Building a Better Healthcare Hammer

"If the only tool you have is a hammer, it is tempting to treat everything as if it were a nail"

-Abraham Maslow, The Psychology of Science

My physical therapist discovered the successful treatment for my debilitating achilles tendonitis in a moment of sheer exasperation. 

We were six months into an extended treatment plan and we had hit a recovery plateau. 

While I was able to function most days, out of nowhere bouts of unbearable pain would pulse up and down my leg. Walking, even with a limp, was out of the question, and I would spend weeks working from bed because I was unable to sit in a chair without feeling like someone was stabbing my ankle. No matter how many lunges or heel raises I did, we couldn’t treat the seemingly random flair-ups that were controlling my life.

That fateful day, Katelin pulled out a box of plastic jars and began suction-cupping them to my leg while I pulled my foot forward and back. 

As she removed the cups, the agony of those five minutes gave way to a sensation that I hadn’t felt in over a year: nothing. 

My achilles—the tendon over which I had obsessed for months—suddenly felt no different than any other part of my body.

Realizing our breakthrough, my physical therapist recommended that I go see someone who specialized in cupping and acupuncture as part of the next stage of my treatment. At that moment, my physical health finally got back on track after almost two years of uncertainty and atrophy.

My path away from traditional medicine was the exception to the rule. I didn’t have to deal with months of doctors not believing my symptoms or a lack of insurance preventing me from affording tests and diagnostics. I was (ironically) fortunate enough to have symptoms so severe that they couldn’t be ignored and good enough insurance to get 30 blood tests and 23 x-rays in less than a week.

One of these knees is not like the other…

My diagnosis was a welcome relief because I finally had a name for what I was experiencing, and after refusing an immune system-impairing Remicade injection that I would have to take for a lifetime, I started building a treatment plan focused on making me my healthiest self.

Unfortunately, I’m one of the lucky ones. Many patients don’t get the luxury of a named condition or doctors that trust them. They are gaslit by the medical system into thinking that what they have is at best undiagnosable and at worst a figment of their imagination.

For all the proselytizing about the miracles of modern medicine over the past several years, we still know relatively little about the why of the human body. We generally know how it works and are effective at treating ailments, but much of the underlying pathological je ne sais quoi remains a mystery to us.

This may sound pessimistic, but I state it with hopeful sentiment. There is much more to discover and many more ways to treat that which ails us. It means there is an opportunity to extend the experience of modern medicine to more patients.

We see evidence in this gap of understanding between how and why in the variations of treatment by country. The common trope is that faced with the same diagnosis, American, German, and Chinese doctors would all focus their treatments on different organs. While I was prescribed medication and physical therapy for my condition in the US, in France, my diagnosis would give me access to a three week long trip to a thermal spa for hydrotherapy and enforced leisure.

My experience with the healthcare system coincided with building On Deck Health, and I was fortunate enough to work with some incredible founders building startups to increase access to emerging treatments.

Many of these founders were imbued with the passion and drive that only comes through lived experiences with the problems they were looking to solve. They were young, otherwise healthy individuals who had found an alternative path when modern medicine had failed them. 

The emerging treatments that they turned to ranged from EMDR therapy, to psychedelics and nutrition. They were augmented by startups within On Deck Health building a new infrastructure for diagnosis from streamlined lab work to at-home vaginal microbiome testing. While these treatments vary dramatically in scope, they all had one thing in common: they are, at best, not taught in medical schools and at worst were actively looked down on by the clinician community.

Let’s use nutrition as an example. 

Working with medical students at Osmosis, I was shocked to learn that the study of food was often something that happened over the course of a week rather than a semester. On the surface it seems so obvious: we spend a significant part of our waking hours preparing and putting these chemical compounds into our bodies, of course this is something doctors need to deeply understand. Instead, beyond the dangers of high-fat high-sugar diets, most clinicians approach the concept of nutrition with a  smirk or a shrug.

This is despite the fact that a healthy diet is tied to positive health outcomes and that up to 20% of premature deaths historically in the US have been connected to poor diet.

When I got my diagnosis, I remember my doctor telling me that diet had “no proven effect” on auto-immune conditions, but that many of her patients “found a mediterranean diet to be effective at preventing symptoms.”

As it turns out, there’s tons of scientific evidence of the effects of food on the symptoms of auto-immune conditions, it’s just not something that registers for most clinicians. Perhaps it’s because it’s so personal. Our bodies are perfect, differently-calibrated machines, and our current system doesn’t give doctors the space to fully explore and embrace these beautiful nuances that make us individuals vs. Westworld machines.

As I spent more time with these founders—watching them build with absolute certainty and attract real customers from the get-go— I learned three things that reinforced my lived experience:

1. There are millions of people ignored by the current treatments and best practices of our healthcare system

2. The rejection of emerging treatments by the healthcare system are not caused by a lack of efficacy, but by a conservative undercurrent in how we train clinicians and research alternative treatments

3. Despite this, many of these emerging treatments are actually covered by health insurance, with education and access being the biggest barriers to receiving them

This gap between the treatments that clinicians are equipped to recommend and what payers are willing to cover presents a massive arbitrage opportunity for founders. 

How massive? Just zooming in on one category of condition, there are an estimated 50 million Americans living with an autoimmune disease and that number is rapidly increasing. Despite the US healthcare industry spending an estimated $100B per year on the management of autoimmune patients, a significant number of patients are unsatisfied with their course of treatment. 

In a survey of patients with Rheumatoid Arthritis, half reported being satisfied with their course of treatment and only 30% reported their conditions going into remission after starting medication. It’s no wonder that more than half of respondents said that they found at least some difficulty in finding a health care provider that they were comfortable discussing their condition with.

Socioeconomic background, gender, and race all play a role, as well. In a survey of over 2,400 women who experience chronic pain, including many with autoimmune conditions, more than half of respondents reported that they felt pressured into a surgery, test, or treatment that they didn’t want. Over 70% found alternative treatments ranging from massage to nutritional changes and acupuncture to be effective at helping to relieve pain.

In 2008, Americans were spending $3B per year on alternative medicine (roughly 3% of national ambulatory health care expenditures). Since then the alternative medicine market in the US has grown to $21B in 2021, and there are signs of even quicker growth in Europe and the Middle East. This is attributable to both an increased willingness among patients to pay for these treatments out of pocket, as well as the increase in coverage of these treatments by payers.

Something is clearly broken and top investors are starting to take notice. In the past 6 months, a16z have invested in a food-as-medicine startup and Graycroft recently announced their investment in a psychedelic-guided therapy startup. 

This is just scratching the surface of the opportunity in this space.

The incentives couldn’t be more clear: you have a patient population looking for solutions to often chronic healthcare conditions and Payers looking to get to the root cause treatments for unexpectedly high cost patients in what is usually a lower-risk pool. That is a formula for building venture-scale businesses in healthcare with minimal risk of competition from traditional providers.

More importantly though, it’s an opportunity to affect patients at scale, give them peace of mind, and let them take their lives back.