Seeing what wasn’t there – 5 observations of opportunity at the #JPM16 conference

As a researcher, I find the best scientists are those who digest a broad spectrum of data and find what isn’t there. If you want to cover new ground, you have to see what others have been missing. At the euphoric, dizzying meeting frenzy that was JP Morgan Healthcare conference, and as a physician transitioning to full time entrepreneur, these are five absent areas I found begging for new businesses.

1. Pain management. JPM16 was all about new and exciting cancer therapeutics: Illumina is spinning off Grail, making liquid biopsy cancer tests; Sanofi and Warp Drive are collaborating to make oncology drugs; even the local paper featured OncoMed’s CellGeneinvestment as a top story. But while the direct costs of cancer are US $88B a year, pain costs us $300B. Seriously. Americans spend $60B on pain directly. Why are so few companies investing in and addressing nonpharmacologic mechanisms of pain? The barriers to pharmacologic R&D are clear – Vioxx is still in the news. However, as the CDC releases new guidelines that will further curtail prescriptions of opioids, the need for viable pain research and relief is a huge opportunity. Full disclosure, my VibraCool devices help in this niche… but there is room and demand for so many more solutions.

2. Patients are people. Companies focused in their talks on the patient journey, patient experience, and patient satisfaction with the intensity of a magnifying glass on an ant. The attention given in the annual reports was brief, bright, and often misplaced. Few applied innovation to aspects of care that matter to patients. Service companies focused on surveys, but didn’t address how to enhance the relationships home health patients miss. Injectable companies talk about how many new biologic therapies are in the pipeline, but didn’t notice that needle phobia is 63% in the demographic that will be taking those injections. Or, perhaps, won’t. “Our most successful product is a warm blanket for patients” noted one 3M executive. 3M gets it – patients are people, who at their most vulnerable want comfort, security, and diminution of fear. Whiz-bang therapeutics need to couple with comfort to ensure uptake in a generation who feel increasingly alienated from healthcare.

3. Physician substitutes or support – The next ten years will bring a projected deficit of up to 90K physicians. This AAMC study didn’t take into account the bomb dropped by the ABIM in 2013 with its misplaced attempt to enhance self-policing by requiring more stringent (and expensive) Maintenance of Certification, or MOC. MedCityNews writer Westby Fischer wrote a powerful story noting physicians’ loss of trust in the Board, and by extension, their realization of a new role as owned cogs in administrator-run healthcare. Job satisfaction requires autonomy, life long learning, a feeling of making a difference, and feeling appropriately compensated. As physicians feel these satisfaction points diminishing, organizations like the Society of Physician Entrepreneurs grow… and successful members eventually quit practicing. In a crazy good Op Ed in the LA times, resident Rich Joseph questions why more physicians aren’t defecting to the world where you have free catered lunches, car services, and top notch health facilities instead of cement block call rooms. This is an opportunity beyond telemedicine apps that let fed up docs dispense advice in their jammies. Create physician longevity programs that make Silicon Valley chic as cool for docs, or docs will go to the dark side where they have cookies.

4. Prevention of disease and palliation – There were some cool start ups at JPM dealing with prevention, actually, though the business paradigm naturally rewards the pound of cure. Cancer Prevention Pharmaceuticals strives to prevent colon cancer, and the Human Longevity Initiative seeks to find problem genes before they can cause problems. A corollary to preventing disease is preventing excessive futile care. Here, there are even more opportunities – slow medicine at the end of life. There must be ways, like a reverse mortgage, to monetize end of life with dignity rather than expensive desperation. While death panels and euthanistic sci fi make letting the old go peacefully seem creepy, concepts like Dartmouth’s Slow Medicine validate the concept of “don’t just do something, stand there.” People overwhelmingly say they want to die at home and comfortable in their own beds; some company will figure out how to help them do so.

5. Women-created concepts – Women disrupt patterns. While men typically search for solutions, women can feel better with discussions or understanding alone. Case in point, 23andme. With 2/3 female founders, the company knows curiosity-scratching ancestry answers may be more of a draw than health info. While technically health tech, they were able to grow even when the FDA didn’t like their health compliance – women are curious enough about family to pay for data. Maria Bailey showed the consumer goods world that women control 80% of domestic spending, changing marketing approaches. By extrapolation, women likely control discretionary healthcare expenditures as well. Women were conspicuously sparse at JPM: in the sea of shark grey suits, the 10% of colored clothes stood out. Women could bring a perspective of differential empathy to healthcare tech; women tend to oversee end of life care, tend to appreciate the needle phobia of the children they take for their vaccines, and can give a perspective on what adds comfort to care. There are enormous pools of wealth for startups that realize that to feel better, sometimes patients prefer a certainty of caring to a chance of a cure.