The Future of Healthcare Technology with Eli Lilly and Company's Diogo Rau

How is technology transforming the healthcare space? Malcolm sits down with Diogo Rau, the Chief Information and Digital Officer at Eli Lilly and Company, to discuss the ways his company is innovating to deliver care to customers who need it. Rau also previews some new products Eli Lilly is especially excited about. See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:00Speaker 00

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• 0:34Speaker 01

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• 1:31Speaker 01

  Welcome to Revisionist History. We have a special treat today. I had a chance to sit down with a guy named Diogo Rao, who worked for years at Apple, way up high, and then left to become the Chief Information and Digital Officer at Eli Lilly and Company, one of the biggest drugmakers in the world. Diogo, as you will learn, is irreverent and fascinating, and sees a good 10 years ahead of the rest of us. At the end of our conversation, Diogo said to me, "You know, we never got to AI," which is true. Can you imagine a conversation about technology so interesting that you never get to the subject of artificial intelligence? That's what you're about to hear.

• 2:12Speaker 01

  We're going to talk about a whole number of things, but I wanted you to start because you're a very unusual figure. You work for Eli Lilly, but you are a very unusual figure at Eli Lilly. Is that a fair statement?

• 2:25Speaker 02

  I think I have that reputation of being unusual. At least I like to try to do things a little bit differently.

• 2:32Speaker 01

  No, no, I was talking about your background.

• 2:34Speaker 02

  Yeah, yeah.

• 2:35Speaker 01

  You worked in the tech industry for how many years?

• 2:38Speaker 02

  I worked in the tech industry, well, really my whole life. But the last 10 years before I came to Lilly, I was at Apple. And before that, I was doing other kinds of technology work at McKinsey. And before that, I was in the startup world. So I've really spent my whole life in technology.

• 2:54Speaker 01

  How many people do you think have moved from Apple to a life sciences company?

• 2:59Speaker 02

  About five. I think I know them all.

• 3:01Speaker 01

  Do you guys get together?

• 3:02Speaker 02

  I recruited most of them.

• 3:03Speaker 01

  Oh, I see. And how do you... So this is a kind of... I want to start on this little tangent, but how did that work exactly? So somebody comes to you and says, "Have you ever thought to work for a pharma company?"

• 3:17Speaker 02

  Well, yeah, and that's the way a lot of these things start. It's a... You know, there was a recruiter that I worked with who gave me a call and said, "Hey, I've got this opportunity. It's in life sciences." And I was like, "I've never done anything in life sciences before." He's like, "That's okay." So I look at the spec, and the spec is, you know, it's pretty interesting. So I'm like, "Okay, it's worth a phone call." And then I meet our CEO and our head of HR. And like, these people are really nice. And so that's like the second thing that I noticed is that they're really, really, really nice. And that's a big difference, by the way, coming from versus the tech world. I have to say a little more about that. And then I start talking to our head of research and development about some of the problems that we're trying to solve in life sciences. And I realized, wow, this is like a fascinating space.

• 4:02Speaker 02

  I kind of thought that like everything exciting in the world was happening in tech. And then I came to realize, no, actually, there's a lot of exciting stuff that's happening outside of just the tech world.

• 4:12Speaker 01

  Yeah. So let's start... So you make this... When did you start your job at Lilly?

• 4:18Speaker 02

  May 17, 2021.

• 4:21Speaker 01

  So go through, just off the top of your head, the most surprising things you learned moving from Silicon Valley to a life sciences company?

• 4:34Speaker 02

  Well, the number one thing that I actually saw was actually the nice people part. But you know, the second thing that I noticed was really long timescales. Like the size and the duration of things is just, is just beyond belief. My first executive committee meeting in 2021, we were talking about a revenue forecast that was for 2030. And that's nine years out, like in tech, like looking like 18 months out in revenue is ridiculous.

• 5:02Speaker 01

  Wait, so when you see that, what's your, what's your reaction?

• 5:05Speaker 02

  Oh, it's BS. There's like no way we can predict our revenues for, you know, for nine years from now. And of course, now I realize that I'm in here, that there are a lot of things that you can predict. And it is actually very predictable. It's a big bet and if it works, you'll, you know, you'll, you'll hit it. But it's much less volatile. It's, uh, these timescales are crazy though, because like at our last executive committee meeting, right before the break, we were talking about a product launch. I'll, I'll ask you a question. When, guess when our product launch is that we were talking about in December?

• 5:36Speaker 01

  Well, now that you've primed it, it's going to be five, six, seven years.

• 5:41Speaker 02

  No, 2036.

• 5:43Speaker 01

  Oh my God.

• 5:44Speaker 02

  And there is, I can guarantee you there are zero tech companies right now talking about what they're going to launch in 2036.

• 5:50Speaker 01

  Yeah, yeah.

• 5:52Speaker 02

  And

• 5:52Speaker 01

  Wait, there, not only, so there is certainty that this, this product will be approved, but just the, the, you can be, you can be 10 years away and be certain it'll be approved, but know that you still have 10 years worth of work to do?

• 6:09Speaker 02

  Yes. You can't be certain, of course, that anything is going to be approved. And so we apply a probability of technical success. This phrase I'd never heard of before I got here, but every step along the way has probability of technical success. And so you, you factor it in and you, you know, you, you take all that into account. But you know, when you have a good medicine and you know what it's going to take. But it just takes 10 years to take, bring a medicine to life. And it's, uh, and I don't think that was one of the things that I realized before I came into this, just how long it takes and how much money it takes.

• 6:38Speaker 01

  So it is possible that you will work on things that you will never see come to fruition?

• 6:43Speaker 02

  Uh, in fact, most of our scientists that work here, uh, will never see their medicines that they're working on come to life. Which is kind of crazy to think of.

• 6:53Speaker 01

  It affects the culture of your business.

• 6:55Speaker 02

  It gives it a really long-term perspective, like crazy long-term perspective. When we're talking about things, making decisions, we're really not thinking, you know, like at an executive committee level, there are some things that we're doing on a this-year basis, but there are a lot of things that we're doing that we're really talking about like the 2030s, like just a much different timescale from anything else. And so we're not going to do anything stupid, I think is one of the good things. We're not going to trade off some of the long-term to get a little bit of benefit in the short term. So I think it makes us much more rational that way. I guess I would say we play the long game.

• 7:30Speaker 01

  But I want to go back to, so you come to Lilly, and I'm curious, so what did they want from you?

• 7:39Speaker 02

  My boss, our CEO, gave me a mandate to really change, to like bring in technology into everything that we did. So it was not a cure-taker role, sort of a mandate, you know, we want you to just keep running the things. We want you to really figure out like what can you do to shake things up? And so that was really, that was really the goal. And I think a big part of it was bringing a consumer orientation as well. And I think this is an industry that has largely worked the same since the 1950s. I mean, if you look at it, the way you get medicines today as a patient is basically unchanged. You go to your doctor, they write a form, maybe now they submit your prescription electronically.

• 8:22Speaker 02

  You still have to make sure you can pay for it, you still have to go to a retail pharmacy in most cases. None of that's really changed since the 1950s, even though we have so much more. So a big part of what we're trying to do is actually, a big part of my mandate is to really bring this into the 21st century, or at least the late 20th century.

• 8:40Speaker 01

  But is there, within the portfolio of things that Lilly does, do you touch on everything or just are you focused on the consumer side of the business? I mean, what's the kind of, what's your remit?

• 8:54Speaker 02

  The great thing is, is that I get to focus on all of that stuff. So everything that's technology-related, I...

• 9:00Speaker 02

  I do cover everything from the discovery side through the consumer side. And actually, those are probably some of my favorite parts. And I'm going to, because of course I shouldn't be saying favorites. But you know, I love the discovery side and discovering new molecules and what we can do there. A lot of cool stuff, especially with AI. We could talk for hours about. And the consumer side is also the place where I see, where I have a passion coming from my prior life at Apple and just seeing the potential we have to change everything there. And I think this whole industry hasn't really focused on like, how do we make it an amazing experience and work backwards? I think the kinds of things that you see at Apple and a lot of other consumer oriented companies just haven't, haven't arrived here yet.

• 9:40Speaker 01

  And how does putting the customer first in that chain of the, in that chain of kind of interest groups change the way you do business or change the way you think about what you're doing?

• 9:52Speaker 02

  That was the most fundamental thing that I learned from my time at Apple. And I think most companies will say, oh, we care about the customer. But you know, whenever you start a project, people will have, I don't know, they'll have five pillars or five things you need to go after. Well, maybe there's the business case, the product, the customer, the, you know, you have like five or six different things. And the way you'd always do things at Apple was, was different. You would always start by like, what's the customer, the consumer experience that you want to create? And then work backwards and then figure out, you know, can you make a, can you make it a financial case around it? Well, maybe you can't. Okay, so we need to, maybe we can see how we can change things back and forth. But it really was, everything was centered on the customer experience. It wasn't like a pillar of one thing of five. It was like the thing that was, that was guiding everything.

• 10:37Speaker 02

  And I think that's, we're not there yet, but that's like, that's the kind of thing we need to do like every single time. We need to go, we need to go back and see what's, what's the customer experience like? We need to actually focus on like making a customer experience better.

• 10:52Speaker 01

  Yeah, yeah.

• 11:00Speaker 00

  This is Jacob Goldstein. With ChatGPT, you can do more than get answers. You can get things done. When you're running a business and looking to expand, you need a clear view of the landscape before making any decisions. ChatGPT can help you prepare. Connect your Google Drive, point to relevant files and reports, and ask it to research competitors, industry forecasts, and market signals. It can turn the findings into a strategic deck in your team's template that you can review before presenting to your leadership team. Growing a business is ambitious, and ChatGPT can help you do it with confidence. Get started today at chatgpt.com.

• 11:40Speaker 01

  You have a whole table full of goodies over there. I want you to pick a goodie. And let's use this as a specific. Walk me through the kind of thinking behind the product, the kind of challenges, the specific challenges, how it represents this process that you've been talking about. You pick.

• 12:02Speaker 02

  Okay, great.

• 12:03Speaker 01

  Just so people know, there's about a couple of feet from Diego is there. There's about, it looks like, eight to 10 mysterious boxes that are...

• 12:16Speaker 02

  So I have to share with everybody that like, Malcolm and I had a little prep call before, you know, a couple of weeks ago. And it was only about 10 minutes because he just said, "Okay, you know, if you've got any toys, any goodies, like, bring them along." And so like, my team gave me a box of goodies here, which is all split out on the table. And then I think he said, "Okay, and I don't want to talk too much more. Let's not do any more prep. Let's just get going."

• 12:38Speaker 01

  Well, the thing is, if you have small children, as I do, you think exclusively in terms of shiny little gifts. You'd be surprised. I almost said, "Can you bring snacks?" That would be on the top of my...

• 12:50Speaker 02

  Awesome. All right. So let me grab a box. All right, I'm going to show you something that's, that is... No, let me grab that one. Yep. And I'm going to hide it here for just a second, tell you what the problem is that we're going after. One of the big challenges in the world right now is medicine and medicine safety.

• 13:11Speaker 02

  When I was at Apple, I saw counterfeit iPhones. And I couldn't believe it. You wouldn't know that they were counterfeit until you actually picked them up and played with them for like half an hour. And sometimes we'd have to send them in and have them get x-rayed to know that they're fake. Well, that was on, those were on products, you know, that was like a thousand dollar product, that electronics, very hard to make a counterfeit, but the economics were there. Medicines are a lot easier to fake, or at least make them look fake. All you need to do is copy the box, and you know, if it's in a vial, you know, put a label on it, something like that. And with some of the medicines that are out there right now, there's a huge financial incentive for people to have, to make, to say that they're making medicines that they really are not,

• 13:56Speaker 02

  and they're faking them.

• 13:57Speaker 01

  What would be, it's just fascinating. What, is there a particular kind of medicine for which the counterfeiters' motivation is greatest?

• 14:07Speaker 02

  Well, right now, in chronic weight management, we have the GLP-1 medicines. And so, both for us and the other leading maker of GLP-1 medicines, counterfeiting is a real, real threat. And back to formularies and things like that, a lot of insurance plans do not cover chronic weight loss management. And so, there's a huge financial incentive on the black market to say, hey, we're gonna go.

• 14:34Speaker 01

  And some uncertainty about outcomes, so it would take you a while to figure out you're taking a fake.

• 14:38Speaker 02

  Correct. And, I mean, it's not only, I mean, it's not only fake, it's actually, many of these cases are risky, because once you see, once you see like the sterile environments that these medicines go through to be made, you know, that it could, in the best case, it's harmless, right? I mean, the best case is, you don't get any effect. And so, what I've got here is a product. I'm gonna, this can be any product, and it's a, don't pay attention to what product this actually is.

• 15:09Speaker 02

  And I've got the product right here and I can tap my phone against it and I will get it in an NFC tag. And that NFC tag is just like when you do a contactless payment. And it will bring up, it'll bring up a page to show you that could actually verify that the packaging matches something that we've produced. Unlike a QR code, it can't be copied. It's cryptographically secure. And this is where the technology part gets interesting because they can copy the box, they could do all kinds of things like that, but they can't copy that tag. There's one and only one tag that you can, that you can tap and that we can verify it.

• 15:45Speaker 01

  Yeah. So how, how, how long did it take to develop that particular technology?

• 15:49Speaker 02

  So it took, this is something we did within my first few months of coming here. And we haven't launched it yet. So they, the designing it is very easy. The developing it is very hard.

• 16:00Speaker 01

  So you could, you could, what you're saying is what you have is a technology that could be a platform for building an interaction between the, the consumer of the pill, the patient.

• 16:12Speaker 02

  Correct.

• 16:13Speaker 01

  And the, and the manufacturer.

• 16:14Speaker 02

  That's absolutely right. And, you know, we actually don't even care about it necessarily being just for us. Like this is the kind of thing where we'd say, this is a great thing if adherence can improve for patients across all medicines, all manufacturers. That would be fantastic.

• 16:26Speaker 01

  Yeah. How, but you've put that RFID tag on the box.

• 16:31Speaker 02

  Correct.

• 16:32Speaker 01

  But now there's still a thing inside the box.

• 16:34Speaker 02

  There's still a thing inside the box. So this is version one, which is on the box. And then version two, which we'll come to later, will be on the individual medicine itself.

• 16:43Speaker 01

  What about protecting against unauthorized use of the medicine? What if the wrong person taps their phone against?

• 16:49Speaker 02

  Absolutely. Then you could actually make sure that you're taking the right medicine. I also think making sure that you haven't taken your medicine more than once in a day is also an important thing because you know what? It's, it's actually, it's very easy to do. I also think that in a hospital environment, it also is, you know, you could tie it into systems and make sure that you're actually administering the correct medicine, not something that you can imagine a lort flashing up on, on the healthcare provider's device if it's the wrong medicine.

• 17:17Speaker 01

  So this is beta with the box.

• 17:19Speaker 02

  Yeah.

• 17:20Speaker 01

  How long, how many years before you think you'll be actually in the pill itself?

• 17:23Speaker 02

  The pill itself, I don't know if we'll ever get past the consumer. Acceptance of RFID, like if it like actually being in the pill itself. But if we could get there, that's that's not super far out. That's probably, you know, probably five years out.

• 17:39Speaker 01

  Yeah.

• 17:40Speaker 02

  Yeah, but it's not the technology is there.

• 17:43Speaker 01

  Even better version is that you point your phone at your gut and you find out all the stuff that's in there. You're like, oh, goodness, what do they have for dinner?

• 17:52Speaker 02

  Yeah, exactly. It might not be good to find that out.

• 17:55Speaker 01

  Pick another wearable because now I'm interested. First of all, has Lilly ever done a wearable before?

• 18:02Speaker 02

  No, we've not produced a wearable of our own. And it ends up being a little bit challenging as a manufacturer. It'd be a lot easier if we didn't make drugs to actually launch a wearable. But because you make drugs, then then it then the question is as well, are you using this to? Does it have to be, is it required for somebody taking the medicine? So there's a whole host of things that makes it really complicated for us to do it. So the most for the most part where we use these things are in clinical trials.

• 18:30Speaker 01

  So how many wearables, take me 10 years into the future.

• 18:34Speaker 02

  Yeah.

• 18:35Speaker 01

  How many wearables am I wearing if I want to be completely, you know?

• 18:40Speaker 02

  If you're going to nerd out on all of this, you know, I think it's probably on the scale of two to three, I think. I think there are only so many places that that you're willing to put a wearable. You know, I, you know, you can imagine there's your ring, there's a watch. And you might be able to, if you've ever had like a Zio patch or anything like that or patch. Those are not terribly uncomfortable. Insoles, you know, you could, you could imagine. But after that, you don't have that many more places, I think, that you would that you'd be willing to wear something. So I'll go, I'll go with just three tops.

• 19:20Speaker 01

  I was going to say eyes. I was reading.

• 19:21Speaker 02

  Eyes, yeah.

• 19:22Speaker 01

  A really, I was reading a really fascinating study that was looking, trying to figure out what the difference is between a novice police officer and an expert police officer. And they use eye tracking, gave them scenarios and figured out they're looking at different things. Right. So you have a scenario of like a bad guy here and this happening here and someone throwing this here. And we see the experts like looking doot doot doot doot doot doot doot doot. And the novice is looking woo. Right?

• 19:51Speaker 02

  Yeah.

• 19:51Speaker 01

  One spot versus, but I'm just curious about like, you know, my sense is this is kind of, once you start going down this road.

• 19:58Speaker 02

  Yeah.

• 19:59Speaker 01

  There's lots and lots and lots and lots of things.

• 20:01Speaker 02

  No, I thought you were going to go down a different path, which is like the, uh, what you might, uh, like enhancing your eyes or your hearing or things like that, which is also like, that's just another fascinating space, uh, of science and.

• 20:13Speaker 01

  Yeah, yeah. Why? You, one of the things you said earlier, big, my interest, when you said that if you're making drugs and the question, one of the questions that comes up is, are you using the, something like this, uh, a wearable to market the drug? But I'm wondering whether that's, there's another way to frame that is, um, surely one logical step here is that you start to, you're not just giving someone a drug, you're giving someone a drug in combination with a set of wearables that, that allow us to maximize the value of the therapeutic. Right? Is that what we're, are we going to be, are we going to be, are you going to be getting from your pharmacist or your doctor, a package of things to take home along with your medication?

• 20:58Speaker 02

  We do that with some of our clinical trials. You'll get like, here are the devices to, to take with you. But if you look at weight loss medications, we've, we're already all doing that, uh, right now, like, because we all have scales in our house, right? And so, uh, and so I think that is a great example of like, if you give feedback to the person taking the medicine, they're going to be more likely to, to stay on it. At least that's one of my hypotheses. I think that if you took away, if you took away scales and you took away mirrors, I think a lot of people, a lot more people would drop off the chronic weight management medicines, uh, early on.

• 21:30Speaker 01

  Yeah.

• 21:30Speaker 02

  But the fact is, when you get on the scale and you can see, hey, I lost, you know, I lost some weight, uh, you want to stay on it. We don't have anything like that for statins or anything else, right? And that's again, like why people, people drop off. Just imagine if you could just see, oh, hey, actually, um, you know, or I'm, I'm taking cholesterol medication and you know what? Hey, my cholesterol went down versus yesterday, not versus three months ago.

• 21:50Speaker 01

  Yeah. Who controls this data? So interesting, you began this conversation in talking about the multitude of steps

• 22:00Speaker 02

  Yeah.

• 22:00Speaker 01

  that exists between the manufacturer of some of these medicines and the user.

• 22:05Speaker 02

  That's right.

• 22:06Speaker 01

  Now you're talking about a system where presumably the manufacturer can speak directly to the patient.

• 22:12Speaker 02

  Correct.

• 22:12Speaker 01

  Does this mean you cut out some of the middlemen?

• 22:14Speaker 02

  That's my hope. But the data ultimately, the first part of your question, the data really should be with the patient. And I think there's a tendency to say, even still today in this industry, that the data is really for the healthcare provider. And I think that's, I think that's a mistake. I think ultimately the data is for the patient and the patient can choose to share it with the healthcare provider and the healthcare provider can look at it. But it really is, it's really the patient's data.

• 22:40Speaker 01

  My mom is an interesting, has arthritis.

• 22:44Speaker 02

  Yeah.

• 22:45Speaker 01

  Which acts up on, and so she moves around a lot. This is a perfect tool for her. So somebody, so does she, is the model here that she checks her movement scores and that's a way of, and she can choose, she can see, oh, this is time to share that, my data with a practitioner? Isn't it more efficient for her to have someone who is, or some AI or something that's continuously monitoring her?

• 23:13Speaker 02

  I think the continuous measurement part is, you're absolutely correct about it. And, but I think it needs to be, I think she always needs to be able to see the data herself.

• 23:21Speaker 01

  Yes, I can see that.

• 23:22Speaker 02

  And, and by the way, that's not an, that sounds, that's one of those things that sounds obvious if you're coming from outside the industry to inside, but inside the industry is, you know, it's like, why would you share the data with the patient themselves? You wanna, you know, that's something that the healthcare provider should see first. I mean, what, what happens if your mom misinterprets the data without the advice of a healthcare provider? That's kind of the, the big caution that would keep. Uh, keep the industry from uh, from saying your mom should be able to see that data itself. But I, I take a very different view on that.

• 23:50Speaker 01

  But we're moving, what's interesting in all, a lot of these things, the implication of what you're talking about is we are moving the um, uh, the, the, the primary point of contact from uh, the hospital or the doctor's office to the home.

• 24:05Speaker 02

  Correct.

• 24:06Speaker 01

  Right?

• 24:06Speaker 02

  Yeah. That's, if you don't mind me going on a tangent on that too, that's one of the reasons why I'm really, really excited about like how we can change things uh, too, because if you look at it today, it's uh, there are so many barriers to getting medicine. Uh, you know, like first you have to get a doctor's appointment, which we've all suffered through, like it can take months to, to, to get one. Uh, then, then even after you have one, then you also have to be able to get it, uh, actually get access to the medicine, which is um, a big problem because I don't know if you've heard the, the stats before, about forty-five million Americans uh, live in pharmacy deserts. Uh, forty-six percent of counties in the country are in pharmacy deserts, uh, where there's no pharmacy within fifteen minutes um, of, of your house.

• 24:49Speaker 02

  Um, and so I think, and so if you add all of that together, it can take months from like the moment you say, you know what? I'm not feeling well, or there's something I want to change in my life to like the day that you get the medicine. I want to bring that like down to like the same day. You should be able to say, you know what? Um, today's the day that I, I want to do something and you should be able to go in, you know, get, uh, get a telehealth appointment. Uh, and if a medicine is appropriate, get it shipped and get it arrived, delivered, you know, this, the, the exact same day.

• 25:20Speaker 01

  Well, one last question for you. Um, define what success looks like for you. So a year, how old are you?

• 25:27Speaker 02

  Uh, I just turned fifty.

• 25:29Speaker 01

  You're a young man.

• 25:31Speaker 02

  I don't get to hear that very often.

• 25:32Speaker 01

  So you, let's assume you retire from Lilly at sixty-five.

• 25:36Speaker 02

  Okay.

• 25:36Speaker 01

  And I, so take me fifteen years into the future and tell me what would have to happen for you to feel like your time at Lilly has been a success.

• 25:48Speaker 02

  The biggest thing for me is going to be the consumer side and actually making, really cracking this and being able to like get that vision of people saying, I want to take a medicine and I'm going to get it the same day. And then I've got the tools to stay engaged with it forever. Like that would be, that's millions and millions of lives touched by just getting medicine and staying on medicine. That's one side. The other side where I, where I would love to make a mark is on the discovery side. And discovering new medicines with, particularly with AI. Could talk for hours on that. But I think we're going to see medicines no human could have ever imagined coming out

• 26:33Speaker 02

  over the next decade. And because it takes 10 years or more to develop a medicine, it would take about 15 years for that to come to life.

• 26:41Speaker 01

  Yeah. I was thinking, you know, when you were talking, and this is maybe a little bit farfetched, but in the world of deterrence, so the question is, if I have a law that punishes you for a certain crime, your, the deterrent value of that law is a function of three things. The certainty of punishment, the swiftness of punishment, and the severity of punishment.

• 27:03Speaker 02

  Correct, yeah.

• 27:04Speaker 01

  And of the three, we spend the most time thinking about severity. Secondly, thinking about certainty. And the one that we neglect is swiftness, right? Takes years and years and years. And the argument that many people make is that swiftness is actually the most potent of the three. If you know you're getting punished the next day, then you're, now you're, it's funny because if you map that onto what you're talking about, you were talking about the idea of getting medicine the same day. What you're saying is the swiftness variable is the neglected one here. And what if, if we improve swiftness, would you think we would change the psychological circumstances around which people use drugs? In other words, would the adherence problem be solved if we, if we addressed the swiftness problem?

• 27:50Speaker 02

  I think so, actually. I think if we got swiftness and you could actually see an effect and know that something was happening, that would change things. You know, and by the way, I love that model that you just mentioned. In the technology world, we have things break all the time. And what everybody focuses on is like, what's the root cause? And like, what's the severity and how likely is it? The thing that nobody ever focuses on, which is why I was trying to get teams to focus on, is swiftness, the mitigation, time to mitigate. How long did it take you to mitigate? That human process of like, how quickly did you take the feedback and adapt? That's really, you can have all kinds of risks as long as you've got, as long as it's reversible and you can switch, that's great.

• 28:31Speaker 02

  So when it comes to medicines, if you could try it and get feedback that it's not working or not trending in the right direction and change it, that would be amazing. And I think you would find that people would say, hey, now I know that this medicine I tried wasn't working, I'm going to try a new one today. I can see progress. I'm going to stay on it because I know it's doing something.

• 28:52Speaker 01

  Well, this has been really fascinating. Best of luck with all the work you're doing. I hope next time I see you, I will have at least three wearables.

• 29:01Speaker 02

  Excellent. Thank you, Malcolm.

• 29:03Speaker 01

  Revisionist History is produced by Lucy Sullivan with Nina Bird Lawrence and Ben Nadav Haifri. Our editor is Karen Shakurji, mastering by Jake Korski. Our executive producer is Jacob Smith. Special thanks to Matt Romano, Eric Sandler, and Kira Posey. I'm Malcolm Gladwell.