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Interview with Ben Greenfield about Elite Fitness and Endurance Training

Ben Greenfield is an ex-bodybuilder, Ironman triathlete, professional Spartan racer, coach, speaker and author of the book “Beyond Training: Mastering Endurance, Health and Life” (http://www.BeyondTrainingBook.com). In 2008, Ben was voted as NSCA’s Personal Trainer of the year and in 2013 was named by Greatist as one of the top 100 Most Influential People In Health And Fitness. Ben blogs and podcasts at http://www.BenGreenfieldFitness.com, and resides in Spokane, WA with his wife and twin boys.


1) There appears to be an uptick in reports lately about the role and importance of conscientious thought as it relates to longevity and performance. In your opinion, (when looking to optimize performance) what is the relationship between adjustments of the mind/thinking and adjustments in nutrition? We tend to discuss these subjects separately, but should they be?

When we talk about conscious thought as it relates to longevity and performance, we can talk about gut/brain access and the thought that both are pretty intimately intertwined. The two elements of the nervous system, the central and the peripheral nervous systems, are essentially connected and stay connected via the vagus nerve as we grow and reach adulthood.

Whenever you talk about optimizing performance, you have to understand that anxiety and disruptive thought patterns can affect the gut, and there is also a lot of evidence showing that what you eat can have an effect on cognitive performance. So there is no doubt that a synergistic relationship exists between the two.

2) When you’re working with clients, how do you effectively make adjustments and/or additions to nutrition? How do you determine which interventions are beneficial and which are arbitrary? When making recommendations regarding nutrition — specifically any supplement recommendations — how important are therapeutic windows, considering ADME will be unique in different individuals?

We live in an era where genetic testing, gut testing, hormone testing and full blood panel testing are pretty convenient and becoming more and more affordable too. I always recommend at a minimum to get a blood panel, and if you really want a gold standard (especially in regard to nutrition), get a gut test. Get a genetic test, too. A spectral cell analysis will give you a look at micro-nutrients and minerals. If someone is experiencing a lot of autoimmune food allergen-type issues, the tests I recommend are a Cyrex Panel 4 or Cyrex Panel 5.

Really, the goal is to get a good idea of where someone is at from a food summary standpoint. Once you put all of that information together, then you can make a decision, but until then you are taking a shot in the dark. If your budget is limited, you might say “okay, whatever, I’ll start on a full spectrum multivitamin” and skip the testing. In those cases, basically I would recommend best practices for someone based on symptoms and goals, but it is always better to test. People generally get better results when they test, and continue to retest.

Testing can also include something like heart rate variability, where you look at how the sympathetic and parasympathetic nervous systems are responding to a change or intervention. In short, you put an intervention in place and you test to see what’s going on with the blood, or gut, or salivary gland to access the response to treatment. A lot of the folks I work with are testing at least one parameter every eight to twelve weeks.

3) In my interview last year with Dr. Howard Jacobson, we discussed the downsides of using reductionist research when addressing broad nutritional questions. Presumably you make some of your assertions based on this type research. How do you mitigate any potential risks?

I am a proponent of using natural whole food sources when possible. My recommendations come down to assessing whether a supplement or dietary strategy is going to get you a lot of bang for your buck. Take phosphorus compounds for example, they likely have some sort of anticarcinogenic effect — as such I am a bigger fan of incorporating broccoli, cauliflower and onions as staple components of a diet, versus suggesting someone use a sub-level glutathione.

But ultimately there are some situations where, by taking a food group or ingredient down to its complete reductionist form, you can concentrate it and get higher amounts of it. A good example is Chinese adaptogenic herbs, something that I use. I can take the isolated compound in a tiny little packet and it’s the equivalent of 40 pounds of the whole herb, which I physically couldn’t consume all at once.

4) In my 2009 interview with Chris Talley, he indicated there would likely be future developments for those interested in hacking their myostatin levels if they’re willing to experiment with antisense therapies (note: he highlighted the potential for considerable risks, too). I saw this year you mentioned cold thermogenesis as a safer alternative (since this type of therapy might have an effect on irisin). Do you find this to be effective with your clients who are looking to gain muscle? And, do you have any other suggestions regarding reducing myostatin?

With myostatin, one of the big goals is to not be in a consistent anabolic state. I think what you are referring to with a cold thermogenesis type of approach is the upregulation of m4, which is going to essentially downregulate myostatin, helping with muscle cell growth. However, you could potentially get undifferentiated cell growth.

I like cold thermogenesis because you do get hormones like irisin that help activate m4, and yet at the same time you are getting the upregulation of AMPK. That’s actually a perfect example of a strategy I like: an anabolic approach that uses caloric cycling on certain days that have higher levels of physical activity coupled with cold thermogenesis, because strategic fasting is also a way to reduce myostatin.

5) Piggybacking off cold thermogenesis: If you ask Tim Ferriss for his cliff notes on unconventional tried-and-true tips for weight loss he’s likely to tell you ice baths, his PAGG regimen, and 30 grams of protein within 30 minutes of waking up. What are a few of your unconventional tried-and-true tips for amateur endurance athletes looking to improve performance?

If you are asking for tips that fly under the radar, I am a fan of isometric protocols like long 30-second eccentric contractions and holds for 3, 4, or even 5 minutes in lunge or squat positions. Basically, it’s filling your muscles with a bunch of lactic acid, so you are upregulating your lactic acid buffering capacity.

If someone has a lot of inflammation and muscle damage from chronic repetitive motions, I am a fan of curcumin. I have been using a lot of curcumin phytosome, and there is a brand called Meriva, which a lot of supplement manufacturers are using now. It is a form that is well-absorbed and has really good anti-inflammatory effects.

Lastly, it’s not sexy, but I am a big fan of making sure that you engage in low-level activity all day long — basically standing on your feet, getting a standing work station, or even using a treadmill desk. Avoid sedentary positions for a long periods so that all day long you are building low-level physical endurance, which you can then rely on during your interval training and endurance training. A lot of people do not understand that a lot of your available endurance simply comes from your daily routine. If you are trying to improve performance you are not doing yourself any favors by sitting at a desk all day long.

Interview with Nir Eyal about the Hook Model and Product Development

Nir Eyal is an educator, entrepreneur, author, and blogger who maintains the website NirAndFar.com. In addition to his blog, Nir has written articles for TechCrunch, Psychology Today, and Forbes. Nir’s new book, “Hooked: How to Build Habit-Forming Products,” debuted on the Wall Street Journal business best seller list this year.


1) What is a creative “growth hacking” method you have seen bolted onto the Hook Model that can positively influence the viral coefficient (or alternative variable) and amplify the effect of your model? Clickbait is one potential example (adding a trigger to a hijacked audience); are there any better ones?

Clickbait is an okay example. I tend to think of engagement and growth as two things that can be connected, but that do not necessarily have to be. So when I look for opportunities to invest in or consult with companies, the three criteria I always look for are: growth, engagement, and monetization. A startup must possess two of these at the onset, with a strategy to obtain the third, or I’m likely not going to be interested.

Most viral strategies have nothing to do with engagement. This is important to note; most viral growth strategies lack engagement. These strategies are usually just a way to get people in the door. Sometimes you see innovators get so hung up on virality that they stop there, and unfortunately stop short of incorporating engagement into their product. For me that is what is interesting: how can you make engagement part of the product itself, part of the growth strategy? It is pretty rare to see engagement as part of the overall growth strategy. It’s pretty hard to do well unless you are a social network. Most others are doing it as a bribe: “Here is ten dollars; invite your friend.”

2) In your teachings, you speak about the power of negative valence and how feelings such as boredom, fear, and depression can be effective mechanisms to get someone to act. In your opinion, why have emotions with positive valence (such as a joy) proven to be less effective action triggers?

When we feel happy, we don’t have a problem. Every solution is used to address a problem. Negative valence states are painful. They create pain points and we seek to correct those pain points. One could also argue this is teleosemantic… two sides of the same coin. For instance, is someone lonely or do they simply desire connection? I like to focus product makers on the negative so they understand that they should be solving a problem. Unfortunately opportunities are generally not found when people are hunky-dory; opportunities are found when people are suffering from something.

3) In the process of your research, what are one or two of the most effective reoccurring external triggers you’ve seen that do not use the computer or mobile phone as the conduit? Is there anything on the horizon that might match or come close to the utility of smartphones with regard to effective trigger conduits?

Mobile devices are fairly new, but visual triggers obviously are not… advertising, storefronts, etc. Smartphones simply let us interact more effectively with these triggers. As far as something on the horizon, I think the smartwatch is going to be huge. Whenever there is a broad base interface change, it opens a world of opportunities to build innovative products. And as simple as this sounds, some of the most powerful triggers are often hidden in your pocket. You cannot see that you have an incoming email if you have put your phone on silent. A watch is ever-present; however, the downside is there is a lot less real estate to grab your attention (than a phone). This is going to make creating habits more important because with less real estate there will be less opportunity to grab your attention. It creates a more competitive environment for app makers.

4) In a previous conversation, you and I discussed that fitness is hard to position as a reward because fundamentally it’s punishment, making it inherently difficult to inspire this action. Are there strategies to help bolster the perceived intrinsic value of a difficult action in an attempt to strengthen the perceived reward?

It is not my position that fitness is “fundamentally” punishment. I don’t think it creates pain for everyone; some people are clearly passionate about fitness and get a lot out of it. They get pleasure from exercise. It is rewarding and they love it. It is what they like to do in their spare time.

What I do suggest is that those who do not enjoy exercise feel that way because it is potentially perceived as punishment and not viewed as rewarding. I believe that these people view exercise as not fun; simply put if they thought it was fun they would be doing it. The problem is people who don’t already enjoy it make up a majority of the general market, right? People making fitness products, or at least most of them, are trying to create behavior change in the hope of making inactive people become active. It is the proverbial brass ring that people in the fitness industry are reaching for.

From what I have seen to date, it just doesn’t work; it is just punishing users. Look at the phenomenon of “moral licensing”: when we do something that we feel punishes us, when we feel we are suffering in one area of our lives, we tend to go overboard in other areas. That’s been shown with charity giving, and it’s been shown with recycling: sacrificing in one area of life leads to indulgence is other areas of life.

If someone gets into this spiral — for instance they workout each day and burn 300 calories but then reward themselves with a 400-calorie Jamba Juice — what happens over time when they do not see results? They ask, “why am I gaining weight? I guess I am just a fat person.” In the end they come to a conclusion, “well, I’m just fat; it’s who I am.” And that’s the saddest part of this story, because “being fat” has become a part of their identity, and identity is much harder to change than behavior.

At a global level, a person’s environment is going to play a major factor in the obesity crisis. People make poor choices about what they eat because unhealthy food is easy to get. If we had better access to healthy choices, I believe that would go a long way. In that regard I love what the company Pantry Labs is doing. Pantry Labs makes it easy for companies to offer fresh foods to their employees through vending machine innovation. If you enable people to make healthy choices, I think this is an easier intervention to implement than expecting everyone to pick up exercise.

5) Continuing the theme of influencing healthy behavior change, in your TechCrunch article Why Behavior Change Apps Fail to Change Behavior you state, “When our autonomy is threatened, we feel constrained by our lack of choices and often rebel against doing the new behavior.” I believe this to be true as well. However, I also believe Barry Schwartz’s contention that choice can often be paralyzing. Personally I struggle with the coexistence of these concepts when it comes to prescribing varying fitness modalities to a population (especially in light of data that suggests you get higher participations rates when you limit choice). Where do you believe the balance exists, if there is a way to find balance? 

I believe you are talking about two different things here, I don’t think it is apples to apples. When we talk about the “paradox of choice,” we address things we desire, like picking between 24 flavors of jelly. We want the jelly, but we cannot decide which one we want. When we are talking about issues of autonomy and choice, we’re addressing things that we do not want to do. “I do not want any jelly; I hate jelly,” is different than the statement, “I want jelly, but which one do I get? It’s just too difficult to decide.”

There is some crossover — there is the concern that making choices, even simple choices, may tax one’s willpower — and there is this other issue of behavior, high willpower versus low willpower. The “behavior change matrix” can be helpful in explaining the difference and how it relates to forming positive habits.

Automatic behaviors — in other words, our habits — fall into one of four modes: amateur, expert, habitué and addict. I categorize them by how much self-control is required (high willpower vs. low willpower) and whether motivation can be classified as pleasure seeking or pain alleviating. Amateur and Expert are both pleasure-seeking modes, but amateur requires little willpower while expert requires a high degree of willpower. Both modes tend to result in beneficial behaviors that people want to increase.

Habitué behaviors are pain alleviating but require little willpower. They may be beneficial or destructive. Addictive behaviors are primarily negative and people seek to rid themselves of them. If you want to change someone’s behaviors, or help them develop new ones, you need to understand the matrix and use techniques in line with these four behavior modes. In other words, we do not need to frame this as “finding balance” rather understand that various desired behavior change types call for different strategies depending on the situation.

How Can Health Clubs Benefit From Wellness Initiatives?

How Can Health Clubs Benefit From Wellness Initiatives?
Earlier this year I wrote an article for the CCD News Update about how the Affordable Care Act is affecting the health club industry. The article summarized how new incentives and public policy changes put forth through health care reform are opening up great new possibilities for health club operators who want to boost membership and improve their club’s bottom line. The simple truth is as the cost of health care goes up, employers that self-insure are bearing most of the burden. Many have turned to wellness programs and employee incentives as a way to lower their costs and encourage their employees to stay (or get) healthy.

We are also now seeing doctors and allied health professionals start to work more closely with health clubs as a way to encourage their patients to make positive changes in their lives. Overall there’s an increasing trend toward prescriptive wellness — and this positive trend, and the opportunities that come with it will undoubtedly continue to increase in the coming years. As an extension of my prior article, this quarter we take a little closer look at examples of how clubs in California are benefiting from this rising tide in the hope of fostering ways your club might be able to benefit too.

Health Care Reform and Health Clubs

So where does your health club fit into this changing landscape? In the first article, I highlighted that the Affordable Care Act (ACA) includes provisions addressing two kinds of wellness programs: participatory programs and health-contingent programs. Participatory programs can potentially subsidize the costs of a club membership across an entire employee base. Health-contingent programs, on the other hand, require participants to meet specific health-related criteria. An example of this type of program in California is California WorksWell (for more information visit: http://www.calhr.ca.gov/employees/Pages/wellness.aspx) , which provides state employees with discounted memberships at health clubs across the state through a partnership with GlobalFit, as well as free guest passes at partnered health clubs. It is no secret that major corporations in California are increasingly offering wellness discounts for its members. If you are club operator on the MINDBODY platform it may behoove you to learn more about their Exchange program (for more information visit: https://www.mindbodyonline.com/exchange/get-listed).

Focusing on Health-Contingent Wellness Programs

Among health-contingent wellness programs are physician-referred exercise programs (PREPs). These programs have several potential benefits. First, physicians are an often-untapped source of prospects. Doctors and allied health professionals are increasingly encouraging their patients to get more active (reference: http://www.cdc.gov/nchs/data/databriefs/db86.htm). Second, if you convert these referrals they are generally more likely to be intrinsically motivated, couple this “drive” with effective economic incentives from their employers, and the data supports that your are likely to retain these members for longer than your general member based (for the supporting data visit: http://exerciseismedicine.org/documents/ACSMRoundtable_GlobalizingEIM_MegBouvier_webversion.docx).

Finally, these programs can also benefit your staff by reconnecting them with a higher purpose. With PREPs, the goal isn’t just selling memberships – it is about helping people change their lives for the better. For general managers worried about employee morale, reminding your staff about the positive change they create every day is a great way to get them reengaged your club’s “why”.

If you want to try to use PREPs as a way to improve membership, try these tips for connecting with the medical community:

  • Make friends with the office staff of local medical centers
  • Host an event for medical professionals at your health club or find other creative ways to encourage them to visit your club
  • Attend events you know will attract medical professionals and network
  • Hire a liaison to help you make connections with physicians
  • Have a knowledgeable staff member provide guest content for a local medical website and negotiate some sort of reciprocity agreement

Boost Business by Targeting Key Demographics

You can also boost your club’s business by targeting underserved demographics. For example, SilverSneakers (http://www.silversneakers.com) is a nationwide program available through various health care providers, including Medicare, that encourage senior citizens to focus on their health. It empowers them to get fit by providing free memberships for seniors. And the market holds plenty of potential for this segment. Consider these statistics:

  • People 55 and over control more than 75 percent of America’s wealth
  • Baby boomers, the people born between 1946 and 1964, spend more than any other generation — $400 billion more each year — on goods and services

By offering special programming targeting this group you can draw in an otherwise underserved demographic. SilverSneakers provides compensation to health clubs based on participation, along with additional opportunities for revenue from supplemental programs. You also get access to program and marketing support, free class equipment, and free training to better serve your members. You can attract SilverSneakers members by emphasizing benefits such as fewer hospital admissions and lower medical care costs.

It is important to note that these opportunities transcend the baby boomers demographic. The ACA also needs low-risk populations to buy health care coverage from their exchange. Covered California, the state’s health care exchange, is awarding millions of dollars in grants for outreach programs that educate young adults about the benefits of health and encourage them to enroll.

More to Come

There are many more ways health clubs can use health care reform to their advantage. If you are willing to deal with the often-complex regulations of HIPAA, you can collaborate with employers to offer health screenings and track biometric data. This biometric data can be used by employers to offer discounts on health care premiums. There are California startups like Jiff (http://www.jiff.com) that you can partner with to make it easier to offer these type of services at scale.  

Furthermore, in 2018, health insurance benefits exceeding a certain threshold ($10,200 for individuals and $27,500 for families) will be subject to a 40 percent excise tax. High-end employers will start looking to wellness programs to help further reduce their costs and alleviate this particular burden. Given this segment has significant disposable income it could be an advantageous group to target if your club is properly set up to cater to a high-end demographic.

For the original California Clubs of Distinction print version please click here.

Interview with Ben Rubin about New Product Development

Ben Rubin is the cofounder of Change Collective, a new innovative platform to assist users in changing their behavior. Prior to Change Collective Ben cofounded Zeo, a sleep management company that helped users track their sleep. Ben also blogs about life hacking and other topics at BecomingAwesome.com.


1) The MOOC (Massive Open Online Courses) market has almost reached saturation; what is (or will be) the secret sauce that makes Change Collective different than other online educational platforms?

When you think about different types of learning, you can think of different types of learning and how they might benefit from different course networks: the type of learning like you might find in history classes or second-grade math, maybe knitting or even graphic design and Photoshop. Platforms like Coursea, Khan Academy and Udemy… each of these takes a slightly different approach in terms of the type of learning and the way the content is created.

This type of learning is split into two axes: one axis is user-generated content versus professional content. What we see is that within the didactic learning section, most of the market is well covered. In behavior change however, there’s a bit of a different game going on; it’s no longer just learning a skill and having knowledge. It’s about changing a behavior and learning things is actually just a very small part of the process.

Where we see the next technological shift — in terms of being able to serve this market — has been the pervasiveness of smartphones, the pervasiveness of availability of health data through wearables. The enablement of technology allows us to build a course platform that’s geared towards behavior change. Since traditional educational platforms are not specifically or necessarily native to mobile they cannot be with you, can’t remind you, or can’t stay there with you. Individual change fundamentally has to be accomplished in your everyday life, as you are walking around the world.

We see ourselves differentiated in three ways. The first is content type: we are specifically geared toward behavior change. Second, our delivery mechanism is mobile. The third way is in the product experience and design. We are firmly grounded in change science: from psychology, to behavioral economics, to community, and how all of these interact.

2) With regards to change you have said that, “when change matters, identity must shift.” What does that mean and how will you use technology to support this idea?

When you go back to our primal understanding of behavior change, we believe change generally occurred because someone you looked up to did that thing: If you were training to be a hunter, farmer, or woodworker there were role models, village elders, who would show you the way. Their behavior was passed down and modeled. In modern times, the idea of “role model” has shifted into the idea of world-class experts. Instead of mentors being chosen from a small group of people around us, these experts now have a global reach. We can match an individual to a mentor or an expert that has “been there – done that” for a specific aspect of what a person wants to change and/or improve.

When we were interviewing consumers about change and asking them what worked, again and again they would mention community and the community’s respective leader. It became very clear that one of the key aspects of behavior change is actually shifting your identity to become associated with the view within the group. This concept/idea is supported by academic research, too.

Vegetarianism is a great example of this. Someone who has a moral objection to eating meat is very unlikely to choose an expedient and tasty the hamburger, because their identity and their morals are tied up in that position.

Our realization was we could use technology to bring great expert content and actual change facilitation to a wide audience. The experts can now better tell their stories, create communities in a scalable way and enable user identities to shift (which will help effect change).

3) You have spent significant time on product development since announcing your new project at the 2013 QS Conference. What have you learned about your customer segment and product during the process?

We have been talking a lot with experts, and talking with consumers. The process really boiled down who our target customer is. We describe them as one of two personas: The first is the Healthy Achiever. This person tends to be 20 to 55, female, interested in holistic life change, interested in sustainable change across a broad range of avenues from physical life, to raising kids, to household products, to her spiritual life.

The second persona is the Performance Optimizer. This person tends to be male, in a similar age range as the Healthy Achiever, and interested in optimizing risk. He prioritizes career over the rest of his life, but is interested in hacks across the board, and really wants to apply the minimum amount of effort in order to get the maximum amount of the gain. He is less worried about sustainability and a holistic approach.

So we really had a chance to dive in deep, understand those personas, understand who we are going to cater to and then talked to the experts who have already served those market segments somewhat and are well-respected by those consumers. So we have learned a ton about both the consumers in this market and the experts who serve them.

4) Given you are an avid life hacker yourself, what are three “hacks” you have successfully implemented in your own life that have yielded significant desirable results?

I will give you four because I know them well.

1) Sleep: Get 8 to 9 hours in a dark cool room, with black out curtains. You need the appropriate amount of REM and deep sleep. If you sleep right, the rest of your life will follow.

2) Nutrition: For me, the hack is Paleo, but there’s good reason to believe that lots of different approaches work for different people, so you need to discover what works for you.

3) Physical activity: Specifically, for me, it’s a combination of CrossFit and Olympic lifting that works. That will not work for everyone. However, I do tend to suggest some form of resistance training or other type of weighted work.

4) Meditation

5) What is the most valuable takeaway from your experience building and winding down Zeo?

I will give you two:

1) Listen to your customers. We always knew they didn’t love wearing headbands. We also knew Zeo was a great product — the device gave amazing data quality — and we projected that consumers would get over their objections (to headbands) because the product was so amazing. That never happened. Had we listened to our customers more, gathering stronger intelligence earlier in the product lifecycle, we would have more quickly shifted to non-contact sensor products.

2) The importance of building a corporate culture based around shared values. We started Zeo when we were 20 years old, just a couple of college kids who got together and started building something, perhaps without a truly defined shared purpose. When I look at the thing that has really worked for us at Change Collective, it is unity and shared values and really being mindful of building those shared values into the organization and company culture.

Interview with Craig DeLarge about Digital Mental Health

With a career in health and wellness spanning two decades, Craig DeLarge has held significant leadership roles for Johnson & Johnson, Communications Media, Inc., GlaxoSmithKline and Novo Nordisk. Craig recently left his management role with Merck, serving as the Global Leader of Multichannel Marketing Strategy & Innovation, to pursue opportunities in the digital mental health space. In addition to Craig’s pursuits in health and wellness, he is also a successful business coach and blogger. Craig’s coaching blog can be found at WiseWorking.com.


1) After a long and successful career in pharma, what are the major factors pulling you to now focus your energy on digital mental health?

There are 2 major factors that have contributed to my pivot. The first is that I have fortunately reached a period in my life where I have the luxury of taking a sabbatical. During this sabbatical I am bringing together my 15 years of digital health care experience with my personal interest in mental health as a professional coach/trainer and mental health advocate. I am not a psychologist, but I have experience helping people with change and personal growth. I also have a personal interest because I am a caregiver and due in part to that personal journey I have done extensive work with the National Alliance on Mental Illness (NAMI).

The second is there a major paradigm shift in health care from a pay for service model to a pay for outcome model. I am interested in playing a part in the evolution of this change. I realized I need to contribute to commercial models focused on health outcomes.

2) What has impressed you so far about the budding digital mental health space? What has been a disappointment?

As I have surveyed the space of digital technologies focused on the prevention or treatment of mental health/illness, I have been impressed with the breadth and variety of available technologies.

I won’t call this a disappointment, but what I would like to see more integration of individual technology solutions. Although there is clearly a lot more out there in digital mental health, I have yet to see many players integrate their offerings and create a holistic solution to the benefit of the patient and caregiver.

3) Given your unique vantage point, what role do you believe pharma plays in supporting digital mental health initiatives succeed?

Pharma can help integrate these products with their core product – drugs – to get a synergistic 1+1-3 safety & efficacy effect. For instance, drugs are only effective if you take them. In mental health there is a lot of non-compliance. There is a chance for digital health tech to have a complementary effect strengthening compliance & support. There is also the opportunity for better use of patient’s data to create win-win therapy & outcome situations.

Another point is Pharma has the money to invest to support digital health in a venture capitalist & scale up role. Most of the big Pharma players already have innovative investment funds, and have mechanisms for investing in budding digital health technologies.

Lastly, Pharma is skilled at influencing public policy. In that respect, Pharma can help assure there is room for relevant digital health technologies to grow in their beneficial application and use.

4) One of the early assumptions about wearables specific to digital physical health was that data in and of itself would be a change agent. There is growing evidence that to improve physical wellness, the human element is still required and that digital monitoring is simply another tool to augment mentorship and coaching. Do you think the same will be true for digital mental health?

The simple answer is yes, but not in the short-term. There will come a day where artificial intelligence will be smart enough to help mental health patients. I am confident of that, but we are not close yet for two reasons. One, the technology is simply not sophisticated enough yet. Two, my generation does not possess the comfort level with technology that they would see their phone as their therapist. However, our children and grandchildren are growing up in a new world where their generation might be able to have that type of relationship with technology. There is a degree of acceptance that needs to occur for technology to supplement the human element at that level and that will not come quickly, but it is coming. In the short-term although I do not believe digital health tech can replace human mediation, I do think there is a good chance that the right technology will be great at augmenting traditional therapies. These technologies today have an opportunity to act as supplements and/or amplifiers to the experience a person has with their healthcare providers and caregivers.

5) Playing the role of an optimist but tempered by the current results of activity tracking and cognitive brain training (thus far), how much do you think can be accomplished regarding digital mental health over the next five years?

This might be out of bounds regarding the specific questions, but I would hope simply we are more accepting, less judgmental, and have erased much of the stigma around mental health and mental illness that currently exists in society.

Going back to a previous answer, I hope in five years developed comfort with these technologies allows us close the gap between our view of physical health and mental health as separate things. The two are interrelated and it is damaging to separate them. There is a rising tide of awareness, and through social media it is amplified, which is bringing awareness to mental health issues. As a leader, I want to make sure this momentum is supported and progresses.

Additionally, I think wearables will become ubiquitous and invisible, and improved in their ability to reliably measure for outcomes. Its digital health adoption will grow exponentially. As a caveat, I don’t think you will see people who suffer from hallucinatory illnesses (such as schizophrenia) really benefiting from these technologies, but other mental illnesses, like depression, bipolar, anxiety, borderline personality disorder, etc., where increased mindfulness, awareness, and social support can be an important intervention should benefit greatly. 

Lastly, I would love to see technology help the caregivers of the mentally ill. There are opportunities to support this groups and especially in the face of comorbidities they face as part of the caregiver role. My hope is that innovators can find ways to help caregivers and create technologies that works for them too.