Last month, Nitasha Tiku wrote a short article for BetaBeat on Jay Parkinson, a young physician with a gift for self-promotion and lofty aspirations. A few years ago, he built a reputation in New York’s technology scene as a doctor comfortable with the way elite knowledge workers live now:
At the time, Dr. Jay, as he’s known around town, used tools like Google Calendar and Skype to redefine the conventional office visit for the web age. In lieu of humorless receptionists and cumbersome insurance claims, he offered to meet patients anywhere and accept PayPal. With lower overhead and no margins lost to the insurance companies, he could offer a concierge service to patients—house calls and hour-long appointments—and still pay off more than $200,000 in med school loans.
The slew of articles that followed focused on Dr. Parkinson’s start-up Hello Health (also based in Williamsburg), which attempted to formalize the system he’d hacked together into a streamlined social platform. Light-weight technology, meet the creaky old American health care system.
The idea was to build something that could scale nationally, enabling any small practice to join the digital revolution. But Hello Health quickly ran into problems when it tried to incorporate doctors who wanted to accept insurance and navigate the attendant maze of regulations and guidelines.
Parkinson left Hello Health, and now he’s working on a new start-up, The Future Well, that aims to advance a new vision of medical practice focused on fostering wellness rather than just intervening to combat illness:
“I’m trying, basically, to stay out of the medical world and focus more on health,” he explained. “I think the medical world is an intractable problem. I do not want to engage in any sort of system where I have to engage with the health insurance industry.”
In practical terms, that means he’s targeting those who are already either healthy enough or wealthy enough to sidestep some of the most trenchant problems in the health care system in favor of a boutique approach.
“Boomers are too far gone, diabetes is too far gone,” said Dr. Parkinson, who will deliver this message in upcoming speaking engagements at Google, Stanford and the Mayo Clinic. “All we can do is focus on people who are young, really well or relatively well and get them to be conscious of the fact that their behavior today influences their life 10 years from now. I like to talk about that. I like to talk about the standing desks.”
Dr. Parkinson was referring to research that shows that people who stand all day have a 65 percent lesser chance of cardiac events than those who sit at a desk. “That’s waaay better than what Lipitor would do and it’s a simple thing,” he said. “Plus I lose 300 calories a day from standing up and working. I mean, that’s like three glasses of wine.” Through his influential Tumblr, he’s already inspired a change in start-up offices around the city. Which is sort of the point. By seeding his ideas with the type of people who made up his short-lived practice, he hopes to watch the influence roll downhill.
This approach will raise hackles. I can already imagine lefty readers gnashing their teeth, and it actually gets “worse,” from their perspective:
“Everything good starts in Williamsburg, in New York City,” Dr. Parkinson said in soft-spoken, drawn-out cadence that sounded vaguely surfer-ish, until he told The Observer he’s from St. Louis. “A couple years later, it trickles down to the rest of America. A couple years later, it trickles down to the poor in America, you know? So to me, you always have to start with the innovators and the ones that have the means to adopt early. Look at what Michael Pollan has done to McDonald’s. Happy Meals replacing their fries with apples—you can’t say that’s Michael Pollan, but he’s part of the ecosystem that’s encouraging them to do that.”
He offered another example. “Whole Foods when we were kids was like something that a bunch of hippies in California did. Now it’s a whole industry,” Dr. Parkinson said. “Jamie Oliver didn’t exist. Rapha, which is really kickass bicycling gear in London, teamed up with Paul Smith to design clothes that you can wear to a business meeting. I think that’s absolutely amazing.”
Tiku references the more obvious critiques:
Others are hard-pressed to envision how a prescription for better health that fails to grapple with the poor or infirm could have any real effect on the problem. …
Dr. Parkinson shrugged off the criticism. “You can beat your head at trying to figure out solutions for, like you said, a creaky system,” he acknowledged, “or you could design things that people want, and if they can afford it, they can afford it.”
While I disagree emphatically with Parkinson’s apparent view that “everything good starts in Williamsburg,” I was impressed by his broader analysis. Some people should and will attack our dysfunctional health system frontally. But of course there is a place for some firms to attack the pathologies of the health system from the “easiest” angles. Solving the problem of getting mobile phones into the hands of everyone in the world, starting with the poorest countries, would have been very difficult indeed had there not been an elite niche market of people with lots of disposable income willing to experiment with new approaches. One is reminded of William Gibson’s famous remark that “The future is already here – it’s just not evenly distributed.”
Yet the problem with the health system is that we’re profoundly uncomfortable with the idea, and indeed the reality, that some cures and therapies are going to be accessible to some rather than others, and that some virtuous life strategies for wellness will be embraced by the affluent, the educated, and those who’ve cultivated or somehow been blessed with fearsome reserves of willpower. For an example of this anxiety at work, consider Peter Orszag’s recent Bloomberg View column “How My Wi-Fi Scale Adds to America’s Class Divide“:
If the new personalized health technologies wind up being used disproportionately by people with more education and income, driving that group toward even better health, they will probably cause the gap in life expectancy to widen still further.
The true health-improving potential of devices such as the VITAband and the Fitbit will be realized only if they are used by those who most need to change their health behavior — the same people who have been lagging in life expectancy. If not, just as technology has helped expand income inequality over the past four decades, it may likewise play a major role in expanding life-span inequality.
What confuses me is why this should alarm us — we should, like Parkinson, recognize that the spread of useful medical innovations, like the spread of all useful technological innovations, takes time, and that it is natural for the risk-averse or the less-curious to be late-adopters and for the risk-tolerant and ultra-curious to be the kind of early-adopters, or to use Amar Bhide’s wonderful term “venturesome consumers,” who will spend more than they can afford to have the latest and greatest technology. And of course those with plenty to spend will buy new gadgets and either allow them to gather dust or use them, raising the status and prestige of said devices and demonstrating their usefulness, spreading a covetous desire for said devices, and creating demand that clever entrepreneurs will meet by driving down prices.
America is the home of the world’s most venturesome consumers, which leads to very visible manifestations of material inequality yet that also is a great source of economic strength, as this wonderful old article in The Economist made clear in a discussion of Bhide’s work:
Mr Bhidé finds plenty of nice things to say about many of the things that most trouble critics of the American economy: consumption as opposed to thrift; a plentiful supply of consumer credit; Wal-Mart; even the marketing arms of drug companies. He thinks that good managers may be at least as valuable as science and engineering graduates (though given where he works, perhaps he is talking his own book). But he has nothing nice to say about the prophets of technological doom. …
The most important part of innovation may be the willingness of consumers, whether individuals or firms, to try new products and services, says Mr Bhidé. In his view, it is America’s venturesome consumers that drive the country’s leadership in innovation. Particularly important has been the venturesome consumption of new innovations by American firms. Although America has a lowish overall investment rate compared with other rich countries, it has a very high rate of adoption of information technology (IT). Contrast that with Japan (the original technology bogeyman from the East) where, despite an abundance of inventive scientists and engineers, many firms remain primitive in their use of IT.
That’s right: the people Parkinson is looking to serve are a crucial source of America’s economic strength. Meeting their desire to achieve a superior state of well-being is crucial to meeting larger health challenges. But we have to start somewhere. While some are going to start with the poor and the sick, and will hopefully accrue some amount of “psychic income” as a result, Parkinson will start with the rich and the healthy, and perhaps he will accrue a bit more market income than psychic income. He is no less central to the discovery process that drives the creation of useful innovation. It takes all kinds.