Yale historian, Frank M. Snowden wisely notes in his 2020 book, “Epidemics and Society”, that “We must avoid the pitfall of believing the driver of scientific knowledge is ever a single genius working alone.”
His insight came to mind this week as I was reviewing the January 11, 2020 Forbes article by Seth Joseph, health tech policy correspondent, titled “What Bubble? Digital Health Funding Year in Review 2021.”
By one measure of success – dollars invested – it’s been a banner year. According to Joseph, there was over $29 billion funded, and 729 digital health US-based startups in 2021. But according to Scott Barclay, Managing Director at Insight Partners, who is quoted generously in the Forbes piece, “digital health is still in its relative infancy.”
This level of churn, passion, and (some might say) financial frenzy is reminiscent of another moment in scientific history – the latter half of the 19th century. Over a few decades, “The Germ Theory” was fleshed out with unprecedented and remarkable human progress following in its wake.
The breakthroughs were not the result of 729 often-repetitive and unoriginal ideas, but rather the work of three successive innovators whose work built on each other, combining innovation, technology and health.
Snowden termed the three “The Famous Trio.”
The first was Louis Pasteur (1822-1895) a chemist with a sharp eye and mind. He had been hired to find a solution for wine and milk that was spoiling too fast. The tools he wielded were mostly observational, including a still primitive microscope. With it, Pasteur was able to identify putrefying microbes as causal but went two steps further. He noted that a heating process killed the microbes and halted the product putrefaction, and tied the microscopic organisms to specific human diseases. With this knowledge, he unveiled a commercial process of serial attenuation of disease-causing microbes that allowed safe inoculation of humans and acquired immunity.
The second of the trio was Robert Koch (1834-1910), a physician 20 years younger than Pasteur. While studying Anthrax at the University of Gottingen, he visualized the large causative bacteria, introduced it into a lab animal, and reproduced the disease. Going one step further, he described resistant spores of the bacteria, identified them in grazing fields, and proved that eating grass laden with spores could spread Anthrax between animals. His careful investigative approach led to the uncovering of the etiology of tuberculosis and to “Koch’s Postulates”, four steps still in place today, which when followed, constitute laboratory-based scientific proof of a theory. Beyond this, Koch was a technology innovator, teaming up with the Carl Zeiss optical company, whose lenses, in combination with specialized tissue stains and fixed culture mediums, allowed Koch to visualize and describe M. tuberculosis.
The third innovator was Joseph Lister (1827-1912), a professor of surgery at Edinburgh. Thanks to the development of ether and nitrous oxide in the 1840s, pain management intra-operatively was under partial control. Improving techniques and tools helped control blood loss. But post-operative infection remained a persistent and deadly threat. Viewing the work of Pasteur and Koch, Lister recognized the possibility that contamination with microbes might be the cause. In carefully designed studies, employing hand scrubbing, sterilization of tools, and spraying the patient with carbolic acid, rates of post-operative sepsis declined. Other colleagues added sterile gowns, gloves, and masks, merging these added measures with Lister’s support.
Arguably, the life-saving “Germ Theory” was the work product of complementary insights and serial incremental progress. It might then be reasonable to ask, of the $29 billion funded 729 digital health tech US-based startups in 2021, how many represent additive and progressive insights that might eventually lead to game-changing advances in the health of America?
Scott Barclay appears to be mining this same territory. In Forbes, he says, “The green shoots of the past 10 years are turning into new vibrant ecosystems that are growing, but young. We are early in what may turn out to be a two-decade epoch of super innovative ideas, strong founders with execution experience bringing change to a $4T sector of the economy that has been sclerotic and in many parts oligopolistic. The majority of the largest digital health companies in 2040 public markets have not yet been started.”
Does Digital Health Technology have a “Famous Trio” in the making to link infrastructure, AI diagnostics, and evidence-based health? Who are they, and how do they complement each other?
Mike Magee, MD is a Medical Historian and Health Economist, and author of “CodeBlue: Inside the Medical Industrial Complex.“
