Musician D.A. Wallach Is Out to Disrupt Medicine

Editor's Note: Although medicine was not his initial career choice, 30-year-old D.A. Wallach now stands to have an outsize impact on the field. In this One-on-One interview, Medscape Editor-in-Chief Eric J. Topol, MD, talks with the musician-turned-investor about his plans to disrupt and democratize healthcare.

From Harvard to Touring Musician

Eric J. Topol, MD: Hello. This is Eric Topol, editor-in-chief of Medscape, and we have a very special guest today for One-on-One. He is one of the most interesting people I have ever met.He wasn't in the medical community until recently, but that provides a fresh perspective, somewhat like when we had Malcolm Gladwell here, who isn't in the medical community but has many great ideas about how we can improve medicine. D.A. Wallach is a musician who went to Harvard University, majored in African-American studies, and somehow made some very special connections there within the music world. Tell us a little bit about that.

D.A. Wallach: In my freshman year of college, I started a band. For 4 years, we were basically trying to figure out how that could be our job when school ended, which is a difficult thing to do. Not many artists get the privilege of doing it professionally. It was looking like I might have to become a management consultant or an investment banker, and then right under the gun, 2 months before we graduated, a couple of very famous artists heard our music and offered us a chance to do it for real—Kanye West and Pharrell.

Dr Topol: Were you in the same class as Mark Zuckerberg?

Mr Wallach: I'm 1 year younger than him, but I knew him in school. In fact, it was missing out on Facebook that taught me my first great investing lesson, which is that you should recognize when something is working under your nose. I was one of the first 2000 users of Facebook and knew Mark, but my only interest in knowing Mark was wondering, "How do we use this Facebook thing to promote our band?" It never occurred to me to say, "Do you need $1000 to keep the servers on for another month?" Anyway, that started me on a trajectory of trying to think about how we could use technology to build our audience and be intelligent as a band.

Dr Topol: That was the Chester French band?

Mr Wallach: Exactly.

Dr Topol: Where did it go from there after you made those really hot contacts?

Mr Wallach: That was in 2007, about 9 years ago. It was a long time ago in my world. We moved right out to L.A. as soon as school finished, put out a couple of records, and toured for 3 1/2 years. We were touring with Lady Gaga, Weezer, Blink 182—huge artists who were much bigger than us. We were the opening act.

Dr Topol: You were the warm-up act?

Mr Wallach: We were the ones who were out there while you're looking at your watch, thinking, "Geez, when are they leaving so the real thing can come on?" Then, about 4 1/2 years ago, I decided that I didn't like living in a tour bus. I enjoyed Los Angeles and wanted to hang out there and spend more of my time focused on things outside of music. I still make music, but I started thinking about what I could do in technology as an investor or in the context of companies that I thought were exciting.

Dr Topol: Obviously, you're very modest. As an accomplished musician, you've been featured all over the place, from Rolling Stone to Vogue, and you've been on late-night television with Jimmy Fallon and Jimmy Kimmel. You've been all over the place.

The Destruction of the Music Industry

Dr Topol: You have a lot of interesting parallels that you've conceptualized between the music industry and the healthcare industry.

Mr Wallach: Basically, the music industry has been destroyed over the past 30 years by the Internet, or, more specifically, by the failure of the industry to respond to the Internet.

In the early '90s, Napster and other piracy services came onto the scene that let consumers get all the music that they wanted for free. Naturally, people liked that and stopped paying for music. The record industry and many of the artists rebelled against this because they were morally indignant about the theft of something that had been protected property. I can't blame them for that type of moral response, but on a practical level, they failed to figure out a way of monetizing this new consumer behavior that people really exhibited, which is to just search for a song on your computer and get it right away.

It wasn't until Steve Jobs figured out how to build a business model around that, and he launched iTunes. In the subsequent 15 years, iTunes has become the number-one retailer in music. That is, until a few years ago when I got involved with a company called Spotify. Spotify had the next-generation version of this. Instead of paying for individual songs or albums, it allows you to pay a monthly subscription fee and consume all the music that you want. You can do it on your phone or your computer.

As an artist and as someone who has been involved in Spotify, I've witnessed all of these changes in the music industry, which is a really complex and tough business with all sorts of big egos and tough incentives to balance between stakeholders. After learning about that business in depth, I turned my sights onto the wider world and tried to think about other industries that could benefit from similar types of—the overused term is "disruption"—but, frankly, industries that are having trouble helping themselves. I think healthcare is one of those industries.

Disrupting Healthcare: The Three-Bucket Model

Dr Topol: Where do you think healthcare can go?

Mr Wallach: As I've been looking at healthcare companies as an investor for the past year or so, I've created three buckets in my mind in which to categorize things. The first bucket is for people who are putting in the work to fix stupid stuff that we're doing. There are all sorts of things in the healthcare economy—for instance, like that nobody knows the costs of many things. Literally, hospitals have no idea what an hour of your time costs them. They could do the analysis, but they don't really know. Different insurers who usually foot the bill are paying different prices for the same things. These are the types of complaints that surfaced in the debate about the Affordable Care Act, which I think was a really impressive moment for our society because everyone turned their attention to this. I think that we're still riding on the momentum of it. It got people excited about fixing this system.

The second bucket is a little more interesting to me because it looks at the technology that is out there. You've been a leader in outlining how people can do this. We've got all of this amazing technology at our disposal that we're using in other industries: sensors, wearable devices, and big data and analytics, broadly speaking. Just applying these technologies that are well developed elsewhere to healthcare can produce an enormous amount of savings and patient benefit.

The third bucket, which is what I'm most excited about, even though it's the hardest to predict, asks, what does the future of medicine look like as a science, and how does the speed with which we're going to be able to understand how the body works impact our ability to intervene with things that happen in our bodies? There are brilliant physicians—and you're one of them—who understand everything that we know right now about, for example, the heart. Basically, medicine occurs at the mechanical scale today, when, in fact, the things that kill most of us are effectively molecular diseases. My big bet long-term is that we have to figure out how to understand the way the body works. Right now, the methods that we're using to advance that understanding aren't fast enough.

Consumers Need to Take Charge

Dr Topol: We met because, through a mutual friend, you read The Patient Will See You Now, and we said, "Let's get together."

Mr Wallach: Yes, it's one of my favorite books.

Dr Topol: Thanks. You obviously understand the consumer side of things. You were out there in the real world on a road tour and you, of course, were involved very much with Spotify. Where and how can the consumer get activated to take charge more in medicine—not at the individual but on a broader level?

Mr Wallach: Not only is it a good idea for consumers to be at the center of their care and to take charge of it, but it's a numerical imperative right now. We just don't have enough doctors. Look at other industries that have been affected by technology, like taxicabs with Uber. We've just seen this revolution explode in the past 5 years. Basically, the problem was that cities were artificially limiting the number of taxis that were out there, so everyone became accustomed to believing that it was too expensive and impractical to call a car. The only Town Cars you could get were very expensive. People came to believe that there wasn't even a market for on-demand rides. It was just a thing that rich people did.

I always loved that quote—I forget who it was, but the idea is that the future is already here; it just isn't evenly distributed. You can look at the way that rich people engage with the healthcare system right now. Sheiks from Abu Dhabi, for example—and I'm sure you see them at Scripps—folks who have unlimited amounts of money have a wide network of physicians. They basically manage their own care. They talk to experts all the time and they pay whatever it costs to get access to them. They make really informed decisions about their own care management.

I think the future is all about empowering every person in the world to have this ability, but in order to do that, we have to take medical knowledge out of the best physicians' minds and somehow productize it as technology. My assumption is that what a really terrific physician accumulates over decades of experience is effectively an algorithmic approach to thinking about a lot of diverse scenarios regarding peoples' health. If we can extract that knowledge from physicians and democratize its accessibility to people by turning it into scalable technology products—this is all fairly general, "pie in the sky" talk, but I think there are ways to do it.

The Tesla of Healthcare

Dr Topol: You also had a concept of the Apple and Tesla of healthcare. What would this look like?

Mr Wallach: Tesla is a very interesting company. It's an inspiring model because they've said, "Look, we have to get electric cars for everybody. We all know this is the way we should [drive], but it's very expensive right now. So what we're going to do is build products for rich people because they value the status that comes from being an early adopter and they're going to basically subsidize the future for everybody else." I think this is effectively what could happen in healthcare with things like genomics and proteomics and all types of complex data problems.

We know that all of these things are pieces of the puzzle, but you hear physicians say things like, "Why would you get your genome sequenced? We don't know what to do with that information." But then you have a chicken-or-the-egg problem, which is that if everyone thinks that way, we will never know what to do with the information. You have to extract data from a lot of people in order to derive insights that you can act upon. I think that the cutting-edge things that we know we could do in medicine should initially be made accessible to people who are price insensitive. A great company could build around delivering to them the highest-quality care possible on a large scale.

You see some of the more advanced concierge physicians doing this type of stuff, really innovating around customer experience. There is a group called Private Medical that my friend, Jordan Shlain, runs. They've done a great job figuring out a model for rich people to get care that is extraordinarily convenient, respectful, high-quality, and almost luxurious. From those types of businesses, we can extract ideas that can be systematized on a larger scale for more and more people.

"Why Is the System Making It So Difficult for Me?"

Dr Topol: You had an experience with your wrist and the possibility of needing surgery. Can you recapitulate that?

Mr Wallach: Yes. A few years ago, I was trying to learn how to snowboard. I obviously didn't learn well enough, because at the end of the 3-hour lesson, I fell and broke my wrist. I asked around and someone said, "This is the best wrist guy in L.A." I went to see him at UCLA. After a 2 1/2-hour wait—typical—he looked at my x-rays and said, "You have two options. Either I can operate on this on Monday and it's definitely going to heal—it'll be fine, there is a trivial chance of infection—or you can come back for imaging every week for the next 9 weeks. But if it moves at all, I have to operate, so you might as well just get the surgery." I thought, "I'm weird about needles. Surgery seems like a big deal—I don't know if you're really experiencing the pain while you're being operated on and then just forgetting it. That's scary to me."

It was a bigger deal to me than it was for him, a guy who does 30 of these a day. So I saw another physician in L.A. who was much more methodical and analytical. He wanted more pictures and different pictures. After thinking about it for a long time, he concluded, "If you were my son, I wouldn't operate. I'd see how it heals. I think it's going to be fine." Unfortunately, this doctor wasn't in my insurance network, so I paid out of pocket. Seeing him for a couple of months cost me a couple thousand dollars, which is nothing to sneeze at. Despite that, it saved my insurance company an incredible amount of money because they didn't need to operate. In fact, the insurance company would only reimburse for his services what their negotiated rates were for their in-network doctors. He might have charged me $400 for a visit, but they said, "If he were in network, we only would have paid him $200, so that's all that we're going to apply against your deductible." This was one of these experiences that, to me, seemed so irrational. I thought, "This was great for the insurance company. It was great for me. It was great for the physician and the health system because they didn't have to do an expensive surgery. So why do we have a system that would make it so difficult for me?" If I didn't have the $2000, I couldn't have done it. I would have gotten the surgery.

Organized and Accessible Medical Records

Dr Topol: When we first met, one of the things that you presented to me, which I was really struck by, was the fact that you had all of these medical records on your mobile device—scans, hospital/clinic notes, and lab tests. This was PicnicHealth, one of your investments. I contacted them and tried it. I got 25 years—in three different cities and 25 different doctors—everything that has ever happened to me, connecting the dots from every lab test and scan right to my phone. And I'm saying, "Why doesn't everybody have this?"

So what is holding us back?

Mr Wallach: If we go back to my three buckets of problems, the third bucket is futuristic medicine—that stuff that only gets funded and executed by people who are really intrepid. They believe that in the future there is something unknown that we should be chasing after that is going to be amazing. So, for that one, we just have to rely on crazy thrillseekers.

Bucket 1, the stupid stuff that we should stop doing, like not giving everyone all of their records in this way—it's a no-brainer that we should do that. It's impossible to imagine a downside to that. Bucket 2, which is applying existing technologies: These are interesting business problems to me because it's hard to find an industry where, if you get smart and capable people to just do the work, it's almost guaranteed to succeed. There are so many opportunities like this. That's not to say that anything is a sure thing. Companies fail for all sorts of reasons. But I actually think the biggest problem is attracting smart, capable people who could go and start what might seem to be a much sexier company in a much sexier industry. Noga [Leviner], who runs PicnicHealth, went to Stanford and is in the startup world in San Francisco. She has Crohn's disease and so it was her own experience that brought her this idea. She was managing relationships with so many different physicians over a long period of time. Getting people like her the capital and the support from the community, like the support you've provided in just endorsing and using her product, is the way that we can attract more talented people to the healthcare industry. I think that's all that is holding it back.

Dr Topol: The old adage that "It's not the stagecoach drivers that are going to build the railways" is what we're seeing here. We have evidence of tech titans—the likes of Google, Apple, IBM, and Microsoft—coming into medicine. We have extraordinary talent like you in the music industry and other sectors of the world that are coming into healthcare because this is like the last frontier. It's so messed up. We need people like you.

Mr Wallach: Thank you.

Dr Topol: It's very refreshing to hear your views and some of your experiences. You are the youngest person I've interviewed for Medscape One-on-One, only 30.

Mr. Wallach: I'm honored.

Dr Topol: Congratulations on just getting married.

Mr Wallach: Thank you.

Dr Topol: It's people like you—the way you think, the refreshing perspective that just isn't within the community—that's the kind of stuff we need for medicine to heal.

Mr Wallach: It's easy because I read your book and then I go and summarize it for people at lunch conversations, and they think I'm a genius. Keep writing, or I'm going to run out of ideas.

Dr Topol: You're very kind. And you're very kind to do this One-on-One interview.

Mr Wallach: Of course. Absolutely.

Dr Topol: Maybe the medical community doesn't know D. A. Wallach, but they will know you more in the future. Your impact, as you have had in music, is likely going to be simulated in the medical sphere. Thanks very much.

Mr Wallach: Thank you. I appreciate it.

Dr Topol: Thank you so much for joining us for this Medscape One-on-One with a very interesting person who did not have his original career in medicine but is now starting to have a significant impact.