July 10, 2025 • 34 mins
In this special episode, recorded onsite at Aspen Ideas: Health 2025, Mohit Manrao, Senior Vice President and Head of the US Oncology Business Unit at AstraZeneca, sits down with Karen DeSalvo, Chief Health Officer at Google to explore how cutting-edge technology—including AI and Google Cloud—is revolutionizing healthcare. Discover how these advancements are making care more personalized, accessible, and effective. Take a behind-the-scenes look at real-world innovations and learn what the future holds for patients in a world where health meets the power of tech.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Unknown (00:04):
Brendan, welcome to That's understandable. I'm your
host. Brendan McAvoy, US head ofcorporate reputation and digital
communications at AstraZeneca,as we kick off for third season,
we're introducing a new twist.
Some episodes will be hosted bymy talented colleagues bringing
new perspectives to our missionof making healthcare and science
more understandable. Today, I'mexcited to hand things over to
(00:26):
Mohit man Rayo, Senior VicePresident and head of the US
oncology business unit. Enjoythe episode.
Hello everyone. Welcome toanother episode of That's
understandable. And I'm here onground at the Aspen health
ideas. And today I have a veryspecial guest with me, Karen.
(00:48):
And Karen, great to have youhere with us. And thank you for
joining me to begin. Could youplease introduce yourself and
talk a bit about your currentrole and how you got into this
field? Well, thank you forhaving me today, mohith, I'm
really excited for theconversation. It's great to be
here at Aspen health IdeasFestival. It always brings new
(01:08):
ideas, new perspectives, into mybrain. So this will be another
fun way to have a conversation.
So I am currently the ChiefHealth Officer at Google. I'm
actually the first Chief HealthOfficer we've had at the
company. I've been there overfive years, and my job has been
evolving since the moment Iwalked in the door, but in
essence, I'm leading a globalhealth team that works to unlock
(01:32):
our technology and platforms tohelp everyone, everywhere live a
longer, healthier life. Thatmeans we work with governments
and healthcare systems andpharma partners to use our AI
technology, use our cloudplatforms, but also many other
(01:52):
ways that we that we helpadvance their goals. And the
same thing for individual peopleevery day who come to us on
surfaces like search. I came tothis job because it was a place
where I could apply all in onerole, the three worlds that I
have had professionalexperiences in across my career,
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the world of medicine, the worldof public health and the world
of technology, and so every dayI get to blend those worlds and
think about how together theycan help create for people all
over the planet.
Your experience and skillset isamazing, because I kind of think
about the golden era of sciencewe are in. But science can also
(02:39):
be accelerated today with thetechnology that is unlocking the
power, and if the public policyis right, we can have
exponential impact. And I thinkyou having had an experience in
all those three and taking arole at Google, which was so
instrumental, and I want to comeback to it at the end on your
leadership lessons there, it'sbeen great. But today for our
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audience, I want to start withyou mentioned about AI and
emerging technologies. The lastdecade has seen a huge shift in
how consumers digitally engage,and here in 2024 in the United
States, half of the populationat least had one telehealth
visit. From your vantage point,what are some of the
opportunities and challengesyou've seen from that evolution
(03:21):
of tech in healthcare.
You know, I started medicine ina time in the early 90s when we
still had digital pagers, youknow, that spoke to us or
bleeped out numbers to callback. And so I've seen quite a
lot of technology introducedinto medicine across my career,
the internet, smartphones, clouddevices and AI increasingly in
(03:44):
these last few years, I thinkthat the view that I have from
being in a company like Googlethat I don't think I saw when I
was working in government oracademia or nonprofit world, is
how much People actually begintheir health journey with
digital tools. So most peoplestart their health journey
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online on a, you know, a digitalsurface, a question and answer
tool like search or some ofthese new AI interactive bots
that people are using Ours iscalled Gemini, but but around
the world, we get about 500million health questions every
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day from people who are askingabout something, you know, their
own health, their family'shealth, what they're trying to
get more clarity about what theywere told when they went to the
doctor's office. And I think itreally helped me understand that
by the time they someone doesarrive in the doctor's office or
in the hospital, they've beentrying to understand and learn,
(04:49):
and that, I think helping thehealth system recognize that, be
respectful of that, feels like aresponsibility we have at
Google, but I think it's all.
Also a way that we try to help,help the healthcare system and
all of the health ecosystemunderstand that, that there is
knowledge work that we're notmeeting, that need, sometimes on
(05:13):
the healthcare sector. And sopeople are using digital tools
just to get information, muchless what you mentioned, to
connect with the care system,and that is, you know, both
synchronous, like withtelehealth, or asynchronously
communicating with clinicians. Ithink what we're the world that
we're in already now is onewhere health systems of all of
all ilk, but especially thoseare providing care, are starting
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to use technology bots tointeract with people between the
care experience or to help themnavigate the care experience. So
it's not even asynchronouscommunication with a human or
telehealth visit. It's actuallya circumstance like a
Hippocratic AI, which makes anurse bot that reaches out and
does an outbound call to apatient to see how they're doing
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after a hospital discharge. Andthey're not the only company
doing that. We're seeing lots ofthat grow around the world, and
I think, all to say, theopportunities that we've that
we've been seeing, especially inthe last few years, are that
we're getting better at meetingpeople where they are, because
they were already trying to comemeet the health system. They're
trying to learn about newmedications they were on. They
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were trying to figure out wherethe science was, where they can
enroll in a trial. It was reallyhard. It's gotten easier with
the admin and the Internet, withthe digitization of their
records, of other records, theyhave a patient portal, but also
other ways that the system isnow starting to be able to use
those tools to reach out andhelp people, even in their own
home, 500million is a number, and that is
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absolutely kind of a signal ofthe unmet need, of how we people
are looking for information. Andknowledge is king, as it relates
to you know when you are goingthrough any treatment and you
want to understand more aboutit, and empowered patients lead
to better outcomes, for sure,having said that, you also
talked about med Gemini, and Iknow alpha forward came from
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Google's shop. So from thatperspective, what are the
challenges of integrating thesehealthcare tech solutions or AI
innovations in the real world,whether it is at the hospital
side, where you have experiencein managing a health system, but
also at a patient level, like,how do you how do you integrate
that? What are the challengesthere?
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So this is a one of the veryinteresting things about a
company like ours being involvedin in building solutions for
consumers, but also forenterprises. So on the consumer
side, patient, pre patient, pickthe language, and then for
individuals, we are because ofthe scale of the several 100
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million, because of the morethan 200 billion views of health
videos we have a year onYouTube, because of all the
interactions we have on surfaceslike maps, we're we're getting a
lot we get a good feeling of theanonymous experience of people,
and what are the priorityquestions that they're asking
about? How hard is it for themto find an answer about a new
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condition that emerges on thescene, like COVID? And so we
think about ways that we can wecan make that easier, but we're
able to do that almost in realtime. So our user research for
consumers is constantlyhappening and iterating. And
it's a, it's a, it's quiteexciting and great. And it was,
I think, during the pandemic,which was the early part of when
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I was at Google. I just couldn'tbelieve how helpful it was.
Because when you're in publichealth, I had been, you know, on
the front lines in publichealth, you like, what are the
questions people are asking? Howcan I help them get more
information? How do I help themnavigate to the right sources?
We as a as a company, are ableto amplify what the CDC or the
local health officer or anyorganization is trying to get
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out to folks and help peoplenavigate because they're
starting on that, that digitalplatform. But we can also see
like we work with, say, a globalentity that's trying to provide
information like Gavi, which didvaccines? We were able to have
our marketing teams work withthem and to create ads on the
search homepage that wereinteresting and invited people
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to click and navigate to GAVI tolearn more about vaccines. It
was one of our philanthropicprograms that we did during
during the pandemic, and so wecan take what we know about how
users interact with the platformand apply that to a public
health good. It's harder on theenterprise side, because we
don't run hospitals. We don't,you know, do directly research
(09:36):
into building new newpharmaceuticals. We're not going
to we'll use alpha fold in thewet lab, if you will, but we're
not using it in the real world.
And we learned pretty early onthat we need to not only build
AI that works in the laboratory,if you will, that works in in
the research environment, butwork with partners to put it in
the real world. And one of ourearly examples of that was some
(09:57):
work we did on. Mammography withone of the trusts in the UK,
where we built a model thatcould read a mammogram, do that
on par with a with aradiologist. But what was needed
in the UK still is, is a secondreader. So if you have a
mammogram, you need to have two,two readings of it before the
(10:18):
woman can get the report, butthey have a shortage of
radiologists to read mammograms,so they said, Could you help us,
you know, figure out if we couldapply this in the field? And we
learned so much by just saying,Okay, we built the tool. Now
let's put it in the, you know,the environment, and see how the
clinicians respond to that as asecond read. Figure out when to
push that information into thesystem. What's the right timing?
(10:41):
We learned other things withrelated work that we did, like
with Northwestern that readingmammograms to help a
radiologist, you can do you canhave the the AI read it, and
push the abnormal scans to thetop of the cue, so that's the
first thing, first ones that thefresh eyes of the radiologist
read and or they get read beforethe the patient leaves the the
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radiology suite. So if they haveto do additional views, or do
ultrasound, whatever, they'realready there. So those are
examples of how we we test andlearn it in the real world. I
want to say maybe, maybe, ifthere's time, I can give you a
more detailed example about GenAI, but we have a work, some
work in the field right now,with a medically tuned model
called on me, which doesessentially Q and A with people
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about, oh, you have a fever,have you been traveling, etc,
and we're doing that with one ofthe Harvard systems in the real
world, because patients don'talways read the textbooks.
That's what we learned inmedical school, right? And so it
things show up in different waysin the real world environment.
So we'd never say it's done whenwe've just built it in the lab.
But you know, I think the one ofthe things that I have been
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really intent on since I came toGoogle is to build health
expertise for our health team.
Because we support all of webuild health use cases into all
of our products at the company,all the ones I've mentioned,
from search all the way throughto cloud and in the research
teams that underlie all of thatwork. And what I need for our
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team members are people who haveexperience in coordinary
academic environments or insmall clinics. I need people who
have worked all over the world.
I need nurses. I need clinicalpsychologists. I need
physicians. I need people whoare regulatory experts. So I
really have looked for peoplewith with different walks of
life, you know, who have thesedifferent lived experience,
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because they also will reallyunderstand the environment. You
were sharing a little bit aboutyour background earlier, and it
reminded me of one of thephysicians I have who grew up in
India, ran a rural hospitalthere. Then he worked in the
Middle East for a while, then heworked in the UK for a while,
and then he came to work in theUS for a while. And so, you
know, it's just Joel. Is hisname. He has this really
interesting global perspective.
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Then I have others who have gonevery deeply in the Japanese
market for years. And so theyreally understand research and
work there. So I'm counting onour team, but we know it's a
beginning, not the end. So wehave to work with partners, and
then we have to see how the howthese tools work out in the
field.
No, absolutely. And I thinkdiverse people in the team who
have had different livedexperiences, they help us
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innovate and push the boundariesto learn more and adopt more.
And technology can be actually aleveler, whether it is, as you
said, in terms of drivingefficiency or filling in
infrastructure gaps that exist,it could help leapfrog systems
and and you talked aboutpartnerships. I want to also
come back to we just came fromASCO, and ASCO is is kind of the
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Super Bowl for oncology, wherenew clinical data gets
presented. And every year,plenaries get presented, there,
where big data presentationshappen, that will transform
care. And I kind of say, I wishthat transforms care is for
everyone tomorrow. It doesn't atzip code level, gaps could
exist, and whether it isunderserved population, whether
it is vulnerable populations. Soat Google, how do you think
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about partnerships with orinitiatives that help address
specific vulnerable populations,underserved populations, with
the needs that they may havewith regard to driving equitable
outcomes for those or educationfor those.
It's a priority for us, and webuild with inclusion by design.
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On the other hand, we also knowthat sometimes you have to build
customized solutions, becauseone size won't always fit all.
In fact, ASCO is one of ourpartners. That of cloud was
there and talked about some workwe're doing to help bring make
it easier, to bring evidencebased guidelines to the
fingertips or brains of theclinicians serving individuals.
And our CFO was there, and shetalked about her lived
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experience as a cancer survivor,and some work we'd done with the
American Cancer Society on theconsumer piece of that equation
to help them find theinformation they need. So you'll
often find us on both sides ofthat of that equation of helping
the consumer and the clinician.
So I mean to say that. Thatinclusion by design and that
we're thinking about how to helpeveryone everywhere find health
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on their own terms, is how wesay it. It's it's yes about
vulnerabilities based uponthings like geography, rural
populations or things likeincome or literacy levels. But
it's also true that sometimes wewant to build solutions for
highly vulnerable populations orhelp protect them from from
(15:25):
finding misinformation on someof our surfaces. I'll give you
an example of that. Mentalhealth is has been a priority
for us, you know, in all of ourareas. So we think about, okay,
someone's going to come onYouTube or search or platform
and look for information abouthow to commit more effective
suicide or how to if they havedisordered eating, how to find
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ways to eat a 300 calorie a daydiet and and what we don't want
to do is satisfy that userintent that. But typically,
that's how our company is built.
Like, Oh, you're asked aquestion about Greece, we're
going to get fined to theanswer, but we want to interrupt
in those cases, so we use AI totry to, especially if the
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question's not crystal clear ofwhat they're asking to see. Oh,
this is a person who seems to betrying to get more information
about suicide tasks or somethinglike disorder eating. And
instead, in say, suicide, whatwe would do is not help. We
would not direct them to findthe information they're looking
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for about the more effectiveways to harm themselves. But we
interrupt that user intent witha with what we call one box. And
in the US, for example, thatwould be 988, but based on the
Geo, we would that's big boxwith the big numbers shows up in
front if you need help. This iswhere you can call or you can do
a chat and sort of give them,give them that information. So
when we think about vulnerablepopulations, we are thinking
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about the whole as much as wecan, the whole spectrum. But we
do prioritize life and death inthose kinds of circumstances,
and we've done that, forexample, with Gen AI and our new
our new services like Bard orGemini, is what we call it,
because we want to make surethat as we're putting out new
tools and technology in theworld that we don't, we don't
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always want to just satisfy whatpeople need. There's a flip side
to that, where we also will workwith local organizations, local
governments to try tounderstand, hey, how can our
tools be more useful on thefront lines? We have some ways.
We've done this with Android,something called Open health
stack. We work with frontlinecommunity organizations that are
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serving mental health or otherneeds. We're not going to build
the tool, but we'll help thembuild it so it makes more sense
for them on the front lines.
Maybe the easiest way to say itis that this is major priority
for us across all our products,in all of our areas of work as a
company, but in health, majorpriority, because it is about
life and death, and because ifyou don't attend to it when
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you're creating the model orcreating a product, you could
exacerbate disparities, and techactually has the potential to
eliminate disparities, Andthat's the direction that we
would want to go as acompany. That's great, and that
resonates with me. Karen as aspart of my second hat I wear. Of
course, I run the oncologybusiness for AstraZeneca in the
US, but I also chair and run ourfoundation, and we work with a
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lot of NGOs on the grassrootlevel to understand the
barriers, and use localambassadors to educate on those
barriers or provide localsolutions to drive that. Because
to your point, we can, we can.
We cannot solve everythingalone, and we need to depend on
partners, and those partnershipsare key, but also the right
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point of care intervention, likeyou gave this example of people
wanting to find informationabout harming themselves. That's
where you need to intervene. Andintervene with trust is where it
makes the biggest impact. Soabsolutely, I think the
technology could be an enablerwith a trust that comes
alongside from if they hear fromthose whom they trust. So that's
something I think we are workingon. You also,
(18:57):
can I just this trust thing? Iwas just looking at a survey
that Edelman did, and that stillsurprises me, which essentially
said that about a third ofpeople, this is 116,000 people,
are surveyed in 16 countriesaround the world, and about a
(19:20):
third of people said that therethey are more likely to trust
something they read online andor something they hear from
family and friends than theirdoctor. And in some age groups
like this, 18 to 34 it's aboutalmost half. It's like 45% so
this notion of trust, by theway, going back to medicine,
like I always thought, coming upin medicine, right, that
(19:42):
patients are going to trustdoctors and but we certainly saw
this increasing in the pandemic,in this surveys from just a few
months ago. And I think it'sthis word Trust has different
meanings for different peopleand and so I think your your
point about partnership alsomatters, because sometimes
people are going to trust you.
Their local pastor. Sometimesthey're going to trust their
doctor. Sometimes they're goingto trust a sports figure. I
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think all the ways that we canget the right information in
people's hands to help peoplenavigate is certainly what we'd
want to do. But I think whatthat I've had to expand the way
I think about who people trust alot in the last few years,
I have to sometimes tell mymother what she reads on a
messaging service is not maybethe only thing, and she needs to
double check, but yes, that'strue. At the same time, you've
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had the opportunity to work ingovernment, both at state and
federal level, and talking againabout partnership and building
trust. How can health systems,industry, government,
communities come together tokind of drive not only trust,
but impact and bring especiallythis technological wave of
innovation to life.
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You know, it's, I think, comingout of the pandemic, globally,
there's been more distrust oftraditional institutions. And it
is, I think it's something thatwe're all going to have to lean,
lean our heads together, andthink about how to restore some
of that trust. You know, when Iwas a local public health
(21:08):
officer, if we had in NewOrleans, we often had challenges
with our water plant, and so wedidn't need a water we'd have to
have a boil water notice,because there would have been a
power outage or something. And Iused to always think that the
most important thing was, wasthat when I went on the
television, because that was,you know, whatever, back in the
(21:30):
day, or the radio, and said topeople, boil your water, they
needed to trust me and do that.
And so I needed to be reallycareful about everything I ever
said to them, because I didn'twant it to ever get gray,
because that was become sort oflife and death, especially for
some some populations in thatenvironment. And I think the
part of the reason the pandemic,I think, was hard for folks, is
because information did changeas we learned about the virus,
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as we learned abouttransmission, as we learned
about new therapeutics, thingsthat evolve. But I do believe it
can be restored, but I alsobelieve that we have to
recognize sort of like thisEdelman survey results that I
mentioned, which is that thatyou cannot take for granted that
people are going to trust thesame resources and sources. Some
people will trust government.
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Some people won't. I one of thethings that we did learn a lot
during about during the pandemicwas that that it's not just the
message, but sometimes themessenger, which is essentially
what I'm saying, about who totrust, and we learned things
like, if people are alreadywatching a sports figure that
they trust, and we can and thatsports figure has an interest in
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an area could be something likeinfectious disease, like the
pandemic, could be mentalhealth. We've used it in those
spaces, and we can provide themwith evidence based information
that comes from not we Google,but, you know, link, link them
up with the CDC or the NHS, or,you know, whatever government
around the world wants to workwith them, then they can be the
messenger, and people are goingto receive that, and and and
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trust it. Well, it, it soundssimple when I say it like that,
but a lot of medicine stillfeels like they should be the
messenger of the message. And Ithink the reality is, is that we
have to let that go, because themost important thing is people
hear the evidence, hear the hearthe right data driven, you know,
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information and decisions andwho delivers that? We have so
many more options, basically, inthis day and age, if it's done,
if the pairing is done properly,with messengers on the different
surfaces and places where peoplereceive care in public health
there are, there's not a newidea. This goes back, you know,
I worked the Ebola outbreak, andit's very similar thing. You
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know, just couldn't be that itwas what the World Health
Organization wanted to tellpeople locally in the community,
they had to find local faithleaders, etc, to help carry that
message. We see this withcommunity health workers all
around the world, who are oftenthe most trusted individual. So
it's a flexibility notion that Ithink we're all going to have to
get comfortable with. But what Ido hope is we'll, as a health
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ecosystem broadly, start to do abetter job of having a shared
set of facts, even if we werecomfortable having separate
messengers.
Yeah, and I think that messageon the right messengers for the
audience, where they connectwell with and trust is key,
because I think the intent iseverywhere good. But if the
messenger is not the right one,it may drive people in the
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opposite direction. Actually,we, as part of AstraZeneca bold
ambition to one day eliminatecancer as a cause of death. We
believe we cannot do it alone.
We have partnerships. But wealso believe not only
pharmaceutical interventionswill drive it. We can drive it
by also driving early detectionof cancer, and we've got a
partnership with NHL, whereactually the NHL and NHL, you
know, the player Association,and everybody involved in that,
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are the voices sharing theirstories of how early detection
helped them to communicate tothe hockey community and then
encourage them to talk to theirplus one to go and get screened.
So it's. Yes, it's society has arole to play, but finding the
right messenger so it absolutelybrings home the point that there
may be more trust there, versusXYZ companies standing up and
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saying that, go get yourscreening done. So I do relate
to that. And I think Google hasis in a position where people do
do searches and trust a lot ofthis and the work you just
talked about with theinformation is really
key. Yeah, and even there, we'velearned we recently started out
a thing like people like you,because people, when they search
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on a topic, it's easy onYouTube, because they're looking
for people like them, but onsearch, they also want to find
people who have the conditionthey have and have had the
experience. So we've done athing with Reddit where we can
connect folks and people reallythat experience is really
positive, because they can allsometimes they just identify
with another individual who hasthe condition. But I love this
NHL example. I want to hear alittle more
(25:51):
about it later. Yeah, okay, justdon't talk to me about hockey
terminology. I'm still pickingor me either. I mean, I would
say yes one, one of the thingswe said is, go get your body
checked against cancer, whichhas been very successful because
the hockey community relates tothat line, yes, and we are
trying to do more with that. Andagain, everybody has a role to
play. Talking about role youstarted off with introducing and
(26:15):
talking about, when you came toGoogle, you were the first Chief
Health Officer. You started thatin 2019 and very recently, you
announced that you're going toretire as of August 1. And I'll
come to that what you're goingto do after it. But as you think
about all you have accomplished,what advice would you pass on to
your next person, but alsopeople listening in from your
(26:36):
leadership lessons, not only atGoogle, but broadly across
clinical government and all thework you've done
today. Well, you know, one ofthe things that I will do in
retirement is I'm gonna do a lotof processing. It's interesting,
you know, I've I about what I'velearned. I'm one of those people
that went from thing to thing tothing without break. And I
(26:58):
started working when I was inhigh school, actually, my first
job, I was 13, I taught tap so Icould pay for my own dance
lessons, and I paid my waythrough college. I, you know,
sort of, I've been on a go, go,go. And I think I'm gonna, if
you ask me, in a year, I'llprobably have processed a lot
more. But what I would say is, Ithink that, I think people need
(27:19):
to enjoy the journey. Sometimespeople get really fixated on, I
want this job or this role atsome point. And I sometimes I
get asked, Did you ever thinkyou'd work at Google and be the
Chief Health Officer? And myresponse is, there was no Google
when I went to med school.
Therefore I would have neverimagined. You know, there's so
many things that have evolvedthat I would have never imagined
(27:40):
are ways to help people, whichis the second category, and that
is for me, the choices I've madeabout where I've gone, where
I've said yes to taking on arole as a place where I felt
like I could help people. Andmedicine very much was that way
I practiced for 20 years. Iloved caring for patients, but I
always was thinking about thesystems in which they were
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trying to navigate, and how,frankly, they were more built
for doctors than for them. Andyou know, how could you change
that so that it was really builtaround the people we were here
to serve? And that story isrepeated for me over and over
and over again in my roles ofwhat are the ways to get
information in people's hands,like when I was national
coordinator, and changing theway that we got gave people
(28:24):
access to their electronichealth records, or ways that I
get to do that at Google, wherewe give more knowledge and
insights, and I'd say power topeople about their own health.
We're building personal largelanguage models that that our
hardware, like Fitbit users, canhave to help them know what are
the right questions to ask whenI go into the clinical
environment, or what are theways that I can get better
(28:45):
sleep? That is that side of theequation, the patient, the
consumer, is the part that Ithink it's left behind a lot
when we're designing systems orthinking about the best way to
pay or do technology orimplement Gen AI, and we often
think about, what's the what'sthe way that we're going to make
the doctor's life better? NowI'm a doctor. I'm married to
one. I love doctors. Don't getme wrong. I taught a lot of
(29:07):
them, however, we're just apiece of the puzzle, quite
honestly, and I think I do hopethat of the things that I've
learned, and I'm seeing more ofis that people are realizing
that it's team based care, andpart of that team is the patient
or the really, most people don'twant to be thought of as a
patient. They want to be just aperson, right? And they want to
(29:27):
be healthy most of the time. AndI think that this era that we're
in with Nai is allowing more ofthat. So it's very exciting. So
journey focusing on what youreally care about and what you
choose east of your job. And forme, it's been like figuring out
how to equalize some of thatknowledge and power so people
have more access to where theywant to navigating their own
(29:49):
health journey on their ownterms. And I think, I think the
other piece that's been thematicfor me is it's really it is
possible to both do. Good and dowell, that sometimes people
think it's two choices. Oh, Ican go work in private sector.
I'm gonna go work in thenonprofit, and I've done all
that. But I also know thatthat's very true, that you can
(30:09):
help people, but you can also dothat in a way that that has
makes the business a goingconcern. I'm gonna give you a
specific example about that thatwas taught to me by patients
after Katrina, Hurricane Katrinain New Orleans, we were remaking
the health system there. It wasa one that was very much about
(30:30):
hospital based. Most people wereuninsured, so about a quarter of
the Louisiana populations, abouta million people were uninsured,
and most in New Orleans area,most individuals. So most of the
time, what happened is, ifsomebody was sick or had a
chronic condition, even theyused the emergency room for care
because there was no communityhealth so we were taking the
opportunity from the tragedy tobuild a community health network
(30:54):
and infrastructure. And after alittle bit of time, I had one
patient say to me, you know, itwas free for the beginning,
because we had a lot ofphilanthropy and volunteerism,
and we were trying to figure outhow to give people access to
community based, neighborhoodbased care. And a patient say to
me, y'all should start charging.
(31:14):
And this is a service worker inNew Orleans, very low income,
person without health insurance.
They said, Just chargesomething, because if you don't,
you're not going to be around totake care of us in the future.
And this is our medical home inthe neighborhood, and we want to
keep it and so I think,predicated on that, some other
conversations we had with thecommunity organizations, with
when we worked across the area,we did start charging a little
(31:36):
bit on a sliding scale. Andpeople really felt a sense of
dignity. They felt a sense ofownership, and when they could
come in and it was $1 orwhatever it was, and, and it was
a good lesson for me about also,you know, you think you're doing
good for the community, but, butthey want to be a part of this.
They want to feel like they'vegot some some knowledge, that
you're going to be there for thelong haul, right? Because
(31:59):
sometimes philanthropy comes andgoes and they also they're
smart. They know that that abusiness has to pay its
employees. Many of their friendsand family were working there.
So just one example of many I'vehad across my career that it is
possible to do good and do well,and I would encourage people to
think that way and not think ofit as just a choice in one
direction or theother. Love it. Karen, thank
(32:19):
you. I'm going to take that withme. You can you can do well and
you can do good.
I think that's the job you haveright now. Quite honestly, I
think this is something whichwill drive our audience as well.
One last thing I'll say is whatI took away from what you said,
amongst many things, was journeyis critical and destination
(32:41):
incidental. And as we thinkabout our patient's journey,
team based care for them,thinking of them as individuals
is key. Destination isincidental. I know you are a bit
hiker. What's your nextdestination? As we wrap this up,
well, I'm really looking forwardto handing the baton to the guy
who's currently my deputies,tremendous human being and
(33:03):
physician and leader, and I'mvery excited to feels great to
be able to hand it off tosomeone I really trust. I'm also
very excited to put on hike andchoose and we have a number of
trips planned in the Southwest,and then planning up a bigger
trip to do the Tahoe Rim Trail,which is to hike around Lake
(33:23):
Tahoe. It's, it's about 175miles, so just a couple of weeks
of through hike. But I'm gonnado that one as an intro before I
decide if I'm taking on anythingbigger. But mostly I just want
to have some time to reflect andrelax and and build up more
gratitude for this career thatI've had.
Yeah, thank you. And thank you.
You had an amazing career, 35plus years of contributing in so
(33:43):
many places. We wish you thevery best. And thank you for
being here. And I'm sure you'llcountry contribute further on,
even in during your retirement,into many things and many
companies on this tech journeyin healthcare. So thank you so
much for being with us. Thankyou very much. You
Brendan, welcome to That's understandable. I'm your
host. Brendan McAvoy, US head ofcorporate reputation and digital
communications at AstraZeneca,as we kick off for third season,
we're introducing a new twist.
Some episodes will be hosted bymy talented colleagues bringing
new perspectives to our missionof making healthcare and science
more understandable. Today, I'mexcited to hand things over to
(00:26):
Mohit man Rayo, Senior VicePresident and head of the US
oncology business unit. Enjoythe episode.
Hello everyone. Welcome toanother episode of That's
understandable. And I'm here onground at the Aspen health
ideas. And today I have a veryspecial guest with me, Karen.
(00:48):
And Karen, great to have youhere with us. And thank you for
joining me to begin. Could youplease introduce yourself and
talk a bit about your currentrole and how you got into this
field? Well, thank you forhaving me today, mohith, I'm
really excited for theconversation. It's great to be
here at Aspen health IdeasFestival. It always brings new
(01:08):
ideas, new perspectives, into mybrain. So this will be another
fun way to have a conversation.
So I am currently the ChiefHealth Officer at Google. I'm
actually the first Chief HealthOfficer we've had at the
company. I've been there overfive years, and my job has been
evolving since the moment Iwalked in the door, but in
essence, I'm leading a globalhealth team that works to unlock
(01:32):
our technology and platforms tohelp everyone, everywhere live a
longer, healthier life. Thatmeans we work with governments
and healthcare systems andpharma partners to use our AI
technology, use our cloudplatforms, but also many other
(01:52):
ways that we that we helpadvance their goals. And the
same thing for individual peopleevery day who come to us on
surfaces like search. I came tothis job because it was a place
where I could apply all in onerole, the three worlds that I
have had professionalexperiences in across my career,
(02:16):
the world of medicine, the worldof public health and the world
of technology, and so every dayI get to blend those worlds and
think about how together theycan help create for people all
over the planet.
Your experience and skillset isamazing, because I kind of think
about the golden era of sciencewe are in. But science can also
(02:39):
be accelerated today with thetechnology that is unlocking the
power, and if the public policyis right, we can have
exponential impact. And I thinkyou having had an experience in
all those three and taking arole at Google, which was so
instrumental, and I want to comeback to it at the end on your
leadership lessons there, it'sbeen great. But today for our
(02:59):
audience, I want to start withyou mentioned about AI and
emerging technologies. The lastdecade has seen a huge shift in
how consumers digitally engage,and here in 2024 in the United
States, half of the populationat least had one telehealth
visit. From your vantage point,what are some of the
opportunities and challengesyou've seen from that evolution
(03:21):
of tech in healthcare.
You know, I started medicine ina time in the early 90s when we
still had digital pagers, youknow, that spoke to us or
bleeped out numbers to callback. And so I've seen quite a
lot of technology introducedinto medicine across my career,
the internet, smartphones, clouddevices and AI increasingly in
(03:44):
these last few years, I thinkthat the view that I have from
being in a company like Googlethat I don't think I saw when I
was working in government oracademia or nonprofit world, is
how much People actually begintheir health journey with
digital tools. So most peoplestart their health journey
(04:06):
online on a, you know, a digitalsurface, a question and answer
tool like search or some ofthese new AI interactive bots
that people are using Ours iscalled Gemini, but but around
the world, we get about 500million health questions every
(04:27):
day from people who are askingabout something, you know, their
own health, their family'shealth, what they're trying to
get more clarity about what theywere told when they went to the
doctor's office. And I think itreally helped me understand that
by the time they someone doesarrive in the doctor's office or
in the hospital, they've beentrying to understand and learn,
(04:49):
and that, I think helping thehealth system recognize that, be
respectful of that, feels like aresponsibility we have at
Google, but I think it's all.
Also a way that we try to help,help the healthcare system and
all of the health ecosystemunderstand that, that there is
knowledge work that we're notmeeting, that need, sometimes on
(05:13):
the healthcare sector. And sopeople are using digital tools
just to get information, muchless what you mentioned, to
connect with the care system,and that is, you know, both
synchronous, like withtelehealth, or asynchronously
communicating with clinicians. Ithink what we're the world that
we're in already now is onewhere health systems of all of
all ilk, but especially thoseare providing care, are starting
(05:39):
to use technology bots tointeract with people between the
care experience or to help themnavigate the care experience. So
it's not even asynchronouscommunication with a human or
telehealth visit. It's actuallya circumstance like a
Hippocratic AI, which makes anurse bot that reaches out and
does an outbound call to apatient to see how they're doing
(06:01):
after a hospital discharge. Andthey're not the only company
doing that. We're seeing lots ofthat grow around the world, and
I think, all to say, theopportunities that we've that
we've been seeing, especially inthe last few years, are that
we're getting better at meetingpeople where they are, because
they were already trying to comemeet the health system. They're
trying to learn about newmedications they were on. They
(06:23):
were trying to figure out wherethe science was, where they can
enroll in a trial. It was reallyhard. It's gotten easier with
the admin and the Internet, withthe digitization of their
records, of other records, theyhave a patient portal, but also
other ways that the system isnow starting to be able to use
those tools to reach out andhelp people, even in their own
home, 500million is a number, and that is
(06:44):
absolutely kind of a signal ofthe unmet need, of how we people
are looking for information. Andknowledge is king, as it relates
to you know when you are goingthrough any treatment and you
want to understand more aboutit, and empowered patients lead
to better outcomes, for sure,having said that, you also
talked about med Gemini, and Iknow alpha forward came from
(07:07):
Google's shop. So from thatperspective, what are the
challenges of integrating thesehealthcare tech solutions or AI
innovations in the real world,whether it is at the hospital
side, where you have experiencein managing a health system, but
also at a patient level, like,how do you how do you integrate
that? What are the challengesthere?
(07:29):
So this is a one of the veryinteresting things about a
company like ours being involvedin in building solutions for
consumers, but also forenterprises. So on the consumer
side, patient, pre patient, pickthe language, and then for
individuals, we are because ofthe scale of the several 100
(07:49):
million, because of the morethan 200 billion views of health
videos we have a year onYouTube, because of all the
interactions we have on surfaceslike maps, we're we're getting a
lot we get a good feeling of theanonymous experience of people,
and what are the priorityquestions that they're asking
about? How hard is it for themto find an answer about a new
(08:10):
condition that emerges on thescene, like COVID? And so we
think about ways that we can wecan make that easier, but we're
able to do that almost in realtime. So our user research for
consumers is constantlyhappening and iterating. And
it's a, it's a, it's quiteexciting and great. And it was,
I think, during the pandemic,which was the early part of when
(08:33):
I was at Google. I just couldn'tbelieve how helpful it was.
Because when you're in publichealth, I had been, you know, on
the front lines in publichealth, you like, what are the
questions people are asking? Howcan I help them get more
information? How do I help themnavigate to the right sources?
We as a as a company, are ableto amplify what the CDC or the
local health officer or anyorganization is trying to get
(08:53):
out to folks and help peoplenavigate because they're
starting on that, that digitalplatform. But we can also see
like we work with, say, a globalentity that's trying to provide
information like Gavi, which didvaccines? We were able to have
our marketing teams work withthem and to create ads on the
search homepage that wereinteresting and invited people
(09:15):
to click and navigate to GAVI tolearn more about vaccines. It
was one of our philanthropicprograms that we did during
during the pandemic, and so wecan take what we know about how
users interact with the platformand apply that to a public
health good. It's harder on theenterprise side, because we
don't run hospitals. We don't,you know, do directly research
(09:36):
into building new newpharmaceuticals. We're not going
to we'll use alpha fold in thewet lab, if you will, but we're
not using it in the real world.
And we learned pretty early onthat we need to not only build
AI that works in the laboratory,if you will, that works in in
the research environment, butwork with partners to put it in
the real world. And one of ourearly examples of that was some
(09:57):
work we did on. Mammography withone of the trusts in the UK,
where we built a model thatcould read a mammogram, do that
on par with a with aradiologist. But what was needed
in the UK still is, is a secondreader. So if you have a
mammogram, you need to have two,two readings of it before the
(10:18):
woman can get the report, butthey have a shortage of
radiologists to read mammograms,so they said, Could you help us,
you know, figure out if we couldapply this in the field? And we
learned so much by just saying,Okay, we built the tool. Now
let's put it in the, you know,the environment, and see how the
clinicians respond to that as asecond read. Figure out when to
push that information into thesystem. What's the right timing?
(10:41):
We learned other things withrelated work that we did, like
with Northwestern that readingmammograms to help a
radiologist, you can do you canhave the the AI read it, and
push the abnormal scans to thetop of the cue, so that's the
first thing, first ones that thefresh eyes of the radiologist
read and or they get read beforethe the patient leaves the the
(11:02):
radiology suite. So if they haveto do additional views, or do
ultrasound, whatever, they'realready there. So those are
examples of how we we test andlearn it in the real world. I
want to say maybe, maybe, ifthere's time, I can give you a
more detailed example about GenAI, but we have a work, some
work in the field right now,with a medically tuned model
called on me, which doesessentially Q and A with people
(11:27):
about, oh, you have a fever,have you been traveling, etc,
and we're doing that with one ofthe Harvard systems in the real
world, because patients don'talways read the textbooks.
That's what we learned inmedical school, right? And so it
things show up in different waysin the real world environment.
So we'd never say it's done whenwe've just built it in the lab.
But you know, I think the one ofthe things that I have been
(11:48):
really intent on since I came toGoogle is to build health
expertise for our health team.
Because we support all of webuild health use cases into all
of our products at the company,all the ones I've mentioned,
from search all the way throughto cloud and in the research
teams that underlie all of thatwork. And what I need for our
(12:10):
team members are people who haveexperience in coordinary
academic environments or insmall clinics. I need people who
have worked all over the world.
I need nurses. I need clinicalpsychologists. I need
physicians. I need people whoare regulatory experts. So I
really have looked for peoplewith with different walks of
life, you know, who have thesedifferent lived experience,
(12:32):
because they also will reallyunderstand the environment. You
were sharing a little bit aboutyour background earlier, and it
reminded me of one of thephysicians I have who grew up in
India, ran a rural hospitalthere. Then he worked in the
Middle East for a while, then heworked in the UK for a while,
and then he came to work in theUS for a while. And so, you
know, it's just Joel. Is hisname. He has this really
interesting global perspective.
(12:55):
Then I have others who have gonevery deeply in the Japanese
market for years. And so theyreally understand research and
work there. So I'm counting onour team, but we know it's a
beginning, not the end. So wehave to work with partners, and
then we have to see how the howthese tools work out in the
field.
No, absolutely. And I thinkdiverse people in the team who
have had different livedexperiences, they help us
(13:16):
innovate and push the boundariesto learn more and adopt more.
And technology can be actually aleveler, whether it is, as you
said, in terms of drivingefficiency or filling in
infrastructure gaps that exist,it could help leapfrog systems
and and you talked aboutpartnerships. I want to also
come back to we just came fromASCO, and ASCO is is kind of the
(13:37):
Super Bowl for oncology, wherenew clinical data gets
presented. And every year,plenaries get presented, there,
where big data presentationshappen, that will transform
care. And I kind of say, I wishthat transforms care is for
everyone tomorrow. It doesn't atzip code level, gaps could
exist, and whether it isunderserved population, whether
it is vulnerable populations. Soat Google, how do you think
(13:59):
about partnerships with orinitiatives that help address
specific vulnerable populations,underserved populations, with
the needs that they may havewith regard to driving equitable
outcomes for those or educationfor those.
It's a priority for us, and webuild with inclusion by design.
(14:20):
On the other hand, we also knowthat sometimes you have to build
customized solutions, becauseone size won't always fit all.
In fact, ASCO is one of ourpartners. That of cloud was
there and talked about some workwe're doing to help bring make
it easier, to bring evidencebased guidelines to the
fingertips or brains of theclinicians serving individuals.
And our CFO was there, and shetalked about her lived
(14:42):
experience as a cancer survivor,and some work we'd done with the
American Cancer Society on theconsumer piece of that equation
to help them find theinformation they need. So you'll
often find us on both sides ofthat of that equation of helping
the consumer and the clinician.
So I mean to say that. Thatinclusion by design and that
we're thinking about how to helpeveryone everywhere find health
(15:03):
on their own terms, is how wesay it. It's it's yes about
vulnerabilities based uponthings like geography, rural
populations or things likeincome or literacy levels. But
it's also true that sometimes wewant to build solutions for
highly vulnerable populations orhelp protect them from from
(15:25):
finding misinformation on someof our surfaces. I'll give you
an example of that. Mentalhealth is has been a priority
for us, you know, in all of ourareas. So we think about, okay,
someone's going to come onYouTube or search or platform
and look for information abouthow to commit more effective
suicide or how to if they havedisordered eating, how to find
(15:46):
ways to eat a 300 calorie a daydiet and and what we don't want
to do is satisfy that userintent that. But typically,
that's how our company is built.
Like, Oh, you're asked aquestion about Greece, we're
going to get fined to theanswer, but we want to interrupt
in those cases, so we use AI totry to, especially if the
(16:07):
question's not crystal clear ofwhat they're asking to see. Oh,
this is a person who seems to betrying to get more information
about suicide tasks or somethinglike disorder eating. And
instead, in say, suicide, whatwe would do is not help. We
would not direct them to findthe information they're looking
(16:28):
for about the more effectiveways to harm themselves. But we
interrupt that user intent witha with what we call one box. And
in the US, for example, thatwould be 988, but based on the
Geo, we would that's big boxwith the big numbers shows up in
front if you need help. This iswhere you can call or you can do
a chat and sort of give them,give them that information. So
when we think about vulnerablepopulations, we are thinking
(16:50):
about the whole as much as wecan, the whole spectrum. But we
do prioritize life and death inthose kinds of circumstances,
and we've done that, forexample, with Gen AI and our new
our new services like Bard orGemini, is what we call it,
because we want to make surethat as we're putting out new
tools and technology in theworld that we don't, we don't
(17:11):
always want to just satisfy whatpeople need. There's a flip side
to that, where we also will workwith local organizations, local
governments to try tounderstand, hey, how can our
tools be more useful on thefront lines? We have some ways.
We've done this with Android,something called Open health
stack. We work with frontlinecommunity organizations that are
(17:32):
serving mental health or otherneeds. We're not going to build
the tool, but we'll help thembuild it so it makes more sense
for them on the front lines.
Maybe the easiest way to say itis that this is major priority
for us across all our products,in all of our areas of work as a
company, but in health, majorpriority, because it is about
life and death, and because ifyou don't attend to it when
(17:52):
you're creating the model orcreating a product, you could
exacerbate disparities, and techactually has the potential to
eliminate disparities, Andthat's the direction that we
would want to go as acompany. That's great, and that
resonates with me. Karen as aspart of my second hat I wear. Of
course, I run the oncologybusiness for AstraZeneca in the
US, but I also chair and run ourfoundation, and we work with a
(18:15):
lot of NGOs on the grassrootlevel to understand the
barriers, and use localambassadors to educate on those
barriers or provide localsolutions to drive that. Because
to your point, we can, we can.
We cannot solve everythingalone, and we need to depend on
partners, and those partnershipsare key, but also the right
(18:36):
point of care intervention, likeyou gave this example of people
wanting to find informationabout harming themselves. That's
where you need to intervene. Andintervene with trust is where it
makes the biggest impact. Soabsolutely, I think the
technology could be an enablerwith a trust that comes
alongside from if they hear fromthose whom they trust. So that's
something I think we are workingon. You also,
(18:57):
can I just this trust thing? Iwas just looking at a survey
that Edelman did, and that stillsurprises me, which essentially
said that about a third ofpeople, this is 116,000 people,
are surveyed in 16 countriesaround the world, and about a
(19:20):
third of people said that therethey are more likely to trust
something they read online andor something they hear from
family and friends than theirdoctor. And in some age groups
like this, 18 to 34 it's aboutalmost half. It's like 45% so
this notion of trust, by theway, going back to medicine,
like I always thought, coming upin medicine, right, that
(19:42):
patients are going to trustdoctors and but we certainly saw
this increasing in the pandemic,in this surveys from just a few
months ago. And I think it'sthis word Trust has different
meanings for different peopleand and so I think your your
point about partnership alsomatters, because sometimes
people are going to trust you.
Their local pastor. Sometimesthey're going to trust their
doctor. Sometimes they're goingto trust a sports figure. I
(20:03):
think all the ways that we canget the right information in
people's hands to help peoplenavigate is certainly what we'd
want to do. But I think whatthat I've had to expand the way
I think about who people trust alot in the last few years,
I have to sometimes tell mymother what she reads on a
messaging service is not maybethe only thing, and she needs to
double check, but yes, that'strue. At the same time, you've
(20:26):
had the opportunity to work ingovernment, both at state and
federal level, and talking againabout partnership and building
trust. How can health systems,industry, government,
communities come together tokind of drive not only trust,
but impact and bring especiallythis technological wave of
innovation to life.
(20:48):
You know, it's, I think, comingout of the pandemic, globally,
there's been more distrust oftraditional institutions. And it
is, I think it's something thatwe're all going to have to lean,
lean our heads together, andthink about how to restore some
of that trust. You know, when Iwas a local public health
(21:08):
officer, if we had in NewOrleans, we often had challenges
with our water plant, and so wedidn't need a water we'd have to
have a boil water notice,because there would have been a
power outage or something. And Iused to always think that the
most important thing was, wasthat when I went on the
television, because that was,you know, whatever, back in the
(21:30):
day, or the radio, and said topeople, boil your water, they
needed to trust me and do that.
And so I needed to be reallycareful about everything I ever
said to them, because I didn'twant it to ever get gray,
because that was become sort oflife and death, especially for
some some populations in thatenvironment. And I think the
part of the reason the pandemic,I think, was hard for folks, is
because information did changeas we learned about the virus,
(21:51):
as we learned abouttransmission, as we learned
about new therapeutics, thingsthat evolve. But I do believe it
can be restored, but I alsobelieve that we have to
recognize sort of like thisEdelman survey results that I
mentioned, which is that thatyou cannot take for granted that
people are going to trust thesame resources and sources. Some
people will trust government.
(22:12):
Some people won't. I one of thethings that we did learn a lot
during about during the pandemicwas that that it's not just the
message, but sometimes themessenger, which is essentially
what I'm saying, about who totrust, and we learned things
like, if people are alreadywatching a sports figure that
they trust, and we can and thatsports figure has an interest in
(22:34):
an area could be something likeinfectious disease, like the
pandemic, could be mentalhealth. We've used it in those
spaces, and we can provide themwith evidence based information
that comes from not we Google,but, you know, link, link them
up with the CDC or the NHS, or,you know, whatever government
around the world wants to workwith them, then they can be the
messenger, and people are goingto receive that, and and and
(22:57):
trust it. Well, it, it soundssimple when I say it like that,
but a lot of medicine stillfeels like they should be the
messenger of the message. And Ithink the reality is, is that we
have to let that go, because themost important thing is people
hear the evidence, hear the hearthe right data driven, you know,
(23:19):
information and decisions andwho delivers that? We have so
many more options, basically, inthis day and age, if it's done,
if the pairing is done properly,with messengers on the different
surfaces and places where peoplereceive care in public health
there are, there's not a newidea. This goes back, you know,
I worked the Ebola outbreak, andit's very similar thing. You
(23:40):
know, just couldn't be that itwas what the World Health
Organization wanted to tellpeople locally in the community,
they had to find local faithleaders, etc, to help carry that
message. We see this withcommunity health workers all
around the world, who are oftenthe most trusted individual. So
it's a flexibility notion that Ithink we're all going to have to
get comfortable with. But what Ido hope is we'll, as a health
(24:03):
ecosystem broadly, start to do abetter job of having a shared
set of facts, even if we werecomfortable having separate
messengers.
Yeah, and I think that messageon the right messengers for the
audience, where they connectwell with and trust is key,
because I think the intent iseverywhere good. But if the
messenger is not the right one,it may drive people in the
(24:24):
opposite direction. Actually,we, as part of AstraZeneca bold
ambition to one day eliminatecancer as a cause of death. We
believe we cannot do it alone.
We have partnerships. But wealso believe not only
pharmaceutical interventionswill drive it. We can drive it
by also driving early detectionof cancer, and we've got a
partnership with NHL, whereactually the NHL and NHL, you
know, the player Association,and everybody involved in that,
(24:47):
are the voices sharing theirstories of how early detection
helped them to communicate tothe hockey community and then
encourage them to talk to theirplus one to go and get screened.
So it's. Yes, it's society has arole to play, but finding the
right messenger so it absolutelybrings home the point that there
may be more trust there, versusXYZ companies standing up and
(25:08):
saying that, go get yourscreening done. So I do relate
to that. And I think Google hasis in a position where people do
do searches and trust a lot ofthis and the work you just
talked about with theinformation is really
key. Yeah, and even there, we'velearned we recently started out
a thing like people like you,because people, when they search
(25:29):
on a topic, it's easy onYouTube, because they're looking
for people like them, but onsearch, they also want to find
people who have the conditionthey have and have had the
experience. So we've done athing with Reddit where we can
connect folks and people reallythat experience is really
positive, because they can allsometimes they just identify
with another individual who hasthe condition. But I love this
NHL example. I want to hear alittle more
(25:51):
about it later. Yeah, okay, justdon't talk to me about hockey
terminology. I'm still pickingor me either. I mean, I would
say yes one, one of the thingswe said is, go get your body
checked against cancer, whichhas been very successful because
the hockey community relates tothat line, yes, and we are
trying to do more with that. Andagain, everybody has a role to
play. Talking about role youstarted off with introducing and
(26:15):
talking about, when you came toGoogle, you were the first Chief
Health Officer. You started thatin 2019 and very recently, you
announced that you're going toretire as of August 1. And I'll
come to that what you're goingto do after it. But as you think
about all you have accomplished,what advice would you pass on to
your next person, but alsopeople listening in from your
(26:36):
leadership lessons, not only atGoogle, but broadly across
clinical government and all thework you've done
today. Well, you know, one ofthe things that I will do in
retirement is I'm gonna do a lotof processing. It's interesting,
you know, I've I about what I'velearned. I'm one of those people
that went from thing to thing tothing without break. And I
(26:58):
started working when I was inhigh school, actually, my first
job, I was 13, I taught tap so Icould pay for my own dance
lessons, and I paid my waythrough college. I, you know,
sort of, I've been on a go, go,go. And I think I'm gonna, if
you ask me, in a year, I'llprobably have processed a lot
more. But what I would say is, Ithink that, I think people need
(27:19):
to enjoy the journey. Sometimespeople get really fixated on, I
want this job or this role atsome point. And I sometimes I
get asked, Did you ever thinkyou'd work at Google and be the
Chief Health Officer? And myresponse is, there was no Google
when I went to med school.
Therefore I would have neverimagined. You know, there's so
many things that have evolvedthat I would have never imagined
(27:40):
are ways to help people, whichis the second category, and that
is for me, the choices I've madeabout where I've gone, where
I've said yes to taking on arole as a place where I felt
like I could help people. Andmedicine very much was that way
I practiced for 20 years. Iloved caring for patients, but I
always was thinking about thesystems in which they were
(28:02):
trying to navigate, and how,frankly, they were more built
for doctors than for them. Andyou know, how could you change
that so that it was really builtaround the people we were here
to serve? And that story isrepeated for me over and over
and over again in my roles ofwhat are the ways to get
information in people's hands,like when I was national
coordinator, and changing theway that we got gave people
(28:24):
access to their electronichealth records, or ways that I
get to do that at Google, wherewe give more knowledge and
insights, and I'd say power topeople about their own health.
We're building personal largelanguage models that that our
hardware, like Fitbit users, canhave to help them know what are
the right questions to ask whenI go into the clinical
environment, or what are theways that I can get better
(28:45):
sleep? That is that side of theequation, the patient, the
consumer, is the part that Ithink it's left behind a lot
when we're designing systems orthinking about the best way to
pay or do technology orimplement Gen AI, and we often
think about, what's the what'sthe way that we're going to make
the doctor's life better? NowI'm a doctor. I'm married to
one. I love doctors. Don't getme wrong. I taught a lot of
(29:07):
them, however, we're just apiece of the puzzle, quite
honestly, and I think I do hopethat of the things that I've
learned, and I'm seeing more ofis that people are realizing
that it's team based care, andpart of that team is the patient
or the really, most people don'twant to be thought of as a
patient. They want to be just aperson, right? And they want to
(29:27):
be healthy most of the time. AndI think that this era that we're
in with Nai is allowing more ofthat. So it's very exciting. So
journey focusing on what youreally care about and what you
choose east of your job. And forme, it's been like figuring out
how to equalize some of thatknowledge and power so people
have more access to where theywant to navigating their own
(29:49):
health journey on their ownterms. And I think, I think the
other piece that's been thematicfor me is it's really it is
possible to both do. Good and dowell, that sometimes people
think it's two choices. Oh, Ican go work in private sector.
I'm gonna go work in thenonprofit, and I've done all
that. But I also know thatthat's very true, that you can
(30:09):
help people, but you can also dothat in a way that that has
makes the business a goingconcern. I'm gonna give you a
specific example about that thatwas taught to me by patients
after Katrina, Hurricane Katrinain New Orleans, we were remaking
the health system there. It wasa one that was very much about
(30:30):
hospital based. Most people wereuninsured, so about a quarter of
the Louisiana populations, abouta million people were uninsured,
and most in New Orleans area,most individuals. So most of the
time, what happened is, ifsomebody was sick or had a
chronic condition, even theyused the emergency room for care
because there was no communityhealth so we were taking the
opportunity from the tragedy tobuild a community health network
(30:54):
and infrastructure. And after alittle bit of time, I had one
patient say to me, you know, itwas free for the beginning,
because we had a lot ofphilanthropy and volunteerism,
and we were trying to figure outhow to give people access to
community based, neighborhoodbased care. And a patient say to
me, y'all should start charging.
(31:14):
And this is a service worker inNew Orleans, very low income,
person without health insurance.
They said, Just chargesomething, because if you don't,
you're not going to be around totake care of us in the future.
And this is our medical home inthe neighborhood, and we want to
keep it and so I think,predicated on that, some other
conversations we had with thecommunity organizations, with
when we worked across the area,we did start charging a little
(31:36):
bit on a sliding scale. Andpeople really felt a sense of
dignity. They felt a sense ofownership, and when they could
come in and it was $1 orwhatever it was, and, and it was
a good lesson for me about also,you know, you think you're doing
good for the community, but, butthey want to be a part of this.
They want to feel like they'vegot some some knowledge, that
you're going to be there for thelong haul, right? Because
(31:59):
sometimes philanthropy comes andgoes and they also they're
smart. They know that that abusiness has to pay its
employees. Many of their friendsand family were working there.
So just one example of many I'vehad across my career that it is
possible to do good and do well,and I would encourage people to
think that way and not think ofit as just a choice in one
direction or theother. Love it. Karen, thank
(32:19):
you. I'm going to take that withme. You can you can do well and
you can do good.
I think that's the job you haveright now. Quite honestly, I
think this is something whichwill drive our audience as well.
One last thing I'll say is whatI took away from what you said,
amongst many things, was journeyis critical and destination
(32:41):
incidental. And as we thinkabout our patient's journey,
team based care for them,thinking of them as individuals
is key. Destination isincidental. I know you are a bit
hiker. What's your nextdestination? As we wrap this up,
well, I'm really looking forwardto handing the baton to the guy
who's currently my deputies,tremendous human being and
(33:03):
physician and leader, and I'mvery excited to feels great to
be able to hand it off tosomeone I really trust. I'm also
very excited to put on hike andchoose and we have a number of
trips planned in the Southwest,and then planning up a bigger
trip to do the Tahoe Rim Trail,which is to hike around Lake
(33:23):
Tahoe. It's, it's about 175miles, so just a couple of weeks
of through hike. But I'm gonnado that one as an intro before I
decide if I'm taking on anythingbigger. But mostly I just want
to have some time to reflect andrelax and and build up more
gratitude for this career thatI've had.
Yeah, thank you. And thank you.
You had an amazing career, 35plus years of contributing in so
(33:43):
many places. We wish you thevery best. And thank you for
being here. And I'm sure you'llcountry contribute further on,
even in during your retirement,into many things and many
companies on this tech journeyin healthcare. So thank you so
much for being with us. Thankyou very much. You
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