Datica Podcast

October 28, 2015

Dr. Chris Wasden, Executive Director, Sorenson Center for Discovery and Innovation at the University of Utah

TranscriptCatalyze: Thank you, Chris so much for joining us today. Excited to talk to you about innovation and specifically some of the topics that you cover in your new book – Tension: The Energy of Innovation. One of the topics in the book that you talk about is failure, and failure being the spark that ignites the innovation cycle, but considering specifically startups, there’s an incredibly high failure rate, whether you call it a failure, pivots or whatnot. I’m curious about failure and pivots and how startups can use that to ignite their success.

Dr. Wasden: I differentiate between mindless failure and mindful failure. Through mindless failure we march off and think we are right, create something, but we never really ask the market; we never look for pain points and never try to get to root cause of failure. We never try to understand how our solution will eliminate that tension between the current state and the desired state. Then, we launch into the market and are surprised that it failed. Well, that’s a mindless failure. We really didn’t think mindfully about what needed to be done, nor did we go and talk to 100 different people that have this problem to understand how to solve the problem.

If you look at diabetes as an example, there are apparently over 400 diabetic apps on the app store. Ninety-nine percent of them are awful and this is because they were never designed to be very effective. They are based upon someone’s very limited understanding of diabetes. They might be diabetic themselves, but also never understanding how to harness the technology in a novel way that would really eliminate the route cause of the pain that people have, which is the failure.

I’m currently working on an I-Corps™ grant with a team at the University of Utah, and one of the requirements of an I-Corps grant is that you have to do at least 100 face-to-face interviews with stakeholders within your problem set that you are trying to focus on. You are not trying to sell them your technology, but to understand what the pain points are they are experiencing. Then from that, trying to understand what sort of solution you need to create to eliminate that failure and pain. That’s what I think most of the failures are about. They are not trying to be mindful in going about this. They are not asking 100 people in face-to-face interviews what really needs to be addressed. They are coming out because they can develop apps very quickly and inexpensively with what they think of as an app or solution.

Now, if you look at WellDoc as an example, they’ve done a lot of the right stuff. They have peer-reviewed research that shows their app is two and a half more times effective than the best drug. They have economic research that shows they can save $1500 to $1800 dollars a year for a health plan. They’ve still had many failures though. So just because you do a lot of this doesn’t mean that you won’t fail. They’ve done lots of pivots. They initially came out and thought that this would be so effective and so compelling that people would just run to it. What they found is that generally people aren’t going to use an app like that unless somebody else pays for it, because that is the model we live in within healthcare. Even if you know it is going to be effective, you still expect someone else to pay for it.

So then they pivoted and said, "If that’s not going to work then maybe we need other channels of distribution," so they partnered with AT&T and others that have hundreds of millions of customers. AT&T is a mobile company and this is a mobile app; they’ve got lots of employees that are diabetic. WellDoc did a pilot study with AT&T and found out that AT&T employees performed much better with this app than without it. They had evidence that they were right. But still they couldn’t get traction because AT&T is not the right channel to distribute this to health plans or to employers. They then pivoted again, saying well, maybe we need to be more like a drug. If we are two and a half times better than a drug, maybe we need to be on an app formulary, so that the payers will view us like a drug and doctors can prescribe us. That’s given them more success and they started to get some payment levels. But even there was interesting.

I had a prescribing WellDoc doctor on a panel at the mHealth Summit and we had this conversation:

“How many diabetic patients do you have?”

“Five hundred, “ explained the doctor.

“Great, so you prescribe WellDoc 500 times?”

“No, I’ve prescribed it about 50 times,” he responded.

“WOW. Why only 50 times when you have 500 diabetics?” I asked.

“The reality is…not all my diabetics have a big problem,” he said. “Their pains are not that great, because there are different levels and stages of diabetes. It’s a great solution, very effective, no question about it. But it’s very expensive, so I’m only going to prescribe to those patients that have a severe enough diabetic problem that it’s worth paying $100 to 150 dollars a month for the WellDoc solution.”

This is the sort of work we have to go through to become great innovators. And it is not easy; it’s very painful, creates lots of tension, and causes lots of different pivots to do that.

Catalyze: You talked about the numbers that WellDoc has for savings on a per-patient basis and there are a few companies that have effectively done that, like Propeller and Omada Health, and some others. Does WellDoc have granular data where they’ve actually segmented the diabetes population? Have they actually done that sort of segmentation so that it is not on the gestalt of the provider to say, “Well, this is a severe diabetic and they need this.” Versus saying, “Well you are pretty well managed?”

Dr. Wasden: That level of sophistication is part of their algorithm, so they can drive people toward some sort of intelligent machine learning approach to change their behavior. Then they’ve stepped-wise to say, “Well how do we do that same sort of thing to make the sale to a health plan or an employer that our solution will, if you were to stratify this risk population of diabetics…how do we stratify and then how do we think about prescribing it to which type of patients?"

That’s not where they started, but these are the failures that allow you to learn and then from learning, you figure out how to better apply it.

Catalyze: I think it is one of the things that as a funded company, there’s just so much pressure to be massive and to talk about the total addressable markets. There is this tendency to throw everything out there, before you end up segmenting what is potentially your total addressable market, but segmenting it. With each segment, there are multiple cohorts and I imagine the data, selling and pricing on each is different.

Dr. Wasden: Here’s the challenge. This is part of what we go through with this I-Corps program that I’m part of. There are different synonyms for the word “tension.” You used the word “pressure” – pressure is a synonym for tension. The real tension you have as a funded company is that no VC is going to fund you unless they think you can become a billion dollar opportunity. To raise $100 million dollars, unless you are going to be a billion dollar company, it’s not going to work out. So you have the one tension, which is that you’ve got to present that you are a billion dollar opportunity, but on the other side I can’t think of very many technologies that were able to succeed by launching in a big market. You almost always have to launch into the very small, narrow niche market. In fact, if you look at Clayton Christensen’s work on The Innovator’s Dilemma, that’s really the key finding of his work. You have a new technology and a new paradigm. You have a company that comes along and it doesn’t attack the big, main market; it goes after some niche market that the big market offering can’t really address well. Over time as it gets better and better, it then gets into the big market.

I have experience with this phenomenon and with my own medical device company. I invented a new technology to diagnose/treat hearing loss. Hearing loss effects 20 percent of the U.S. population. Primary care doctors do not get involved with diagnosis and treatment of hearing loss today. My idea was, what if I got 300,000 primary care doctors to use an automated diagnostic tool to now diagnose the 20 percent of the U.S. population with hearing loss? That would be a huge market with great opportunity.

We got through the FDA process, we go to market and then to primary care doctors, and they say, “I would never buy your product.”

We asked, “Why?”

“How many ENT doctors use your product?” they questioned.

“None,” we replied.

“Well until an ENT doctor uses a diagnostic hearing testing device, I will never use it.”

So then we considered which ENT market we should go after? Which ENT doctors have the most audiologists? Obviously the answer was big ENT practices. So we go there and ask, “How would you like to fire your audiologist and buy our device and save lots of money?”

“I would never fire any of my audiologists,” they responded.

We replied, “We’ve got this workflow benefit and whatnot...”

“Look,” they replied. “Audiologists are critical, not only to diagnosing hearing loss but to treating it, because half the patients are going to be treated with a hearing aid and I need to have them dispense it.”

Okay, strike two! Then we went to our first medical device conference in San Diego. We were on the showroom floor and ended up having a lot of individual ENT practices buy our device. We asked, “What is the value proposition for you?”

They said, “Well look at this. Audiologists are in short supply; the ones that I have only work part-time. What you enable me to do is to diagnose hearing loss 24/7 365. That’s something a human can’t do for me. The other thing is that I have lots of patients that speak more than one language, so I have to be able to diagnose in multiple languages. Your device diagnoses in 11 languages and, that’s pretty valuable to me. The more high value activity for my audiologist is for her to dispense the hearing aid; it’s not doing the test. Your product frees her up from doing the boring, mundane work and allow her to do the higher value added work.”

We found out for the one- and two-man practice, our device was great. We sold a couple hundred of devices to them. Then after we sold a lot to them, big practices realized they could use some swing capacity. Their audiologists would sometimes be completely consumed and they wouldn’t necessarily fire anyone, but if they had one or two of our devices, they had some extra capacity, and the multi-language stuff had value. Then once we did that, some smart ENT doctors said, “I should buy your device and put it in a primary care doctor’s office, because they could then diagnose hearing loss and they could refer them all to me.”

Suddenly we started getting in the primary care market, but we got to that market last, not first. We had to find the ones that had the real pain in the marketplace and go to them first, because they would run to our technology. Whereas the ones that only had modest pain, which were the larger practices, would tiptoe or walk towards it. And, the primary care doctors would only do it if, it was promoted by those that were the prominent practices that really used this type of technology. I think all new technologies follow that same path.

Catalyze: Are there other types of tension that you think founders or entrepreneurs need to be thinking about and would play into their innovative process and how they actually get to market and succeed?

Dr. Wasden: My doctoral dissertation was on taxonomy of tension. I looked at the types of tensions that are out there, and then how those tensions impact the innovative or creative effort. At it’s core, I found there were three cardinal tensions that we deal with on a day-to-day basis.

  1. Maladaptive tensions – those that are created by failure and pain and perpetuate themselves as failure and pain.
  2. Adaptive tensions – those are something that allows us to transform maladaptive tensions into things that are just a bit better.
  3. Creative tensions – those things that are step changes. They make things 2x, 5x 10x better.

Every type of tension requires a different type of structure or practice to have it operate. Let me give you an example with biking.

A. If you have a chain on your chain ring and the chain is really loose, so that every time you pedal it falls off -- that’s a maladaptive tension.

B. If you have a chain that is too tight that you can’t even pedal, that’s a maladaptive tension.

So how do we deal with that maladaptive tension in biking? We have a rear derailer. A rear derailer is a magical device that changes the tension on that chain, regardless of what gear you are in, so you can go downhill, uphill, or on different types of terrain and always have the optimal tension on that chain, so you are getting the right force out of every pedal. I live in Utah, where there are tons of mountains, where I’ll do 4,000-5,000 feet of elevation in a day. What I find is that regular sort of chain ring and tension system isn’t as optimal in getting me to that sort of climbing that I need to do. So, I’ve been looking at a new type of chain ring that is oval, not round. With an oval chain ring, you can get more torque out of every pedal, due to the physiology of how you pedal and the mechanics of the bike.

Now the difference with the creative versus the adaptive tension, is that the adaptive tension with the rear derailer is adjusting the tension within a current system. I don’t have to change any of the parts of my bike. Whereas with the creative tension, I’ve got to change physical parts of my bike; it’s a structural change. And also that structural change forces a new practice – as I pedal it is different. Those are three different types of tensions that we as innovators choose to transform a maladaptive tension into either an adaptive or creative tension.

Now as an entrepreneur, what I found running my own medical device incubator, is that there’s not enough money to be had in starting a company just to be an adaptive tension transformer. To make things 10 to 20 percent better, you can’t raise venture capital, you can’t get people excited about it. It’s really the creative tension that creates the transformation that makes things that are five and 10 times better and those create the opportunities worthy of starting a new company and raising venture financing. As an entrepreneur, what I’m really seeking is how do I transform a maladaptive tension into a creative tension so that I can really do step change.

Let me give you some examples with Elon Musk. Elon Musk has this Hyperloop – the train that he has designed that will be in California. If you look at trains from a maladaptive perspective, they are currently very maladaptive. I used to live on the east coast and take the train to the northeast corridor. They are always breaking down; they go pretty slow; you can drive faster than the train can go. It’s incredibly expensive to maintain them, so there’s tons of maladaptive tensions in our current train system. So an adaptive approach says: Let’s take the same basic technology and make it go a little bit faster. If you look at the California high-speed rail initiative, those trains will average 80-90 mph versus 60 mph of a regular train. Now I know they have peak speeds of 200 mph, but they don’t represent that they will be going 200 mph; they are going to be going about 30-40 percent faster than a regular train. That’s an adaptive approach. And that adaptive approach costs 70 billion dollars. Elon Musk has an approach where the trains will be averaging 700 mph, so 10x faster, and it would cost seven billion dollars or 90 percent less. So that’s a creative tension approach. I’m not going to use the existing structures and practices to make them go a little bit faster and make them a little more efficient. I’m going to create entirely new structures and practices that are 10x better and cost 90 percent less. When you look at smartphones, telecommunication and a look at a lot of these new technologies, what they are doing is offering that type of a value proposition. I’m going to be 10x better and 90 percent less.

Catalyze: In our health system we have tons of tension and there are probably lots of different areas. I’m curious to hear your thoughts on where you think the biggest opportunities are in healthcare, in terms of where the tension is and then potentially what you see as an example in healthcare of maladaptive versus adaptive and creative tension.

Dr. Wasden: The most powerful tension in every organization, including healthcare, is the tension between running the business of today and creating the change of tomorrow.

The reality of running the business of today is that all the existing structures—the reimbursement structures, the educational structures, the technology structures—all those structures that support the business of today are in fact barriers to create the business of tomorrow.

Our problem within healthcare is that the structures are much more rigid in healthcare than they are in other industries. You didn’t have to get FDA approval to go from paper media to digital media. You didn’t have to get FDA approval to go from a flip phone to a smartphone. It didn’t require a regulatory approval of the device; it didn’t require a regulatory approval for the payment.

Generally, you didn’t have a separation between those who paid and those who received the benefit—the buyer and the beneficiary tended to be the same. With healthcare, Peter Drucker said, it’s the most the most complicated of all industries in the world to try to manage and improve. It’s not going to be easy. It’s also shocking to me that you have an organization like Google that tried to go after Google Health, did three different innovations, failed, then ran away and said we will never touch healthcare again. But now what are they doing with Alphabet? Over half of all their initiatives are healthcare-oriented.

I don’t want to be critical of Google’s efforts just because we don’t know what the business model is yet. When Google launched as a product itself, its business model was merely to copy the software licensing and business model, and they only went to the ad model when the portals of the day rejected Google selling its product under the old business model. The tension or failure of what they had caused a new business model which was successful. I’m all for Google coming up with lots of ways to create value and then figuring out what the business model is later on in the process.

I do think what Google is doing is interesting because they are looking at areas of high cost where they can come up with something that could radically change the way things are being done, and they are doing that in ways that are not necessarily saying that we are going to go after this big market and try to get every doctor to change. But they are saying, let’s create these small experiments. Look what they did with the cars. They didn’t go to the big automobile manufacturers and say, “Hey, we’ve got this great idea for new technologies for cars and you’ll be able to automate it and whatnot.” They just did it. You see the same sort of thing playing out in healthcare where they are just going to do it. And then they’ll try to get some partners. You’ve seen that they’ve already started to get some pharma partners with their glucose monitoring contact lens, but they didn’t try to get them initially. They developed the technology, figured out if it worked and then started to find partners where they could find partners.

The reality is that there are some healthcare organizations that are interested in being disruptive. The key is to find those partners who are really willing to push the envelope to do things differently, because the vast majority of the healthcare profession does not want to innovate.

I’ve seen some statistics that suggest over 50 percent of doctors are going to retire within 10 years. That 50 percent of doctors, they don’t want to do anything different for the next 10 years. They just want to get to the finish line. They don’t care about mobile health and digital health records. They don’t care about genomics or anything else. It will take decades to train the current young cohorts going through medical school, so they can be the next vanguard of innovation in healthcare. Most innovations take about a decade to make a significant impact in the market. In healthcare, it’s two to three times long as other industries try to achieve radical change. Denmark implemented electronic health records in 1973. The United States passed laws to start implementing electronic health records in 2003 – 30 years later. That’s the pace that we are on in healthcare.

Catalyze: Are there ways that you see to operate as an innovator to constantly kind of learn in healthcare despite that relatively strict regulatory structure of the industry?

Dr. Wasden: The most important thing that I’ve learned in innovating with doctors is that doctors need to see evidence that something works. You look at the 99 percent of all the healthcare-related apps out there, there’s no evidence that any of these things work. Most apps are failures; most apps have no evidence that they’ll work, so I think we need to focus more on the design side. We need to have a human centered design. By the way, medtech companies don’t do, and pharma companies don’t do.

These new technologies really have an opportunity to differentiate themselves versus the traditional players that really don’t apply this sort of approach to innovation.

If you ask a medtech or pharma company: Who is your customer? It’s not the consumer, it’s a doctor. But what’s happening with healthcare is that the consumer is becoming the customer. We now have a new opportunity in this new paradigm of actually designing things that are consumer, customer-oriented, rather than physician-oriented. That’s one thing to focus on. I know you are a doctor and so I try not to offend every doctor that I meet, but most doctors have no clue how consumers think and act. They don’t think about patients as consumers. Because of that, they don’t really respect what the consumer can do, the consumers opinion. There’s too much paternalism within medicine. We are starting to see now this transformation where we are starting to get away from the paternalism. We are enabling patients now to control their healthcare more effectively. Physicians are beginning to adapt to and accept this.

My dad is a great example. My dad has some back pain. He did his own diagnosis with Google. Then he went to the doctor and said, “I’ve done my research and I’ve identified that I have this problem with my back. I’ve looked at the treatment options. I’ve chosen this option and I need you as a doctor to validate my diagnosis, and I need you to confirm my treatment options, and then we need to move forward."

The doctor does his work and validates my dad’s diagnosis; he also validates that those treatment options are truly the options, but he then cautions my dad and says, “I’ve done the option that you’ve chosen several times before and I’ve had a less than 50 percent success rate and so I don’t recommend you do that.”

My dad says, “I know that you are not good at this procedure, but I’ve found a doctor at the University of Utah Medical Center that has an 80 percent success rate and so I’d like you to refer me to him.” So my dad was referred to him; he had the procedure and it was completely successful. My dad walked out of the hospital the next day and the problem was solved. Now I’m not saying everyone is as smart as my dad. And, I’m not saying that’s the way everyone will be treated, but that’s a world that could not have existed 10 years ago. This is the world that we’re all moving around healthcare. Increasingly, we’ve got to have our healthcare system adapt to people becoming more engaged in their healthcare and being able to do self-diagnosis and self-treatment.

Catalyze: You work with the medical students at the University of Utah, right?

Dr. Wasden: Correct.

Catalyze: Do you see the shift in the medical students and residents compared to some of the older physicians that are within five to 10 years of retirement?

Dr. Wasden: I see more of that. You also have another phenomenon that might help that. More of these younger doctors, well half of them are women. So you have a different perspective from a women’s versus a man’s all the time. The other thing is that most of them are employed. Although there are still production expectations and whatnot, I think they are a little bit more open to new ideas, more so than if they had to put out their own shingle and live by whatever they could kill.

Catalyze: The majority of my younger physicians are really interested in sensors and patient recorded data and those things. I’m probably skewed toward knowing more younger physicians, but that group certainly seems a lot more interested in those things. You read about cloud computing and the cost of infrastructure and all these different pieces as being enablers of software eating the world, in the words of Marc Andreessen. You actually mentioned it as a potential risk, where it is so easy to create something and so easy to create a market with the technology and so easy to miss some of the other essential steps like talking to 100 users and really trying to understand the problem that you are trying to solve, because it makes it so much cheaper, faster, easier to jump right into actually building a solution as opposed to actually understanding the problem and what the solution should be. Could you speak a bit more to that point and some of the risk associated with jumping right in, because technologically you can today.

Dr. Wasden: Let me give you a personal experience I had in college. Thirty years ago I got an undergraduate degree in accounting. This was before there were computers and spreadsheets like that and the capstone course is a course where you had to, on a big green tablet spreadsheet, do all the financial transactions and analysis for a company. Anytime you make a mistake on paper and pencil, you have to erase it and the professor gave you one green sheet of paper and that was it. So every time that we made an assumption, we would think really hard about that, not on the green piece of paper, but on another piece of paper and make sure we had the right answer before we put it on the big green piece of paper.

A few years after that, we had Lotus 123 and then Excel. What happened was that all of the cost of being wrong, that is making a mistake on the big green pad and erasing it goes away. Because we have these electronic spreadsheets now and we can make mistakes all the time. What happens is that people started gravitating toward using these huge complex financial models where they didn’t even think through the assumptions very well, because the cost of changing things was so low that they didn’t need to invest thinking about it upfront.

As an investment banker at JP Morgan, I would have all these junior associates working for me, they would spend hours and hours on mindless financial analysis, making all sorts of data assumptions, because again the incremental costs of making a mistake was so small that they’d just start building the model. I would call them back and say that I would not allow them to use Excel until after they’ve created a prototype of the financial model on a piece of paper with a pencil, and you’ve thought through all the critical assumptions that you want to do, all the sensitivity analysis that you want to do, and once you’ve got it as a mental model and a paper model and then we can talk about it and go to the spreadsheet and start to work on it. They just wasted too much time on senseless, mindless stuff, because they hadn’t thought through the real problem, what are the variables that will make a difference in our analysis, what are we trying to get through in the end point?

The cost of development is 90 percent less than they were five to 10 years ago. People rush to building a tool, building a solution before they ever really think about what should that solution be?

Catalyze: I know that we’ve talked in the past about wearables. We’ve talked about patient-recorded data. I think the last time I saw you, you were wearing at least a couple of bracelets, tracking things like your activity. Where do you think we are in terms of the state of innovation around these sensors based technologies compared to two years ago or five years ago?

Dr. Wasden: Five years ago, you end up having most people who thought this was a complete waste of time. No one thought that FitBit would become a billion dollar plus company. The early versions of the FitBit product were very unreliable. I went through five in one year, because it kept breaking; it would fall apart. But FitBit was incredibly generous. Every time mine broke, I notified them and they’d send me a new one for free. Since it only cost them $5.00 to make and I’d paid them $100 already, I kind of pre-paid for 20 of these things. They helped perpetuate it; their apps got better and more people started to see the use cases of gathering data.

Then, I don’t think we’ve gone far enough with this, but increasingly we’ve seen the Mayo Clinic and others start to indicate that activity is the most effective therapy for any medical condition that you have. Period. Doctors need to start prescribing activity just like they would prescribe a drug and now we are increasingly getting to more nuanced activity where we are thinking about what is the duration. With my Apple Watch now, it makes sure I know that I need to do this activity for at least 30 minutes a day. We’re getting more to the level of activity and the intensity of it, so does it need to be interval training? Does it need to be just walking at a moderate pace? Does it need to be aerobic – things like that?

The problem is that the medical field itself has no clue how to answer any of these questions. If I go to my primary care doctor and say, “How much activity should I have on a daily basis? What type of activity should I have? What level of intensity should I have in my activity? How will that impact my other health-related problems?” They don’t know. They have no idea. Activity is a new vital sign. They were never trained on the activity by their medical school and so they don’t know how to interpret it. We have a long ways to go in regard to educating the field of medicine. Activity is just one measure of a wearable, because if you look at almost every measurable wearable we have, these are all new measures that no doctor has ever been trained on.

Take heart rate for example. We are developing the ability to monitor continuous heart rate. Show me a doctor out of medical school that was trained on how to interpret the continuous heart rate data of a patient. What about continuous temperature measurements? The medical profession doesn’t know how to deal with all this new information and data that we are collecting and therefore it is the consumer and these digital health companies that are creating the need for the medical profession to do something with it.

Catalyze: It seems like that’s a massive opportunity for the private sector to develop evidence to define those reference ranges. Physicians need that evidence. I think evidence related to data is largely like clinical decision support for that data.

Dr. Wasden: If you look at the truth of wearables, truth goes through three phases. It’s ridiculed, then violently opposed, and finally enthusiastically endorsed.

When all these wearables and the data that we were collecting was first coming out it was being ridiculed. “Who cares about steps?” “We’ve had pedometers for decades and they didn’t make a difference.” “Patients can’t do this; we can’t trust the patient. They are going to put that blood pressure cuff on their dog.”

Then it became violently opposed. “This is actually malpractice. It’s not really going to create better healthcare. We are deceiving patients by having them buy these devices and wasting their money on that because it is not going to make them healthier.”

And now, we are seeing that most employers, most physicians that think that actually a patient gathering data is not a bad idea and there’s certain elements such as their weight, blood pressure, diet, sleep and it would be great if they would collect those things.

What we see now from the research is that patients that collect their own vital signs are more engaged in their health than patients who don’t, and because they are more engaged in their health they are more likely to do healthy things that promote health and wellness. Now we have this accepted conventional wisdom, but it wasn’t that way five years ago. Now the challenge is being smart enough to know what to do with it. It’s not easy to answer those questions.

I have my Apple Watch here. I like it; it’s nice. There are some decent use cases for it, but to be honest, it’s not like my iPhone. I still don’t know the compelling use case that I really need to have it for and maybe there will never be one. Or maybe we’ll eventually figure it out, but we’re not there yet.

Catalyze: Apple Watch comparison is a great one. I had one on order but canceled it, because I got to the same point where I couldn’t figure out what I would use it for.

Dr. Wasden: There were lots of compromises that Apple made that are hurting it, so I just read that a guy got rid of his Apple Watch to get a GPS, heart rate monitor running watch because it had all the things in it that he needed and he didn’t need to carry his phone with him. So I think it is still that we are trying to figure out what we need to sense, what devices we need to have, what are the use cases we need to have. Do we need to have different watches for everything that we do? Hopefully not.

Catalyze: I want to thank you a lot for your time. You have a lot of great insights.

Dr. Wasden: Alright, thanks!