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Dr. Geeta Nayyar: Better Healthcare in a New Era of Tech

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“Inevitably, at the end of the ‘myth and disinformation train’ are doctors and nurses cleaning up the mess in the emergency room. There is a potion or snake oil for every ailment, from skincare to curing baldness…”

On May 16th, Merion West’s Henri Mattila interviewed Dr. Geeta Nayyar, a leader at the intersection of technology and healthcare. Dr. Nayyar currently serves as the Chief Medical Officer (CMO) at Radiant Graph, a company focused on intelligent personalization for consumer health engagement and sits on the board of the American Telemedicine Association. Previously, she has held the role of CMO at both Salesforce and AT&T. She received her medical degree at the University of Miami Miller School of Medicine.

Dr. Nayyar is the author of the 2023 book Dead Wrong: Diagnosing and Treating Healthcare’s Misinformation Illness, which examines the spread of myths and disinformation in healthcare.

In this interview, Dr. Nayyar discusses her background as a CMO and delves into the challenges and opportunities presented by the evolving landscape of technology, including her insights on the promise and peril of social media and artificial intelligence. Notably, she calls for a new paradigm of regulation so that healthcare professionals and institutions can be emboldened to speak directly to consumers and patients in social media spaces.

Editor’s note: this interview has been lightly edited for clarity.

When we talk about healthcare in the United States, I have found that the conversation virtually always goes to talking about everything that is wrong with the system. I would like to break this pattern by starting with the following: What are some victories that Americans should be proud about with regards to their healthcare system?

Oh, wow. You’re the first person to ask that, and that’s a good question. One of the first things we can be proud of—and I’ll come at this from a post-pandemic reflection—is that we innovate. Compared to the rest of the world, we are a country of innovation. Perhaps the only silver lining of the pandemic is what we saw happen with telemedicine; overnight, we were able to take our hospitals and our clinics into a telemedicine environment very quickly. We were able to open up both legislation and reimbursement that made that possible. As a result, hybrid medicine—the idea that you can do telemedicine but also brick-and-mortar medicine—is definitely here to stay. And we’ll continue to innovate in that space.

We also have terrific technology. We have CT scans, MRIs, etc. We have all kinds of technology from a diagnostic therapeutic standpoint, while others can’t say the same. We have terrific specialty care; you can get a specialist within a specialty. We also have centers of academic excellence in medicine, whether we’re talking about the Mayo Clinic, the Cleveland Clinic, and many others. To the extent someone is able to see the world specialist in X, Y, or Z, typically the world specialist is sitting in the United States, and that begets research, more innovation, better diagnostics, and better therapeutics. I think that will continue to happen. I think that will continue to flourish. Those are all wins of American healthcare that are indisputable.

America also leads the world in drug development innovation since this is the place where most of the funding happens and the greatest commercial opportunity lies.

Turning to your professional background: When I hear the title Chief Medical Officer—or CMO—my mind conjures images of hospitals or drug developers, not technology giants like AT&T and Salesforce. Could you shed some color on the nature of that position?

Pandemic aside, the typical CMO role, particularly in a healthcare or health tech company, is someone who has deep expertise in healthcare, clinical medicine, and technology. It’s someone who can sit at the intersection of business, medicine, and technology. In reality, this means helping the tech teams and product teams build good, clinically relevant products that will lead to efficiencies and better workflows for physicians, nurses, and patients. It also involves articulating that vision to the industry, stakeholders, customers, and clients. It’s about speaking both languages, clinical and tech, and realizing the business development opportunities that come with it.

There are some CMOs, while the title is the same, who are more focused. You can have a CMO that strictly does product, and all they do is sit with the product teams and build good health tech products, but they’re not necessarily articulate or able to bring credibility or confidence to the market. Then you have some that might be really good at doing the external work but aren’t good at sitting down with the engineers and building products. My role has always been both, but you can have some CMOs that do one or the other.

What do you see as the role of non-government entities in American healthcare today?

It’s funny because I would say that employer health is public health in America. Your health insurance is mandated by your employer, so that is a huge role for private enterprises, which effectively employ special employees to take care of their workforce’s healthcare. It’s a tremendous responsibility.

It’s a rather bizarre arrangement in my mind. Earlier this year, I spoke with Harvard Business School professor Regina Herzlinger, and she believes the employer should be taken out of the equation of healthcare management. What’s your first reaction to that?

Theoretically, that makes sense, but it’s been done for so long in the United States. At this point, that’s just our way of life. The amount of knowledge that employers have, particularly the Fortune 500 companies—I think they’re really good at it now. Whether they should have had to develop that muscle or not is a much bigger question. What you’re getting at is: Was the system even set up correctly? That’s an absolutely fair debate, but I think, at this point, they have the most experience out of anyone.

Because the system is already set up this way, it’s very tough to change—but perhaps incrementally, over a very long period of time?

That’s right. I also think that we, in the private sector, just see the disruption and the innovation happening. I think that’s another space for innovation, certainly from the health tech standpoint. Any number of startups are looking to disrupt the system, and I think it’s terrific.

Can you give examples of startups or technologies that you’re particularly excited about?

I’m currently the CMO for a company called Radiant Graph. Essentially, what we do is intelligent personalization for the consumer to personalize the engagement between the consumer and the health plan to the point that they feel that they have a trusted source of knowledge, but they’re also inspired (and motivated) to take action, such as getting that mammogram or scheduling that doctor’s visit. So much of where we fall down in healthcare is in the compliance part.

For example, it’s in knowing our patients well enough to know when they go quiet and stop coming to the doctor. We saw this during COVID. People stopped going to the doctor. How do you get those patients back? And how do you get them back to make sure that they’re doing daily preventative things? That’s just one example.

We’ve seen it with telemedicine. Telemedicine is now a mainstay in the industry, and these technologies all began as startups. We see it now with everyone having a smartwatch or ring: Everyone’s measuring something, and that all originated in the startup space.

There are concerns that telemedicine might be a fine alternative for some particular conditions or treatments. However, there’s no substitute for in-person meetings. The cynic would say that the whole system and the healthcare establishment love telemedicine because it saves money and is more efficient. What are your reactions to that view?

It all depends on the type of visit. There are certain types of visits like a counseling visit. If I’ve gotten lab results back or I want to go over mammogram results that are relatively benign, a telemedicine visit is probably more efficient since the patient does not have to drive in traffic or sit in the waiting room. Doctors can also do this quickly in between patient sites.

The intangibles that you miss with the telemedicine visit are if you have to do a physical exam, if you have to palpate something. If you do a procedure, there’s no substitute for doing those things in person. There are also intangibles where you’re picking up on someone’s body language, wanting to comfort a patient by a gesture, holding their hand, or giving a patient a tissue. These are all things that build trust and build a relationship. The patient-physician relationship is one of the most intimate relationships you can have because a person is coming to you in some sort of crisis or with some sort of very personal concern.

You want that to be a trusted relationship. You trust someone when you are able to have access to them; they show up for you; they know you; and you know that they care about you. Sometimes it’s hard to express that over a telemedicine visit. If you think of your own relationship with friends or family, it’s so nice when we get together in person. We always say that, like, “Oh, it’s so nice to see you, as opposed to Zoom you.” But if the alternative is not seeing the person or having to wait nine months for a visit, telemedicine is certainly a good substitute.

So you see them as complements?

They’re complementary; one can’t substitute completely for the other. When we only had in-person visits, it was hard to get an appointment; people had to take off half a day at work to go to the doctor, and they would often put it off. There is a role for both. Hybrid medicine is certainly here to stay.

Indeed, much like hybrid work seems to be for white-collar jobs.

Same idea. If you try to put the genie back in the bottle, no one’s going to work for you.

You wrote the bestseller Dead Wrong: Diagnosing and Treating Healthcare’s Misinformation Illness. I think “misinformation” and “disinformation” are ambiguous terms; what exactly are you referring to?

The book is a look at myths and disinformation in healthcare, particularly during the pandemic. The issue of myths and disinformation is not a new one. It’s been around since the Black Plague. What has changed is the era of technology we’re living in. Because of the era of technology we’re living in—whether it’s social media or AI—myths and disinformation are traveling six times faster than the facts.

The call to action in the book is largely because the misfits that are promoting disinformation profit from it. Definitions are important here. Disinformation is the intentional manipulation of facts and data to manipulate people, whether to buy something or to have some action, like a vote, for example. Misinformation is just when you get the facts wrong, like you misunderstood something, or you heard it, kind of like a rumor, but there was never a pretense that it was coming to you as if from a journal article or something like that. The call to action in the book is to say that we need healthcare leaders to pay attention to this issue and own the narrative because so many people are profiting off of our patients.

Inevitably, at the end of the “myth and disinformation train” are doctors and nurses cleaning up the mess in the emergency room. There is a potion or snake oil for every ailment, from skincare to curing baldness, whether you drank the Clorox or decided on the supplement for $29.99 to cure cancer. This is a call to action to say that healthcare has left this gap because we haven’t taken the microphone and taken the time to use the same technology for good (i.e., to propagate the facts), we’ve left an open space for others to profit off of the consumer.

Based on my experience on social media and TikTok, this is indeed a widespread phenomenon. Is this activity just profit-driven?

They can just want your subscription or following. I don’t say that to vilify social media or artificial intelligence. I’m pro-technology, but when used correctly and for the betterment of humanity. We haven’t—in healthcare—paid attention to it. We’ve accepted that we operate in a world where myths and disinformation exist, instead of saying that our hospital should have a TikTok channel, and every one of our doctors should be paid to be on it, and we should be inspiring people to take care of their health.

Of course, we should be accountable for what we say because we’re giving out advice. But if something goes wrong, people can come and make an appointment. Whereas these other TikTok influencers—most of them are not real. They’re not real doctors, not real scientists, and don’t have a license that could be in jeopardy. There’s no accountability.

It sounds like where you stand is—more or less—that the solution is not to try to get rid of social media but, rather, for the institutions and the professionals to step into those spaces and reach the patients and consumers directly.

That’s right. Because we regulate healthcare so much, doctors and clinicians are afraid to use social media. So, part of this is how we regulate it. At the same time, social media right now is largely regulated by the social media companies. We haven’t put the healthcare regulation in the right place. As we think about artificial intelligence, we want to be mindful while we take some of the lessons we’ve learned to date from technology and apply them to these new emerging technologies to make sure we’re safeguarding people’s health.

To clarify: Are medical professionals afraid because they believe they are going to get in trouble because the compliance standards are so high and the legal repercussions loom so large? 

The biggest concern is always medical liability. We have to create safeguards at the same time to protect physicians who want to build trust back into science. We also have to look at how we regulate social media. As institutions, whether we’re life science companies, providers, or payers, we want to encourage physicians. We want to make it easy for true healthcare leaders to be out in the world talking science, which we saw during the pandemic. The other fear is that many people, particularly those talking about vaccines, have received death threats, as have their families. It’s all of those things that create fear.

I started the conversation by asking you about some of the historic wins of our healthcare system. Is there anything in particular that excites you most about the future?

Artificial intelligence is a buzzword, but I would say it is exciting when you think about some of the mundane, routine, repetitive tasks that we have in healthcare—whether from documenting notes to prior authorization, etc. There are mundane tasks that are burning out the workforce. Physician burnout is a real issue. Care team burnout is a real issue. To the extent we can unburden physicians and nurses to take better care of patients and put the humanity back in medicine…that’s the most exciting thing that I see ahead. When we think about also applying artificial intelligence for better diagnostics and better therapeutics, the sky is the limit. On the flip side, we need to understand the technology. We need to understand the good, the bad, and the ugly and make sure we’re intentional about how we apply it in healthcare. The opportunity is truly limitless to transform clinical medicine. There’s no doubt in my mind.

I’m sure we’ll be talking and hearing about artificial intelligence a lot for the years to come. Thank you for joining me here today, Dr. Nayyar.

Thank you so much.

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