Great advice for healthcare entrepreneurs – via Elizabeth Holmes

It was a privilege to see Elizabeth Holmes, CEO of Theranos, being interviewed this week, at the Cleveland Clinic Medical Innovations Summit.  

It was an enchanting 40 minutes of Q&A,  the interviewer was Toby Cosgrove CEO of Cleveland Clinic. It was particularly fascinating as Ms Holmes has been battling intense media criticism of her company in the last 2 weeks.  She gave a robust defense of her company but that is not what I want to share.

The one question and subsequent answer that stood out for me and also electrified the capacious room was this one.

What message would you have for an entrepreneur interested in the field of health care?

I would first understand what you really want to do, what your absolute passion is and why you want to do it

There are a lot of people who make the statement “I want to start a company”

But if you start a company you really have to know why, especially if it is one you want to win with in the long term, because it is really hard.

And in our experience, having done this for 12 years it takes a long time.

So that mission, and it’s a mission that can’t be about you, and it can’t be about any of the great things that can happen along the way, In our experience it has to be about who you are serving and why.

It has to be really really personal.

And when you find that, then you are ready to be able to deal with everything you have to deal with, when you try to change things.

That passion and that absolute obsession with doing something that you would do over and over and over again, even if you got fired, or even if people didn’t pay you, is the answer to being able to build something great.

Elizabeth Holmes October 26th 2015 – Cleveland

Latest Healthcare Innovations

Some recent Health Innovation news

Good examples of patients engaging in mobile health (#mhealth) solutions.  

Diabetes patients have improved outcomes from #mhealth coaching

And this app can apparently prevent heart attacks – at least patients are engaging and demonstrating healthier behaviors as a result

Apple Watch owners seem pretty convinced about #mhealth with 5 out of 6 saying the device contributes to their overall health

We all know about the Proteus ‘microchip’ pill but is Jawbone building a health tracker you can swallow?

Talking of diagnostic stuff, some sweet examples

A smartphone device that can quickly diagnose cancer

An eye-test device on virtual reality screens that could lead to prescription

Turning the Apple Watch into a seizure detector

Outputs from this innovation can flow into the Big Data stream, as Apple expand their Research Kit disease areas to include Epilepsy, Autism and Melanoma (previous disease areas included Diabetes, Asthma, Parkinson’s Disease, and Breast Cancer)

FDA Challenges?

Blood testing outfit Theranos according to the WSJ has FDA and other issues, CEO Elizabeth Holmes hit back last week

Genetic testing company 23andMe Returns with FDA-Approved Genetic Health Tests ‪

Now that is Mobile Health!

Samsung brings its high-tech medicine to the west coast community in  a van 

Advice for Start-Ups #MIS2015

At the Cleveland Clinic Medical Innovations conference

Charlie Lougheed – Chief Strategy Officer at Explorys, acquired by IBM and part of the Watson cloud solution has some great advice for start ups

  • You have to be able to build a team, yes incentives, stock options are important – but there needs to a great mission that they believe in.  They need to believe in you, the CEO
  • Pay attention to companies doing well in the market, what can you learn from them?  And don’t trash them – they may end up acquiring you!
  • Have a support infrastructure available.  Cleveland Clinic were a great support for Explorys and even introduced them to customers
  • Have a good idea, a good one is good enough! Great ideas are usually overrated and distracting
  • On being acquired – is the acquiring company aligned with your mission and a good fit?  If not do your best to keep going and raise more funding

What makes a good client?

I posted this blog about a year ago, it seems to have got lost in a botched wordpress back up

This post relates to the previous post, but from the opposite perspective.  I have not amended it to include the last 14 months I have spent in the US (a separate post is required) but a key observed difference is the business culture here is more straightforward and frank discussions are more welcome.  That can only be a positive in enhancing the client agency relationship.

There is a clear paradox, an agency has to extend a certain amount of respect to clients as without them we no longer exist. Yet if we are too deferential then we move from the role of trusted partner to humble acolyte, which serves neither party in the long run.   So actually candour is very important in the agency-client relationship.

I should stress these are my views; this is less of a disclaimer, more recognition that those in the agency I work for and other agencies are likely to have different opinions and experiences. I will be interested to hear those.

So in no particular order:

Be open and transparent

After signing the required paperwork and being a supposed trusted partner I have had some strange experiences where the client in question must have been working for the FBI or MI5. Everything is on a ‘need to know basis’ Other agencies are working on the project / brand, yet what their role is, is made deliberately unclear. Even the project objectives appear top secret. These are extreme cases, however the more a client can open up about their business & personal goals, and overall approach, the more value a good agency can add!

Be honest

I am not accusing clients of lying here. The damning charge I cite is that they are often too nice! If a client has even the slightest concerns about the project delivery, approach, team chemistry or anything seemingly trivial, then it helps immensely to raise this up front before it festers into a bigger issue. As a client I was fairly candid to my agency partners, in hindsight I could have been even more so!

Be bold

A good agency will respond well to a client who has big ideas and is willing to disrupt the ‘usual’ way of doing things. As a client I found most agencies responded positively to being pushed. And if they don’t, give them some sharp feedback, if that still does not work then just fire them.

Be accountable

There will be times when a client screws up, missing key deadlines or actions. The agency is usually easy fodder for the blame even in a public forum. An agency may be prepared to take the ‘bollix bullet’ on behalf of the client but it is likely to be detrimental to the partnership

Be understanding

Agency folk are human, yet they will work with superhuman tenacity when it is required. The challenge back to the client is ‘does this absolutely have to be delivered by 9am in the morning?’. I have seen thankfully only a few cases where clients have demanded something at short notice, as a way of asserting their power over the agency. Often it is an internal miscommunication on the clients side that leads to an agency team working needlessly through the night. Clearly this can lead to some ill feeling.

Be responsive

Ok I used this one in my previous post as an essential agency quality. It applies equally on the other side. As a client, in the throes of business planning the last thing I wanted was to be ‘disturbed’ by my agencies. I have to admit deadlines sometimes suffered as a result of my tunnel vision.

Be clear

I am hoping as we reach #7 that this list does not already smack of pretentiousness. If any one of the number risks being labeled patronising and high-handed, it is this one, yet too many client briefs are either vague, unclear or contradictory.

From the busy perspective of the client side I have seen the pressures of time lead to incomplete briefs (Note: I chose not to use the word skimpy here) with the assumption that a good agency would ‘figure it out’. An agency’s creative talent should be unleashed on a clear brief rather than channeled into second guessing a clients desires.

Good brief + Good agency = Good result.

Hold your agency to account

This is not meant to sound one sided, rather using a mutually agreed metrics framework to assess project and agency success. This will help frame discussions re: point #2 above.

In the unfortunate event that it is not working out after sustained bilateral effort then it is better for both sides to go their separate ways

I hope the above list was useful and did not engender too much client hatred towards me. Any feedback or thoughts from client and agency persons would be most interesting.

What does a client need from an agency partner?

The below is based on an original post (Oct 2014):

Here are my top 8 qualities (in no particular order) required for a consultancy or agency to best support pharma marketing teams. Despite the passage of time these all feel just as relevant today, however I am interested in any contrary thoughts or indeed qualities I have missed.

1) A partner that is willing to be stretched

A good pharma marketer will contribute ideas and be willing to do things differently, move faster or take a more extreme path in order to be successful. As a client I responded positively when agencies came back to my challenges with fresh ideas and were willing to enhance their offering. I was less positive when agencies came back with the same dogmatic ideas and templated approach that had blatantly been rolled out to previous clients.

2) A partner that attempts to stretch their client

No matter how good you think your idea is as a client, a competent agency should provide fresh thinking and ideas. They should also be prepared to challenge you to take risks in order to make the final product even better. As a client you still need your agency to help minimise these risks and maximise ‘rewards’. The ‘stretching’ clearly needs to be centred on improving the project rather than a self serving ‘upsell’ of more products and services

3) Good collaboration with other agencies

It is rare for 1 agency to do everything for 1 brand. Joint working with other agencies is the norm. As a brand manager it made my life so much easier to have the various agencies working smoothly towards the same goal rather than having to align a bunch of self-entitled primadonnas.

4) Be a link of continuity for the brand

Brand managers come and go, an incumbent agency can provide great support to a new marketing manager by sharing their knowledge and experience. It is important that this process is two way and the incumbent agency listens to the ideas and needs of the new guy. I unfortunately fell out terminally with one particular agency for persistently pushing their own views in a rather high handed way.

5) Be responsive

An agency can have great ideas and do great work but this is undone if the client can’t reach them. I felt frustrated as a client, when an otherwise good partner would not pick up the phone and was slow to return calls. It can be hard to manage multiple clients but no one wants to feel like they are bottom of the food chain, especially when they are paying for a premium service.

6) Attention to detail

As a marketing guy I have seen what I thought were fantastic pieces of agency work undone by a very small number of typos and grammatical errors. This attention to detail is a ‘hygiene factor’ that if not present at the foundation, will ensure all great concepts and ideas come tumbling down.

7) Meet deadlines

Obvious right? Of course work needs to be planned so it hits clients deadlines with time to spare. As a marketing manager it was embarrassing to announce at a company conference, that I could not present the latest working version of a project, rather just some boring screenshots of what it would eventually look like when the agency got around to finishing it. It is of course a partnership and often client processes can increase the risk of a delay. It is up to the agency to hold the client accountable and highlight when their activities or more likely inactivity is holding things up.

8) Understand my needs before the business needs

All marketing managers should be focused on their customers, i.e. the patients and the doctors and of course what is best for the business. However we are human therefore also have our own personal needs. They could be personal development, developing expertise in an area, a fun approach to working, external and internal recognition or something else entirely. An agency absolutely must know what drives their client on a personal level. The agency can deliver projects that smash every business KPI but if they neglect the clients personal needs then they have failed.

Quantified Self Meetups

I try to get along to as many London Quantified Self Meetups as I can. Most of the presentations are very interesting.  The discussion of peoples unique experience in personal experimentation is usually fascinating (If like me you are interested in that sort of thing!)

What is great, especially if you can’t make a meeting, is that all talks are recorded.  Ok you miss out on the interaction, questions and networking but it is still a great resource.  Thanks to Ken, one of the organisers for making this happen.

The archive of Videos and Presentations can be found here.  I would certainly recommend having a look.

And of course in the true spirit of self promotion I have embedded my recent quantified self video and presentation below🙂  Of course I hope it is interesting, but if not you have plenty of others to choose from! Maybe see you at the next #QS Meet Up🙂


A Wikipedia Geek

After my previous Wikipedia post I became curious to see what was going on with Pharmaceutical company Wikipedia pages.  I submerged myself in some geeky analysis, using data from Wikipedia.  I confess I rather enjoyed it.

There is a lot of discussion around Wikipedia being used to look at Pharmaceutical products but less so about Pharma corporate pages.   This is clearly understandable from a patient and doctor perspective however there is a significant PR consideration for companies and ‘their’ prominent Wikipedia entries.

I have attached slides below from my analysis that (sadly perhaps) enthralled me, however I hope you at least find them interesting.  Before that a quick summary of the main findings:

  • The bigger companies Wikipedia pages are seen over 1000 times per day
  • GSK has the most edited Wikipedia page however most pharma co’s will have their pages edited every few days
  • The number of Pfizer edits has dropped by 55% in the past year and those for Novartis has increased by 63%
  • Pfizer & GSK have the most ‘watched‘ pages but all Pharma pages will be watched by many hawk-eyed Wikipedians
  • There are a relatively high number of editors but a small kernel has a disproportionate influence
  • The number 1 editor of both the GSK & Pfizer pages has a very high proportion of edits and a very significant individual influence (interestingly he did have, he is now blocked by Wikipedia)
  • All companies have a well optimised owned media presence and opportunity to increase visibility on their corporate sites

Pharma companies have an opportunity to work with the Wikipedia community to correct inaccuracies in the corresponding Wikipedia pages.  They should also ensure their own websites are of sufficient value to attract and retain those who are searching for information about their company

Enjoy the slides!


A Wikipedia Week

Wikipedia seems to be attracting even more Pharma interest in recent weeks, particularly as a recent IMS report highlighted how much doctors and patients rely on its content.

It was a pretty immersive week for me last week regarding Wikipedia:

  • A breakfast meeting on the subject
  • Meeting up with some devout Wikipedians over Sunday lunch
  • Finding a little time to make some edits of my own (non pharma related of course)
  • Personally fielding some professional questions about this fascinating community of knowledge

I saw an excellent presentation from, Paul W , a veteran Wikipedian, with 10 years tenure, over 10,000 edits and nearly 400 articles to his name.  He is also a professional PR guy.  You could be forgiven for thinking that these 2 personas would not sit comfortably in the same room, let alone in one human shell.

Paul shared some valuable Wikipedia guidance for PR agencies, that demonstrate PR & Wikipedia are not incompatible entities, as long as the right approach is taken.

These guidelines actually make very useful reading for those in Pharma.  Page 10 is particularly interesting as it outlines the steps required when editing.  There is also a nice summary of Do’s and Don’ts.

These guidelines were created collaboratively on an open Wikipedia page, with input from the community.

Meeting ‘real life’ Wikipedians was an interesting experience.  My discussions with them reinforced the need that anyone with a conflict of interest needs to work with the community to make edits.   I met an administrator who proudly declared he had deleted over 100,000 pages.  While this deletion count seems to be a badge of honour, the motivation behind this, is ensuring Wikipedia, is of a high quality and authored from a neutral point of view.  So any ill advised attempts by Pharma to blunder in and start editing drug or disease pages will inevitably backfire.

Some of my Wikipedia recommendations:

  • Work with the community.  Wikipedia is written from a neutral point of view (one of its five pillars ) The premise is that if you work for a Pharma company, then your opinion about that company, one of its drugs or disease areas, will be biased.  The solution is to work with the community to develop content, identify suitable editors who have contributed good quality articles on similar subjects, suggest articles for creation, use forms to request an edit or use the talk pages.
  • Be transparent and declare conflicts of interest  If you try to contribute under XPharmaCo it won’t work and rightly so.  Corporate or group accounts are not allowed on Wikipedia. It should be, for example, Rebecca, who, on her user page, clearly states she works for XPharmaCo, outlines her conflicts of interest and intent.
  • Be human  You need to speak like a person not a corporation.  Any attempts at corporate speak or a heavy handed approach will simply be met with contempt.  Wikipedia is not a corporation rather a community of dedicated volunteers.
  • Be bold Industry regulations are unclear when it comes to Wikipedia.  Take a clear ethical and considered standpoint.  You will need to have a plan however don’t expect clear regulatory guidance. The UK PMCPA digital guidance spectacularly misses the point, suggesting if a company starts editing Wikipedia it should ensure everything is correct.  I am afraid the community and consensual nature of Wikipedia makes this impossible to guarantee.
  • Have a go If you think Wikipedia is of interest why not try editing it yourself!  You may also want to look for volunteers in your organisation to start making edits.  Clearly these edits need to be outside of any conflicted area and the above bullet points still apply!

I look forward to hearing your opinions or examples where Pharma is currently or is planning to get involved with the Wikipedia community.  And if you have any suggested edits for this blog just let me know…



Social Media in Pharma – Making it Happen

Last week I presented at the SMI Social Media in Pharma meeting in London.  I got some nice positive feedback that the cases I presented were both practical and useful.

So I have embedded the slideshare deck below complete with speaker call outs.  Feel free to comment on this post or on slideshare.  Happy viewing🙂




Is the Swiss Healthcare system just perfect and the NHS, well just the opposite?

When I visit Switzerland, it is immediately obvious that everything just works.  It is quite tempting to make damning comparisons with my homeland.

Ignoring the obvious one, about public transport that actually runs on time, I cast my mind to the Swiss healthcare system.

Apparently it is an example to the world, of how a healthcare system should be run and the US affordable care act has at least, been partly modeled on the Swiss system.

Some may say it is unfair to compare the respective healthcare systems of the UK and Switzerland due to the latters relatively low population size and high wealth per capita.  But who cares I will do it anyway.

I should say I have never received medical treatment in Switzerland and the below is formed on an interesting report I read, some discussions with end users of the system and a doctor friend who is based there.

Some points I picked up about the Swiss system:


  • It is private, however it is means tested, those with reduced incomes pay lower premiums, or in some cases have the full premiums met by the government
  • Insurers can’t discriminate based on pre-conditions, risk or age and must insure all applicants at the same rate
  • The Swiss have to make a contribution. In a given year an excess (or deductible) of anywhere between CHF 300 and 2500 is paid towards treatment, with premiums adjusted accordingly.  They also must make an additional copayment of 10% of the total costs, up to a cap of CHF 700 (at the time of writing one CHF is worth slightly more than one US Dollar)


  • In this private system the patient is king.  If a doctor does not offer an appointment at a convenient time or the right service, the patient can threaten to go somewhere else or indeed do so.  Swiss patients are treated like customers, because, well they actually are
  • Things happen quickly.  A Swiss patient can make a same day or next appointment with a GP/PCP.  Blood tests, for example, can be taken and results delivered on the same day. At my primary care practice, it takes me 1 week to get an appointment with the doctor, a further week to get an appointment with the nurse to take the bloods and another week to get the results.  So 1 day versus 3 weeks
  • Urgent MRI scans can be booked in with results the next day
  • A broad range of investigations happen at the primary care doctors office.  e.g. stress ECG tests and ultrasounds


  • The impression I get, is not that the Swiss have the most advanced and innovative individual pieces of health technology, rather the system fits together and actually works
  • Doctors don’t spend their days chasing after test results.   IT systems in the same hospital can actually talk to each other.  This is a direct contrast to the experience of UK doctors in my recent video blog post

There are of course big differences between the 2 health systems.  The Swiss seem to accept making a contribution, often up to 25% of the total costs.  The English would no doubt hate the idea of paying, even though we do anyway, via our national insurance contributions and taxes.

The NHS is changing but surely the top priorities are to:

  • accelerate the patients transition to a customer of health and wellness
  • make sure the technology works, in an integrated way and reduce some of the huge inefficiencies

I am interested in comments or thoughts, from Swiss, English, patients, doctors… or indeed anyone with an opinion.

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