The Experiential Technology Zenith: The Empathy Machine

My friend Zack Lynch, author of The Neuro Revolution, said something to me the other day that stopped me in my tracks. It was one of those satori moments, a thunderclap. “You know,” he said, “in the future, human beings will evolve as a society because of the empathy machine.” Those two words, juxtaposed, illuminated a mental puzzle, a koan, that I had been wrestling with for a long time.

Let me explain: We live in an ever more complex world. Separations between the fortunate and the less fortunate have never been larger. Those whose cultures are more traditional see an even bigger chasm between themselves and those who are pressing at the margins of a future society. We continue to celebrate a more multicultural society at the same time that we witness the injustices of the day-to-day affairs of living in it.

The paradox of technology

No doubt, technology is accelerating society’s pace of change and extending our capabilities. At the same time that we delight in making a hotel reservation across the world from a cell phone, we are frustrated by the distance these same technologies can create between individuals living in the same home. We see the power of the technology to give us autonomy, but we fear the automation of our lives and our human interactions themselves.

We are quickly but almost imperceptibly moving into a machine age where blistering computer speed clearly supersedes analog human processing. Human judgment in many cases is better substituted by algorithmic magic. We know that we benefit from the literal and figurative autopilots on airplanes and robots on the assembly lines yet we strive to amplify the roles where humans clearly excel: discerning, contextualizing, and understanding human emotions and interactions.

Against the computational backdrop of daily life, neuroscience discoveries continue to unlock the potential for human performance improvements in our cognitive capabilities and our ability to better understand ourselves. We have discovered ways to enhance our cognition and accelerate learning. We recognize the value of striving to be our best and to deliver to our families and our world our most prized assets – our attention, our thoughts, and our feelings. We also have the feedback loop of being able to see all of the individual human data points play out in real time in social media — a large scale neural network of our collective consciousness.

A human performance imperative: empathy

Technology relentlessly infuses our lives and our minds. We exercise our bodies and our brains to increase our productivity while at the same time trying to keep our command and edge over the very technology that further enables us. So where does this ultimately take us? It takes us to Zack’s empathy machine. The empathy machine may be the ultimate nexus where our most uniquely human and most powerful asset – our capability for empathy – can be further leveraged by technology.

We see a future where human beings en masse in society, like Eastern monks through the ages, will be able to train our brains to hypertrophy our empathy skills. For sure, neuroscience is currently showing us ways to understand the biology of the social mind and how to use technology to enhance our empathy skills.

What if the fitness craze of the future was not about optimizing cardiac output and muscle efficiency, or even cognition, but about exquisitely tuning and maximizing our brains for their intrinsic capabilities for empathy? What if the very artificial intelligence machines we so worry about became, in fact, a new form of neuro personal trainer? What if we could program machines to relentlessly mine the big data of our consciousness to harvest new and better capabilities for human empathy?

When we strengthen the musculature and stamina of our empathy, we will reach new heights as a society. We will climb to the summit of technology’s capabilities and see a clear view of our purpose in life as human beings: to feel each other deeply and thus be compelled to act accordingly.

Experiential Technology Improves Human Performance

Unlocking untapped human potential

All human beings possess vast untapped potential. Even those who have achieved amazing things usually admit they have more to offer. This potential to improve originates in our brains. Contrary to prior dogma, we now know that the brain is capable of developing throughout life – allowing us to think better, to release new creativity, and to connect with others more meaningfully. We can continue to hone our ability to control our own thoughts and emotions over time, skills that are essential to enhancing human performance in all realms.

Recent advances in neuroscience are unraveling the mechanisms and pathways of the brain. Brain imaging now reveals where and how certain brain functions occur. We understand many of the ways in which the brain can falter over time or with disease. More important, we know how the brain can improve or expand its capabilities via certain mechanisms, inputs, and experiences.

Convergence of human-computer interaction with neuroscience

At the same time that our neuroscientific understanding of the brain is advancing, digital technology that interfaces with the brain is rapidly developing. This new wave of technology profoundly influences the electrical and chemical activity of the brain – unleashing its untapped potential. Technology that modulates brain function used to require direct chemical interaction, such as pharmaceuticals used to treat depression, or direct electrical interfaces, such as deep brain stimulation used to treat Parkinson’s disease.

Today, however, powerful brain-influencing technology can be non-pharmacologic and non-invasive: virtual and augmented reality, sensors and neurofeedback, robotics, artificial intelligence, neurogaming, and non-invasive electrical stimulation systems. We have named this convergence of digital technology that influences the brain to improve human performance Experiential Technology, or “XTech.”

Experiential technology harnesses neuroscientific knowledge to enhance cognition, memory, awareness, decision-making, communication, learning, and motor skills. Experiential technology can improve our wellbeing as normal people and can also reverse certain disorders of the brain. Experiential technology will create major new advances in human performance that will impact health, wellness, education, training, and entertainment.

Experiential Technology (XTech) enhances brain capabilities

Examples of the significant impact of experiential technology (XTech) are diverse and wide-reaching. Recently, National Institutes of Health-sponsored researchers at University of Washington collaborating with a technology company showed that children suffering from severe burns could reduce the pain associated with their wound care by 75% if they were immersed in a virtual reality experience called Snow World that brings them into a make-believe cold, calm, and fun environment. These children required 64% less medication to relieve their suffering during the care of their burns. There have been numerous scientific publications showing the capability of virtual and augmented reality to modulate the brain in other beneficial or therapeutic ways.

Another group at University of California, San Francisco studied older people with normal age-related declines in cognition and multitasking capabilities. In this scenario, neuroscientists specifically designed a training paradigm to stimulate and train neural pathways in the brain that govern attention. They embedded this paradigm into an engaging video game such that the therapy was “working behind the scenes” to deliver an experience that felt more like fun than medicine.

After training with this game paradigm, these older people were able to improve their cognitive abilities to resemble those of individuals in their twenties. These improvements persisted for at least 6 months after the training ended and, critically, the cognitive capabilities they gained transferred outside of the training environment and into real world activities. This work, hailed as major scientific breakthrough, was published in the esteemed and highly selective peer-reviewed scientific journal Nature.

While not widely publicized, many groups, including the United States military, have shown the ability of non-invasive energy delivery to the brain to enhance skill development and training. In one study performed by the United States Army and Air Force, the training time required for elite soldiers to excel at various tasks, such as sniper accuracy or drone pilot training, could be reduced by 50% when training sessions were accompanied by transcranial electrical stimulation of the brain. There are numerous other specific examples of the far-reaching capabilities of experiential technology to enhance the capabilities of the brain.

Large new human performance markets

Experiential technology is advancing quickly as brain science infuses broad digital technology platforms. An investigation into the commercial market has revealed hundreds of companies currently developing and commercializing experiential technology products. These companies are creating brand new sectors in the health, wellness, education, and entertainment markets. It is estimated that new segments of these markets in digital therapeutics, neurowellness, accelerated learning, and neurotainment will reach $50 billion by 2025. As these technologies become widespread, we will have many more opportunities to unlock and expand the capabilities of our brains — and our potential as human beings.

Virtual Reality is the Brain’s Reality: The Coming of Experiential Technology

I am very interested in technologies that can improve the function and capacity of the human brain. Over a decade ago, as an outgrowth of my training and practice as a neurosurgeon, I was an inventor of novel way to enhance the function of the brain with direct electrical stimulation of the cortical surface. The concept was to enhance the natural “plasticity” of the brain and cause it to “rewire” in order to increase its capabilities or to recover from damage such as a stroke. That’s what neuroplasticity is all about.

In the ensuing years, the field of neurotechnology has grown dramatically. Electrical stimulation of the brain has become an accepted and standard treatment for Parkinson’s Disease and several other neurological disorders. The market for neuropharmaceuticals has simultaneously become massive.

Scientists and clinicians have now made thousands of scientific discoveries related to neuroplasticity. While it used to be thought that the brain became “hard-wired” as humans reached adulthood, it is now widely recognized that the brain maintains an enormous capacity to grow new neurons and form new connections, enhancing its function throughout life. The trick is to provide the appropriate stimuli to the brain to maximize its favorable response.

More than chemicals and electricity

A while back, we used to believe that only chemicals and electricity could cause neuroplastic changes in the brain. Those were the relatively crude tools of the trade for experimentation at the time. Now neuroscientists have shown that all sorts of “exogenous” forms of stimulation can modify brain activity – even permanently. It is now recognized that light, sound, tactile stimulation, and various cognitive tasks such as meditation can also enhance neuroplasticity of the brain. These kinds of stimuli can cause favorable changes in the brain that can last a lifetime.

While it took decades for neuroscientists to elucidate the molecular biology underlying all of this – and it is very much still a work in progress – the results really aren’t very surprising, are they? Of course the brain itself changes in response to light, sound, physical sensations, and cognitive tasks. That is why we continue to learn and grow throughout life as we are exposed to enriching environments and activities! There is no doubt that the capacity of the human brain is not limited but has an enormous ability to expand. The secret is to expose the brain to exactly the right types of favorable stimuli in order to optimize the results. This is what neuroscientists are still trying to figure out. What are the best ways to stimulate the brain and how?

Computing power has led to massively engaging experiences

Over the same timeframe that the underlying mechanisms of neuroplasticity have become better understood, computing power has dramatically increased. We can now leverage incredible speed, processing power, and graphics capabilities. No surprise, then, that in taking advantage of these technological developments, videogaming environments have become immersive and massively engaging like never before. The videogame industry has become a multibillion-dollar industry. Large segments of the population spend more time playing videogames than watching television, reading, or listening to music – or interacting with others in some cases. Given how enriched these gaming experiences have become, virtual reality experiences are right around the corner.

Here’s the thing: immersive and virtual reality videogaming experiences may very well be providing exactly the kind of visual, auditory, tactile, and cognitive stimuli that can influence neuroplasticity. It may be that this kind of information-rich stimulation to the brain is actually more potent than what pharmaceuticals or devices can provide in the form of chemical or electrical stimulation.

Videogaming causes neuroplasticity

Adam Gazzaley is a widely respected neurologist and neuroscientist at UCSF. His team recently published a seminal scientific paper in the prestigious journal Nature showing that individuals exposed to a very specific and proprietary videogame protocol could reverse age-related declines in global measures of cognition in a lasting fashion.

Critical points:

  1. The gaming protocol was able to generate not only improvement in the skills required to play the game, but these newly learned skills transferred into more global measures of overall cognitive capabilities.
  2. The newly acquired cognitive capabilities lasted for a long time after game training sessions stopped (up to 6 months).
  3. Not any ordinary videogame can produce these results. The game has to be specifically designed with “stimulation parameters” embedded into it that trigger certain neurological reactions in the brain that cause neuroplasticity to occur. It has to be specific and exact in order to work.

To oversimplify, neuroplasticity enhancement, or “brain training,” appears to be like other forms of training: just doing a bunch of running, weight lifting, and snowboarding doesn’t turn you into an Olympic snowboarder like Shaun White. Sure, you have to run, weightlift, and board to become Shaun White, but that is not enough. You have to train specifically to do a triple cork on the halfpipe in order to succeed. Similarly, the brain training experiences that cause improvements in memory or attention have to be very specifically designed and executed in order to improve cognition. And these tricks are just now being invented and refined.

Future of neuroplasticity: Experiential Technology (XTech)

I predict that in the very near future rigorous neuroscientific studies will very specifically demonstrate the types of stimulation parameters related to light, sound, sensation, and cognitive tasks that cause the brain to rewire in adaptive ways – and which do not. These insights will enable programmers to embed these stimulation parameters imperceptibly into immersive videogames. Games that are tricked out in this way will become very powerful enhancers of neuroplasticity in the brain. These videogames will be so potent that their therapeutic capabilities will match or exceed the chemical effects of neuropharmaceuticals or the electrical effects of today’s neurostimulation devices. Not only will those who simply want to improve the performance of their brains benefit, but these turbocharged experiential technologies will develop into an entirely new category of XTech that will benefit individuals with clinical conditions such as ADHD, autism, and depression.

I think of XTech as: supercomputing technology plus neuroscientific knowledge packaged into an immersive, virtual reality experience delivered to the brain to enhance neuroplasticity and brain function. I predict that this will have an enormous potential to improve the human condition.

Health IT Company Growth: A Sequence of Beachheads?

The challenge of growth and scaling our healthcare IT businesses is paramount. The problems to solve are vast. But the most immediate needs of the customer are often relatively small and well-defined. How do we solve small immediate needs while also paving the way for bigger, more comprehensive solutions that form the basis of a larger company?

It’s all about the sequencing strategy. We have to secure the right beachheads in the right order. No amount of ambition or technology prowess will substitute for the right beachhead strategy.

What we typically see with early stage companies is a demo that shows what their current software can do. Often, the initial product provides a nice solution for a clear customer problem. These companies will usually then walk us through why their technology is really a “platform” and describe how it can easily be expanded to solve a host of other additional problems. This is all good. This shows proper anticipation of future customer needs and good technology breadth.

But this kind of conversation doesn’t usually clearly spell out the company’s overarching strategy for success. It usually doesn’t map the entire market and show a comprehensive strategy for knocking down a sequence of obstacles to success. In most cases, the barriers to growth and scaling with customers relate less to what technology our company can create, but what technology we choose to create — and how, when, and to whom we choose to sell it.

A really rewarding conversation might be less about a litany of customer problems and how a technology solves them and more about the rationale for the sequencing of the roll out. Why are certain beachheads selected? Why are they better than others? Why does the specific sequencing of beachheads matter? Why does this make the most sense as a business strategy for us compared to other potential alternatives?

The more specific this conversation is, the better. For sure, no plan ever matches the subsequent reality of the execution, but the plan has to make sense in advance. At the very least, it shows we have recognized that random efforts against the market are less effective than planned, targeted approaches that build from each other in a stepwise fashion.

All too often we see companies building great initial technology and then taking a trial-and-error approach to driving it into the market and scaling it across a customer base. We need to be very specific about which customers we would approach, in which order, with what solutions, and why. Why is this strategy more likely to fuel the ultimate company growth expectations compared to other strategies? Let’s discuss the pros and cons of each approach and the logic for selecting the primary plan, and why the back-up plan is the back-up, and what the triggers are for reverting to it.

The most successful companies in this next wave of healthcare IT adoption will be the companies that have the best strategies for fueling their growth. Great technology will be necessary but not sufficient. Great teams will build great companies because we will secure the right beachheads — in the right order — as our key to obtaining the pole position in the market.

The Beta Pilot: Bang for the $

We’re seeing a lot of interesting new health technology companies that are making a few early dollars go a long way. This is healthy for our industry and is now possible more than ever in this digital age. While it sounds good to say, “I’m all in and I’m putting everything I have into this,” the reality of life is sometimes different.

I love when I meet someone who is torn between finishing her MBA and jumping headlong into her start-up that she’s been funding parsimoniously from the savings from her first job. While an overabundance of caution is usually not a key success factor in an entrepreneurial company, being smart is. Getting it right in the shortest period of time, in the least expensive way, is the best way to do it. Staging risk, and optimizing the timing on when to double down, is the way to go.

A key turning point in a start-up’s lifecycle is the beta pilot. We have to get the pilot study right. It has to ask the key questions, get the critical answers, and involve the right partners. This is what is going to convince us as entrepreneurs, and us as investors, whether we’re on the right track – and whether we should be all in.

A common mistake that we see is a “take what we can get and get going” approach. I think most entrepreneurs underestimate the depth of thought that should go into the pilot. Usually, they speak with a potential customer, grab ahold of the mutual enthusiasm, and jump into a half-baked beta pilot. It is exciting, after all of the market research, team building, and coding, to just get started. Who doesn’t want to see if it works?

But a pilot that doesn’t catapult the company into the next phase is not money well spent. Pilots leading to more pilots is like getting stuck in pit lane with the B-team, a symptom of a company transitioning to the “living dead.”

My advice is that the planning stage for the beta pilot is exactly the right time to deliberately downshift. Really do the hard thinking at this stage: Which questions does the pilot program fundamentally need to answer? What are the likely outcomes? Who will care about the results? Do I really have the right beta partner? If I thought about this differently, would my partner actually help me defray even more of my costs? How will the results lead to the next logical partnering discussions or funding event? How close is the linkage between all of these factors?

What we see all too often is that a lot of time and energy goes into the pilot – and a lot is learned – but the end result is simply crisper clarity on how to run a better pilot program the next time. Most of this thinking, it turns out, could have been done the first time around. And that thinking is the most cost effective and critical element of the program’s execution.

Entrepreneurs should gravitate to working with investors who understand how critical this phase of company development is. Maybe in the earliest stages a venture capitalist doesn’t even provide capital, but provides input into how to conduct this beta program and make introductions to the right partners. It turns out, this involvement could be more valuable than capital. This intellectual investment into the pilot allows the VC to answer the key questions that she has, reducing the threshold for a larger or more strategically timed capital investment later.

I’m intrigued when an entrepreneur sets up a meeting with me with the explicit purpose of rolling up our sleeves together and really going deep on how to design and conduct a pilot. This shows a lot of sophistication and I really get engaged. It also puts me in a position where I can confidently take the output from that conversation to my firm’s strategic limited partners — who are important providers, payors, and corporations — to test drive and refine the ideas even more. This will often help determine (and bring to the table) the best beta partner – often one of my LPs.

When it is time to think about a beta program, hit the brakes, downshift. Speak to as many potential partners (and investors) as you can. Think through this phase very carefully. Most important, think about how, on the other side of the pilot, the knowledge you will have obtained will directly drive a set of objectives, like a significant customer relationship or a financing event. Designing the right beta with the right partners often turns out to be the most important investment we make in our companies.

Healthcare Consumer Tsunami

I’m forecasting that a new healthcare company will emerge over the next few years that will become as big and impactful as Google or eBay. Or maybe we will simply call it a health company. Or maybe we will just call it technology.

Regardless, this new company will be as defining of the current era of healthcare transformation as Google and eBay were to their sectors. The hallmark of this company will be that it will leverage the power of the consumer in healthcare in a completely unprecedented – and probably currently unimaginable – way.

A recent survey by PwC showed that consumers would opt for new, more consumer-friendly models of care, such as home diagnostics or home cancer care, over traditional ones. In their estimate, this transformation would put at risk over $60 billion in current revenue streams for today’s providers.

CVS Caremark has been moving aggressively to provide new levels of care in novel and consumer-friendly ways. I, for one, prefer getting my flu shot while I’m shopping for routine things that I need in the drug store. It doesn’t take much imagination to think through the list of other medical services that can be conveniently provided at CVS.

Consumers have moved quickly to adopt fitness and wellness products and services. This market now exceeds $250 billion. Savvy consumers get that their diet and exercise habits are as much a part of their medical regimens as they are a way of life – valued as hobbies, diversions, and priorities, despite busy schedules. In fact, consumers understood and embraced this notion long before the medical profession did.

Consumers don’t see themselves as patients. They want to go down an autonomous path of health and wellness and avoid “healthcare” at all costs. When they do have to avail themselves of the healthcare system, they’d like that experience to integrate into the larger picture of how they live their lives. They want to return to being — and remaining — healthy and well. Episodic, traditional medical care seems very disconnected from what consumers have evolved to prefer.

Who will win the hearts and minds of consumers? Who will embrace our seamless approach to health, wellness, autonomy, transparency, and support-when-needed from the healthcare system?

Payers have experience assessing health in populations and offering programs to promote health and prevent illness. So do employers. Provider systems have had their hands full managing the sick patients that flood their ERs and clinics, but they are also turning their attention to the community and the health of the populations that they serve. But no one has invented the magic formula for success and greatness yet.

It’s coming: a massively transformational business that rocks the foundations of healthcare. It will empower us to adopt new levels of health and enable us to integrate with providers of care in ways that make sense to us. I’m thinking hard about what that breakthrough approach is going to be like. My fund is currently being flooded with ideas from amazing entrepreneurs. Some of these ideas are shocking. Some seem silly. Some are mind-boggling. I have a feeling that the most outrageous, brazen, and counterintuitive of these may be the ones that fuel the tsunami. Exciting times.

East Coast vs West Coast Health Technology Innovation

Warning:  The following post makes crude oversimplifications for illustrative purposes. If you are prone to taking blogs too seriously, or are offended by generalizations, there is no need to read on. All characters appearing in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

There seems to be some fairly consistent chatter in the circles I travel in that draws a distinction between the way West Coast health tech entrepreneurs and investors differ from their colleagues on the East. It is a vague notion, but let me see if I can tease it out.

If I understand the sentiment, it appears to relate to the idea that the West Coast views consumerism in healthcare differently from the East. To oversimplify, the idea is this:  Silicon Valley will disrupt healthcare in the same way that it disrupted other major markets, perhaps coming at it with something completely new, without regard for entrenched thinking or infrastructure, and with a specific intent to disrupt the status quo.

When you disrupt like this, the thinking goes, a perfect business model coming out of the gate is less important, because in new markets this gets sorted out later.  What is more important is to capture the hearts and minds of the consumers, to build a network effect, and to use this momentum and energy to topple the barriers in the system that are standing in the way of progress.  If you take it to the extreme, I think the logic plays all the way out to something like, “My cellphone with this super-cool app that measures this or that bodily metric and connects me to something or other will prevent me from becoming ill and help me pay less to see one of the 80% of doctors who are soon to be out of business and replaced by my app.”

The East Coast rebuttal views this West Coast mindset as, not surprisingly, a little less grounded than it needs to be.  The East coast “sensibility” is that left-coast pie-in-the-sky thinking and “if we build it they will come” attitude are flawed when applied to such a complex system as healthcare, given its many entrenched and influential stakeholders.  In other words, it’s great that there is an app that does some kind of whizbang thing that consumers dig, but despite all of the engagement generated, we will still be faced with illness — and lots of it.  And, there’s already a massive, well-intended, and frankly quite exquisite system in place to help deal with that illness.  The East Coast thinking struggles to understand how that wellness app leverages the existing healthcare infrastructure, how a real and sustainable business is going to be built, and how the innovation becomes adopted not just by the consumer or the network, but by the totality of the system.

The West Coast response, in return, is that such thinking is too conservative and incremental.  After all, Twitter and Amazon would not exist if we took just one baby step at a time building off the existing and flawed infrastructure.

The East Coast, fighting back, says:  just because Twitter and Amazon are great companies doesn’t mean that every health IT company with a big idea and little or no revenue warrants investors pumping cash into it at an inflated valuation.  They then get into a discussion about a recent health tech IPO with a valuation of 100X revenues and debate whether it is a buy or a short. And the debate continues, on script: You don’t understand the power of the consumer (West).  But you underestimate the power of the system (East).

I work at a national technology venture capital firm, grounded by key limited partners across the country — in the Midwest and on both coasts — who are global leaders in healthcare.  Our view is neither East nor West.  We’re coast-agnostic. We’re confident that youthful consumer apps and big-industry healthcare will act in concert to drive meaningful transformation.  We are catalyzing collaboration between the twenty-somethings in hoodies and the fifty-somethings in suits.

For example, Cleveland Clinic has publicly stated that they will bring unprecedented levels of transparency to healthcare and that they will compete for the healthcare consumer — not just with the best clinical outcomes, but also with the best prices, connectivity, and customer satisfaction. We believe that this kind of unifying voice, from a healthcare giant, is where it is all heading. We think the best innovations will involve consumers, cool apps, great underlying technology, existing infrastructure partners, physicians, hospital systems, and health plans — all working together. The magic happens when all of these stars are aligned and each stakeholder knows what needs to happen. And they are all now trying to make it happen.  Innovations that bring all of these elements together will lead in driving the transformation.

At my firm, we are investing in the best entrepreneurs, who view their solutions as solving multiple facets of the equation by bringing together multiple stakeholders.  Our strategy is to leverage the widest possible network of those diverse resources to help our companies innovate, grow, and make the biggest possible difference. We believe that the battle is not about toppling the system from the outside or about gradually tweaking it from the inside:  It is about fueling the massive transformation, happening right now, with inputs, contributions, and collaboration from all involved.  This is where the big ideas are heading.  And it is happening across the entire country.