It's the innovation, stupid

Creativity plays a growing role in our economies. Success in the future is not about technology, government, management or even power; it is all about people and relationships. Scientists, artists, entrepreneurs, venture capitalists and other self-motivated, creative people are challenging the traditional structures of the 20th century society. The creative class is more important than ever, and healthcare professionals are a great example of citizens of this new class.

Without creativity, traditional jobs tend to commoditize, and they finally fly to emergent economies, at a great loss for cities and countries. Healthcare hasn't seen this trend yet, but it will. Innovation and creativity is the only way out.

In the last years I've been involved in a series of efforts to promote clusters of biotechnology and medical technologies. When you try to promote a cluster, you struggle to understand a very well-known cultural phenomenon: why we see clusters of technology and creative people in certain cities, while other cities remain culturally isolated and intellectually poor?

If you are interested about the answer, I've just read “The rise of the creative class”, by Richard Florida, an astonishing book explaining why creativity matters more than any other thing, and how this creativity correlates with economic prosperity.

When reading it, and seeing how innovation accounts for the wealth of any city, I remembered the “it’s the economy, stupid” quote, pronounced by Bill Clinton in his 1992 presidential campaign… It has become a catch phrase to expose problems. When talking about prosperity in our modern world the time has come to rephrase the sentence. Do we want our society (and our health systems) to prosper, live well and stay ahead in the global economy? It’s the innovation stupid.

An act of rebellion

Breakthrough ideas don’t appear out of thin air, they are the result of a culture and an environment that accommodates innovative thinking. When we teach medicine at med schools, we nail facts into students heads... In our age of information overabundance, we still value encyclopaedic knowledge. Information is a commodity. What we know is no longer important, creativity and connecting the dots to generate new knowledge is indeed more important.

I watched last week a fantastic lecture given by Tom Peters (thanks JB for pointing me there). He explained the story of a 5 years old kid who received a grade of “unsatisfactory” in art. His parents were shocked... How could any kid receive a poor grade in art at such a young age??? Well, his teacher said he refused to colour within the lines...

Sometimes I hire people to lead creative projects. I never hire someone who had a grade average of 10/10 in university to do that... A 10/10 has been colouring within the lines since the age of 5. He probably never questioned what he/she was doing... A 10/10 is usually by definition a conformist. Creativity is an act of rebellion. The best creative people are the rebels, the mavericks, the trouble makers... Every creative team should have at least one of those.

Synthetic biology

There’s been a lot of hype surrounding biotechnology last week. Craig Venter's team synthesized a genome from scratch. It is certainly an important step towards the creation of the first synthetic organism.

We can see the creation of a synthetic organism as a three step process:

(1) Transplant and "boot up" the genome of one species of bacterium into another. Already done.

(2) Go beyond merely sequencing a genome to design and build one. The newly synthesized genome -- a copy of the genome of Mycoplasma genitalium -- has more than half a million base pairs. Already done, this is what was made public last week.

(3) Insert the new synthetic genome into a standard bacterium (“boot up” a cell with the synthetic genome and see if it can live with it). Not done yet, but we can expect the announcement of it in the next months.

At that point, scientists will have brought to life an organism that never before existed. This whole process is “rewriting” one of the last mythic distinctions in science, the distinction between living and non-living matter.

The implications of this from the point of view of innovation and entrepreneurship are huge. Scientists will be able to take a file stored on a computer and using synthetic chemistry, turn that information into life. With the new ability, scientists will begin to custom-design organisms, creating biological "robots" that could produce from scratch chemicals or drugs. The biotech industry would boost forward significantly.

There’s a lot already said about that, just check the news… but the news don’t say something that I find particularly relevant. Venter’s team quietly filed an application last May that seeks to own the synthetic life form his lab is creating.

This may signal the start of a commercial race to synthesize and privatize synthetic life forms. And Venter's company is positioning itself to become the “Microsoft” of synthetic biology. This is an important issue, with far-reaching social, ethical and environmental implications. Should anyone own what the application calls a "free living organism that can grow and replicate"? As we all know, bioengineered organisms have been patented by biotech companies for years, but should this cover organisms made entirely from scratch? And if the answer is yes, where should we draw the line? Owning a bacteria is certainly one thing, but what happens with more complex organisms?

My first reaction would be, why not? (as long as the output is ethically correct)... But I guess the debate has just begun. Now is no longer a theoretical discussion. It is real. It is happening. We all need to think carefully about it.

Transforming the lives of millions

Now and then I hear about entrepreneurs and start-ups that are truly different. Lifestraw is the last one. It has completely blown my mind.

The problem: More than one billion people (one sixth of the world’s population) have no access to potable water. This of course translates into diseases and deaths. More than 6.000 people, most of them kids, die every day by consuming unsafe water.

The solution: Lifestraw, a disposable “medical device” designed to turn any surface water into drinkable water. To make it short, water that is sucked through the straw first passes through a mesh of “filters” and “spaces”, killing bacteria. It has proven to be effective against waterborne diseases such as typhoid, cholera, dysentery, and diarrhea, and removes particles as small as fifteen microns… More than enough to save millions of lives on the long run. It is cheap (less than $2, I heard), small, easily portable (just as a necklace), and it lasts one year.

Already in motion thanks to donations and philanthropy funds, it can become one of the greatests life savers in history and potentially transform the life of millions. I wonder how the entrepreneur connected the dots to bring this possibility to life.

For those willing to understand better how it works, check it here, at medgadget, the journal of emerging medical technologies. And here's an interview with the entrepreneur.

Social entrepreneurship can really change things.

Sometimes we aim too low, and we reach it

“The greatest danger for most of us
is not that our aim is too high and we miss it,
but that it is too low and we reach it”
Michelangelo

A conversation with a friend of mine, today:

JH- Most healthcare start-ups never survive their first year.
LP- Maybe we don’t see enough start-ups failing.
JH- What do you mean? (!!!)
LP- You usually fail when you are trying to do new things.
JH- … (frowns)
LP- … but then you can learn from your failure and finally succeed if you persist. That’s the story of a lot of disruptive and successful start-ups in the market, but we don’t learn from them. We stigmatize mistakes. Most potential healthcare entrepreneurs are too frightened of being wrong. And if they are not prepared to be wrong, they will never come up with anything original.

I like people that aim high and miss, they usually learn and succeed.

Aim high!

Rethinking med schools

Harvard Business School and Harvard Medical School have understood physicians are an immense source of new business opportunities that remains untapped. Harvard Med School has decided to teach to their students a course on innovation and entrepreneurship (given by MBA professors).

One of the teachers involved said some doctors enrolled were “driven to earn MBAs once they realize they innovate better as an entrepreneur than as a doctor.”

Amazing.

Amazing.

Will Europe listen to the winds of change???

Too disruptive?

A very quick thought, after a meeting today with very passionate and “disruptive” entrepreneurs… (maybe too disruptive?)

Technology will never dictate the human experience with healthcare. It takes doctors, interacting intimately with patients to do that. So, technology should always be presented as an enhancer, as a complement, as an aid to achieve excellence, but never as a replacement for the patient-physician relationship.

Opportunities at the frontiers!

I just came out from a meeting with an engineering company specialized in robotics, willing to enter the healthcare marketplace. Very interesting model. I am not at liberty here of commenting further on it, but in the first five minutes I thought they had really something big.

And this reminds me of something that I have always believed (and said): the best opportunities lie at the frontiers of disciplines. It is an uncharted territory where the best minds of both disciplines can find tremendous value.

Just as examples of what I’m saying, think about the space between robotics and healthcare, engineering and healthcare, architecture and healthcare, global warming and healthcare, social entrepreneurship and healthcare… You name it! Innovation flourishes at the intersection of these areas.

Educate or compete

One of the first questions a healthcare entrepreneur needs to answer is whether he is bringing a totally unique product or service to the marketplace (which often necessitates creating the market) or starting a well-understood business (which often necessitates competing against established competitors). It is an important trade-off.

Let’s start by defining four situations:

A unique product/service is a product that no other company is producing (or just a few of other companies do). Maybe no one else produces it because no one has identified the opportunity, because they don’t know how to do it, or (careful, here) simply because nobody really wants the product (i.e. a mobile phone able to monitor your heart rate)

A common product/service is something that the target customer is used to buying (i.e. a specific shunt system to treat hydrocephalus)

We say "established use" when we sell it to a market where it has an already identified use. People “know” the product will solve a particular problem.

We say “new use” when we sell it to a market or segment where it hasn't been traditionally used. The people who will buy it does not know really that the product has this intended use, and therefore needs to be educated.

The typical startup usually struggles between the choice of offering a really unique product to a market that has no idea how to use the product (yet) or offering some more common product facing a lot more competition. When I see an entrepreneur clearly positioned in one of the two “blue” quadrants, I feel comfortable with the project, and I know the start-up will need different resources to accomplish its goals depending on which one is in. One will need a focus on educating the market, while the other needs the company to be prepared for heavy competition.

Careful with the other two options, they may be disruptive and exciting, but certainly their path to success is much more complex. The other two quadrants are possible, but dangerous, at least in healthcare. It is indeed possible to sell a unique product to a market where those types of products have an established use. Some companies are able to sell something very common (let’s say “asthma inhalers”) and make it very unique selling it with a big surplus, as a luxury product, if the inhalers’ brand is for example Cartier. A common product becomes unique. It may sound funny, but you get what I mean here.

It is as well possible to have a common product with a new use, but again this is unlikely. Usually the users of any given product or service have figured out its best uses. Identifying a new use for an existing product generally doesn't yield venture returns to entrepreneurs. This is particularly true in healthcare because even if you discover a new use for an existing product, you can't protect that use and secure some form of IP on it--since you are using a common product to do it.

Follow the demographics

Changing demographics and perceptions offer unprecedented innovative opportunities for entrepreneurs in healthcare. Sometimes the best ideas come from this simple analysis: To where at we heading at? Change is around us, if we look carefully to trends in demographics we may anticipate great opportunities. Here’s my personal list of demographic trends worth watching:

#1. Population is getting older. This is the most obvious one, healthcare products and services targeted to 60 years old and more will continue appearing. At year 2000, 12.4% of the population was at least 65 years old. By 2030, that percent is expected to reach almost 20%. Most of money spent on health care comes from people who are either very sick or very old.

#2. Europe takes care of the disabled. We can anticipate society will take care of more and more disabled / dependent people. Important funds are being transferred to those people (dependency laws), and we can foresee great opportunities in this space.

#3. Sixty is the new forty. Sixty year olds want to live as active as possible, they don’t want to look old. This change in perception has created a vast market for healthcare magazines, alternative medicine, physical fitness centers, other “wellness” services, cosmetic surgery, etc…

#4. Immigration is changing our culture. Every year more and more immigrants blend into the “first world”. There’s a higher mix of cultures, and we can anticipate services and products targeted to those special communities.

#5. Chronic diseases on the rise. It’s well known that five diseases – diabetes, obesity, depression, coronary artery disease, and hypertension – gobble up 70% of total health costs. The advancement of medicine allows patients to cope better with chronic diseases and those patients will live longer and will demand products and services that bring convenience and excellence to their lives.

#6. Physician Shortages. Laws of supply and demand will make physicians a more precious commodity. Services or products that could eliminate redundancies in the provision of healthcare and make a better use of the available physicians will trigger a lot of interest.

Here's to the crazy ones

I just read a great article from Regina Herzlinger (“Where Are the Innovators in Health Care?”, Wall Street Journal). What she says needs no introduction:

“Luckily there is a solution, but there is only one: consumer-driven health care. Let’s take back our $2.2 trillion from the entrepreneur-suppressing status quo and allow consumers to reward those entrepreneurs who lower costs by improving health. Until we control our own health-care system, the entrepreneurs who could reform it – and make our lives better – will continue to look elsewhere for opportunities . Who can blame them?”

Couldn’t agree more with her.

The figures she mentions correspond to the US market, but the problem is exactly the same here in Europe. We need to find and support those entrepreneurs. We need to find "the crazy ones" that may bring change to healthcare.

And while reading Regina’s article, I just remembered my favourite quote of all times… It should be on the wall of every entrepreneur dorm… I really love the way Jack Kerouac praised "the crazy ones" in his book "On the road" (an amazing book, by the way). Later, someone at Apple adapted his text for a “think different” campaign:

“Here’s to the crazy ones. The misfits.
The rebels. The trouble makers.
The round pegs in the square holes.
The ones who see things differently.
They’re not fond of rules and they have
no respect for the status quo.
You can quote them, disagree with them,
glorify, or vilify them.
But the only thing you can’t do
is ignore them.
Because they change things.
They push the human race forward.
And while some may see them
as the crazy ones, we see genius.
Because the people who are
crazy enough to think
they can change the world
are the ones who do.”

Culture.Analysis.Investment.

Here's my prescription for the lack of innovation in Europe’s healthcare.

#1. Culture. We should teach entrepreneurship at med schools. Physicians don't speak the language of innovation, no one has taught them the tools they have to innovate and be entrepreneurial. And they are an immense source of new opportunities that remains untapped. Immense. Believe me, I talk to them every day.

#2. Analysis. Hospitals, institutions, government and healthcare status quo should devote time to detect and analyse the best ideas, and help in transforming them in real opportunities. Hospitals and institutions should have in-house teams trained to do that. We need more Directors of Innovation, and this should be a full time position.

#3. Investment. It is still the most important bottleneck to solve to foster entrepreneurship. Early stage start-ups struggle to find money, there’s a very large gap between government funds and venture capital. Proof of concept needs money to jump to the next stage. We need the government to invest more in venture capital funds. No money, no innovation.

Competition in healthcare has failed

In a normal market, competition drives incremental improvements in quality and cost. Innovation leads to a fast deployment of new technologies and better ways of doing things. Competitors grow and prosper, while weaker companies suffer and go out of business. Quality goes up, prices fall, value improves and the market expands to meet the needs of more consumers. This is what happens in a normal market.

But healthcare is not a normal market. On the contrary, in healthcare costs go up, relentlessly, in some sort of permanent technological inflation, and quality seems to go down. Patients around the world are more and more disgusted with the system. Healthcare providers (hospitals, physicians…) are the central actors in the healthcare sector and the place where most value is actually delivered (see my previous post on the value chain of healthcare). But they don’t compete among them, and at the end of the day, it is how medicine is practiced and the way patients are cared for, that will determine the success or failure of the healthcare system.

It seems then that competition is not working well in healthcare. It is not focused on delivering better service to patients, it is focused on cost: participants compete on shifting costs to one another. For example, does the technology we are introducing really add value for patients? Sometimes it doesn’t, but as someone thinks it does (even if it remains unproved), the technology is adopted. And guess what, all new technologies are more expensive than the previous one.

Maybe healthcare is focused on the wrong kind of competition. Competing on value for patients and not on cost should be the right focus, and certainly the system is not aligned to that, not here in Europe, not in the US or the rest of the world.

I strongly recommend reading Michael Porter's book, "Redefining Healthcare", as an eye opener on this.

Research and Development is dead: Welcome to the age of Research and Acquisition

Research and development (R+D) as we know it is coming to an end. Large companies are rethinking their strategies about it. Of course, new product design and development is still a crucial factor in the survival of a healthcare company. In an industry that is so fast changing such as healthcare, companies must continually revise their design and range of products to remain competitive.

In the last years there have been tremendous efforts done by large companies in healthcare, spending enormous amounts of money, willing to keep pace with the increasing speed of innovation. And they found out, simply, that to keep pace is impossible. In today’s healthcare environment, where everybody, large and small, is innovating heavily, success becomes something very elusive. There is always someone outside who can come up with a better product or service. And more importantly, innovations are becoming more and more disruptive every year, overturning the existing dominant technology or status quo product in the healthcare market in a blink.

The solution to this: research and acquire (R+A). Don’t spend all the money in your own pipeline of innovation, just keep an eye on the market, find innovative start-ups and buy them. All of a sudden, innovation inside big companies flourishes again.

This is good news to entrepreneurs and venture capital, because it certainly creates value for the entrepreneur, and it provides an exit strategy for the investor. We are going to see more and more of this trend in the next years.

Who is the client in healthcare?

Healthcare is the only market that I know (probably someone will disprove me here) where the one who pays, the one who uses and the one who benefits are clearly three separate individuals. It is important to bear this in mind when launching a start-up, because it affects how products or services enter the market.

The “one” who pays is usually governments or hospital CEOs. This payer will likely be ready to buy when there is proof of some cost reduction or some efficiency gain. The useful pitch becomes then something like “if you introduce this in your center or in the National Healthcare System, you will save costs, you will gain efficiency or speed, you will provide a faster service”, etc… any of those will do).

The “one” who uses or prescribes the product is usually the physician, and he/she is certainly looking for things that save him time or bring excellence to his work (“if you use this you will do things faster and safer, your patients will do better, you will be on the leading edge of medicine”, etc.)

And finally, the “one” who benefits from it is clearly the patient, the citizen, and he will value things that provide comfort, convenience, efficacy, or things that empower him/her (“if the doctor uses this in your case you will get better, you will feel more comfortable, you will be more in charge, you will need less waiting”, etc.).

Some of the projects that I see fail to address this, and market their products or services paying attention to just one of the stakeholders. The truth is in most healthcare products or services all three stakeholders need to be interested at the same time. So, if you are planning to bring a product or service to the healthcare market, you should start thinking on how will you pitch its benefits to the three stakeholders. Each one of them needs a different message.

In retail healthcare (and that’s the beauty of it), this triple stakeholder structure collapses, and the one who buys (pays), the one who uses and the one who benefits become the same person, the patient.

The medical devices life cycle

Medical devices start-ups should be seen in the context of the medical device business cycle: (1) research and development, (2) regulation and clinical testing, (3) manufacturing, (4) marketing, and (5) distribution and sale. It is important to see the whole “cycle” and not to focus only on the first stages, because any problem affecting one of these steps may bring the whole start-up to an end. Venture capitalists, when deciding whether to invest in the technology, always consider where an emerging technology is in these streams of activity, and what its prospects are for overcoming any problem arising at any stage.

The second stage, the regulatory pathway, is very “strict” and well defined, with a similar structure both in the United States and Europe. This pathway depends on the classification of the medical device (class I, IIa, IIb or III). Generally speaking, the story goes like this: the lowest risk devices fall into Class I, while devices which are used to diagnose or monitor medical conditions, are in Class IIa. If this is done in manner which could be hazardous for the patient, then the device falls into Class IIb. Class IIb is also reserved for implantable devices or where absorption takes place. Finally, if a device connects directly with the blood or the Central Nervous System, or contains a medicinal product (a drug), then the device falls into Class III.
(For a more thorough definition check this classification criteria from the Official Journal of the European Communities)

I can’t explain all the milestones of the medical device cycle in a single post, it has so many variants, but just as a reminder of its complexity I will list some steps here. To make it short, at some point in the cycle entrepreneurs may need to:

(1) Establish a “design control” framework to design the medical device.
(2) Obtain permission to use the medical device in a clinical study (Investigational Device Exemptions - IDE)
(3) Perform a clinical evaluation to gather safety and effectiveness data. 
(4) Obtain some sort of permission to enter the market, such as Premarketing Approval (PMA) and pre-market notification (510(k)) in the States, or the CE mark in Europe.
(5) Compromise to use good manufacturing practices (GMPs)
(6) Persuade payers and technology assessment agencies of the worthiness of the technology, using outcomes and health economic research.
(7) Conduct postmarket research and surveillance to gather data about the experience of the device in real life.

Entrepreneurs may find problems at any of those steps. It seems complex, and indeed, it is complex, but with good planification of the issues to address at every stage, and depending on the classification of the medical device (class I, IIa, IIb or III) it can be completed in a relatively short time.

A final comment. One of the things I’ve seen is that most new technologies do not result in obvious gains in mortality or morbidity, so at some point it becomes important to demonstrate as well improvements in quality of life and economic advantages. Those improvements will also help to grant market clearance.

Innovation is not a task,it is an attitude

I just had a meeting today with some healthcare managers and MDs at a hospital. We were discussing about how to manage innovation at the center, and at some point of the discussion someone raised the issue that it was not in the best interest of the hospital to distract physicians with innovation, because they already had a huge workload… Assistance, research, teaching… Adding an innovation dimension to their activities was certainly too much… (or so he said).

Well, this concern is a by-product of how people usually see innovation. They figure innovation is a task, a job, a workload. And innovation is not a task, it is an attitude. And if you are a healthcare manager, it is important that you have a clear understanding of this.

Bear in mind, I am talking about innovation, that is, in Peter Drucker words, identifying change that creates a new dimension of performance, and not about entrepreneurship, which is something that obviously generates a great deal of effort on anyone willing to launch a start-up.

The output of innovation, or at least its first step, is detecting needs, identifying opportunities, imagining solutions. And healthcare professionals are in a position where they can identify needs first-hand. And this does not consume time, it just reflects a state of mind, an attitude of permanently questioning why are we doing the things we are doing.

I usually say the best ideas come from upset physicians. Behind an angry physician there is usually an opportunity. It works like this: A physician finds something he hates, he gets upset and then, all of a sudden, he identifies how to solve this problem, generating an interesting idea. We all know that an idea is not necessarily an opportunity, but it is a start. The best ideas I see are the solution of an identified problem, and not a solution in search of a problem to solve.

How much is my idea worth?

This question haunts wanna-be entrepreneurs from the very beginning. I hear ideas from healthcare entrepreneurs very often, and at some point in our first meeting, the entrepreneur asks the question. It is a nonsense question, though.

The short answer is: an idea is worth nothing. Nada, rien, zero. If you execute it, then it may be worth a lot, but the value comes from its execution. The truth is for every great idea you've had, chances are there are probably a lot of people who have had the same or a similar idea at about the same time. An idea is just the start. It is easy to have the idea, but it is very hard to have the ability to bring it to the market. You need to prove to yourself the idea is not just a good idea but an opportunity, you have to think how are you going to execute it (write a business plan), find the team, raise the money, and make it happen.

Many people don't understand this because they don't understand how value is added to a company. Investors do not invest in ideas, but in the execution of ideas. Therefore, the team executing the idea is essential. A great idea with a poor team is usually a failure, whereas a “normal” idea with a “state of the art” team usually ends in success.

Related to this first question is the question of how worried you should be about someone stealing your idea. Again, the answer is not very much. I guess it does happen now and then, but I’ve never seen it first hand. Anyone who would be capable of doing (not just thinking, but doing) something with your idea will be probably too busy with his own projects to steal yours.

Besides that, if your idea can be easily copied and executed by others just by knowing it, you are in real trouble. This means you don’t really add much to the idea, and the barriers of entry are so low that even if you succeed in keeping the idea in secret, it will be easily copied once you launch it to the market.

So, doing and not just thinking is the key. To all of you reading, do something about your ideas.

Biotech business models

Biotech companies have traditionally used a variety of business models to enter the healthcare market (see my diagram). Here’s a very straightforward (and simple) framework to understand the basics of it. Understanding the different business models is essential to entrepreneurs and investors. Different business models need different capabilities. We can find at least four different positionings:

(1) Start-ups that rent/sell their technology to pharma companies (technology platform model): Some start-ups have developed an enabling technology that can be applied in a stage of the drug discovery and development process. For example, a technology able to produce proteins faster. When positioning their start-up as a technology platform, entrepreneurs are not interested in developing drugs or diagnostics, they just want to exploit their technology. Key factors to success:

• the higher the perceived value (the more useful it is to pharma companies), the more likely to attract the interest of investors.

• the stronger the IP protection (patents), the longer the company will be able to generate revenues from it without competitors eroding their marketshare

• understand that if a better technology comes to the market, the sales will be over pretty quickly.

(2) Start-ups that research and develop a new drug to finally license it to a big pharma company in exchange for a royalty on sales (RIPCO model): Sometimes, the technology is so powerful and gives such a competitive advantage to the start-up, that the entrepreneurs use it to research and develop their own products. The Royalty-Income Pharmaceutical Company (RIPCO) usually pushes its first product through the early stages of clinical development, creating as much value as possible, and then transfers this value to a big company able to finish research, produce and commercialize the drug. Key factors to success:

• the larger the market of the new drug, the higher the value

• the sooner the drug can get to the market (the more advanced in the clinical development), the higher the interest of investors will be.

(3) Start-ups that launch their own drug (FIPCO model): Sometimes (very rarely), in the Fully Integrated Pharmaceutical Company model (FIPCO), the start-up wants to push its own product through all stages of the value chain, using technology to research and develop the drug, produce it, and finally bring it to market. Given the large amount of capital needed to develop one drug and the high risk associated with it, few companies have been successful at this strategy. Key factors to success are:

• the ability to raise large amounts of capital (the whole process is very capital-intensive)

• having more than one drug in the pipeline to diversify the risk

• Again, the larger the market, the more interesting the start-up will be.

(4) Start-ups that buy a “discarded” promising drug from big pharma and use their technology to bring it to market (NRDO model): In the No Research-Development Only (NDRO) approach, a start-up licenses from a big pharma a drug that is already in preclinical or clinical testing stage and that has no interest for the pharma company, and then uses its technology to produce it in a very efficient way, making it profitable. Key factors for success:

• access to promising new molecules and drugs on a sustained basis

• speed and competitive advantage when producing and commercializing the drug.

Technology is a language

Some quick thoughts on technology and healthcare. Technology is not a tool, it is a language. You don’t use technology, you talk to it. That’s why our kids "talk" technology so easily, and adults usually struggle to use it. Adults have lost their capacity to learn new languages long ago.

The "digital divide", physicians using technology (i.e. computers) vs. physicians unable to do so makes me think that young people are in a way digital natives, they were born into the digital world, whether adults are more like digital immigrants, we try to understand computers at some later point in our lives. And as immigrants, we retain some accent, that is, our foot in he past, like needing to print word documents to edit them instead of editing directly on the screen, or needing to read the manual for a program rather than assuming that the program itself will teach us how to use it. I’ve never seen a digital native doing this. The younger generations of healthcare professionals are already digital natives, and they will interact with technology in a completely different manner.

Entrepreneurs willing to bring technology to the healthcare market should keep in mind that design is essential. Design is not just what it looks like and feels like. Design is how it works. Technology should be designed to fit the needs of their clients (healthcare managers, physicians, patients, you name it…), and good technology is not designed to be used, but to be talked to. Good technology needs no instructions manual, you just interact with it and works. Healthcare entrepreneurs tend to underestimate the challenge to make people use technology.

Simplicity is a competitive advantage. If something does not need a manual, saves time and can be “talked to” rather than “be learned”, I usually think it will succeed.