EP #504: Design is medicine with Juhan Sonin of Involution Studios

Think about all the opportunities that happen during your day where health data could be collected. We already monitor how we sleep, the number of steps we walk, the air quality, the food we eat, the amount of exercise we get, our weight, etc. The thing about all of these is that they require human input or initiative. We have to strap something on, punch something in or stand on something and, as Juhan Sonin of Involution Studios demonstrates in this episode, humans are quite often the problem.

The challenges of building for the health industry are many but there is tremendous opportunity for innovation and disruption that is literally in our house or car. How? Sensors. Not the generation of sensors worn on wrists but the idea that everything we interact with – a sink, a toilet, a shower, a car seat, a bed or even a bath matt – could help us make decisions that will lead to a healthier and longer life.

This conversation is insanely great and so relevant to the wearable, Internet of Things and mobile world. So much so that it intersects at a point where there is so much change happening and so much innovation and so much disruption that entrepreneurs should be salivating at what is to come.

I saw Juhan speak at UXCamp Ottawa in the fall and knew he would bend minds on UNTETHER.tv and he will do just that to you. Money back guarantee. Just watch and enjoy.

Enjoy!



Key takeaways from this episode. Click on the link and the video will take you to that clip

1. What does InvolutionSystems do? 2:00
2. Juhan’s background with Apple, NCSA and MIT 3:00
3. The state of technology in the health industry 6:55
4. Are current technology companies focusing on the right things? 9:30
5. What is the opportunity for wearable technologies and the health industry? 11:35
6. What does “health happens” mean? 16:45
7. Does enabling sensors in health mean a greater “have / have not” divide? 22:25
8. Where are we on the health/technology curve? 24:30
9. Do the current group of wearables make us lazy? 26:15
10. The 3 steps to using tech to help our health 29:30
11. What is the perception of companies trying to get into the health business 34:45
12. What does the technology do for our quality of life? 37:45
13. 2 entrepreneurial opportunities to look at right now 39:48
14. Are we trying to remove decision making for the average human? 43:00
15. Is their a technology catalyst for the human race to get healthy? 45:45
16. What does “beautiful engagement” mean in the health industry? 49:00

Raw Transcript

Rob: Hello, everybody, and welcome to Untether.tv. I am your host and founder, Rob Woodbridge. Listen, a while back, maybe six months, five months ago, I had the great pleasure of sitting in on something called UXcamp Ottawa, and I sat down to be mesmerized by my guest today. It is Juhan Sonin, who is the creative director of Involution Studios. I’m going to bring him in now. Juhan, welcome. Thank you for doing this.

Juhan: Thank you for having me.

Rob: Listen, there’s a whole bunch . . . I want to get through this, because there’s a great introduction, because two of the words — we were talking about this — two of the words I can’t say are “involution”, which is unfortunately the name of your company, and “emeritus”, which is unfortunately, the companies that you’ve left. But you are an emeritus of Apple, MIT, and the NCSA, and you’ve also — which is amazing — been featured in The New York Times and Billboard magazine. Like, the only other person I know that has been Bruce Springsteen, right? The balance of the two. So you’re up there with him, in my eyes. Juhan and Bruce.

Juhan: Well, that is an unfortunate comparison. For the most part, for his sake, resumes are a ruse. So whenever you see that on paper, it’s just completely different in the flesh.

Rob: I love that.

Juhan: Let’s see if I can stand up to, like, one-tenth of that kind of conditioning.

Rob: Absolutely. I think you can. I’ve seen you speak. And the topic we’re going to be talking about here is “Design is Medicine”. And what really struck me is this evolution of medicine and health, and living, and how a technology is going to play almost a background piece to sensing your health and making sure that it’s a beautiful and wonderful experience. We’re going to be walking through all these things.
Juhan is in Arlington, Massachusetts, which is a step outside of Boston. But before we even go there, I’ve got to know a little bit about Involution Studios, aside from the name. It’s a tongue twister, you know?
I’m not very good with words anyways. But what do you guys do?

Juhan: Well, what we pretend to do is design services, software, and products, and things, usually for the emerging technology sector. So a company will come to us, and they have a particular technology they have in a research lab, or another company may come and say, “Well, we have a commercial aspect for this, and we need it to be productionized, and made beautiful, and have the experience be lovely when using it.”
So that’s the kind of thing we do every single day, and we’ve been doing it for 10 years. I think we have over 150 million people using the software and things that we’ve done in someone else’s fabulous name.

Rob: So how long have you been a creative director there?

Juhan: This is year six for me.

Rob: Year six.

Juhan: So I’m still shedding the snakeskin of the, you know, first half decade here.

Rob: Well, so you worked for Apple, you taught at MIT. What did you do for NCSA? Or can you tell us?

Juhan: Well, I still teach at MIT now.

Rob: Oh, you do. Yeah.

Juhan: Their product design class in the Mechanical Engineering department. And NCSA, which is the National Center for Supercomputing Applications, you may have heard of a small piece of software called Netscape that erupted from there.

Rob: Mosaic, yeah. Mosaic came from there, yup.

Juhan: Mosaic came out of NCSA. I didn’t have anything to do with that. Their IQs were much, much higher than mine, so I was just a plebe working on more of the research science of how do you tell complex stories and data visualization, back when I think that word was just being born. This is almost 18 years ago.

Rob: Unbelievable.

Juhan: So it was a hell of a lot of fun, and I grew my brain a ton.

Rob: And what about Apple? What did you do out there? Can you talk about that at all?

Juhan: I was a minion.

Rob: You were a minion.

Juhan: That was actually one of the least exciting experiences of my professional career.

Rob: How long ago was that, then? That must have been a while.

Juhan: My first gig out of school, which was over 28 years ago.

Rob: They weren’t very cool back then.

Juhan: No. No, no, no. And, in fact, I have, like, scars from the razorblades I was using on my wrist from wanting to get out of there. So it was a lovely experience.

Rob: It was just that kind of, “I can’t get out of there fast enough. So I’m going to run over to the NCSA.” Well, talk about a . . . I mean, again, Billboard, New York Times, NCSA versus Apple. I think that a lot of people would give their left nut to be a part of Apple today. Just saying.

Juhan: Yeah, I think they would. And it’s a much different organization now than it was 20 years ago, in between the Jobsonian divide, right? So you had the German there at the time leading the squad, and that’s when cloning came in. The Newton actually came out not so far . . .
and that was an interesting experiment . . .

Rob: Very much.

Juhan: . . . that led to a lot of other interesting things. But in general, it was not a fabulous company to be at the time. Now, my goodness, it’s probably pretty interesting. But still, my goodness, it’s probably pretty interesting but still there’s grass is always greener [inaudible 00:05:04] help craft my own gig and, two, it’s a beast. When you work for a massive organization like that to think that you’re going to have like immediate impact is laughable. Right? So even at the executive level, so these things take years and years to sort of gestate your impact at a big company like that. So it’s not like you come in there one, two, three, four years and you’re like, “Wow, I slayed it.” I think you’re talking the decade level in that kind of organism.

Rob: Which is still like the half life of government. Right?

Juhan: Yeah, yeah. I wish government were as good as Google or Apple at the moment. That’s just more depressing.

Rob: It is. Well, the other side of this is obviously healthcare, right?
So healthcare’s always been looked at as afraid of change. Well, on one hand the technological advancements are incredible around disease prevention and awareness making and treating of disease, of incurable diseases. Unfortunately I’ve just gone through this with my own mother and watched that deteriorate.
But the challenge here is that, the perception out there has to be that there is that medicine doesn’t move very quickly. Yet here we are talking about something that you call “Design is Medicine” and how they’re going to have to eventually start to leverage the UIUX of the other world and non-invasive stuff in order to be able to make our lives better without us knowing it. Is that ultimately what it comes down to?

Juhan: Yes. Should we even continue the conversation?

Rob: That’s it, done.

Juhan: I’m over it.

Rob: I was blown away by the presentation you gave in Ottawa in November. But is it true that the medical industry is, let me ask you, do they embrace technology or do they run from new technology?

Juhan: I think it’s a fuzzy mess, like almost every other industry. Every industry thinks that they’re unique and they have their own foibles and peccadilloes, right? But in reality we’re very much the same as energy or health is very much the same as energy and manufacturing, all these things where it takes time for people, for humans to sort of swallow new technology and new processes. It’s like behavior change, that’s why everyone is rushing into behavior change because it takes a long time and it’s hard. Right?
You think you can change your life in steps with a Fitbit on you ass, right? It doesn’t really happen like that. So I think every, so the health industry, when you look at it, there’s lots of these strata. Some move faster and slower. Right? So when you’re in the hospital, god forbid you actually have to go to one, sometimes they’re fantastic and sometimes they’re horrible with a doctor going, “I really care about what you’re talking about,” and their back is to you, their head is to you, they’re typing on the machine or whatever they’re doing or in their dictaphone.
It’s a really ancient experience. It hasn’t changed much when you think about how we treat our conditions. For thousands of years it’s been pretty much the same. We roam around, we eat green stuff, drink water, occasionally have sex and procreate, right? Some people have more sex than others but, you know, as long as we’re feeling okay, we think we’re okay. That’s generally true.
The problem is then this health happens, right? Whether we expect it or not or at least want to have it, and that’s where, you know, you talk about the rate of change. It used to be you go to your tribal leader that had 30 years experience in this, right, so they fix it. Now when you go to the hospital, their changes take a lot longer because there’s a massive infrastructure they put in. That’s why they’re using IE7 or 8 [inaudible 00:08:53] to change a damn browser.
So it’s just the rate of change really [inaudible 00:09:00] the farther you get away from the creamy center. Right? Just the basic hospital systems and you playing the same, you understand that same space. Most people in the developed world, or whatever euphemistic term you want to use, have access to hospitals and they’re the slowest. But the little micro clinics, the doctors who are on their bicycles, their electric bicycles and coming at you with their Android phones and Scanadu’s that’s a different ball game.

Rob: It is but it strikes me as odd that a lot of the companies that are attacking the health industry are looking at things, like mundane things like health records and records management and being able to get the diagnosis into the system faster. But are they really fundamentally changing the process around which we actually get health, well, we learn about our health? They’re not, are they?

Juhan: Well, currently the mighty dollar dictates a lot of how you’re treated.

Rob: Right.

Juhan: Quality of outcomes, not quite as important. It’s like a Ford factory for your cars. You just punch people in, punch people in, go, go, go. You claim your insurance. You get your ICD-10 code. That gets processed. The hospital gets paid, and then you, the physician, gets paid. Rarely has it anything to do with the quality of your service, or the quality of your long term health. They just want to put a Band-Aid or Bactine squirt, or rip something out of your stomach because it costs 50 times more to open you up with a knife than it does laparoscopically.
But now, fortunately, at least in the United States — because that’s the center of my little microuniverse, because the rest of the planet doesn’t matter — the Affordable Care Act and other slower moving laws are attempting to push quality and outcomes, and make them transparent across the public. So then I can go look up how is a hospital doing in treating heart attacks, but at a detailed level, not just are you supplying aspirin and things like that. What are the outcomes, the long term, for every individual. That, I think, is really key to get that change going.
Sorry, to round slowly back to your question. There are lots of different levels of health, lots of big organizations that are hard for them to move. They don’t want to move, because they are in a financial situation where they’re already sort of screwed.

Rob: So if that opens up for the pseudo health companies like I wear, because I’ve tried them all. But that must, we’re starting to see a great movement in the sensor world around wearable technology, not just on the wrist, or on the head, or big glasses, whatever. But they are looking at medical as a first place to attack for wearable fabrics, sensors in the fabrics. Is that why these companies are merging, because they think that there’s a good opportunity in helping diagnostically help health care providers, or is it just commercial?

Juhan: I think it’s, again, a multi-variable problem. In that, one, humans have this innate thing where, in general, these are episodic issues that we have. When you break your arm, or you find something growing in your back, like the radishes are starting to come out of your shoulder, that’s already too late. So it’s these periodic things, these rare spikes that require this extreme intervention.
It’s like management by exception, like all the software world, like seagull management. You come in and poop on people, like the doctors do, the doctor gods, and then you get your micro treatment and then you’re out of there. But that sucks. That’s not the way humans and nature works. Usually nature self heals. We’re trying to fight nature that way.
That’s something that I think is critical to how we’re going to treat health in the future. So you talk about your Fitbits. You talk about all these little micro devices. They’re cute. In the design studio I think that we’ve got 12 of us here, almost everybody has some kind of health device on, whether it’s the Basis watch, or the body media band, which I’ve had on for six years. We have about three or four scales, scattered across, we’re a little insane.
But part of the problem is that the batch of current wearables is that they’re just wearable and require a ton of overhead. There’s this mental overhead that I think requires you to put the Withings Pulse in your pocket every morning, that requires a pair of pants. Sometimes I’m not wearing any. But that’s my biggest beef. For me I call them my “non-
forgettables” because the second you forget it, it’s over. I think the question is form factor isn’t the question, because no form factor really probably hits it on the head. Maybe it’s the implant, but it’s definitely the invisible.
Also when you think about devices, I’m going on a small ranch here, but hardware really is the gateway drug to data for the most part. If you are planning to get into health hardware, it’s almost too late. I’m being a little facetious, but the current device lineup that we’re wearing has little to do with the commodity of hardware, and all about your information decision making. That’s where it is.
So then, the flip side of that is, do off times really matter from a wellness point of view? Imagine having your little Fitbit, or whatever it is. When I’m starting to feel sick, I put it on. Then all of a sudden now that dramatically reduces my symptoms and my duration of sickness by 50%.
Now that’s a device I’d wear. For instance, now it’s just giving me a little bit of insight, allowing me to know my numbers, and then do maybe a slight behavior changes, but it ain’t there yet.

Rob: Yeah, you’re exactly that, and the measure of steps which is predominantly what these things measure, and heart rate, and maybe respiratory, or pulse-ox, or whatever you want to do it, they are in themselves just flat out data, but they’re not, I don’t think those change behavior, right?, 10,000 steps, if I hit those, that doesn’t mean that I’m a healthy guy, right?

Juhan: No.

Rob: It doesn’t, it might be a step towards it.

Juhan: Healthier, maybe.

Rob: Healthier, yeah, exactly. I mean, I’m a healthy guy, I can’t hit 10,000 steps in a day. Who’s got that much time right?

Juhan: Well, you get a walking desk, and then you can do it.

Rob: Yeah exactly. Then I’m dead. Can you imagine doing this walking?

Juhan: Well, I started it, so I have to eat my own dog food a little bit. But like half of us now in the studio have standing desks, because Mayo Clinic like a year ago said that sitting is the new smoking. So then I have a little treadmill underneath there which I probably use only about half the time. Have I noticed a huge impact? No, but I definitely feel a little more energetic, and things like that. But the biggest impact is just standing every day. That is just remarkable.

Rob: Well, I have a, a friend of mine, his name is Worley, he is a co-
founder of an organization out of Austin called “Chaotic Moon”, and I’ve done interviews with him like this when he’s been on his walking desk. It’s like the first 10 minutes are great, and he’s a healthy guy, and then by 40 minutes in he’s got beads of sweat going down his forehead. It sounds like a good idea, but I suppose that is what it would take for me to get to 10,000 steps, I try, I try, I try. But I go to the gym instead.
Okay. So listen, we’ve got to talk about this, is that you said something about health happens. In your presentation there’s basically this great timeline of where we were back in the day, and as you started to explain around tribelders to where we are right now which extends into kind of you know, the way things are diagnosed is a little bit more sophisticated, shall we say, with people who have X-rays, and see inside of the body.
But walk me through that continuum to the point where we are today, and then I want to talk about this kind of life first, health second, sensors, invisible sensors that do everything for you, and report on your health status behind the scenes based on doing things that are everyday, things that we do already like, going pee, right?

Juhan: Yeah.

Rob: So it’s a big swath, but walk through this if you can, from the start to the end if you will.

Juhan: Okay, well, if you look at the couple of thousand years we’re still stuck in this land of episodic treatment right? Both in terms of thinking, in terms of engineering, and designing our health. So humans don’t want to think about health, same as 1,000 years ago. So that hasn’t changed at all.

Rob: No. Well, we’re stubborn. We humans are stubborn.

Juhan: Yeah we’re stubborn, we don’t evolve that quickly, it’s very slow contrary to what we want to believe. But part of what my, the forcing function for me, and how we’re going to become a healthier species, and probably evolve faster, and this is going to get sort of 1984 very quickly is that there’s this idea of a surveillance invasion that we’ve been sort of a part of for the past decade and a half.
The example that I’ve fetishsized, probably incorrectly, is the Voight-Kampff machine? This is something that I mentioned is that in ”
Blade Runner”. There’s that device that the interrogator/judge puts on the table, and is talked with Leon who’s the the skin. What was the, I forgot the term that they used, but he was the robot basically.

Rob: Right.

Juhan: This is this really beautiful, awesome looking device that sat there, that looked right at your eye, and did a retinal scan. It look at sort of behavioral issues. Look, for most part, all that sensor tech, there’s this confluence of engineering, of data analytic maturity, and this hardware durability, and evolution. It’s pretty amazing, and all this miniaturization that’s going on that is really a forcing function for what we’re going to get soon as you know, prediction modeling.
And we’re going to have these types of devices, maybe they’re not going to be look like that, but they’re going to have this retinal scanning. Look at what the X-Box One is doing, the new one, is they’re looking at your BP through the camera, and then directly changing the in-
game experience based on the player’s blood pressure. How freaking awesome is that right?

Rob: It’s crazy.

Juhan: Crazy awesome, but also that just screams the set top box is going to be one of these invisible touch points for you and your health, right? So I think that is like a really fantastic thing. So I think machines are about to sync with humans in a whole new way.
And one of those big ones, which you sort of, you know, hinted about, is peeing. I think the bathroom is really going to turn into this invisible sensor haven. Because shouldn’t it be telling you, after you do a number one, number two, or whatever you’ve done, that your dosage of your medication is too high, or is too low? The room should automatically collect data. Like, you slough off a ton of your biome in the bathroom.

Rob: Yes.

Juhan: And everywhere else, you know? I do my, whatever I’m drinking in my coffee at the moment, I’m sloughing off my unique ID right on there, on the handle. I’m doing that all the time on the counters of my bathroom, and my hair follicles, all that kind of stuff, should be able to tell me more than it does today, which is zero.

Rob: Zero.

Juhan: Right? So I think when we get to this space where health just happens automagically and beautifully, and you get this report in the mirror that based on your eating habits for the past couple days, you’re going to lose three days of your life you’re on, right? Or, guess what, now that we look at it, over the past year, not just those 45 1/2 Twinkies, but the 1,400 hamburgers and french fry combinations just dropped you six years of your life, right? That kind of club is going to, I think, work wonders.
Because the last thing you want to do is take a picture of your food and annotate it, and have a food diary. We know that just is over, right?
It’s just a sign of the technology, that we’re not yet over that hump. But that, I think that idea of it just happening, where there’s, like, no mental or physical overhead, and then you get these regular feedback loops, then I think the bathroom is going to turn into your health room.
And this is a lot like Gattaca. This is a lot like Woody Allen’s Sleeper, that movie with the Orgasmatron. I wish health were that fabulous. But that is just screaming for designers, engineers, and health aficionados to make something that amazing of an experience. Because until we get there, it’s this land of episodic engagements.

Rob: It is. And it’s so fascinating to think along those lines. Do you think that something like that, like that perfect, I don’t even know, petri dish which is the bathroom, do you think that enabling sensors like that is a rich man’s game? Do you think that there’s going to be a greater divide between the people who have those things? Like, the people who have a FitBit, or an iPad, or something like that, versus the people who don’t, who can’t afford it?

Juhan: Well, I think initially, that’s going to be a have and have-not case.

Rob: Yeah.

Juhan: However, what I think is an equalizer there is you see many, many big investments happening in, at least in the United States, on concentrating on the 30 million who are uninsured, who are not having extra cash to go get a microdevice, or even a scale or blood pressure cuff. The second you can nail that target, and that sounds very military-esque, probably not right, but if you can help that population become more in touch with what’s happening in their biology, and make those shifts, and do it beautifully, I think you’re going to have a sea change. Because guess who’s going to take it up when they see results there? I mean, so yes, and technology generally gets cheaper really quickly. I mean, you’ve got, you know, one nanometer resolution spectrometers coming out for, like, $15.

Rob: That’s crazy.

Juhan: That is amazing when, for people with food allergies, they’ve got a peanut allergy, they can just snap a picture of their food — and I’m getting back on the picture thing –or they just wave their phone over it, and all of a sudden it picks up, at the atomic level, almost, or the cellular level, oh, there’s X% of peanut in that, right? And they know that there’s a threshold there, if it’s over .0001% or whatever, that they’re going to keel over.
But that is like a $15 or less kind of technology at the moment. And it’s coming, it’s in the lab now. So it’s not like this is sci-fi at all. The future is here.

Rob: My wife accuses me all the time of being a fanatic around this stuff, right? So, I’ve done everything. I’ve watched what I’ve taken in. I’ve gone through some daily calorie consumption, and balanced that, and I wear one of these things. I’m looking at my sleep patterns, and all that kind of stuff, right? So I’m one of those guys. I exercise quite regularly.
But do you think it’s that there’s this fanatic stage that this happens at, where the early adopters come in and they do all of this stuff, and then they prove out the market? Because it is relatively unproven at this moment, right? All of this technology could be useless, like a FitBit.

Juhan: Yeah, sure. So are we… are some of us now in the front of the S-curve when it comes to this? Sure. But there are things that we’ve known, again, for thousands of years that are good for us, and we still ignore them, right? Because we’re human, and we’re nitwits.

Rob: Because we like cake, man. We like cake.

Juhan: Bingo! I mean, if we ate relatively decent, right? If we had more green stuff in our diet, had the occasional tasty meat stick, right, and had a lot less food in general, I mean, think about the difference in the population health, right? We’re just getting fatter and more disgusting. And this is self-inflicted, right? So we can have all the devices we want, but if we don’t actually move a little more, eat a little better, and eat real food, and eat a little bit less, and there are lots of these tenets which are universal for humans. Start there, and then the technology can just amplify it.

Rob: Do you think we become lazy with this kind of stuff? You know, because you’re right. Whenever you describe that, I think back to that scene in Wall-E where they’re floating up in space because they’ve got… they destroyed the earth, and they had to fly off, and they’re all fat people who don’t walk anymore.
But do you think that we get lazy or we look to these devices or all these sensors as a way of kind of, I don’t know, the quick fit kind of solution? I don’t even know how to describe it. But that, “Oh, I’m wearing a FitBit.” Because I see people wearing a FitBit, and I’m like, “But don’t eat the burger,” right? Or don’t eat that cake, or put the cigarette down. I mean, there’s a conflict there. So do you think we get lazy because of these things?

Juhan: Yeah. Again, humans are really good at justifying in the short-
term, right? And so you mentioned, I’m wearing a device, I’m getting some steps in, I get an extra thousand steps in, and now I’m going to go chow on a huge, massive meat burger that’s been grown on the Cowschwitzes of Texas, right? We also are really bad at looking at the long now. Are horrible at it.

Rob: “Long now.” Love that.

Juhan: I stole that from Stuart Brand, The Clock of the Long Now. So we have to do a much better job at seeing that, right? So that’s why I mentioned, Well, great, if I’m getting these constant feedback loops that I’m not actively engaged in all the time, in terms of putting the data in, and it shows me what kind of life I’m going to live, right, and says, “Hey, look at this. All of a sudden now, based on that last week, it’ll change your life this way,” I think that’s a big sort of moment in health. Versus the micro-justifications that we do every day with these microdevices. It’s a very temporary excuse.
But it fits the biology of our brains, though, you know? We’re hunter-
gatherers at heart, man, right? Let me go stab my food, fricking cook it, and done. You know?

Rob: It’s fascinating because I see people attacking this industry, not physically or verbally attacking it. But they’re going after this in-home market, right? So they’re talking about the connected living room, and the connected home, and everything like that. Then I look at this health side of it, which is a pressing issue. But you’ve got the balance between the home entertainment and the couch-sitters, and then you’ve got the living room, or the bathroom, sorry, as the way to justify your health, or figure out what your health is like.
But it all comes down to, like, an interface of some sort and the Xbox could be that for the living room, and the idea of the mirror on the screen, as your computer readout for your body, and your biometrics, and your health status. But you almost have to take it out of the medicine, out of the medical realm, and put a good user interface on that, like Microsoft did with the Xbox, in order to get it functional.
So your idea of basically sitting back and saying, “You know, those nine burgers you had over the last two weeks cost you 47 days of life.” Is that what it’s going to take for people to turn it around? Is that what we’re looking for, that number?

Juhan: Yeah. Well, numbers can be liberating and dangerous, both, right? So you bring up an interesting point. I mean, part of it is first we need the data, in some ways, right? It’s like we’re getting the bio, let’s do the exercise, or the mental calculus, and envision it for a minute is that you’re getting your biome. You’re doing emotional analysis. You’re doing graph evaluation or these are new technologies that are coming out. Voice analysis, you can use your phone and listen to your voice and tell you in advance if a cold is coming on a week in advance or god forbid you’re getting Parkinson’s or something like this, right.
All these, I think these bots ultimately are going to be coursing through our stomachs and our blood streams at the molecular level and there going to be gathering intel. Okay, so we are going to be seeing disease and conditions erupt at the cellular level. Not when they physically manifest on our bodies when we can see them. It’s too late at that point, it’s too goddamn late. So if health is beautifully integrated our everyday life so that we’re getting these continuous assessments on how to adjust in near real-time, I think that that’s a step one of this whole thing
The step two of that, then you get into this thing of how do we start looking at that data. So I think that where going to have these little services that are, I don’t know what were going to call them, they’re almost like guards, these digital services that pound on my massive data sets and look at prior patterns, look at predicted patterns to identify trends. How do I get healthy? How do I reduce my sickness exponentially?
That going to be the second step because I think that my family and my data are going to activity guarded. Just like Citibank, for me, is one of my banks and they have this anti-fraud detection thing, right?

Rob: Right.

Juhan: Where for $10 a month, it monitors every transaction of mine across spaceship Earth and then it notifies me if something is a little bit off. So I think that this kind of model is going to come a la Netflix where you punch over a dollar or a thousand dollars a month or whatever that deems to be, to look over and protect my data, probably proxy my data, know whose touched it, predict behavior, and tease out my behavior so I can live a longer, healthier life.
So I think that in conjunction with the hyper-personalized medicine where when it detects something at a cellular level that it pops out the medicine at the local pharmacy based on my genome and all my goodies, I just pick it up in a dye pack and good to go. I think those are the two or three steps that are going to help get there.
Now, you talked about the resistance, I think your seeing a lot of resistance from the doctors themselves, the doctor jobs. But ultimately I think what were going to is what Orbitz did to travel agents. Orbitz destroyed the travel agent industry. No long do you go to your mom’s cousin’s best friend who lives in the center of town to book you a flight to the green zone in Iraq. Now you’re saying, “Yep, I’m just doing it online beautifully in the confines of my boxer shorts and tank-top at home.” That is what we’re doing basically in the medical technology design and culture shifts are doing the the doctors right now, and they’re rightfully pissed because there going to have to change dramatically.

Rob: I wonder what happens with this next generation of doctor, the evolution takes a number of cycles to work. But I agree with you that this is ripe for disruption and I wonder why people are focused on, I mean, I can understand why people are focused on the entrainment space because it open, the connected car, the connected home, all of those things that we hear the garage door opening, openers of the world. The Sonos, like Sonos is a beautiful thing or the Hue, which to me is a useless tool, so what?

Juhan: Those are very constrained problems sets.

Rob: Absolutely.

Juhan: Biology is frigging hard.

Rob: Yes.

Juhan: And we don’t know it very well in comparison to like, well, let me pump current through some wires and then have a signal tell it to turn off and on. It’s just a different . . .

Rob: But it’s not cool, it’s not cool like this. That’s the thing is I start to think about what the real impact is of were talking about here around this kind of invisible network, a mesh network almost, of sensors about your life and your existence and you kind of wake up an realize that it’s important and it can have such a massive impact. Then you look over and you see the Hue turning from green to yellow because you’re in a depressed mood, but that is just such a weird place.
I understand that there is a huge challenge getting into the medical industry, changing thing around this thing but I look at the guys that are doing this, huge opportunity. Look at car manufacturers as well. I sit in my car 30 minutes to work, two times a day. What could they be soaking off of me in order to be able to make my life better, right? There are opportunities like that, so you think that it’s just a, back to my very original question, do you think that it’s just the perception that it’s so hard to be, to get engaged in this space, into the medical space that everybody just looks away from it?

Juhan: No, I think your seeing a stampede into the medical space

Rob: Oh good.

Juhan: I mean, I live in a town that 30% of healthcare GDP arrives in the one square mile around the studio.

Rob: Goodness.

Juhan: Healthcare GDP of the United States. Again, I’m United States-
focused.

Rob: Yep.

Juhan: So, I think you’re hearing a massive pile of individuals jumping onto this bandwagon. Plus, there’s been a lot of money thrown at it. I think people care more once they get a little older, past 20, when we’re invincible, and we do no wrong. 30, you’re like, “Okay, I’m pretty good,” and 40, “I’m just finding out that, wow, life is going to hell.” In the nicest possible way.
But, look, the space that we’re in is increasingly multidimensional. It’s not a flat decision space. The lights are a little flatter, and we are also linear thinking human beings. We’re not good at non-linear thinking, so doing all the mental calculus in just understanding this space is hard and really quite difficult. Then, having the biological understanding of what happens.
I mean, I went to an amazing in vitro fertilization clinic last week in New York. I didn’t understand all the biology. Well, I understand the basics of what’s happening there.

Rob: That’s good. That’s good.

Juhan: Yeah. It’s not just in vitro anymore. We’re fetal tuning.

Rob: Yeah.

Juhan: So, we are now designing babies. So, this is the more interesting part to me. I mean, there’s a slippery slope there which we’ve gone down already two decades ago, entered this space. So, it’s over. There’s no going back. But we are actually genetically engineering babies at the eight-cell level. So, it splits once in day one. Day two, it goes to four cells, then it gets to eight cells. On day three, when it’s at eight cells, we’re taking out one of those cells, doing genomics testing on it.
But guess what’s going to happen? We’re doing the dip switches of,
“Oh, this one, CF is present here. Toss those. Oh. You don’t need to toss those anymore, so we can just change almost DNA and genomics on the fly.”
We’re going to be engineering our next species. So, it’s too late for us. We’re screwed.
Our current spawn, probably screwed as well. They’ll live probably 20 years longer than us, but I think that next generation will be the next evolution of the species, whether we like it or not. I mean, you just see it. The fact that I saw that last week in New York was just like, yeah, the future is here.

Rob: It’s happening right now.

Juhan: Yeah.

Rob: I don’t know where to go from here. I want to know, what does this do, you just kind of mentioned it a little bit, what does this do for our quality of life, these kind of advances, this motion towards that? I’m not talking about the two generations from now that can live to 200. But, what does that do, soaking up our excess body refuse, what does that do? I’m analyzing. What does that do for our quality of life? Do you think it does anything?

Juhan: Well, quality of life?

Rob: Yeah.

Juhan: The whole hope of this, I think, this entire movement or, again, whatever you want to call it is that we have a much healthier, longer life. It’s like the analog here is that when you go to K-Mart or Sears or your electronics store of choice, you buy a washing machine. You bring that thing home, and it either dies instantaneously, goes up in smoke, and you get it to the house and it’s over, or it works beautifully for a very, very long time until at the very end, there’s this catastrophic failure and, bam, the thing blows up. It’s over. But, it lasts 20 years. You never have to think about it.
I think, actually, are we there yet in our health system? Hell no. But that’s what I think probably, what we’re trying to strive towards is how can I beautifully live for 100 years, not have this road to perdition after I’m 19, or for women it’s 25 or whatever it is. Guys, we have this short window. Poof. It’s over.

Rob: It’s gone.

Juhan: Like a lot of other things in our life. There’s this road to death. That sucks for everybody. I think it’s this idea where, no, no, no. It’s this idea of this inverse bathtub curve graph. We’re born, pretty good, pretty good, pretty good, pretty good, and then catastrophic failure, and you’re over.

Rob: At the right moment. But you haven’t sacrificed anything in between.

Juhan: Well, yeah, hopefully. I mean, I think there are going to be small degradations there. That’s my hope that’s how we’re designing our health.

Rob: Where are the opportunities here for entrepreneurs at this moment?
The way I see it is that all this data is being collected somewhere. So, there’s got to be somebody, very simply, who disseminates and displays the number, my magic number, for example, whatever it might be. What do you think the opportunities are sitting at this moment?

Juhan: Well, whoever makes the first well-validated prediction model — and I think that’s going to happen in the next 365 days — whoever gets in there, and maybe it’s only 5% wrong or something, whatever that algorithm is, I think that’s a huge opportunity for people, for businesses, is what’s the life algorithm. What’s my prediction algorithm based on what data I know about you? And over time, there’s more and more data coming in, whether it’s my financial data that’s coming in, because that’s already pretty well-documented, because people care much more about their dollars than they do their health. Or their travel, or their home mortgage, or their family, all these things coming in, and they’re like, once someone makes a really good, or at least decent, prediction, I think that’s going to be a really good business model to take off. I think the digital guards, the one I mentioned before, is not horrible. So those are two off the top of my head that are more on the digital side.
I think, also, there’s an opportunity to get into policy here for designers and engineers. Because we tend not to think about policy as much. Whether you’re north of the border, where you are, or a more interesting place on the planet elsewhere, the US, the US and Canada have their issues in terms of crafting policy. It takes an enormously long time. But if you’re not in that game some time in your life, I think you don’t see how the sausage is made.
Also, you get neutered by just dancing on the head of the fashion industry, which is design, and infrastructure, which is a little less fast-
moving. Where am I trying to go with this? You really need to see how policy works, and you need to have a stamp on it. I think it should be required citizenship, or a mode of citizenship, where you have to be involved in that, and see how it affects people.
That’s where there’s a complete lack of design. There’s a little bit more engineering, because you have organizations like IEEE or HL7, or all these guys, or ANSI, that are engineering-focused because they don’t want the pipes that are running our refuse into the Pacific Ocean to break in Nevada, or in Los Angeles. They want it to break way offshore so that . . .

Rob: Up in Canada.

Juhan: Yes. Up in Canada, so it floats upward.

Rob: Yes.

Juhan: So there are more engineering specs. I think there’s a big vacuum for design in policy, as well. So, I mean, that’s another place where it’s not necessarily a big money-maker, but I think it’s something that, as world citizens, we should engage much more into.

Rob: I totally agree, 100%. I mean, it’s an interesting question that you bring up, because a lot of people are focusing on the implications of the technology, the sensor world, and what it can do to the individual. But it has to flow upwards like that.
It strikes me, as I’m listening to you, it’s a weird thing that goes through my head, is that, are we trying to do this to eliminate our decision-making process? Like, it’s almost like, you know what, a lot of people say, is that, “I just, you know, my alarm goes off, it wakes me up. My phone rings, I pick it up. My text message, if somebody sends me a text message, it dings. I get a notification on my phone that the television show that I want to watch is on. I now type in an address in Google Maps, and it takes me there without me actually having to decide turning left or right on my own.”
Now, all of a sudden, you elevate this up, where it’s like, you know what? Hair follicles are going into the sink, they’re getting analyzed. My pee is getting analyzed. All that kind of stuff, and it’s like, okay, eat this, drink this, don’t do this, do this, have sex, go and do this, boom boom boom boom. So it’s almost like what we’re trying to do is we’re trying to eliminate the human decision, because humans are the problem, ultimately, aren’t they?

Juhan: Well . . .

Rob: Is that too big a question for this, you think?

Juhan: No, no, we’re trying to amplify our understanding.

Rob: Right.

Juhan: Right? So I think there’s some people who are going to not want to think about it at all, and they’re just going to set it and forget it.

Rob: “Just give me a pill, and whatever.”

Juhan: Well, I think it’s probably not just a pill, or a device, or a thing like that. I don’t think it’s going to be just that. I think it’s going to be a cavalcade of these services. But I think, ultimately, our education as humans has to really uplevel in terms of health. So we’re down here, doctors are, you know, wherever they are. I think ultimately the water is rising so that we have to get a little more understanding of all this.
The problem here is that we’re sort of swamped with conflicting data currently, right? Where rarely are the artifacts driving decisions coordinated or presented well at all.

Rob: Yeah.

Juhan: So I think we’re in that current state. When it gets to be a more beautiful, integrated experience, I think, then, we’re going to relish having additional amplification aspects to our health. So I’m not saying that it’s hands off the dashboard. But it’s a lot more help.

Rob: Yeah.

Juhan: We can’t see into our bloodstream, right? I mean, we can see, there are a few places. You open your mouth, right? You look in your eyes. Your eyes are an amazing resource to look into, because you actually see blood vessels without cutting the skin. But typically we don’t see what’s happening there, and we need help.
So the more nanobots we have flowing through our systems to say,
“Hey, psst, Rob, Juhan, you may want to get this checked out, or, you know, get a little more information about what’s happening here,” I think the more interested we’re going to be with what’s happening with our bodies.

Rob: Where does it start? I mean, for me, I quit smoking. Like, the hardest thing ever to do on the planet, aside from maybe quitting heroine or, you know, something that’s a little harder than nicotine. But for me .
. . Pardon me?

Juhan: You and Rob Ford.

Rob: Yeah, exactly. That’s right. Well, he’s got his challenges. But when it comes to quitting smoking, I used a product, in 1999. It’s 15 years this March that I quit. But I used a product called LifeSign. And the reason I used it was because it told me when I should have a cigarette, when I should not have a cigarette. It wasn’t like it was a cessation program. I don’t believe in, like, taking nicotine and injecting it into my system in order to quit nicotine, right? It just didn’t make sense.
So it’s a little computer — this is before smartphones — where whenever I smoked, I hit a button, and it said, I smoked, I smoked, I smoked, I smoked. And I did that for a week. Then what it did is, the eighth day, it told me when to smoke. So it timed out the number of cigarettes, and then gradually, over four weeks, reduced my cigarette smoking to nothing. Fifteen years later, smoke-free.
So I relied on that as a way for me to quit smoking. It was the decision-maker. Up to me, I’d still be smoking, because it was so good.

Juhan: Rock on.

Rob: So that was it for me, where I had that moment where I’m like, “I’m okay to relinquish control for the betterment of my body,” right? So now the question is, what is the catalyst for the rest of the human population to be able to go through? Is it that simple? Is it, you know, that low-
level? Where does it start?

Juhan: Well, again, we, as a species, are fickle. And that worked beautifully for you, right?

Rob: Yes.

Juhan: And it may not work for me because of my emotional state, because I’m rather unstable. And that my heroine addiction is going to play as a significant variable in there. The fact that I’m doing X, Y, and Z, right? So I think the idea of not one silver bullet for everybody is going to work. So I think that’s another reason why these hyper-personalized medicine diatribes you hear are actually . . . there’s some relevance there, because everyone’s emotional status alongside their life status is quite different.

Rob: Right.

Juhan: And you’re going to have different things hitting you, and different ways that you’re going to need to be forced into behaviors that you’re not used to sometimes. And that’s not going to work for you, what works for me, right? But let’s face it, there are probably a few basic core tenets that every human should be doing. So I think once we grow from that, there’ll be other ways to sort of rope everyone in.

Rob: Yeah. You know what? I just never take that into consideration, that having the data, straight-up data from your body, and then having the data from your environment, and then having the data from your emotional state. The pressure, right? So you mentioned it earlier. It’s like, how many zeroes in your bank account, or negative in your bank account? What’s your living arrangement? What’s your relationship with your kids? All those kind of things factor into the fact that that hair falling into the sink and analyzed, that’s just one number in a greater, greater, greater scope of challenges that you might have against you, or bonuses against you, right?

Juhan: Yeah.

Rob: Like socioeconomic [inaudible 049:03]. It’s fascinating. I want to end with this one great quote. It was the last slide of your presentation. It says we talk about this, throughout this whole thing, about invisible detection. But you say invisible detection, or when it is visible, it has to be beautiful to engage with, right? That has got to be the key for this whole piece, is that it can’t be a new, learned behavior for the humans. Is that what you mean by that?

Juhan: No. That’s damn close. So, yes, you have to design, when a service is invisible, then that’s one kind of design.

Rob: Yeah.

Juhan: But then when I have to engage with something, it should be designed to feel wonderful because I want to be able to think more about life, and think a hell of a lot less about health and security. I know that sounds a little cheesy but I want to focus on my dreams. I don’t want to focus on health. Who the hell does, right?
So when you touch something, when you touch something, when you smell it, when you engage with it, yes, beauty and elegance and being lovely, I think, is critical. The rest of the time, I don’t even want to detect it. It just happens. So, I think that there’s a combination there which we’re going to have to figure out what plays best.

Rob: Man. You know, I could speak with you all day about this stuff. I’m going to stop here, and then I’m going to have you back on after this technology does emerge, maybe in 365 days or sooner. We were discussing right before, maybe that’s too often for us to connect with. Minds will be blown.
So, goinvo.com is Involution Studios. That is where you are Creative Director, and you’ve got this great presentation at designismedicine.com. That’s where I should send people, to those two spots?

Juhan: Sounds good.

Rob: Yeah. Designismedicine.com, his presentation that he did for UXcamp Ottawa is up there and it is stellar, tells a great story. But what I would strongly suggest you do is show up to where Juhan is speaking is next, where he’s going to be talking about this live, because it’s much, much, much, much greater in person. It’s amazing in person.

Juhan: Well, you’re being too kind. Now, the thing we just released as of yesterday . . .

Ron: Yes?

Juhan: . . . are, talk about some basic things to do, I don’t know if you can see this.

Rob: Oh, hold it up a bit more, yeah. A bit more. Perfect.

Juhan: They’re called “health axioms”. They’re like rules to live by, a couple of dozen mantras for patients in order to change themselves, for them to change the healthcare system. So, it’s open source. You can look at it at Healthaxioms.com. But you can get it on Amazon, and I’m pretty proud of these guys. But it’s just very simple. You talk about the antithesis of technology, right?
I use these with my kids. One of these cards is called “wash your hands,” right? And so, I put it in the mirror in the bathroom to make sure after every visit, wash your damn hands, boys. You know?

Rob: Behavior change just like that, In cue cards, basically?

Juhan: That’s the hope. Just very, very low tech idea.

Rob: Oh, man. Well, I love it. Healthaxioms.com or through Amazon. I love this. I love this conversation, Juhan. I appreciated your presentation immensely when I watched it live. It was stellar. And this has not let down, that’s for sure, so no worries there. I can’t wait until the next time we actually connect in person again, to continue this conversation. Thank you for doing this.

Juhan: It was my pleasure.

Rob: All right. We have been speaking with Juhan Sonin. Goinvo.com or designismedicine.com, or healthaxioms.com. I know you’ve found tremendous value in this, so why not reach out, let me know. Reach out and let Juhan know as well. Just tweet or email, I don’t care. Just reach out and let you know what you thought about of this episode. It would be very, very, very appreciated. But that’s it for this episode. We will see you next time on untether.tv. Thanks, Juhan.


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About Juhan Sonin
Juhan Sonin Involution StudiosJuhan is an emeritus of some of the finest software organizations in the world: Apple, the National Center for Supercomputing Applications (NCSA) and the Massachusetts Institute of Technology (MIT). He has been a creative director for almost two decades with his work being featured in the New York Times, Newsweek, BBC International, Billboard Magazine and National Public Radio (NPR). His designs have enjoyed installations throughout Europe and the United States.

About the author

Rob Woodbridge

I'm Rob, the founder of UNTETHER.tv and I've spent 14 years immersed in the mobile and pervasive computing world. During this great time I've helped some of the most innovative companies grow their business through mobile. If you are in need of a mobile business advisor or coach, connect with me here to get things rolling.

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