 00:41:42.273 --> 00:41:47.113 that's difficult in itself or you just say well europe and different nations 00:41:47.113 --> 00:41:50.353 have to just set that up as a more a public. 00:41:51.213 --> 00:41:55.293 Organization, as we have public healthcare systems, we also should have public 00:41:55.293 --> 00:41:58.773 digital healthcare systems. Would you find it a plausible alternative? 00:42:00.223 --> 00:42:09.803 I'm not so sure. If I look at what our public initiatives around the COVID tracker have delivered, 00:42:10.083 --> 00:42:17.423 I think that would have been a task relatively. It was too easy. Yes, I agree. 00:42:17.843 --> 00:42:19.703 It has been a complete disaster. 00:42:20.163 --> 00:42:23.943 I mean, you're absolutely right. But there's a dilemma here, right? 00:42:23.943 --> 00:42:28.383 So, certainly from the perspective of now the collaborating stakeholders, 00:42:28.583 --> 00:42:29.983 and this is a shifting landscape, 00:42:30.343 --> 00:42:37.263 and there is urgency to get this together on time, we might also pay a very 00:42:37.263 --> 00:42:42.783 high price if we just step in with the existing tech giants. 00:42:42.783 --> 00:42:45.483 Because yeah you i think you need 00:42:45.483 --> 00:42:48.483 to find yeah you need to define the framework the accessibility 00:42:48.483 --> 00:42:51.603 of data and the ownership of data i think that's that's 00:42:51.603 --> 00:42:57.303 a key and that is a regulatory thing to do the rest i think should be the market 00:42:57.303 --> 00:43:03.503 enforcement so if you basically enforce them to keep the data on european servers 00:43:03.503 --> 00:43:09.323 so you have still access and control that you have kind of a. 00:43:09.903 --> 00:43:12.903 Neutral surveyor who 00:43:12.903 --> 00:43:15.603 gets access to verify that everything is treated 00:43:15.603 --> 00:43:18.483 properly that you they are 00:43:18.483 --> 00:43:21.523 not in they need to anonymize data 00:43:21.523 --> 00:43:27.103 things like that these type of thing can be enforced by law and that's that's 00:43:27.103 --> 00:43:31.743 a legal regulator has to do i think that's the framework to to provide and then 00:43:31.743 --> 00:43:36.103 the rest is basically let them find the best solution and something that really 00:43:36.103 --> 00:43:39.483 works There are businesses that need to make things work, 00:43:39.643 --> 00:43:41.923 otherwise they are not going to succeed. 00:43:42.363 --> 00:43:44.743 When the state is starting something. 00:43:46.603 --> 00:43:52.583 I mean, who is suing the government four years later for not having properly 00:43:52.583 --> 00:43:53.683 delivered on something? 00:43:53.783 --> 00:43:56.603 It's not possible. Right. But this is interesting, right? 00:43:57.323 --> 00:44:03.343 Government comes. Sure. But that means you're trusting then the market to sort 00:44:03.343 --> 00:44:05.323 of come up with the proper answers. 00:44:05.963 --> 00:44:12.623 However, I would see a challenge there with this question of evidence, right? 00:44:12.723 --> 00:44:15.723 This is also, of course, the big challenge of the pharmaceutical industry, 00:44:15.723 --> 00:44:19.583 Because there they would say, well, certain things we just don't pursue anymore 00:44:19.583 --> 00:44:22.423 because we don't think the market is interesting enough. 00:44:22.623 --> 00:44:28.143 So if we now start to rely on market mechanisms to do that, they might not serve 00:44:28.143 --> 00:44:32.203 the actual goals and values of a healthcare system we want to build. 00:44:32.643 --> 00:44:36.243 But you see, I mean, look at the rare disease area. 00:44:36.443 --> 00:44:42.723 You have diseases with, I don't know, 1,000 patients globally per year or less 00:44:42.723 --> 00:44:44.303 than 1,000, 100 patients. 00:44:45.103 --> 00:44:50.703 And you can still make it work that you find solutions for them by giving the right incentives. 00:44:50.963 --> 00:44:53.163 How did they do it? You get it reimbursed. 00:44:53.943 --> 00:44:59.243 I mean, the 100 patients per year, they don't make a huge difference to the healthcare system. 00:44:59.343 --> 00:45:04.983 Even if you reimburse the medication with a million of dollars per medication, 00:45:05.143 --> 00:45:08.383 per treatment, they do it, and that works. 00:45:08.643 --> 00:45:14.123 So we have a treatment for deadly diseases that are extremely rare. 00:45:14.683 --> 00:45:23.103 So that's a way how we made it work for both sides the pharma company sees value 00:45:23.103 --> 00:45:25.563 in spending money on it because they can. 00:45:27.087 --> 00:45:32.627 They can earn money with it. And for those patients who were death sentenced 00:45:32.627 --> 00:45:34.547 before, we have now a solution. 00:45:34.907 --> 00:45:43.367 So I think that's the markets you create by setting the right incentives or 00:45:43.367 --> 00:45:46.207 balancing those things. 00:45:46.867 --> 00:45:51.607 But so, Alex, in what timeframe do you think we can really start to speak, 00:45:51.767 --> 00:45:57.727 let's say, in Europe about digital healthcare being the standard of care? 00:45:59.907 --> 00:46:04.287 Oh, the standard of care, I think we are still some way out. 00:46:05.107 --> 00:46:14.247 An evolving digital health ecosystem, we can observe already today. 00:46:14.627 --> 00:46:24.307 And I think there are big learnings out of the crisis and some heavy advancements 00:46:24.307 --> 00:46:32.887 that will remain valid even after COVID is our daily news flow. 00:46:33.467 --> 00:46:38.427 And I think it's an accelerator. So we definitely, I would say, 00:46:38.447 --> 00:46:45.507 over the next five to 10 years, we see dramatic changes in medical health and 00:46:45.507 --> 00:46:47.407 how patients are treated. 00:46:47.407 --> 00:46:52.487 And what's the biggest risk that we face in growing in that direction? 00:46:54.567 --> 00:46:59.747 Yeah, losing the trust of the people. So it comes back to what we discussed. 00:47:00.227 --> 00:47:04.087 People are very nervous about. 00:47:06.807 --> 00:47:11.967 Single examples, even they are statistically maybe not meaningful, 00:47:12.247 --> 00:47:20.927 even a single data leak week can already cause the loss of trust and reverse 00:47:20.927 --> 00:47:25.847 some of the developments or slow them dramatically down. Right. 00:47:26.447 --> 00:47:29.427 So we need to be very careful that this doesn't happen. 00:47:30.147 --> 00:47:34.807 And how would the stakeholder landscape then shift by the time we're there? 00:47:34.967 --> 00:47:42.247 So how many of the stakeholders that are central now will have fallen out of the boat by then? 00:47:44.911 --> 00:47:48.911 Let's say hospitals, right? We might not need that many hospitals anymore or 00:47:48.911 --> 00:47:53.671 centers, health centers, because everything has moved to that home context. 00:47:54.691 --> 00:48:02.451 Yeah, I think there definitely will be a shift, but we will not get rid of hospitals at all. 00:48:03.171 --> 00:48:08.171 They need to adapt to this new environment. 00:48:08.511 --> 00:48:11.391 I think it also allows them to get more efficient, patient 00:48:11.391 --> 00:48:15.591 so uh more predictability on 00:48:15.591 --> 00:48:19.031 how long patients stay better manage manageable 00:48:19.031 --> 00:48:22.151 workflows in the hospital that allows 00:48:22.151 --> 00:48:26.611 them also to become more profitable because that's the other part of the equations 00:48:26.611 --> 00:48:32.531 hospitals are at least if they are not part of a bigger group rarely profitable 00:48:32.531 --> 00:48:37.651 they are usually loss making and we need to solve that otherwise the system 00:48:37.651 --> 00:48:40.931 i mean we can only afford this, 00:48:42.031 --> 00:48:43.731 to some extent. 00:48:44.211 --> 00:48:48.831 Ultimately, the system is at the brink, as I said, of color. 00:48:49.311 --> 00:48:55.211 And would you expect that this also will have a measurable impact on life expectancy in Europe? 00:48:57.911 --> 00:49:02.671 It definitely will. Definitely will. I'm pretty sure there's impact. 00:49:04.731 --> 00:49:11.911 No. But But, I mean, life expectancy is growing, and I'm pretty sure it will 00:49:11.911 --> 00:49:14.211 further grow with, in particular, 00:49:14.371 --> 00:49:22.231 prevention and change of lifestyle that can only be steered through early monitoring, 00:49:22.451 --> 00:49:28.251 through big data collection, and through better learning about what behavior 00:49:28.251 --> 00:49:30.471 has which consequences. 00:49:31.571 --> 00:49:34.871 Right. Ferdinand, would you like to add something? Do you have a question? 00:49:38.631 --> 00:49:45.551 Well, I have maybe a question that picks up on something that we discussed before, 00:49:45.811 --> 00:49:54.311 just a new sort of angle on this adoption issue, because maybe let me just briefly come back to that. 00:49:55.651 --> 00:50:01.491 Because you said, well, the doctors that need to have the right incentives to 00:50:01.491 --> 00:50:07.451 adopt these new technologies and that in general they care for the um i mean 00:50:07.451 --> 00:50:08.491 the health of the patients, 00:50:09.431 --> 00:50:14.951 i'm just wondering um whether there could not be more resistance from the doctors 00:50:14.951 --> 00:50:22.171 for two reasons i mean one um one possibility of these new technologies is is 00:50:22.171 --> 00:50:24.351 that it will make a lot of doctors redundant. 00:50:26.133 --> 00:50:30.413 Right so if you don't have to go to a doctor maybe you just look into a screen 00:50:30.413 --> 00:50:35.853 and the camera can detect your i don't know your health status or so then maybe 00:50:35.853 --> 00:50:37.133 you don't need to go to the doctor, 00:50:37.893 --> 00:50:42.633 and so there might be instrumental reason for doctors to resist these kind of 00:50:42.633 --> 00:50:48.533 technologies and the second point is um i mean these technologies they could 00:50:48.533 --> 00:50:51.793 also threaten in some sense, the self-image of the doctor. 00:50:52.693 --> 00:50:58.513 I mean, I think you like to have this competence, right? 00:50:58.593 --> 00:51:03.653 And if a machine is making a prediction that is not consistent with your own 00:51:03.653 --> 00:51:07.033 expertise, so to speak, not consistent with your own opinion, 00:51:08.213 --> 00:51:12.513 maybe then they will also resist because it somehow undermines them or they 00:51:12.513 --> 00:51:15.493 don't trust it because, you know, it's not what they thought, 00:51:15.633 --> 00:51:18.313 but actually the machine might be much better than the doctors. 00:51:18.313 --> 00:51:21.673 I was just wondering whether you could briefly comment on this. 00:51:22.393 --> 00:51:29.213 Yeah, definitely there is this notion of doctors may be redundant or we may 00:51:29.213 --> 00:51:31.493 need less doctors for certain things. 00:51:31.493 --> 00:51:40.293 Things, taking, for example, standard diagnostics tools, 00:51:40.433 --> 00:51:47.073 so reading out the pictures of an MRI or an ultrasound, 00:51:48.153 --> 00:51:48.533 diagnosis. 00:51:52.339 --> 00:52:00.219 And then a computer taking over a lot of that job by pre-selecting or filtering the pictures. 00:52:00.499 --> 00:52:03.219 That is something that's being discussed. 00:52:04.219 --> 00:52:11.119 My sense is that doctors that recognize this rather as an opportunity than a 00:52:11.119 --> 00:52:16.219 threat will be the ones that are more successful because they will adapt this earlier. 00:52:16.219 --> 00:52:20.219 They can treat more patients. 00:52:20.639 --> 00:52:23.599 They can be more effective in how they do it. 00:52:23.639 --> 00:52:30.059 They see the AI as a partner, as an enabler, because it helps them to only focus 00:52:30.059 --> 00:52:32.079 on the really difficult cases. 00:52:32.379 --> 00:52:38.299 And all the standard stuff is being done by a very cost-efficient aid, 00:52:38.419 --> 00:52:42.839 which has basically just the acquisition cost. 00:52:43.039 --> 00:52:45.899 And then the rest is maybe a little bit of maintenance. 00:52:46.219 --> 00:52:50.759 But it's not asking for a monthly salary like other doctors. 00:52:53.379 --> 00:52:57.379 One second, I need to give some signals. 00:52:57.619 --> 00:53:04.439 I have someone here asking for my next advice. 00:53:05.099 --> 00:53:12.019 But the thing is, that threat, I think, I mean, the concern exists. 00:53:12.019 --> 00:53:19.159 I see this in various discussions, but again, the doctors who take this on as 00:53:19.159 --> 00:53:24.379 an opportunity rather than a threat will be the ones that will be successful with it, in my view. 00:53:25.259 --> 00:53:28.539 Okay, Alex, thank you very much for this conversation. 00:53:29.399 --> 00:53:35.339 We learned a lot about… Hi, you listened to one of our podcasts in the series 00:53:35.339 --> 00:53:40.099 on collaboration produced by the Ernst Trommel Forum and the Convergent Science 00:53:40.099 --> 00:53:44.119 Network. 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