Opinion | Healthcare Should Take a Page From the Startup World

As a PA who was born and raised in Silicon Valley, I am endlessly curious about the world of health tech. It’s safe to say that the merging of these two industries — healthcare and technology — is only going to continue, and as this happens, there is a great opportunity for each industry to learn from the other.

In order to gain a better understanding of how health tech startups work, I read Secrets of Sand Hill Road: Venture Capital and How to Get It by Scott Kupor, JD. Kupor provides a wealth of insider insights, drawing from his experience as managing partner at the renowned venture capital firm Andreessen Horowitz. Here are two key lessons from the startup world that are pertinent to healthcare.

First: It’s best to have strong opinions that are weakly held.

Venture capitalists tend to like founders who have strong opinions, weakly held. In order for a startup to be successful, it’s critical that its founder is able to incorporate market data and evolve accordingly. Having confidence and conviction is essential, but it’s equally important to be able to pivot based on feedback from the real world. These principles apply in healthcare too.

As clinicians, we need to be confident in our decision-making. That being said, we also need to keep an open mind — at least open enough to be able to incorporate emerging high-quality evidence that may change the way we practice. Unfortunately, clinicians are notoriously bad at this. In Ending Medical Reversal, physicians Vinay Prasad, MD, MPH, and Adam Cifu, MD, note that it takes about a decade for the medical community to abandon a therapy after it’s been proven to be ineffective. Along the same lines, German physicist Max Planck, PhD, noted, “Science advances one funeral at a time.”

By taking a page from the tech industry and being willing to change course based on new high-quality evidence, healthcare can waste fewer resources and foster better outcomes for patients.

Second: Incentives drive behavior.

In the startup world, it is widely acknowledged and accepted that financial incentives drive behavior, and this is nothing to be ashamed about. Rather, this reality is openly used to inform decisions about how to best motivate people.

In contrast, most clinicians prefer to pretend that incentives don’t drive behavior. According to a systematic review of 36 studies of pharmaceutical industry payments published in the Annals of Internal Medicine, nearly all showed associations between receiving payments and increased prescribing. Aaron Mitchell, MD, MPH, and Deborah Korenstein, MD, summarize the research, noting, for example, that industry payments cause clinicians to prescribe more expensive brand-name medications rather than generics. Moreover, industry payments also increase opioid prescriptions. Nevertheless, clinicians continue to sweep this evidence under the rug and convince themselves it simply isn’t true — it couldn’t be! However, it’s time to remove shame from the equation and reconsider this position. The more clinicians can admit that incentives do in fact drive behavior, the better off patients will be.

Notably, the lessons that can be exchanged between tech and medicine go both ways. Kupor highlights that Ben Horowitz, MS, co-founder of Andreessen Horowitz, uses an analogy about medicine to illustrate a fundamental truth about startups: a startup’s idea or product needs to be significantly different from (and better than) the status quo. Vitamins are nice, but you’re not going to go back home if you forgot to take them. On the other hand, if you have a headache, you’ll likely go to great lengths to get an aspirin. Venture capitalists want to invest in ideas and products that are like aspirin.

The interplay between healthcare and technology is complex and layered. There are plenty of inherent tensions, yet the lessons I took away from Secrets of Sand Hill Road emphasize that there are also many places of potential alignment.

Shannon Casey, PA-C, is a physician assistant and former assistant teaching professor in the Department of Family Medicine at the University of Washington. She writes at The Medical Atlas.