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Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes, and business success, with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.
Saul Marquez: And welcome back to the podcast. Today I have the outstanding Dr. Jack Kreindler. He’s the Founder and Director of the Centre for Health and Human Performance. Jack is a Physician, Physiologist, and Serial Tech Entrepreneur. Since 97 he’s been instrumental in the design architecture and leadership of many innovative tech ventures in healthcare including Douglas Adams HG2.com acquired by the BBC, Via Life acquired by CIGNA to name a couple. While still practicing as an emergency physician from 2002 to 2006, Jack’s incubator Blue Orange Technologies develop the core technology platform for enterprises and high growth startups including visual DNA, genie D.B. and Dictate IT. In 2007, Jack founded CHHP that is the Centre for Health and Human Performance in London’s Harley Street. The Centre for Health and Human Performance is renowned for their work with athletes, complex cases, and celebrities taking on extreme challenges. Jack also lectures internationally on the future of medicine and as a guest presenter and expert for CNBC, Sky Sport, E.T. sport, and the BBC. So Jack, welcome to the podcast my friend. Glad you could be here with us.
Dr. Jack Kreindler: I really appreciate the opportunity. Thank you.
Saul Marquez: Absolutely. So what made you decide to get into the medical sector?
Dr. Jack Kreindler: Well funnily enough I was more interested in becoming a fine artist actually when I was a kid. I….
Saul Marquez: Awesome
Dr. Jack Kreindler: Was also very very few people to do art fine art and design as a what we call A level. Those are the kind of exams that you take when you’re 18. Okay. And I peculiarly it was the only person in the history of UK medical school to be allowed into medical school with two sciences and fine art. Yeah. So actually I actually my my interest in visualization is a very it’s an on running thread really in my career in history both in medicine and on the tech side of things too. So I wanted to do medicine, I did do medicine because my mom said that she would literally kill me if I didn’t do something like medicine because I was really determined to go to art and design.
Saul Marquez: Well hey life threats tend to work from time to time.
Dr. Jack Kreindler: Yes threats to life are indeed a good motivating force to study something which you do think is interesting and let’s face it let’s face it it’s pretty hard to practice medicine. Having just done sorts of stuff in it you know on your own scribbling away you have to learn it and you have to study it. There is a huge tradition there is a lot of knowledge and I’ve been fortunate enough to be able to carry on doing the sort of the more creative work without having to go through many many many years of medical training and practice. So I’ve managed to marry the two things together now which is really wonderful.
Saul Marquez: Now that’s brilliant and you’ve brought your artistic side into this entrepreneurial world which obviously we’ve talked a lot about a lot of things on the podcast you know things that are going wrong, things that could go better, things that we’re doing great and there’s no doubt that innovation keeps our health care system moving forward. What would you say a hot topic that needs to be on every healthcare leaders agenda today and how are you guys approaching it at your Centre?
Dr. Jack Kreindler: So what we do at Centre is essentially the application of human performance science and elite sports medicine to not only help those who kind of like our elite athletes and help them get better and run faster and climb quicker and so we also apply that to help those with the most complex chronic and serious condition. So essentially it turns out that treating people like athletes by looking after their training, and their nutrition, and their recovery, and their sleep, and their headspace and that biomechanics and so on, it turns out that that really gets you amazing results better than a lot of drugs Blockbuster and Blockbuster breakthrough drugs. So just the sort of principle of treating people like athletes and doing that efficiently, economically, and holistically, doesn’t just help athletes it helps even the sickest cancer patients too. So what are the main areas and grand challenges in healthcare that you can apply that to? Well it turns out a lot of things it has applications in. So diabetes, metabolic disease, the obesity crisis, it has applications in the complex chronic diseases that we are facing morals and will increasingly be crippled by I think in our healthcare systems as time goes by and they are yeah things like congestive heart failure, chronic obstructive airway disease, and cancer. So there’s a great many applications for not just fixing stuff but also optimizing the human body and its own ability to repair and be resilient and perform. That is yeah it’s a very very wide reaching a set of applications and it’s not fluffy either. The important thing to remember here is that over the last decade or so we’ve begun to really understand the metabolic, the hormonal, the immunological basis, for why being fit in this sort of very simplistic term that’s a molecular and itself at the cellular level. Why it’s so important in both health and disease.
Saul Marquez: Super fascinating and definitely in need of trying things that work. The number of patients with chronic diseases continues to grow. We’ve got to do something differently. So very fascinating that you guys are taking this approach and sort of turning it on its head by way of like who the candidate for it is very very intriguing there. Can you give the listeners an example of how your organization is creating results by doing things differently?
Dr. Jack Kreindler: Sure. I think if you were to take a standard model of healthcare it’s very much based on good evidence that’s developed through randomized controlled trials usually sponsored mainly as a result of a new drug that can be patented and new agent and new street many of therapy. And once those agents treatments therapies pills potions and so on have been given license to be sold then that effectively incrementally improves the way which we treat a particular condition. Our approach is very much more of an integrative adaptive approach. It’s what you do to improve an athlete’s performance and it’s what you do when there are lots of complex things going on all interrelate with each other that’s very hard to sort of put your finger on one thing that’s gone wrong. And so for us we collect a lot of data about a lot of different topics. So for example we will collect a lot of data physiologically about how the person’s body is functioning for them on an exercise rig and do heart and lung and metabolism testing on their physiology to see just how fit they are with the holes in their physiology or how we can improve those things through the right kind of training the right kind of recovery optimizing sleep, optimizing nutrition, micro nutritionally and so on and then develop a program of training and nutrition and sleep and recovery and getting your headspace right which we don’t make assumptions about, we test and then we adapt. And it’s just like we would do automatically if we were flying an airplane. We wouldn’t make an assumption that we’ve plotted was exactly the right route. We would absolutely test meticulously test in real time but in the case of aviation it is literally in real time exactly what it is that we’ve treated. Is it working? Is it not? Is the condition getting better? Is it getting worse? Is it staying the same? What is the reports from the patient not just what do we see in our exercise test lab or in our blood tests or whatever laboratory exams we’re doing and then we would adapt. It’s exactly what you do to keep an airplane safely and efficiently flying in the sky. Why did we do that in every case in medicine. Previously impossible we wouldn’t have the ability to collect lots of biomarkers and do lots of things efficiently and economically and we didn’t have the analytics to be able to do those adaptions in real time. But now we do and I think we’re moving into an area of medicine where there’s going to be no excuse for personalizing what it is that we do and adapting it in a much more high frequency way that does not mean though that we will lose the very great advances that we have gained from doing randomized controlled trials. But it does mean that when we combine those things to treat complex diseases and complex systems that we also employ all of the tricks that we’ve learned in Economics, in aviation, in the way that we like protect our countries using military security there are countless numbers of examples of different areas where we where we use assumptions and high frequency adaptions to what we do and we have to start doing that in medicine and I think that’s really where we have started where I hope that’s okay.
Saul Marquez: Now I think it’s definitely an interesting approach and as you’ve worked with various different companies Jack, it’s interesting I always love to hear the story from entrepreneurs like yourself of a time that you failed, a setback that you had that you learned so much from. Which moment would you like to share and what lessons did come out of that?
Dr. Jack Kreindler: Absolutely. So I’ll give a very I mean it’s a failure but in a sense it’s not. But for me to a certain extent if you’re going to do something invention business where you or you’ve got shareholders and investors that have put in hard earned cash into your venture and you don’t return that then that for me in a sense the failure even if what you learn from it turns out to be very good for science and medicine. But I’ll give you an example. In 2012 after I left the Singularity University Medicine program I realized that there were a lot of things, devices connected by sensor technologies that were rapidly becoming the quality that we would need to do the same kind of stuff as we do in our lab that could be done at home. And that one of the Grand Challenges which is this astonishing trillion dollar cost of hospitalization and treatment for complex chronic disease patients and probably the most people estimate that may be half a trillion dollars of those costs could be avoided if we could early detect the deterioration of those people and then treat them prior to them coming crashing into hospital. That project we called Centrium and Centrium was there to take simple by a sense of data from these exponentially advancing technologies. These wearables, these bio sensors, which we didn’t build any of. We just use the very latest ones that we built a wonderful. Yeah. And we built a very wonderful interface that allow doctors to type in their own rules as to what they suspected, they wanted to know about, or rather the times when they would want to be alerted to when some was serious. To give an example like you know tell me if a person’s blood pressure decreases or increases 10% over a moving average of the last three weeks or something. They would they would be able to write that stuff in natural language as a set of rules and ever growing sets of rules it. You’re looking at blood pressure weight oxygen saturation respiratory rate time in bed. What willingness on their feet heart rate heart rate variability all of those wonderful things. And then when those alerts were triggered then essentially you’d be able to act early before the patient comes crashing into hospital and save an astonishing amount of money and paying for health systems and patients alike. Sounds like a great idea. And we found out pretty quickly that we could detect five days in advance with very minimal false alarms that patients would end up coming crashing into hospital. Potential Savings astonishing hundreds of billions. But guess what. After 20 million dollars worth of spending money developing this incredible technology which did not need to be which the FDA said they did not need us to go back to them every time we improve the algorithms or explain why in a minute sort of a small stroke of genius on our part so we could rapidly iterate these algorithmic sets of rules. We discovered that there was nothing in the healthcare systems to reimburse doctors or clinicians or hospital systems for keeping people out of hospital. There was the 30 day readmissions thing which you know if you come crashing in. Then of course you know if we can try and help them stay out of hospital there is that. Yes but there is no code for reimbursement for acting early before there’s an actual thing that you can diagnose his pre diagnosis which is a big problem which is an interesting thing is none of us have been trained to act in advance of something going wrong. We only act after it’s gone wrong. And even though we were able to really rapidly iterate these rules sets which was a really remarkable thing. So was human language in. And then you get this wonderful blackbox machine learning system that spits out new rules in the same natural language grammar as the rules were written and which is the real trick. And the doctors would look at them and understand them and go Oh I get that. That means that yeah well I like those new rules which happen to be much much better than human expert rules. And the system will get better and better really quickly. We were able to prove that we could text with minimal false alarms that people were going to be sick and yet there was no way the health system if there was there were no people trained to be able to act differently. And the bang for how often whenever they called up one of their patients to just show them or what the recordings were that not act intelligently beyond just the data stuff that they saw on the screen. So that was a really that was a really big kind of lesson learned is that actually it doesn’t matter how big the challenge is how well the technology can suit the solution to that challenge and how much potential savings and loss of suffering you can achieve if the system if the platform is not there and the people are not ready to make those changes legally or professionally or otherwise if the reimbursements aren’t there. The incentives aren’t there then you’ll hit brick walls. And while that technology and the people that were involved in that amazing project have gone off to become very very important people in places like Beverly and such. Just for me a disappointment to sort of have to have learned the hard way that actually the tech is not the heart that the health systems the heart.
Saul Marquez: Yes. Now that’s such a great great story Jack and and definitely a great lesson to have learned if the technology is not paired with the payer system it’s just not going to take off. They just can’t. You know in the end you do have to produce a business that’s sustainable and indefinitely. Appreciate you sharing that by a lot of great things came out of it. So you’ve now pivoted to the center and you’re using some of these you know biomarkers these different ways of getting things done in this Centre for excellence. What would you say your proudest leadership experience has been to date with that?
Dr. Jack Kreindler: Well first of all the CHHP is sort of predated any of the kind of stuff that we’ve done with Centrium and other machine learning projects using data to earlier better predict stuff. So really it already has. I mean.
Saul Marquez: I’m sorry about it.
Dr. Jack Kreindler: No absolutely it’s. I think in 2008 we’ve been around for 11 years at my institute now we have 14 scientists and specialist working there and really that’s been a kind of a bedrock for us to test and hypothesize as to how our kind of approach to integrative high frequency and adaptive medicine can help to help projects who can take those kinds of principles and do them at scale and centrium. But yeah I think from a leadership perspective I think it is quite scary coming out of a large employer like the NHS. And to set up your own institute that really redefines what it is to practice in an integrative holistic and data driven way but also I think to kind of convince some of the greatest minds and most respected academics to join you in that journey and having a kind of a belief that is sincere and not money driven but impact driven. And to create a team that has done great work in changing the way that we think of human performance science and its application to really help the very sickest patients. And that’s really the most wonderful part about what we do in our institute. It was new, it really was new at the time. And this year we’re now hearing kind of the very very first people who are going to be appointed as exercise oncologists, we’re hearing about metabolism and cardio respiratory fitness being a fundamental part of the way we treat cancer. We’re getting validation at a molecular and research understanding level of why that stuff all works we’re seeing drugs which are targeting some of these pathways now like CPM 31 510 which reverses the Warburg fermentation of cancer cells. The thing that makes those dots Light up bright red in PET scans and how to reverse that that phenomenon. It’s kind of wonderful after a decade or just over to have those principles materialize into things that are being recognized and research the work being published in peer reviewed journals and kind of the world can now see that it’s not just about blockbuster drugs it’s actually about treating the patient as if they were a high performance machine like an airplane which we are.
Saul Marquez: And I think that’s brilliant. I think that’s brilliant and yeah I’d say it’s definitely exciting times. A lot of things validating the work that you and your team are up to Jack. Tell us about an exciting project or focus that you’re working on.
Dr. Jack Kreindler: Again I think on the cancer theme the thing that is the most exciting thing right now is the results of a neighbor of mine actually in London who I was introduced to through the tech community. She was a very famous politician who sadly died in March of this year. Her name was Baroness Tessa Jowell and she died sadly although every possible option being offered to her to try and address her globe last over multi for me the brain cancer. She died from was probably one of the most aggressive cancers that exists as well as the most aggressive brain tumor. We started obviously with her initiation, the UK brain cancer mission and that has now been named the Tessa Jowell brain cancer mission and it really has become a real more than a moonshot, a true multi stakeholder fully integrated effort to try and crack and cure an incurable disease within the next five years. And that is incredible when government, research, charity, the tech sector, the pharma sector, entrepreneurs, big company execs both all the credible people and all the incredible people rally around a particular challenge. And I’ve been most honored I think to have been appointed the lead for a ion technology for that effort alongside an extremely esteemed group of people that are trying to transform the way we research global customer and brain cancers for adults and children out of research and science level. I work at a very strong working group looking at next generation adaptive trials which really kind of redefined the randomised trial model the patient experience group which for the first time is putting patients very much equal first with all of our science and clinical and sort of economic basis for treating complex disease. And finally next generation training for computational and molecular oncologists it’s an incredible project. It’s a beast both politically, and technically, and medically, but it’s probably the most exciting thing that I’ve seen in cancer research indeed in medical research in the last 20 years I’ve been a doctor in 30 years that I’ve been a geek.
Saul Marquez: I love it and I think it’s wonderful. Congratulations on that appointment and sounds like the organization the Foundation is being driven by a lot of highly credible and motivated people and it’s amazing what results when something like that happens. So I definitely wish you guys the best with those efforts. I know that great things will come.
Dr. Jack Kreindler: I very much hope so.
Saul Marquez: And Jack so so let’s getting close to the end of our of our time together here. Let’s pretend you and I are building a medical leadership course on what it takes to be successful in the business of health care. It’s the one on one of Dr. Jack. And so we’ve got five questions lightning round now for you followed by a book that you recommend to the listeners. You ready?
Dr. Jack Kreindler: Excellent. Good.
Saul Marquez: All right. What’s the best way to improve health care outcomes?
Dr. Jack Kreindler: Train doctors as data scientists as well as clinicians.
Saul Marquez: What is the biggest mistake or pitfall to avoid?
Dr. Jack Kreindler: Making sure that the financial and business incentives are not aligned to the technology.
Saul Marquez: How do you stay relevant as an organization despite constant change?
Dr. Jack Kreindler: Constantly remembering to forget what you’ve learned or at least acknowledge that it’s already old.
Saul Marquez: What is one area of focus that drives everything in your organization?
Dr. Jack Kreindler: The grand challenges in health care the things that are going to crush not only economies but also cause the greatest burden to people and their families.
Saul Marquez: And finally what is your number one success habit?
Dr. Jack Kreindler: Hiring the best operators as well as the best tech folk.
Saul Marquez: I love that. And Jack what what would you say your your book that you recommend to the listeners as part of this syllabuses?
Dr. Jack Kreindler: I think very much aligned to your syllabus. I would say read Michael Pollan’s “How to Change Your Mind”
Saul Marquez: Love that. Folks to get a link to this book, a copy of the transcript of our discussion today as well as your many syllabus, go to outcomesrocket.health and you’ll find all that there. Just search for Dr. Jack and you’ll find it there. Before we conclude Jack, I’d love if you could just share your closing thought and then the best place for the listeners to get in touch with you or follow you.
Dr. Jack Kreindler: Sure. Well to get in touch with me I think just Google me there’s a lot of there’s a lot of stuff out the lectures and talks and interviews with some of the most inspiring people I’ve met and obviously anyone’s welcome to reach out to me on LinkedIn or Twitter or the usual the usual kind of social media channels. And my final thought really is we have in healthcare a golden opportunity to change for the better. It is disruptive bull without being disruptive. And I think that it’s just probably of all the industries at the moment the most in need of new thinking and it is the industry that we’ll see by far the most benefit and obviously because it’s really a very human thing. I think it’s probably the thing that the cleverest people in the world should be focusing on but I would say that.
Saul Marquez: I love it Jack. Hey well I certainly am excited to share this interview with our listeners. I know that you’re on the road today so I appreciate it carving out the time to speak with us and looking forward to staying in touch.
Dr. Jack Kreindler: It’s been a real pleasure. And hopefully there’ll be more to come. They’ve be really wonderful to see how this turns into a real action.
Saul Marquez: Consider it done my friend.
Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.
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