A conversation with the chairman of Medpedia.

James Currier: My name’s James Currier, and I’m the Chairman of a company called Medpedia, I’m the main investor in the company.  And my profession is an entrepreneur.  I start companies, I form them, I grow them, hire teams and I’ve been doing that for about 15 years now.

Question: Are people born to be entrepreneurs?

James Currier: I’ve always been an entrepreneur.  So when I was six years old, there was a guy who was – I lived on a dirt road in New Hampshire, and about a mile from the nearest paved road.  And there was a guy who wanted to go fishing at the lake near us and he walked by and asked me, “Hey, where do you dig for worms around here?”  And so I went and I dug him some worms, but them in an old can.  We had some cats and we had some empty cans and I put them in a can and he gave me 50 cents.  And I went back to my dad and I said, “Look, I got 50 cents!”  And I thought to myself.  Well, why don’t I just go dig worms and put up a sign?  So, I made a little wooden sign that says 50 cents for a can of worms, and I sold worms between six and nine years old you know, ever summer.

And in between then and college, I probably started 12 little businesses.  In fact, during college I took a year off to start a t-shirt and boxer shorts business called Hang Loose Boxers because everyone used to wear briefs and you were kind of uptight with briefs, and with boxers you could hang loose.

So, I’ve always been an entrepreneur.  When I got out of Princeton, I went to work for a giant company thinking that I didn’t know enough about business and about how the world worked and that I was going to learn it at a big company.  And that was a definite mistake.  You don’t really learn that sort of thing at a big company.  And it wasn’t until 1994, four years after I graduated that I ended up with a venture firm where I really learned about how wealth was created, about how companies are formed, about how they are financed, about how they exit, how they hire.  I got to see that from a bird’s eye view.  I was an associate of a company called Battery Ventures up in Boston.  And they gave me a great education about how the whole I-Tech space works from the ground up.

I’d been in I-Tech since I graduated from college, but I hadn’t really understood it because it was from a big company perspective, which is very different.  And then from the venture firm, where I was there for three years, I went back to Harvard Business School, which you know, was a good experience, but probably not also the right call for who I was.  I still felt as if I needed to learn more before I really understood the world and would know how to navigate.

At the end of business school, I had a choice of becoming a venture guy and becoming a general partner at one of several firms or going and being an entrepreneur with this idea that I had in my head about user generated content and the Internet.  And I couldn’t get it out of my head; I could not sleep.  And that comes down to the rule, which is; if you have an idea that if you don’t do it, you’re head will explode then that’s when you should do the idea.  So, I decided to do the idea which was Tickle, and that ended up – we almost went out of business about eight months into it, we were maybe three days away from missing payroll and finally go the thing to go and raised a bunch of money and saved it and then a year and a half later we were probably 60 days away from going out of business when we finally figured out the business model and got it profitable, and so it was a success, but only by the skin of our teeth, several times.

And during that period, I realized that, you know, being an entrepreneur is sort of the greatest gift that you can give yourself because it’s a job that requires you to be optimistic every day and to be positive every day, and to always tell everyone around you that we can do this.  And that brings out energy and an enthusiasm in your body and in our mind and in your spirit that animates you and animates everyone around you.  And it makes you young and it makes you excited and that’s the best job to have.

Question: What is virtual currency and why do you find it so interesting?

James Currier: The idea with virtual currencies is that you are having an experience at – on a website, or in a game, or at Burger King.  Any place, any environment that you’re in is a place where you could take out your wallet and use U.S. dollars, which is essentially a virtual currency based on very little as we are seeing recently, right.  I mean, the United States is now printing the money based on their brand.  It’s a currency that we all agree to exchange value using.

You can then take that money and buy other virtual currency that Burger King or the game could make up.  In the case of Wonder Hill, we made up Rubies.  And you buy Rubies.  You can then use those Rubies in that context to purchase all sort of things.  You could buy a wheel barrel, you could buy land, you could buy the ability to shout out to the rest of the community by spending rubies.  So anything that you might want in that context can be purchased using that virtual currency.

The British Pound is a good example.  When you go tot hat world of the UK, you need to use their currency to buy things there.  And now all we’re doing is doing that inside of games.  And so, you’re taking what’s happened in the real world and just mimicking it in the silicon, if you will.  Mimicking it in software.

Second Life has done a great job of selling Linden Dollars to people.  It’s a $450 million a year economy in Linden dollars.  And people take U.S. dollars; they buy the Linden Dollars and then they use those Linden Dollars in the world.  They use those Linden Dollars to pay people to help design t-shirts in the world that they then sell those t-shirts to other people who pay them Linden Dollars to buy the t-shirts.  And that’s all happening inside the virtual world in Second Life.  And at Wonder Hill, it’s happening inside our games, if you will.  They’re Flash-based little games.  One of them is called, Green Spot and you build out your green spot and there’s actually land and you have multiple pieces of land and you put characters on it and you design them and you grow things in this world.  And they’re beautiful things and its entertainment.  And it’s an escape.  And you’re willing to pay for that.  There’s a certain percentage of people who are willing to pay for that.  And that’s how the business works.  That’s what virtual currency is.

And I think that, as I saw in the ‘90’s, everyone was focused on moving magazines and TV and radio onto the Internet, and that was the wrong thing to do.  I mean, it has kind of worked for a few companies, but generally, the really big hits have been user generated content.  That’s what the Internet uniquely does.  And the same way that now everyone is focused on advertising, but the virtual currency model is actually probably a higher margin model that satisfies everyone in the community better.  Right?

So, what happens with a subscription is everybody pays $10 per month, let’s say to get access to the content.  Some people might value that content $1,000 a month, and some people might value it at $2.00 per month.  And the people who value it at $2.00 won’t pay $10.  So you won’t get any value from them, and the people who value it at $1,000 a month, you’re losing $990 per month of value that you’re creating for them.  So, the subscription model is very wasteful in terms of how it captures the value that you’re creating for your users.

Whereas, the virtual currency model will allow that person who values it at $2.00 to pay $2.00 and allows the person who values it at $1,000 to pay $1,000.  At every step of the way every consumer is happy with the service because they are paying up to the value that they ascribe to the service.  And you’re happier because you’re actually getting more revenue for the service that you’re providing.

And so, it’s a much better business model, I think, than a subscription or in advertising because advertising is generally annoying. You’re interrupting someone from what they’re really here to do, and there’s a trade off between, you know, the more money you make the worse the experience is.  You know, certainly with television or radio, that’s true.  The more they interrupt the music with ads, the worse your radio experience is.  The more they interrupt the TV show with ads, the worse your experience of watching CSI is.  And that’s the problem with the advertising model is it’s annoying.

So, I think virtual currency is a much better model.  And just as we went from – just as I felt we were moving from editorialized content to user-generated content, I feel like we’re going to move from subscriptions and advertising to virtual currencies over the next 10 years.  I think that’s going to be the big move that we’re engaged in on the Internet.  And I think you’re going to see that model, which is really most easily implemented on the Internet.  That’s why it started there back in about 2000.  You’re going to see that move external to the Internet.  You’re going to see it move into Starbucks.  You’re going to see it move into Burger King environments or to the NBA.  You’re going to see it permeate other more physically-based entertainment environments.  So, that’s why I’m focused on Wonder Hill.

Question: How is the Internet changing the way we educate and cure ourselves?

James Currier: The way I see it is the Internet is now here and that means that we're going to move from centralized to distributed, right? So this is the major thesis of our lives. I mean, all of us who are in 20's, 30's, 40's, and 50's, this is the main thesis of what is happening for humanity right now. Which is we're moving from centralized control to distributed control because of these zero marginal cost technologies like the Internet.

And we've seen is go from AOL which was a centralized control to the Internet. We've seen it in, you know, encyclopedias centralized control to Wikipedias. We've seen it in paper based business directors moving to things like LinkedIn, right, which is distributed control, you know, wisdom of the crowd’s sort of thing. And so as we look at what is going to happen now that these technologies are here for hemostasia, what are we going to do? We're going go heal ourselves.

Instead of always going through the physician, the physician will become one component of a distributed system that heals us. We can help each other. We can heal ourselves. We can heal each other. We can work with every tear of knowledge - every person of knowledge whether it's a patient or a physician and everything in between to heal ourselves. We can educate ourselves. We don't have to go through these monolithic, you know, public school systems to educate out - and it's not about education it's about developing the human mind?

We've mastered our thinking around developing the thinking mind around the words education, school, teacher, classroom, we all have had that experience. We're all **** in that model. It's very hard for us to think outside that model. I've had many conversations with Erudite, incredibly intelligent people who are in charge of public school systems who are journalists in the New York Times. And they have a very hard time thinking outside of the box that we all knew as children with school, and education, and teacher, and classroom. And breaking through that is going to be a real challenge mentally for people even though the technology has been there now for 10 years. And with the iPad and the iPhone, it's just, you know, education still works today like it did based on the 400-year-old technology of the printing press.

And the Internet has touched everything expect for medicine and education and government. These are the places that have not been touched and so we need to heal ourselves. We need to education ourselves. And we need to govern ourselves, and the way I look at it is, you know, that's why we've done Medpedia is because we think that you can see if you're onto something in the medical world within a year of trying it. In education it might take six or eight years and in government it's going to take 30 or 40 years. And so the order which I want to attack these things, is medicine first, education second, and then government third at the end of my life because that's a more dangerous endeavor to try to help governments change the way they govern.

But yeah I think the potential for how we develop the human mind is sitting there and is literally just a matter of ideation and figuring it out and trying stuff. A good example of what I'm talking about is this company Groupon which launched in August of 2009 and just raised money at a billion dollar valuation. The technology to do that has been here since '95, maybe even '94. It's just on one ideated it, no one actually brought it together and suddenly they created a billion dollar company out of something you could have done 15 years ago.

The same thing is happening in education. Gaming in education is a challenge because to build a game cost hundred of thousands if not millions of dollars and only works on a platform at a particular time, right? So if I built a flash game six years ago, flash works so much better than it did six years ago that if I looked at the flash game from six years ago it's a pretty bad experience compared to everything else I'm experiencing, so you'd have to rebuild it at the cost of $400,000 or $500,000. So it's expensive and only short term to actually build a game.

So I think the approach to education is not going to be about games and this is also true about medicine, it's not about medical games like the Wii Fit that will be useful for two or three years but then stop be interesting to people as the technology moves on. Rather, what we need to do is apply gaming principles to education, gaming principles to medicine, and that's going to require much more standardized interfaces, like a Facebook type of an interface and it's going to require wisdom of the crowds and true coloration and communities. So that the best stuff bubbles up naturally rather than is topped down, which is more of a Wikipedia.

I think if you marry a Wikipedia and a Facebook to medicine and education that's where you're going to see the real benefits I believe because those interfaces can be very inexpensively updates, very inexpensively tweaked, tested, ab tested, and very easy to allow ten's of thousands, hundreds, of thousands of people to collaborate and contribute so that they very best comes out at any given time.

Question: What’s wrong with health care today?

James Currier: It goes back to this idea of the distributed systems and a lot of the costs that they have in medicine are related to the centralized control. You always have to go back to the physician to get your prescription. You always have to physically to their office. You have to wait for your appointment. You can't e-mail your physician today. It's 2010 and you still can't e-mail your physician in most cases.

The centralized - the hospitals are incredibly expensive, the way they're structured, the way they merge business models. So this sort of, you know, your records are held at the central location, mostly in paper still. The centralization is crushing is us in terms of cost and it needs to be distributed. It needs to be more fluid. It needs to be more real-time. And building a platform and a methodology for doing that is what Medpedia is all about, is creating an infrastructure, a HIPAA complaint infrastructure to allow pieces of the medical system to increasingly being disrupted whether it's through your Smartphone communication or whether it's through your laptop, whether it's through the phone or whether it's people helping people as opposed to having to go to professionals if you will.

You know, all the time with oversight from professionals because they ultimately have the greatest amount of knowledge but finding out how to balance that distributed nature of knowledge and learning is what Medpedia is all about. You know, medicine is fundamentally an information management problem and obviously the Internet and those things should be applied to it. So that's really the main direction of Medpedia and I think it's a big idea because it is such an issue for - I mean, it's the ultimate issue, right? It's life or death, ultimately. And it's a big issue for this country in terms of its cost.

And it's a big issue in Europe for those people who are having rationed care, who have to wait for months to get some basic care that you would get here in a week. So there's no one system that's working incredibly well but we know that distributed systems tend to allocate resources much better. And so we want to bring that to the world of medicine, and that's why Harvard partnered with us, Stanford, even the British government is now contributing content, gives us advice, helping us navigate the system. We are not medical people, generally we're interface people, we're technology people, and so we're being assisted by all these people who really know what they're doing as to how to navigate and how to build this. So that's what the Medpedia is about.

Question: How does one use Medpedia?

James Currier:  What we're working on right now is the idea that you as let's say an employee of a company where you get your insurance paid, you know, 70 million Americans are covered by the 1800 top largest corporations in America. So the majority of people are getting their care. I think it's 60 percent of people in the United States are covered by their company. So at your company you sign up, you do a health risk assessment, you then have this personal health record that's stored in a HIPAA compliant way online.

From that you are then presented with a bunch of applications like an application on Facebook like an iPhone app that then appeals or is directly relevant to where you are in your medical life, in your health life, and then you can sign up or not sign up. If you sign up your corporation will compensate you for that. It will pay you more, let's say jiff dollars, you know virtual currencies if you will, to do these programs to improve your health, to maintain your health and maintain your vitality. If you do not then the corporation can actually take money away from you and again it's sort of a gaming mechanical applied to your health maintenance, which isn't game specific. It's a gaming mechanic that we all respond to.

All of us respond to those sorts of incentives and we haven't been able to do that in the medical space before. And once you're engaged in these programs on the back end there's a lot of information from Medpedia that everyone is contributing to. Everyday it gets better and better, deeper and deeper, more and more relevant, better and better worded. And if you have a mediocre experience you can go in and make some changes to the database as well so that these services that you're engaged in are getting better and better everyday, every week. And the whole community contributes to it.

And you have a feeling of community around it and a real sense of personalization of the experience. None of which is true today in your experience of your own healthcare maintenance, so that's the world we're moving toward.

Question: What got you personally interested in improving health care?

James Currier:  It's because of two experiences I had. One was that I have four boys. My wife and I had four boys in 36 months. One of them was having troubling breathing one night. He fell back asleep at about 2:00 in the morning, so I didn't take him to the emergency room right away but I was wondering if I should. So I got online to see what I could learn about babies not breathing well, you know, they don't give licenses to parents.

So I didn't actually have to go through any training to be a parent. And I got online and I ended up on Web MD and I said, "You've got to be kidding me. This is what people experience around medicine? All these Botox ads and, you know, a magazine article that goes for six pages and at the end just say go see your physician." I was like, "Wow, there's not a lot of value here." So that was the first experience. The second experience I had was when one of my boys got cut over the eye and we went to the emergency room because there was blood everywhere and I don't know you just go to the emergency room.

We got a bill for $7,300 and they didn't do anything but put a band-aid on it and he's fine but there was three or four people conferencing to decide what to do about it. They put a Band-Aid on it and it's $7,300. You know, I paid, I don't know, $700 out of pocket for that and I had never heard of an urgent care clinic. I'm pretty educated and I had never heard. So our lack our knowledge around how to actually interface with the medical care system is profound. So those two experiences led me to want to start something that used the principles that I've learned over the last 15 years about how the Internet works about distributed information management to actually improve the situation.

So I went to Mitch Kapor who founded Lotus and he and I were on the board of Second Life, one of these emerging systems. And he - I said, "Shouldn't we do something about this? Shouldn't we," and, you know, he's one the Wikimedia foundation board and very involved with Open Source software and he said, "Yeah I've been thinking about this for several years and I just haven't had a chance to do it. So why don't you go do it." So I went and went back and started talking to people in the field. I started my last company with some Harvard professors and so I went back to Harvard and ended up talking to the medical people, the guys running the Harvard Medical School.

And they said, "This is a great idea. This is going to happen. We don't know what it looks like but you're probably the guy to figure it out. Let's do this." So that's how it all got going and as I've gotten more into it, I've really understood the sort of difficulties of medical service design, if you will. The design of the experience of getting your healthcare. So you can call a doctor and you have to go through six different, you know, buttons to try to navigate to where you're supposed to be. That's kind of dangerous, frankly, the way it's working today, or you have to go to the doctors office and wait and by the afternoon, you know, she's two hours behind and you have to kind of wait. And then everyone in the office is sick and so you're catching things from them.

Over 100,000 people a year die from mistakes in hospitals and whatnot in the United States and many more hundreds of thousands get infected with, you know, bugs and viruses that exist only in hospitals, that are very virulent forms of things. My father almost died two years ago because of this. He went in for a knee operation and got an infection with a particular type of virus that only exists in hospitals now and it almost killed him. It literally almost killed him and they had to open up his neck - I mean, it was crazy. So the healthcare system as it exists today has a lot of challenges and the people who are working on it are incredibly dedicated. They are incredibly talented. They are working so many hours and so hard, and they're incredibly well trained, and it's still not getting better all that much faster.

And so the application of what is I think our generations greatest tool, which is the Internet, and coming now smartphones, that sort of mobile equivalent. Look a smartphone today is more powerful than the typical computer of 2001. Facebook today is bigger than the whole Internet in 2002. Like things are really changing in terms of information technology. This is an enormous hammer that we can use. An enormous tool we can use to help improve things for what is a life or death issue for people around medicine. So I think we can go from a place where service is poor not because people don't want service to be good, because they're trying their best but the methodologies and the tools  that we use today are just inferior to what almost every other industry is using.

And so we can move us from there, from one place to the next over the next four or five years and really make a difference.

Question: What are some medical costs and conditions that Medpedia is aiming to tackle?

James Currier: So there's a whole lot of them. Seventy-five percent of medical costs stem from behavioral and cultural issues, overeating, eating too much corn syrup, smoking, lack of exercise, the basics. The absolutely basics are causing tremendous cost in the system and tremendous misery among the people who have the conditions. Helping people understand their role in their own health, helping people move through a mental space where they actually participate in making their health better, which ends up producing costs for their companies and for their insurance companies. Is what we need to use this technology to do and lots of people might respond to the ability to earn money by keeping yourself healthy.

But some people might not. Some people might only responds to other motivations like loosing money or social pressure, or entertainment, or being in the know - being helpful to others. If you give someone an opportunity to be helpful to others with your condition you see their health improve dramatically, for some personality types. At our last company Tickle we had 100 million registered users, 20 billion questions answered. We had five PhDs on staff around the psychology of your personality and where you work and that sort of thing. Taking that understanding about human motivations and creating a set of experiences which address the seven or eight main motivation types which apply to seven or eight different personality types is going to start to deepen our ability to help people move through behavioral changes they need to make to really change their health and the costs of their health - of maintaining their health.

So that's one of the things that we're trying to do. The main cost comes from diabetes, heart disease, obesity, and asthma, and allergies. Those are the sort of main low hanging fruits. That's where if you look at where your costs are coming from, that's where they're coming from. You know diabetes is an epidemic in this county. Eight percent of people have diabetes at this point. That's a major cost center. So going after those diseases with these new methodologies, you know, we've tried disease management in the past but it’s generally been only going after one personality type which is a nurse calls you twice a week to berate you into maintaining your health.

That works for some people but it only works for one personality type. You need to apply many more tools to getting people to change their behavior. And you need to deploy them in a  much more cost effective way which having an experience nurse twice a week to the whole population is a pretty experiences way to do it. And so those are models that have failed but there are many more models to try and some of them are going to work over the next five or ten years. And so that's what Medpedia is. It's a platform for trying out all these different ideas and then capturing those stats about what's working and then iterating on that. And focusing people on the things that are actually working.

Those are evidence based sort of behavior change and that's where we're going. Another big cost canter is misdiagnosis. So in your local area you're going to have a physician diagnosis you and they may or may not have the up to date information about how to diagnosis someone with these things. It's estimated that upwards of 40 percent of serious cancer cases are misdiagnosed. No that you don't have lung cancer, it's just what type of lung cancer and the stage you're at could be misdiagnosed, which causes you to have the wrong drugs, or the wrong program for taking those drugs, or the wrong treatments.

And if it's 40 percent, that's an incredible cost to the person to be misdiagnosed and an incredible cost to the system to have to treat them for five or six months in the wrong way before they actually get the proper treatment. So that's another way Medpedia can help is by processing the information more effectively and having the most up-to-date stuff available to everyone including your local physician who can then tap into that knowledge base and help that physician diagnose you properly more often that not.

Recorded May 27, 2010
Interviewed by Andrew Dermont