Breathing life into innovation

Credit: Dr David Van Sickle

This is an interview I did back in 2016. Dr Van Sickle, PhD, is the co-founder and CEO of Propeller Health, a Madison, WI based company that develops digital health programs for chronic respiratory disease. Previously, Van Sickle was a Robert Wood Johnson Foundation Health and Society Scholar at the University of Wisconsin School of Medicine and Public Health. From 2004–2006, he was an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention (CDC) in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. Van Sickle received his PhD in medical anthropology from the University of Arizona in 2004. In 2011, he was named a Champion of Change by the White House for his work on innovation.

“There is more opportunity and urgency than ever to apply digital approaches to health and healthcare problems.”

Propeller, technology that helps patients with asthma and chronic obstructive pulmonary disease (COPD) track their medication use. How did you come up with your idea?

Despite the development of effective medications, chronic respiratory disease remains a persistent health problem. Today, guidelines encourage physicians to more closely monitor whether treatment is truly controlling symptoms and improving quality of life but few have the means to do so between visits. For their part, patients often assume that little can done to eliminate their symptoms and allow them to participate fully in the activities they choose. They need help recognizing when they need more attention and better ways to communicate that to their physicians. More than a decade ago, I was working in applied public health at the Centers for Disease Control and Prevention (CDC) in Atlanta, and came to believe that we were limited by a lack of timely and objective data about the burden of asthma. I realized that clinicians and public health experts suffered from the same gap in information, and saw a simple remedy: Add electronics to the inhalers that people carry around and use to manage their asthma so that we could measure how people are doing in real time.

Exactly how does it work?

Propeller builds small electronic devices that attach to the different types of inhaled medications people have to manage their asthma. That includes both the daily anti-inflammatories and the short-acting bronchodilators. These sensors passively capture details about the use of these medications in daily life and communicate that information to Propeller. From there, a set of smartphone applications and enterprise tools for patients and physicians, respectively, put that information to work to improve and encourage effective self-management and more optimal care and treatment. For example, Propeller is able to monitor how often a person uses their regular medication and encourage them to be more adherent through reminders on their phone or the inhaler itself. Over time the system learns about the factors associated with the onset of symptoms, such as relevant locations or particular exposures, and can educate individuals about how to avoid or mitigate those influences. And because the time and frequency of use of bronchodilators is a marker of disease status, information from their medication sensors serves as a vital sign of impairment and risk, so that we can alert physicians to individuals who need more attention.

Once you came up with your idea, what were the steps involving in taking it from theory to practice?

We spent the first few years developing prototypes of the system and examining its reception in small populations and its potential to help individuals improve their day-to-day management of asthma. In these trials we were able to show that such information was meaningful and useful to individuals and could contribute to their efforts to control their symptoms. Next we decided that there would be value in creating an organization around commercializing the technology and the mission to apply emerging digital tools, such as smartphones, to the work that respiratory disease requires of individuals and their physicians.

What did you need to learn to make your idea a success?

Each stage in the development of the company has proven uniquely challenging and educational. As the company has grown, my role has evolved to one focused on developing and encouraging an inventive and enthusiastic company culture and to thinking about and planning for how digital can continue to spark and strengthen improvements in therapies for chronic respiratory disease. At the same time, I try to keep the team committed to delivering technology that has practical benefits and mechanical advantage. In other words, tools that make it easier to more effectively manage chronic respiratory disease with less effort.

Do you feel that innovation or entrepreneurship are skills you could learn or train in, or do you feel they are ‘innate’ traits that you just have or you don’t?

There are some people who, either for reasons of timing or personality, struggle to appreciate or prosper in the face of the daily ambiguities we confront when building a company. Others, particularly people who never think to create imaginary obstacles for themselves or their colleagues, thrive in this social context. Working with a collection of people characterized by this energy may be the most rewarding thing about Propeller.

How did you inspire and recruit others, especially investors, to join you?

The argument for Propeller, and much of digital health in general, has revolved around the potential for technology to help improve outcomes and lower costs from chronic disease. We know that in the case of asthma, for example, an individual who does not have their symptoms under control requires considerable additional healthcare each year. Our commercial model is built on our ability to put information and power in patient and physicians hands so that organizations can avoid these costs while reducing the unnecessary suffering they represent. The potential role and value of digital health in emerging models of clinically-integrated, financially-accountable healthcare has grown quickly and attracted considerable private investment.

Are you still using any of the skills and knowledge you gained during your academic training and experience at the CDC?

Understanding paths to better clinical outcomes and potential utility across populations continues to be an important part of my job. Our goal is to help health care systems figure out ways to benefit their communities of patients and members. It is effectively an epidemiological problem. But digital health can simultaneously improve and connect both individual and public health. I continue to be encouraged by the potential for digital tools to serve as an organized and ad hoc bottoms-up complement to the more traditional top-down approach of municipal public health. Where traditional public health surveillance has focused on using a small number of sentinel events such as hospitalizations to try to understand patterns of disease epidemiology, today we have the ability to collect direct information about the burden and management of chronic diseases among populations in daily life.

Do you have any advice for anyone considering a similar career pathway?

There is more opportunity and urgency than ever to apply digital approaches to health and healthcare problems in the US and around the world. For the most part, these are messy and persistent problems characterized by multiple challenging, and rewarding, sides. As an anthropologist, my suggestion is to spend time developing a clear-eyed, up-close understanding of the human behaviours and practices that will ultimately represent the practical context for your proposed solutions.

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Disclaimer: The content is provided for information and education only and is not intended as a substitute for medical, psychological, financial, legal, tax or other professional advice. The content is not necessarily representative of any organisations or institutions affiliated with Dr Behrooz Behbod. The views or opinions expressed by guests are not necessarily shared by Dr Behrooz Behbod.

Harvard & Oxford trained public health physician, improving human & planetary health, one Entrepreneur at a time. https://www.entrepreneurs.doctor