GUEST POST from Arlen Meyers

Dear Susan,

Congratulations on your recent graduation. I’m sure you are thrilled to start medical school in August and are looking forward to taking a break this summer.

The usual commencement speech I’d give, had I been invited, goes something like this:

Given your interest in building the company you started in college,however, you might want to rethink that vacation in Europe. You probably can’t afford it.

You see, while things are gradually changing for budding medical student entrepreneurs like you, don’t expect that you will have neither the time nor support to pursue your entrepreneurial endeavors. Medical school is all consuming, so you’ll need to squeeze in any extra time on your own. What is more, it is extremely unlikely that your medical school will offer the knowledge, skills and attitudes you will need to be successful as a physician entrepreneur i.e creating user defined value through the deployment of innovation.

You will also need to think about paying off that debt. A 2017 survey conducted by AMA Insurance indicates that 35 percent of medical students expect to have loan debt in excess of $200,000, while 21 percent indicated they will have between $150,000 and $200,000 in debt. It is no surprise, then, that 43 percent of students indicated that paying off medical school debt was their most pressing financial concern. Other significant financial concerns among students surveyed included providing for elderly parents (25 percent) and funding college expenses for children (21 percent). Still, the significant debt load can play directly into those secondary concerns. If you marry another medical student in debt, that further compounds the challenge.

Do you really want to borrow more money to get an MBA, and, if you do, how will that debt burden affect your future entrepreneurial activities?

Perhaps you should consider taking a digital health internship in a top tier digital health ecosystem like Prime Health in Colorado.

Here is some advice:

1. Do an internship with a startup this summer before you start medical school in the Fall and, if possible, between your first and second year of medical school. Here are some examples from medical student entrepreneurs.
2. Network as much as you can and find a mentor. A good way to do this is to join The Society of Physician Entrepreneurs at attend local chapter meetings.
3. Be sure to use social media aggressively to find like minded students around the world.
4. Take advantage of free MOOCs being offered in bioentrepreneurship, medical innovation and digital health.
5. Identify others in your class who are interested in biomedical and health innovation and entrepreneurship and start a special interest group or student club and invite members of your local cluster or ecosystem to speak at lunch and learn sessions.
6. Focus on getting education, access to resources, networks and mentors and experiential learning. Find out whether your school offers bioentrepreneurship workshops, courses or degree programs and rethink getting an MBA. You should also look into iCorps training.
7. Keep your head down and focus on medicine. Don’t tell faculty or other students about your entrepreneurial endeavors lest they think you are not taking medicine seriously enough.
8. Factor in your entrepreneurial career objectives when it comes time to choose a specialtyor employed or independent practice arrangement.
9. Be sure to complete a residency and several years of practice to understand the problems beguiling sick care and possible opportunities to fix them.
10. At this stage of the game, stay fixed on being a problem seeker, not a problem solver. Start by developing your entrepreneurial mindset and practicing entrepreneurial habits. Here are 10 crucial steps to becoming a “pre-entrepreneur”.
11. Start to learn about the business of medicine particularly innovation, marketing, the use of health information technologies and business models.
12. If you are not internally motivated to do this for some time, then quit now and save yourself a lot of heartburn.

You should start taking care of your financial health just like you would take care of your personal health day one in medical school. Creating and following a risk management plan means educating yourself and getting the right professional help as soon as possible. The likelihood is that by the end of school , you will be burned out and somewhat cynical and unaddressed financial burdens will only add to the weight on your shoulders.

You should also consider taking a leave of absence, or a mid-gap year, to pursue your entrepreneurial dreams like these medical students.

Here are some more tips.

The good news is that several medical schools are rethinking medical student entrepreneurship education so you are lucky to be where you are at this time.

Remember, you were not admitted to medical school because of your creativity. You were admitted because of your ability to memorize things, take standardized tests and conform. Simply put, you might not have what it takes to be a physician entrepreneur and , if you are, you will most likely fail.

Again, congratulations on your achievements. Hopefully, when you complete your residency and possibly fellowship training 10 years from now, the environment will be less hostile and more supportive of your initiatives. Please send my best regards to your parents, who, I’m sure are very proud of you.

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GUEST POST from Arlen Meyers

During residency, Dr. Jones, realized there were many surgical problems that needed innovative solutions. During his chief year of residency, he started his first company and created and acquired patents around a more convenient surgical instrument. While working on this project, he identified several other clinical problems that needed to be solved and began to add to his portfolio of products.

A short time after completing his residency, Dr. Jones combined all of his devices into a new company, hired an experienced management team and raised his first round of funding. Because of the demands of the business world, he left full-time clinical practice to become the Chief Medical Officer for the company.

You probably think the next step is to find investors, and you would be wrong.

Instead, if you are like Dr. Jones and have the urge to commercialize a new idea, invention or discovery, then you will need to follow a defined pathway to insure your success.

You will need to follow a process to assess your new idea, identify potential pitfalls, and follow the pathway to commercialization. The roadmap to success has several phases.

First, you need to answer The Three W’s: Why are you doing this? Is the opportunity worth it? How can you win at it?

The first is problem identification, understanding and analysis. Most doctors, engineers and scientists create solutions looking for problems. At the early stages, the idea is to be a problem seeker, not a problem solver. You need to have a thorough understanding of the market, customer segments, their market pain and the competitive landscape. Identifying customers involves interviewing and observing potential users, including vendors, distributors and ,particularly in healthcare, those involved the multi-sided market like payers and patients.

There are several ways to understand the problem, the competitive industrial landscape and potential market segments you intend to dominate. A common one, doing a SWOT analysis(Strenghts, Weaknesses, Opportunities, Threats) 

SWOT analysis is a methodological tool designed to help workers and companies optimize performance, maximize potential, manage competition, and minimize risk. SWOT is about making better decisions, both large and small. It can help you determine the efficacy of something as small as introducing a new product or service or something as large as a merger or acquisition. Again, SWOT is a method that, once mastered, can only enhance performance.

John Mullins, Professor at the London Business School, suggests The New Business Road Test, specifically analyzing the macro and micro elements of your intended industry and market and team and identifying your potential new opportunities.

The next step is Idea Generation. New ideas generally come from two sources. The first source is from discoveries, inventions or designs that result from basic or clinical research. Those who create these new technology-based ideas, called technopreneurs, are usually solution focused and have little or no understanding of the market demand or need for their products. A typical example is a university- based researcher who creates a prototype of a device incorporating a new paradigm, such as a nanoprobe to image head and neck cancer in vitro, or an optical probing device to be used in surgery to detect molecular margins. The inventor’s main focus is proof-of principle, not market acceptance. Likewise, a clinician who designs a new instrument for endoscopic sinus surgery is more interested in solving a particular surgical problem, not how many customers will buy the product.

On the other hand, market perceivers identify a market opportunity or problem and try to develop solutions. While the former, like doctors and scientists, are more problem solvers, market perceivers, typically with a background in marketing, finance, or business development, are problem seekers. They usual are more interested in market size, growth and customers and whether there is sufficient “pain” in the marketplace to warrant identifying a solution.

Dr. Jones is a little bit of both. He recognized a clinical problem that might have a broader application and had the training and technical background to invent a potential solution. Biomedical innovation is like identifying a big enough and important market lock and creating and inserting the right technical solution key. Only by inserting the right key into the market lock can you open the door of opportunity.

The third step on the roadmap is Idea Assessment. The developer takes a high-level look at the commercial potential of the idea with a focus on the market size, potential customers and market growth. At this point, the bioentrepreneur or clinical champion does an initial analysis of the primary market, technical and intellectual property risks involved in moving forward with commercial development.

At this early stage, the principle questions are:

• Will the product or service work?
• How will I protect my idea?
• Is there enough of a market for my idea?
• What kind of people will I need to move this idea forward?
• How much money will I need and how do I plan to use it?
• What are the regulatory and reimbursement issues?

A useful tool at this stage is creating a business model canvas, where you define core underlying business model hypotheses and then test and validate them.

The keystone of your business model canvas is your value proposition, the promise you make to your customers. Use one of the templates explained here to craft your initial value proposition. As you learn more over time, expect it to change substantially.

The fourth phase, writing a Feasibility Plan,and developing a business model canvas, comes next. Lean startup methodology has three basic components-creating a minimally viable product, executing your customer development process (compared to a product development process) and devising and validating the business model canvas.

Now that you have done a risk analysis during the idea assessment phase and have decided to proceed, your task now is to do more research and a more detailed analysis of the business opportunity. During this part of the process, you should describe:

Management Team Analysis

Current management team

Ideal team

Staffing plan

Product/Service Analysis

Purpose of product/service

Stage of development

Proprietary aspects

Government approvals

Product/Service legal liability

Reimbursement issues

Related products/services and spin-offs

Marketing Analysis

Total market size

Growth potential

Competition Profile

Features and benefits

Customer profile

Target markets

Market penetration

Pricing/cost

Financial Projections

Price list

Sales estimates

Cost of product/service

Gross margin

Startup expenses

Capital expenditures

Feasibility Plan Evaluation

Positives

Negatives

Value of opportunity

At each step, you should decide whether to proceed, modify your idea, or abandon your idea. Your task with each of these stages is to identify those issues that are “deal-killers” early in the planning process so you can move on to something else and not waste precious resources and time on an idea that will predictably fail. Most importantly, you should validate your business model assumptions, not just technically and commerically, but clinically as well.

The final phase, writing the Business or Commercialization Plan, is intended to tell your business development “story” to potential stakeholders and investors. If you have done your homework, most of details of the business plan will already have been addressed in the feasibility analysis. Now is the time to identify how much money you will need, what you will do with it, how you will structure the company and how you will execute your sales and marketing plan.

So, if you have an idea, what should be your next step? You should identify your next critical success factor and find the people and resources who can help you achieve it. It could be finding an IP attorney to help protect your idea. It could be finding seed money to create a prototype. It could be finding a regulatory affairs consultant to help plot your strategy. Or, it could be finding advisors or co-founders to help you create the right product-market mix and business model. Here are some tips on how to find them.

Here is a process for deciding and then actually taking your inspiration from an invention idea to a sustainable business:

1. It all starts in your head (think it). Start with what you know, but think outside the box. As you think and explore and imagine the possibilities for new products, remember that it should have a broad opportunity, appeal to people who have money to buy, and needs to have pizzazz to get people’s attention in this age of information overload. Innovation starts with the right mindset.
2. Now get real (cook it). Before you get too excited, it’s time to do some homework. Find out if something very similar is already selling, and who your competition would be if you proceed. Ask some potential customers to see if there is real interest, and start thinking about price versus cost. Look hard at the technology for feasibility and risk.
3. Keep thieves away (protect it). Limit your disclosures to people you trust, and learn the use of non-disclosure agreements (NDA). File at least a provisional patent and one or more trademarks. Be wary of crafty shysters who will flood your mailbox with official-looking mail offering to help for a fee, or demanding fees you forgot to pay.
4. Make ‘em want it bad (pitch it). “Pitching” is the insider term for presenting your product idea to people who could conceivably buy it or fund your efforts. Start by developing an “elevator pitch” that you can deliver in 30 seconds to hook a potential investor. Attend trade shows and network to find the right players and pitch your product.
5. Factory in the garage (make it). This is the point where you work on the specifics of being able to deliver your product or service. Relevant questions include the type of business entity (LLC or C-Corp), licensing or manufacturing, sales and marketing, and staffing. It’s also time to build prototypes to make the product come alive.
6. Continuous improvement (replace it). Once you have a real product, and it’s actually selling itself online, or on store shelves, you may think you can just sit back, relax, and collect your riches. But remember that complacency kills, and you always need to be thinking of the next product iteration, new territories, and new competitors.

In other words, fail it, nail it, scale it and sale it. 

Remember that a technology is not a product and a product is not a business. Plus, an idea is not an invention nor is it an innovation. The keys to biomedical business success include a compelling value proposition, a business model that makes sense, a management team that can execute and customers willing and able to buy your product. By following a clear business development pathway, you will identify and address potential landmines and limit your risk of failure.

The life science innovation roadmap filled with hazards. But, if you take the journey a step at a time, you will either discover early the errors of your thinking and kill or change your approach or move forward with some level of confidence.

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GUEST POST from Arlen Meyers

My parents were traditionalists. I’m a boomer. I work with a lot of Gen-Xers. I teach a lot of millennials. We are all trying to understand each other and adapt to how we teach and learn.

Some teachers have to deal with helicopter parents more than the kids.

Since we are all, mostly, products of our environment and the cyclical events of history, we all look at the world through that lens and, unless you have the right optician, you can have a hard time seeing what’s in front of you. Plus, we all change as we get older so, in many ways, generational stereotyping is stupid.

Here is how I have changed my lens prescription:

1. Make it personal. Link learning to experience.
2. Embrace technologies, but don’t let technologies get in the way of learning. Hey! Stop checking your cell phone while you are reading this. You will learn more if you take notes by hand and it shows respect for the instructor.
3. Prune to fit. Limited attention spans means you have to hit the high points and list them in 2 minutes, like what I’m doing in this post.
4. Practice what you teach. You just can’t fool those folks and they will see through your hierarchical facade. In fact, those that do really do teach and students really like a view of your real world and making connections to working domain experts so they can get jobs.
5. Be social. The org chart these days looks more like a network
6. Demand the same respect for your outlook the same way others demand you value theirs. Play nice together
7. Use immediate access to information to your advantage. Why memorize anything when it’s at the tip of your thumbs on your mobile device? Move from recall to interpretation to problem solving to wicked problems that have no real solutions. Flip the classroom and use the lectures as the start, not the end.
8. Encourage creativity and drive out fear
9. Learn to engage using educational technologies that improve learning like reflective questions, hierarchical learning, role playing, video and gamification and team based learning.
10. Learn to give and receive feedback. Radical candor is the feedback flavor of the month. Glasses are not the only thing you need as you get older. You will also need a better way to hear and listen. It’s a two way street.
11. If you want to learn something, try to teach it. The problem with expertise is that it doesn’t necessarily come paired with an openness to new ideas.
12. Create a space to give students time to think instead of falling into the trap of filling every moment with lessons, practice, trips, sleepovers and homework.
13. Unless a student has a learning disability, make students turn off their cell phones and laptops during class, since research shows you learn and retain more by taking hand written notes
14. Use PPT presentations as little as possible. Class should be a creative exercise, not a funeral after death by Powerpoint
15. Every class should the right mix of informing, entertaining and interacting. The most impactful interventions for student success are someone who cares, experiential learning and , in the case of adults, repetition, repetition, repetition.
16. Find a millennial to be your mentor, particularly to keep you in touch with trends and technology

Teaching to learn requires learning to teach. Unfortunately, most of us think it is easy, everyone can do it and we should not pay for it. It’s time to get our hearing and seeing prescriptions checked.

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GUEST POST from Arlen Meyers

Startups, in general, fail for many reasons. One observer mentioned his top 5 reasons as 1) lack of capital, 2) expanding too soon, 3) heavy reliance on debt, 4) poor strategy, and 5) poor business model and plan.

Ultimately, there are two basic reasons: 1)They make stuff no one wants to buy, and 2)they have a business model that is not valid repeatable, scaleable and profitable.

Digital health startups. be they telemedicine, data and intelligence or remote sensing companies, suffer from the same symptoms, but, because of the unique and complicated sick care and health care ecosystems, there are other reasons too:

1. Entrepreneurs underestimate the complexity and special challenges of USAsickcare, Inc.
2. They don’t involve end users early and often enough to develop and validate their business model. They don’t listen to physicians and other members of the care team.Cumbersome, frustrating, maddening products result.
3. They don’t satisfy the needs of mulitple stakeholders, instead focusing on just one
4. They overestimate patient healthcare IQs
5. They make products that interfere with physician workflow instead of making it easier
6. They create products that save neither time nor lives
7. They launch products that are not clinically validated and simply don’t do what they are supposed to do
8. They rely too much on changing human behavior
9. They are designed to scale quickly and do not have a sustainable business model
10. They are not different or offer a compelling value proposition

There are many digital health design, development and deployment gaps. Most companies don’t close them and that is why half don’t last 2 years. . The results are failed startups and digital clutter in the marketplace, further confusing doctors and their patients. Digital health is still in its infancy so we can expect to see a lot of failures. What we should not expect is for the situation to persist much longer . We need digital health infrastructure and ecosystems to reduce the cost of failure and that result in inexpensive, easy to use, effective products.

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GUEST POST from Arlen Meyers

Open innovation, a rarity in sick care, depends on the free flow of information from inside to outside and vice versa. For that to happen, it takes a permeable membrane to drive osmotic flow of information and possible solutions across the separator.

Like a polaroid lens that allows you to see things only when the optical conditions are right, likewise, the barriers to open innovation impact depend on collaborations between several participants in the sick care innovation ecosystem to enable the free flow of information across the osmotic gradient. They include:

1. Entrepreneurs and industry
2. The public sector
3. The academic sector
4. Community participants and non-profits dedicated to improving socioeconomic determinants of disparate health outcomes
5. Payers
6. Service providers
7. Domain experts, including regulatory affairs, end users, intellectual property, reimbursement and experts in clinical trial design and execution,

However, just putting dots on an ecosystem map does not guarantee the free flow of information. Sometimes, cluster koombaya turns into WIIFM.

One of the key determinants of an innovative organization or cluster is information rheology. There are three basic elements to the equation.

The first has to do with the number of nodes in the network, both internally and externally. Network theory tells us that the more nodes, the more value. Having one fax machine in the world added nothing. It took a lot to unleash the value , as the development of social media has exemplified.

The second has to do with how the nodes are connected. Some are robust and some are not.

Finally, and most importantly, the two previous parts are not nearly as important as the velocity, acceleration and lack of resistance to the flow of information from one node to the next. We usually refer to this as a cluster or innovation district being “user friendly” and is typified by the free and rapid flow of information from one place to the next. Malcolm Gladwell described facilitators in the process as mavens, experts and connectors. Clusters cultures either drive or hinder interplay.

Successful innovation districts have certain characteristics. In addition, cluster and innovation district success should be measured by clearly defined key performance indicators.

There are simply too many moving parts and complicated systems to expect impactful outcomes from open innovation when all the players are not at the table. Unfortunately, entrepreneurs are nimble, impatient and swift at adjusting and have little patience with the other players who are not. Sick care can’t be fixed from inside, but it takes a permeable membrane that separates those with outside solutions to be effective.

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GUEST POST from Arlen Meyers

Patricia Hempl has written The Art of the Wasted Day. In it, she posits that the founding fathers didn’t do us a favor when they charged us with the pursuit of happiness. Psychologists, authors and philosophers, you see, have been telling us for 2000 years that the first and most important key to finding happiness may be the most difficult for many people (especially those reading this article): To find happiness you must not seek it! In other words, the more you try to find happiness, the more it will elude you. Nathaniel Hawthorne (1804-1864) said it best, “Happiness is a butterfly, which when pursued, is always just beyond your grasp, but which, if you will sit down quietly, may alight upon you.”

Entrepreneurship is the pursuit of opportunity under conditions of uncertainty with the goal of creating user defined value through the deployment of innovation. Entrepreneurs do it for many reasons. However, if you think the pursuit of opportunity is a way to find happiness, you will be disappointed if you are doing it the wrong way and for the wrong reasons.Practicing some intentional behaviors may help happiness find you:

1.  Sense of Purpose. Commonly people believe that a life of leisure provides happiness. They believe that if they had plenty of money, didn’t need to work and could play all day, they would be happy. And yet studies of truly happy people show that they often have a high commitment to goals and a sense of purpose driving their lives.
2. Affiliation and Service to Others. Our relationships to others is a strong factor in overall level of happiness. As Epicurus stated over 2000 years ago “Of all the means to insure happiness throughout the whole life, by far the most important is the acquisition of friends.” However, the way that we affiliate may differ according to personality style. Outgoing individuals may be more interactive with many people, whereas introverted folks may be content with one or two relationships. Some people may find sense of purpose in their service to others whereas others are content with socializing.
3. Philosophical Perspective. How we frame the world and our experiences within it influence our degree of happiness. Those who tend to be more optimistic about creating positive outcomes are more likely to engage in active problem-solving and to be more content. However, this does not mean being unrealistic in assessing outcomes which can be detrimental (as discussed below in the section on emotional tolerance). Innovation starts with the right mindset.
4. Resilience: Most problems are worsened by the inability to tolerate emotions.
5.  Self-Contentment. Research shows that happier people tend to have greater self-confidence and belief in their abilities. People become entrepreneurs because they think they can do things better than others and they don’t want to work for someone else. Success does not lead to happiness. Happiness leads to success.
6. Choice. Happier people believe not only generally in their ability to control their experience in life but also specifically in their ability to choose to be happy. “Happiness is a choice that requires effort at times (Aeschylus, 525-456BC).” The single biggest reason for job stress and burnout is the lack of control. You choose whether or not to regain that control.
7.  Health Behaviors. Researchers find as important as personality variables are to happiness, health behaviors are of even greater importance.
8. Making happiness a habit: Here are some entrepreneurial habits that will help you get from said to done.
9. Avoiding social contagion: Stay away from toxic people. Follow the no asshole rule.
10. Practice creative boredom

There are many perfectly good ways to “waste” your life by giving up the pursuit of happiness. Fly fishing is one. Entrepreneurship is another if you do it for the right reasons without expectations.

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GUEST POST from Arlen Meyers

If for nothing else than the future of your children, take 12 minutes to watch this:

If you agree, then thriving in the fourth industrial revolution will require nothing short of restructuring public education at all levels, not just K-12. Even doctors will need to change how they educate their young. How many things can you do with a paperclip?

Many not-for-profits are directing their efforts to provide equitable access to public education. However, putting more students in a broken, dysfunctional system won’t yield the outcomes and impact we want. Instead, the very structure and process of education will need to change if we are to provide students with the knowledge, skills, abilities and competencies they need for jobs that have yet to be created.

What’s more, unless we address the gender social and cultural stereotypes, the 4IR could make gender inequity worse, not better.

One goal should be to create entrepreneurial schools and universities, and by that I don’t mean teaching children how to start businesses. Instead, creating the entrepreneurial mindset is about the pursuit of opportunity with scarce resources with the goal of creating user defined value through the deployment of innovation. Creating a successful business is but one of many ways to do that.

Here are 10 different ways to encourage youth entrepreneurship. The same techniques might apply to graduate students as well.

Other learning objective and curriculum themes are emerging:

1. Encouraging private, public and academic collaboration to define market-based competencies
2. Teaching horizontally, not vertically, in limiting smokestack domains
3. Developing soft skills that are in high demand
4. Experience cultural competence
5. Alternative pathways for teacher training and development
6. Job searching techniques that are state-of-the-art
7. Mandatory experiential learning opportunities
8. Developing and testing alternative intelligence measures
9. Replacing memorization with creative problem-solving, problem seeking and divergent thinking.
10. Hiring for creativity and finding and supporting educational reform champions
11. Like sick care, recognizing and addressing the socioeconomic determinants of academic failure, like housing, illness, disability and nutrition.
12. Rehabilitating the brand image of teachers

Here is Dan Pink explaining how motivation will have to replace extrinsic motivation – autonomy, mastery, purpose:

Here is how automation may affect economies around the world.

Our economy and standard of living hinges on meeting these wicked challenges. But, like medicine, government and other risk-averse and sclerotic industries, the resistance to change will be substantial. Only bottom-up pressure led by creative, courageous innovators who practice what they teach will remove the obstacles in our path. Many of those obstacles are in the classroom next door or the corner office.

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GUEST POST from Arlen Meyers

The Fourth Industrial Revolution is a mental model created by the leaders of the Joint Economic Forum and describes how physical, digital and biologic technologies have collided and the resulting challenges and opportunities that presents.

Here is how AI is changing sick care. Here is how 3-D printing is changing sick care. Here are the opportunities using VR/AR in sick care.

Google and Apple will give you the weapons to win.

When software, hardware, materials,biologic systems, cloud, AI/ML and other slicktech collides, it creates an interesting situation with certain highlights. Here are some challenges.

When the agrarian economy evolved into the industrial one, there were three phases that enabled humans to leverage their labor and productivity- those powered by water, electricity and computers/IT technologies. We are now living in the fourth revolution.

Physician entrepreneurs, along with everyone else in the world, will have change how they adapt if they are to surthrive.

Klaus Schwab has defined four principles which should guide our policy and practice as we progress further into this revolution.

Firstly, we must focus on systems rather than technologies, because the important considerations will be on the wide-reaching changes to business, society and politics rather than technologies for their own sake. The launch of 5G wireless is an example.

Example: Sick care cannot be fixed from inside and will depend on the coherence of diverse ecosystems. While STEM has been the buzzword, BMETAL-the convergence of Business, Medicine, Engineering, Technology, Arts and the Law- will be new paradigm for innovation education and training.

It will also require that we rethink how we regulate software as a medical device and clinical decision support systems.

Secondly, we must empower our societies to master technologies and act to counter a fatalistic and deterministic view of progress. Otherwise, there is no room for optimism and positive transformation, and society’s agency is nullified.

Example: We must change how we educate and train the future workforce. In medicine, that will require a re-engineering of workflow, competencies, structure and processes of delivering care as we evolve from a sick care system to a health care system. In addition, we need to address the socioeconomic divides that are contributing to the “deaths of despair”, particularly in white males without a college degree. That will mean rethinking non-college career tracks and retraining programs that are not working.

Here are five of the most in-demand sick care jobs:

1. Data
2. Experience
3. Innovation
4. Blockchain
5. Toucher

Thirdly, we need to prioritize futures by design rather than default. Collaboration between all stakeholders must play a central role in how we integrate these transformative technologies. Otherwise, our future will be delivered by default. Winning the fourth industrial revolution is a wicked problem.

Example: Design thinking needs to place the patient and doctors first. We need to rethink how we educate and train students from P-20.

And lastly, we must focus on key values as a feature of new technologies, rather than as a bug. Technologies used in a way that increase disparity, poverty, discrimination and environmental damage work against the future we seek. For the investment in these technologies to be justifiable, they must bring us a better world, not one of increased insecurity, dislocation and exclusion.

Example: The Fourth Industrial Revolution, like the 3 that preceded it, has already produced inequalities in value and wealth distribution that will exacerbate an already contentious global society.

We also need to be wary of the dark side of AI and answer How can we forecast, prevent, and (when necessary) mitigate the harmful effects of malicious uses of AI?

1. Policymakers should collaborate with researchers to prevent and mitigate malicious uses of AI.

2. Researchers and engineers should consider misuse and reach out to necessary parties when harmful applications are foreseeable.

3. Best practices should be developed for addressing dual-use concerns.

4. Developers should expand the range of stakeholders and experts in discussing these concerns.

Ultimately, winning the fourth sickcare industrial revolution will mean 1) reengineering the processes of care, 2) delivering user defined value, and 3) doctors and patients saying “no” to unnecessary and wasteful spending as the price for access and quality. Here are some other tactics:

One key to winning the fourth industrial revolution is to speed the pace of digitization and robotics in sick care, not slow it, and do to sick care what it has done to financial services and retail.

Change is happening faster and it outpacing the ability of many to cope with it. Unless we take control and prepare people, including physician entrepreneurs and their patients for the future, the cracks in our society will widen.

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GUEST POST from Arlen Meyers

Almost 20 years ago, a report from the National Academy of Sciences and the Institute of Medicine described the results of a conference addressing and the barriers to academic-industry collaboration and solutions to overcome them. While there has been slow progress addressing these issues, for the most part, the barriers persist and industry frustration with academic medical centers continues.

Trends in University-Industry Collaboration

• Participants noted that university-industry research collaboration is becoming more frequent and extensive, with growing complexity in individual partnerships. Over the last two decades, industry-supported research has steadily grown nationally in amount and as a percentage of all university research.
• Update: Industry supported research has increased with several research partnerships created between BIG PHARA and AMC drug discovery and development entities. Since the publication of the report, digital health has emerged as a new opportunity for industry-academic collaboration requiring new models that, in many instances, are unfamiliar to AMCs used to packaging and licensing drugs, diagnostics and devices. Some are outsourcing the function to digital health accelerators or incubators.
• A number of collaborative mechanisms were discussed, including (1) university research sponsored by companies; (2) faculty consulting; (3) licensing of university-owned intellectual property to existing companies; (4) university support for start-up companies in the form of loans, grants, and equity ownership; (5) “mega agreements” between individual companies and universities that cover a range of interactions; (6) research centers and other government-supported efforts to encourage university-industry collaboration; and (7) industry consortia to support university research.
• Update: Innovation centers have replaced technology transfer offices. Given the academic culture, some question whether they are capable of generating enough customer defined value to justify their expense and low research quotient i.e. the value produced per unit of input.
• There is significant diversity in the approaches taken in different fields. Participants remarked on differences between industry-university collaboration in health care and the life sciences vis-a-vis[vis-à-vis] physical sciences and engineering. Most of the discoveries that have produced significant licensing revenue for universities have been in the life sciences.
• Update: The vast majority of significant medical advances and the revenue that flows to those places comes from a hand full of leading AMCs
• Participants noted that a growing array of rules, procedures, and institutions, particularly on the academic side, govern collaboration. Protecting and managing university-generated intellectual property has become a significant task, and some institutions are delegating this work to non-profit and for-profit subsidiaries.
• Update: If anything, given the growth of regulation and compliance, the red tape is worse than before and significantly impedes academic faculty participation

Barriers to Collaboration and Tools to Overcome Them

• Culture, management, and goal alignment. Despite the long experience that many companies and universities have in pursuing collaboration, workshop participants still considered the development of trust an essential but sometimes neglected precondition for success. The discussions covered tools for structuring and managing partnerships and approaches to reconciling different time horizons.
• Update: Trust both internally and externally continues to be a major barrier
• Institutional incentives. University and private industry incentive structures may not sufficiently recognize or reward the key contributions that ensure successful collaboration. Workshop participants discussed ways that incentive structures could be changed with funding mechanisms and evaluation systems that are better targeted.
• Update: Several AMCs still refuse to grant promotion and tenure credit for the scholarship of entrepreneurship or have anti-entrepreneurial policies , procedures and taxes that make academic-industry collaboration too painful for most faculty
• Proprietary rights. Issues of proprietary rights and their disposition were a special focus of the workshop. Proprietary rights issues are often linked to other areas such as project management and incentives. There was a broad range of perspectives on the issue of how aggressive universities should be in patenting and licensing their inventions. The participants also covered such issues as the patenting of research tools, the structure of university technology transfer operations, and agreements on confidentiality, and delay of publication.
• Update: The patent landscape has changed and , in the case of digital health, might be irrelevant
• Lack of a faculty entrepreneurial mindset In my view, because of the way faculty are chosen, developed and rewarded, about 1% have an entrepreneurial mindset
• Lack of faculty entrepreneurial skills, knowledge, abilities or competencies Few faculty are interested in bioentrepreneurship education and training and, sometimes, discourage graduate trainees from participating. Iinstead, they see that activity as a distraction from the core research scientific mission and waste of grant time and resources
• Lack of a sense of urgency and focus Industry focuses on what’s important. Academics focus on what’s interesting and they go wherever that leads
• Problem solvers v problem seekers Industry focuses on tightly defined customer problems. Academics focus on basic research solutions looking for a problem
• Different ways of keeping score Academics are judged by publications, grants and how many trainees they have. Industry measures profits.
• Disagreement on process, people and culture innovation leadership and management KPIs

Possible Future Tasks

• Participants made a number of suggestions on possible future tasks. Many participants believe the policy framework for university-industry interactions established by the Bayh-Dole Act, formally known as the Patent and Trademark Laws Amendments of 1980, is working well, while a few participants believe a fundamental reconsideration of that law is in order. Technically, the Bayh-Dole provisions influence university-industry collaboration only when a university invention is developed using federal funds.
• Individual participants suggested that key industry and university bodies consider development of (1) accepted standards for training and credentialing of university and industry technology transfer professionals; (2) a statement on acceptable indirect cost practices in university-industry research, which may need to address the government’s role; and (3) a declaration of principles concerning responsible conduct in industry-university research collaboration.
• Several participants stated that further study and exchange of ideas on the way universities successfully structure technology transfer operations would be useful. Similarly, a detailed examination of industry effective practices in research collaboration with universities would be helpful. These exercises could also explore whether there are areas in which pursuit of proprietary rights is counterproductive for all concerned.
• Including bioentrepreneurship education and training as part of biomedical graduate programs
• Promotion and tenure credit for the scholarship of entrepreneurship
• Seed stage funding mechanisms to “buy out” clinical faculty time to pursue entrepreneurship
• Eliminating internal rules, regulation and policies that are anti-entrepreneurial
• Recruiting, developing and promoting faculty for innovation

Fundamentally, universities are from Venus and industry is from Mars. If the two planets are ever to be in synchronous orbit, it will take changing some rules of physics or doing a much better job of reconciling the differences in cultures, leadership, strategies and incentives.

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GUEST POST from Arlen Meyers

Being an innovator takes courage. You are a guerrilla fighter waging war against the status quo, vested interests and corporate bureaucracy that have sophisticated defenses against intruders that seek to threaten their cash flow, culture and business models. You are fighting for the hearts and minds of patient customers ,payers, providers and non-users alike and will need to overcome your fears, willing to sacrifice and do the hard work. But, would you push someone who is afraid of flying into an airplane?

Here are some tips on how to overcome your fear of failure. You can also try these tips to overcome your other fears. What will you do today that scares you?

Attachment theory might help explain your fears and help you find a safe place to confront them.

Entrepreneurship, the pursuit of opportunity with uncontrolled, scarce resources has its goal the creation of user defined value through the deployment of innovation. Entrepreneurs confront the unknown with not just a mindset, and entrepreneurial habits but with courage based in their hearts. The very act of entrepreneurship involves embracing uncertainty. often living in darkness. After all , the English word for courage is connected to the heart, coming from the Latin word cor, which means heart.

Author and psycotherapist Estelle Frankel offers some perspective on confronting and accepting the unknown in her book, The Wisdom of Not Knowing. There are many similarities between the spiritual lexicon and the entrepreneurial one, for example, walking through the valley of death, going to the dark side, embracing the journey instead of the destination and having faith in how failure in one thing will open the doors to success in another.

Frankel further notes that the basis of creativity is often suspending your concepts of reality and entering the unknown as if in a dream or mindful state. For example, did you know that the brain scans of jazz musicians during improvisational work resemble those found during deep states of REM sleep?

Former Surgeon General Vivek Murthy noted that, “In the end, two emotions drive the decisions we make: love and fear. Everything else is a manifestation of one or the other, Murthy said. Love manifests itself as generosity, kindness and compassion. Fear shows itself in jealousy, anger and rage. “When fear drives our decisions, more often than not it tends to lead us to darker places. It tends to have negative impacts on our health and it tends to drive us apart, separate us and isolate us,” he said. “When love is driving our decisions, and informing our interactions with each other, it tends to be nourishing, it tends to be good not only for our health but it also builds that connection, that cohesion in society that we ultimately need.”. Drive out fear. Do something every day that scares you.

Here are some lessons from the cowardly lion.

Confronting the uncertainties of customers, products and markets is child’s play compared to having the courage to confront your inner demons or the ultimate uncertainty, death. And yet, do it you must if you are to have enough courage to live your life as an entrepreneur. Remember Steve Jobs at the Stanford graduation. Stay hungry and be playful.

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