What Yiren Lu's magnificent portrait of Silicon Valley can teach us about digital health

Writing in the New York Times Magazine last Sunday, computer science graduate student Yiren Lu offered an unusually eloquent and nuanced account of today’s Silicon Valley start-up scene.

Lu conveyed the excitement of young programmers hired by the hottest companies in town (generally, consumer web applications), and draws contrasts with an older generation of developers, like her dad, who generally work at companies considered more establishment, like Cisco, that contribute to the vital infrastructure upon which trendy apps depend.

Lu distills the challenge concisely, describing a recent evening studying for a midterm,

“… with several friends who will be working at Dropbox and Facebook this summer. Around 9 o’clock, we ordered Chinese food on Seamless. I paid one of the guys back with the digital wallet Venmo. This summer in San Francisco, I’m living with three roommates, also students doing tech internships in the valley, two at Google GOOG -0.25%and one at the news aggregator Flipboard. For better or worse, these are the kinds of companies that seem to be winning the recruiting race, and if the traditional lament at Ivy League schools has been that the best talent goes to Wall Street, a newer one is taking shape: Why do these smart, quantitatively trained engineers, who could help cure cancer or fix healthcare.gov, want to work for a sexting app?”

The reason, she argues, is a combination of name recognition (it’s cool to be working for companies whose products you recognize and can use every day) and prestige (other smart people want to workfor these companies so you want to as well).

Moreover, she explains, starting a web tech company has become ridiculously easy – useful shortcuts (application programming interfaces, or APIs) are ubiquitous, and you don’t need much more than a laptop, since almost every startup uses the servers of Amazon Web Services to host their data.

The good news is that, as she puts it, tech has become democratized, driven by ideas, not technology.

On the other hand, as Lu describes,

“The sense that it is no longer necessary to have particularly deep domain knowledge before founding your own start-up is real; that and the willingness of venture capitalists to finance Mark Zuckerberg look-alikes are changing the landscape of tech products. There are more platforms, more websites, more pat solutions to serious problems — here’s an app that can fix drug addiction! promote fiscal responsibility! advance childhood literacy! Companies like Meraki that build enterprise-grade hardware and leverage years of research tend to be anomalies among the new guard. Even as the pool of founders has grown and diversified, the products themselves seem more homogeneous, more pedestrian.”

The article suggests that perhaps the valley’s young programmers and older engineers might benefit from finding a way to work together, and blend the younger generation’s appetite for risk with the older generation’s experience in building substantial products and businesses; Apple AAPL +0.68% and Google are both cited as examples of companies successfully blending youth and experience to achieve greatness.  Lu even quotes Sequoia Capital’s Doug Leone, optimistically asserting, “I see the old guard and the new guard coming together again.”

I hope he’s right.

Lu’s characterization of the valley not only rings true, but also helped me better understand the valley’s approach to healthcare – or perhaps less diplomatically, why young developers’ approach to healthcare (to the extent they’ve deigned to approach it at all) seems to have generated far more heat than light, and resulted in thousands of pointless apps, and remarkably few impactful innovations.

While healthcare desperately needs to become more “consumerized” – engaged consumers, empowered consumers, skin-in-the-game consumers, etc. – I suspect that materially impacting healthcare – i.e. significantly improving care or reducing costs – requires tolerance for complexity, patience to demonstrate value, fortitude to deal with regulators and entrenched incumbents, and respect for the distinct importance of human health.  I’m not sure there are all that many hot shot web tech developers in whom these qualities bloom – though Uber’s (as I’ve discussed) and Tesla’s battles with regulators and incumbents are positively inspirational.

It’s incredibly compelling to envision the integration not only of generations, as Lu imagines, but also of domains – finding a way to functionally unite fearless creative developers with experienced healthcare experts equally determined to change the world.

Can it work?  To paraphrase Margaret Mead, I suspect it’s the only thing that ever will.

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