The Future of Health with Dr. John Mattison

Charting the Future of Health: An Interview with John Mattison, MD

Our CEO Paola Telfer recently sat down to interview John Mattison. In this piece, he shares his insights as a recognized thought leader and sought after speaker on the future of medicine, data privacy and wearable technologies. John brings a unique blend of deep medical and deep technical experience to the Sens.ai science advisory group.

Please tell us about your background.

I was an evolutionary biologist and marine biologist before I decided to go to medical school, and then became board certified in internal medicine and critical care. Practiced internal medicine, critical care, trauma medicine, helicopter medicine. Started the hyperbaric medicine program at UCSD, was one of the original physicians for the Life Flight trauma system.

Practiced thyroidology in the endocrine clinic, practiced preventive medicine and primary care and was director of a critical care unit before I moved to Kaiser Permanente, where I became a primary care internist and practiced for a couple of decades.

But simultaneously, I moved from a full-time clinical position into a full-time informatics position, and then led all of the digital transformation, including electronic health records, clinical decision support, machine learning, natural language processing, in systems from laboratory, to a hospital, to pharmacy, to ambulatory outpatient health records, to inpatient health records. And everything associated with that including writing strategy for data centers, writing the strategy for cloud computing, and co-leading the virtual care initiatives for Kaiser Permanente at the national level.

I left there two years ago to join Arsenal Capital, where I serve as an operating partner and chief medical information officer, advising and consulting, and helping both due diligence on interesting healthcare and health tech companies.

I have taught at numerous medical schools, universities, and teach leadership and health technology to physician leaders at UC San Diego. I teach every year at Singularity University in the Exponential Medicine course, and have been very active in interoperability. I'm the founder of the XML standard for interoperability known as the clinical document architecture in the CCB, the continuity care document. And I've been active in genomic standards, and co-chaired the committee with Andrew Morris of the UK on translational medicine for the Global Alliance for Genomics and Health.

And I understand that you have contributed to many health technology publications and conferences.

Yes, I have authored papers on various aspects of health technology, privacy, ethics, genomics, machine learning and personalized medicine, and co-edited a textbook on medical informatics. I also speak at many health tech conferences about how we are converging exponential technologies including genomics, microbiomics, machine learning, and advanced decision support to help personalize care for every individual while protecting privacy.

What do you consider the pillars of the future of healthcare/wellness? What does this mean to the individual?

The covid pandemic has accelerated the use of virtual care, but has also led to more disintegrated care. We need to focus more on advancing how we safely integrate care whether it is delivered in a hospital, clinic, remotely at home, or through self care supported by wearable sensors and furthering interoperability of data from all sources. As we begin to monitor our health and healthy habits more carefully, every individual has a better opportunity to become more active in managing their own health.

What it means to the individual is that everybody has the potential to live to be 100 years old, and it really depends upon how you manage your life, and your lifestyle, and your stress more than anything. But when we have specific genetic vulnerabilities to things, it's still relevant to pursue personalized medicine and precision medicine in ways that allow us to adapt specific interventions for specific people. These are not necessarily even the same for identical twins - identical twins don't necessarily have identical outcomes.

Let’s dive into prevention a bit.

Prevention is a key pillar of the future of health and wellness. The biggest opportunity is clearly to support healthier habits in everyone. Dan Buettner demonstrated in his book Blue Zones how the healthiest blue zones on the planet achieve long healthy lifespans. And it's fairly simple: healthy diets, regular sleep, regular exercise, and healthy social communities without relying on drugs, hospitals or doctors.

Dean Ornish, MD demonstrated decades ago that helping people change their basic habits and lifestyles can not only halt the progression of disease but can reverse major diseases like cardiovascular disease, obesity and diabetes. Changing bad habits is difficult, and we need to focus much more on cultivating and supporting healthier habits earlier in life in our children. We live in a very complex world with many sources of stress. It is critical that we build resilience to stress in all of our preventive care. One of the best proven methods for achieving that resilience and health is through meditation.

Can the proliferation of consumer Wearable technology really help in prevention?

Yes. We need to simplify and coordinate how complex sensor information is translated into simple actionable information to the individual so that they can incorporate this information directly into how they eat, sleep, exercise and socialize, where they live, work, play and pray. The more each one of us ‘owns’ our own health the less disease we have, and the more that we can reduce the demand on our healthcare system. Reducing the demand on the healthcare system from avoidable disease allows our resources to be directed to preventive measures, which is ultimately more cost effective. We need every individual to embrace healthier habits so the healthcare system can support the health of entire populations.

What characteristics do you look for in a consumer wearable? What is the potential of Wearables for society at scale?

The more we build in mindfulness and awareness, the better we can be to modify our habits intuitively and automatically, rather than with a system of nanny alerts. So what we don't want to do is be constantly reminding people to improve their posture, to eat better, to sleep better. What we want to do is give them the tools to embed new habits in their firmware - in their brains - so that they do the right thing the first time instinctively, and reflexively, and automatically, rather than in response to alerts.

Because alerts induce alert fatigue, whereas mindfulness guides our life journey in ways that are very self-sustaining, and very gratifying when done properly. So there's lots of bad applications and digital health technologies out there that much more resembled a nanny device than a mindfulness conditioning device, and so we need to be much more aware of the necessity of using the devices not to monitor people, but to teach them how to monitor themselves and automate their performance towards wellness.

If we could just get rid of bad eating and exercise and sleep habits, we could crush the pandemics of obesity that have swept the world in just the last hundred years. I mean, it's amazing if you watch video sporting events, or any sort of crowds or marches or demonstrations from 50 years ago, there are hardly any single obese people in a large crowd. And yet today, you look at videos of large crowds, and the majority of people are significantly overweight. Achieving the ideal body weight is not a goal.

That's a collateral benefit of living healthy, and it's a marker of all the underlying inflammatory conditions of the immune system, and the dysbiosis in the gut, and all of the sequelae of poor habits in obesity, including diabetes, dementia of many forms, cancer of many types, heart disease, stroke. Those are all derivatives of unhealthy lifestyles. And so the promise of prevention is to intervene in all of those.

There's just an explosion of information that can help us better understand the state we're in, and help us become more mindful about managing our stress level, managing our attitude, managing our mindset, managing our whole self, and in doing so we can help manage those around us in ways that are healthy for them as well as for us. So there's a network effect, of the more people we surround ourselves with, and the more people we cultivate in our surroundings that are leading healthy lifestyles, the better our lifestyle will become.

The first time, the network effect of leading healthy lifestyles was really documented in beautiful detail was in a book which has an online version called Connected by Christakis and Fowler. And what they showed is that disorders of lifestyle like obesity are actually contagious diseases within social networks. And they actually animate, and you can look online at the online book version, and watch how obesity propagates through a network.

And people who work in a company where everybody's obese tend to gain weight, but if they leave that job and go to a company where people are riding their bike to work and tend to be healthy, their weight drops. So what we consider lifestyle choices are actually contagious diseases. So how do we capture the network effect for not only each individual, but their social contexts?

What do you recommend as the principles of a good data privacy policy? How should companies strike that balance between health data privacy and scientific innovation?

The dilemma is how to provide access to detailed health data while preventing the re-identification of individuals from those detailed data, resulting in privacy breaches. There are a variety of efforts to improve our ability to pool healthcare information to innovate new discoveries and new solutions, while protecting the privacy of the individual. There are not simple solutions, but there are promising technologies like blockchain, federated databases with credentialed access, and multiparty authentication protocols or homomorphic encryption. Social media is not exactly a safe place to expose your personal health information if you are concerned about privacy.

What we need is some simplifying measures that allow for companies to declare how they conform to a standard set of practices, and how their compliance with those practices can be measured, and certified, and validated, so that it's more apparent and transparent to the consumer who they can trust for what, and who they can't.

Covid has no doubt accentuated some of our societal problems and yet accelerated certain exponential technologies to solve for these. What medical advances may not have otherwise happened as soon?

The biggest advances catalyzed by the pandemic include the widespread availability of virtual care and video consultation between individuals and their care teams. What remains to be done pervasively is the integration of all your health data no matter where you are seen so that each physician caring for you has access to your complete health record. Making key health decisions with only pieces of your health information can be dangerous. We need to close the loops between all sources of data and venues of care for each individual, while preserving privacy. When we have all that information, we can more safely implement algorithmic support for optimal decisions.

Some of the greatest social benefits of this approach are the better access to care, greater equality of care across socioeconomic boundaries, and lower cost of care to both individuals and our country as a whole.

Why did you join the Sens.ai advisory group?

One of the most disturbing aspects of the Covid pandemic has been the increase in two serious issues: behavioral health issues across all ages, including depression, anxiety, and PTSD, and burnout of health care professionals from being chronically overwhelmed. We need to build greater emotional and stress resilience in everyone including all members of the healthcare team. There is rigorous scientific literature proving that regular meditation helps reduce stress, lower blood pressure, and provide longer healthier lives.

But not everyone finds it easy to use traditional methods of meditation. What Sens.ai has demonstrated is that we can provide the benefits of meditative states quickly and effectively for anyone, whether they’ve ever tried conventional meditation methods or not. This technology can be much more accessible to anyone so that the proven health benefits of meditation can be realized inexpensively and at scale. Sens.ai has enlisted the support of an advisory board with a wide array of expertise, focused on advancing the health of both individuals and entire communities.