Physician, physiologist, serial entrepreneur, public speaker, and recently the mind behind TedxLondonSalon, ‘The End of Ageing’, Dr Jack Kreindler has an impressive track record. I interviewed Jack at his CHHP labs, The ‘Centre for Health and Human Performance’ on Harley Street, an underground physiology and sports medicine boutique with a spa-like feel, filled with bikes, cardio machines and high-spec monitoring equipment.
It is for those curious about their physiology whether to optimise self-management of a chronic condition, enable elite performance in sport or to improve everyday functioning. They treat the very sickest patients and athletes alike, training them to achieve the best possible outcomes.
Sentrian Inc., a CHHP spin out, is one of his latest technology projects. Sentrian is a cloud based Remote Patient Intelligence company that aims to leverage the biosensor and machine learning revolutions to detect deterioration in patients’ health, before they become acutely unwell.
You describe yourself as a ‘physician and a physiologist’ and use data to improve healthcare for those with complex chronic conditions. At the moment, you are mainly rolling out projects in the US, what barriers have you faced in implementing innovation in the UK?
As I see it, California especially has three key ingredients:
1. A critical mass of ‘geeks’ with drive and vision to change the world.
2. A critical mass of money to fund the wild ideas of No.1.
3. A critical mass of innovative healthcare payers and providers that are all in competition with each other.
Currently, the UK is behind California in these three areas. Firstly, there is perhaps a sentiment in the UK that entrepreneurial doctors are not focused and/or are selling themselves out to the private sector. Whereas, at Stanford, it might be normal for an entrepreneurially minded doctor to be running three start-ups, at least! Secondly, it is harder to find the money required with very early stage ideas. Finally, there is only one client in the UK to professionally sell to, the NHS. If we conquer these three barriers, there is potential for the UK to be the best island of medical intelligence and the fastest to test, iterate and scale innovation across a whole healthcare system.
There is potential for the UK to be the best island of medical intelligence and the fastest to test, iterate and scale innovation across a whole healthcare system.
You spent a number of years working as an Emergency Medicine doctor but have in the past mentioned that you ‘knew your destiny wasn’t in the NHS’. How did you know when the right moment was to venture ‘off-piste’? Do you have any advice to doctors who share these sentiments and consider that they might like to use their skills in alternative ways?
I have been venturing ‘off-piste’ from Day 1 of medical school! Whilst I acknowledge that well accepted norms of practice are there to ensure safety, efficacy and a scalable health service, I always question these norms and I am constantly thinking of ways to improve or disrupt them. In this respect I much prefer ‘off-piste’. I was lucky to have mentors that encouraged me to explore these things and pursue innovation alongside practice.
Being an entrepreneur, at times, and especially in the early stages, is notoriously a stressful experience. With your insight into how humans behave and react physiologically under highly stressful conditions and your own experience as an entrepreneur, what tips do you have for entrepreneurs to reduce the impact of entrepreneurship on their own health?
Two words: resilience and adaptation.
A good functioning physiology can withstand stress and adapt to a stressful environment. Once adapted, it is able to be more resilient the next time. In the world of entrepreneurship and innovation, you have to be resilient as well as persistent and passionate about what you want to achieve. For me, what I want to achieve is not financial gain personally, but to help improve outcomes for less cost and make the experience of healthcare more fulfilling for doctors and patients alike. Without money as your metric it sometimes leaves you very exposed from a financial security perspective. This can hurt. But a good physiology heals quickly, even when it breaks, as does a good entrepreneur.
But a good physiology heals quickly, even when it breaks, as does a good entrepreneur.
Two challenges associated with future technological innovation is the regulatory challenge of containing such changes and also the need to test in the field and see whether the interventions work/are safe, how would you suggest we begin to tackle these challenges?
It takes nine months to make a baby. I consider that trying to accelerate whether technology helps biology or health system faster than the biology or the system allows poses hazards.
Regulation has to embrace the kind of evidence technological engineering requires rather than sticking to ways of measuring success using pharmacological or surgical techniques, which is really a different universe. The FDA, NICE and other health and safety regulatory bodies, in my view, need massive overhauling if they are to keep pace with exponential change. If they don’t, my fear is that people will simply bypass systems in favour of un-scrutinised, personalised medicine. Do it right, and we can accelerate efficiency and safety within an industry just like we do with innovation in aviation which is currently much safer and more efficient than healthcare!
Do it right, and we can accelerate efficiency and safety within an industry just like we do with innovation in aviation which is currently much safer and more efficient than healthcare!
Sentrian is focused on improving the healthcare of those suffering with complex chronic illness using machine learning and biosensors. Traditionally, those with chronic diseases have been a hard-to-reach group and less interested in engaging with healthcare interventions especially if their health is declining than their ‘worried well’ counterparts. How at Sentrian have you addressed this problem?
One thing we learned in trials with Sentrian is that those with complex chronic disease, unlike triathletes who love their data, is that the sick do not want to see graphs of their inevitable decline. They are worried about people watching them at home, are hassled by reminders, false alarms and phone-calls when they feel okay, and don’t want to burden anyone. However, explaining to people that their contributions are helping thousands of others like them to live healthier and happier at home and also helping their loved ones and professional caregivers to make meaningful contact with relevant advice and/or change interventions just when they need it, can change a patient’s view of remote monitoring. This is why at Sentrian, we call it Remote Patient ‘Intelligence’, not just ‘Monitoring’.
We call it Remote Patient ‘Intelligence’, not just ‘Monitoring’
Dr Cat’s Big Question
If you had one week for the medical school curriculum based on your vision for the future and desire to improve healthcare, what would you put on the syllabus for that week?
It’s funny you say that, I have just been asked to do that for the groundbreaking surgeon Shafi Ahmed who is introducing a new curriculum at a London medical school for next year. The balance between practicing what is best today and innovating what is better for tomorrow without resting on laurels or being consumed by hubris is vital. We must remember that in 100 years time we will be laughing at what we do today. Understanding exponentially advancing technology, like computer medical genomics and real world data that drives decision-making for personalisation of care, might make that happen 50 years from now, maybe even 20, we just need to go do it.