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  Tyler Suiters                      

  Hey everybody. I'm Tyler Suiters with the Consumer Technology Association. We are the owners and the producers of CES, the world's largest, most influential tech event there is. And we are here to help you get CES Ready. The next edition is January 7th through the 10th, 2020 in Las Vegas, as always. And today we are talking about tech innovation that is helping empower us to help take control of our wellness and also lower costs on the way. We are talking about digital health, the way it's transforming the way we understand our own bodies and health, the way our physicians and medical teams treat us and care for us both reactively and proactively, and again, that element of lowering costs, making healthcare more approachable, more feasible for so many. Now, CES is the only venue where the entire digital health ecosystem comes together in a single place. This is where you see technologies revolutionizing healthcare and you can discover what's possible in the world of digital health.

  Tyler Suiters                      

  So today, a pair of interesting interviews, I promise. One, a name you'll know very well. Procter & Gamble, a consumer company with almost 200 years of experience… Let's let that settle in a little bit... and a tradition of innovation, but in a more tangible sense, right? Razors, paper products, detergent, hey, two-in-one shampoo and conditioner. That's innovation right there in terms of personal healthcare. But P&G is taking it so much further now, getting into the digital health space and helping us, with that connected, often AI-enabled technology, to better care for ourselves. Also, a conversation with the American College of Cardiology. This is a group that is transforming cardiovascular care and improving heart health, and it's clear that technology will drive digital health and help the ACC achieve this goal and lift all of our heart health overall. A key conversation about our lives today and our health to come and this edition of CES Tech Talk.

  Tyler Suiters                      

  With us now is Lisa Ernst. She is Vice President of Oral and Personal Healthcare Research and Development at Procter & Gamble, the true giant in the industry. Lisa, excited to have you with us today. Thanks for your time.

  Lisa Ernst                            

  Well, I'm very glad to be with you. Thank you for inviting me.

  Tyler Suiters                      

  All right, so research and development is something that we and our audience certainly can digest and understand. Oral and personal healthcare, that's a bit of a bigger umbrella. Tell us a bit about what that involves from P&G's perspective and the technology angle on that.

  Lisa Ernst                            

  Sure. I'm happy to talk about that. I'm really excited about the job that I have because I get to touch consumer health broadly, having both of our oral care and personal healthcare categories. So the brands I touch and that my organization delivers innovation against are Crest, the toothpaste that first got the ADA seal in North America, Oral B, one of the few toothbrushes to go to the moon with Apollo 11, Vicks VapoRub and the Vicks franchise, which is over 100 years old, Pepto Bismol, which is also near 100 years old, Metamucil, psyllium fiber that helps with regularity and other health issues like heart health, and Prilosec OTC and Align, a couple of other digestive wellness brands. We also manage daily supplements in North America. That would be things like our New Chapter vitamin brand.

  Lisa Ernst                            

  And then with our Merck Consumer Health acquisition, we have a lot of brands globally that deal with respiratory care, digestive wellness, and the supplement space. So really a nice host of brands, and our organization manages end-to-end innovation. Think of it as we touch the products that are on the shelf today, the products that are coming to the shelf tomorrow and the products that will be on the shelf 20 years from now. We're really looking end-to-end, what do we have to do to support today and create the future of those brands.

  Tyler Suiters                      

  So a very interesting cross section there, Lisa, in that I think I can picture the labels or the branding or the logo of virtually every product you just named, I mean, speaking to how ubiquitous they are in consumer medicine cabinets and bathrooms and purses and what have you. So, given the traditional market share and prevalence of all those products, where does technology fit into it in terms of a driver advancing those brands and finding either new uses or new applications?

  Lisa Ernst                            

  Well, technology is a pretty broad term. I would say we look at the fundamental chemistry that goes into each brand and are always on the outlook for what can be new and what could help us better formulate products to meet consumer needs. From an electronic technology point of view, I really think about the digital space overall and how can we create digital experiences end-to-end. So even if a product isn't electronic, like my toothbrushes are clearly the best example of where it's embedded into the product itself, but even if it's not, how can I create digital experiences either online or through other virtual experiences that the consumer could have to educate her about the problems or issues that she's having and how our technologies can help her manage those or just have an overall better brand experience?

  Tyler Suiters                      

  It's an interesting point in that I think the first, or one of the first waves of broad tech applications to healthcare products, oral care products, was connectivity, right, the IoT, that you could pull down data from whatever product you were using to some extent. It seems that what's being layered onto it now is this element of artificial intelligence, which is seemingly an exponentially more valuable technology platform and application for this entire suite of products.

  Lisa Ernst                            

  Absolutely. So as you mentioned, we launched a connected toothbrush in 2016, so that was our first Genius series, and it really helps people collect their own brushing data for the first time. Now, I will say the technology has advanced significantly, and as you also mentioned, we launched Genius X this past year. In fact, we debuted it at CES, and that is the first toothbrush to use artificial intelligence. So we spent over two years collecting data from thousands of users to create the algorithm.

  Lisa Ernst                            

  And I think what was really impactful about this launch is that we created a bit more seamlessness in the experience for the consumer. So before, if I really wanted to grab my data in a way that was useful to see all of the places where I might be brushing my teeth or not, I had to have a camera. Genius X is the first time that the consumer can get accurate position detection without having a camera, and the data gets stored in the app without the user having to have the app open all the time. So again, creating a seamlessness in the experience as part of the internet of things, and we are really excited about this brush being able to help consumers get to better habits which will get them better oral health outcomes.

  Tyler Suiters                      

  So Lisa, we started this by touting your impressive title in R&D there at Procter & Gamble, and here I am asking you a marketing-based question, I'm afraid. But project a little bit to what point do we as consumers start using all of these tech-enabled products that are parts of our daily routines without thinking about that? Do we ever reach that point where we're not considering the data that's being offloaded from our toothbrush and giving us better tips or identifying problem areas and challenges?

  Lisa Ernst                            

  We've seen a variety of responses to that, Tyler. I would say at some point, it will depend on the individual. So I'll give you a few examples. I know friends and have colleagues who do not want anything to do with the connected product world. It scares them. It's just frightening to them and they don't want their data. They don't even want their own data. And then you've got the other spectrum where people are just saying, "This is part of the ubiquitousness of the technology and it's going to help us get better."

  Lisa Ernst                            

  I think we're already beginning to see a consumer desire for even more seamlessness. If we could just have everything enabled and not have to have apps, consumers are saying that some of them would like that. I think we're going to continue to see a range of consumer reaction and desire for the whole internet of things as we go into the future. And frankly, to use the marketing language, this is just typical to anything we see that we introduce as new. You've got very early adopters and you have laggards. I predict we'll continue to see that as we look at the internet of things.

  Tyler Suiters                      

  Right. So you said these are friends who don't want to have anything to do potentially with connected devices or a connected lifestyle. This is your passion. This is where you invest your time and your talent. How do you respond to them standing around the barbecue when they say something like that?

  Lisa Ernst                            

  Well, they'll all accuse me a bit of being a little geeky because I'll pull up my clinical data and I'll tell them that if they'll start using my product and take the coaching that the artificial intelligence provides them, they'll actually get to better oral health. So I know that 75% or more of the people who have used the connected product have a noticeable oral health improvement that gets reported to them by their dentist, and they also see an improvement in their gingivitis scores, and we know that left untreated, gingivitis can lead to terrible oral health outcomes like tooth loss. I tell them if they really care about their mouth and teeth, they ought to be using these products.

  Tyler Suiters                      

  That should compel them pretty strongly to move in that direction.

  Lisa Ernst                            

  Well, I think so. The other thing that I remind them of that we take very seriously is data privacy. So we are very careful about the data that is collected on our app and ensure that it gets treated with great care.

  Tyler Suiters                      

  Moving back to the R&D side, Lisa, what is the development process like there at P&G? Tech innovation moves so quickly. How do you adapt as a very large multinational company?

  Lisa Ernst                            

  Yeah, that's a great question. Certainly things are moving quickly and we see industry disruption at a pace that I have not seen before, and I've been at P&G now for 33 years, so this is just kind of mind boggling when I look at all the new players that are entering the market and how quickly technology is changing. So in order to stay competitive, we also change. We have made great use of lean methodology, great use of scrum, which started in the software industry, as ways to manage our innovation processes and get things done much more efficiently and effectively.

  Lisa Ernst                            

  We also leverage multi-functional, very diverse teams. I've got a whole suite of people managing the software for the app that are in house now at P&G. It's actually an in house agency that we've created called Alchemy, where we've hired developers that were previously working for startups in Cincinnati and now they're developing our app, so it gives us great access immediately to people like that. We've also got them working with my suite of electrical engineers and electronics experts who work on what goes into the brush itself, so everything stays connected. And then I've got folks who really worry about the product design. So we've got industrial designers, as well as UI/UX designers who work on the product and the digital interface. And then I've got folks who look at, are we developing and delivering the absolute right consumer experience that will deliver the irresistible superiority that we've been touting at P&G that's so critical and fundamental to our business model?

  Tyler Suiters                      

  Irresistible superiority is a phrase I'm going to start using more often, and you say you're not in marketing, or I say that. Lisa, a bit of a look ahead, if you would, just to 2020 and your plans for CES. You're a CES veteran. I know you know the show well. What are you most excited about for P&G's plans there?

  Lisa Ernst                            

  I am really excited that we're going to bring the Life Lab back for a second year. I think we've got some great products. I will be onstage again, I predict, talking about some exciting new developments, so I am very excited about that. And we just see CES as a way to remind the industry that even though many of our products don't have electronic tech built into them, we are redefining consumer experiences so that we can deliver the irresistible superiority that we think people want in their lives every day. Brushing your teeth can be really fun and enjoyable and I hope to deliver four minutes of excellence to people who use my powered toothbrushes every day.

  Tyler Suiters                      

  Is it fair to look ahead to, let's say, CES 2030? And I won't ask you, of course, for specific plans, but what will the oral and personal healthcare landscape look like at the show in 10 years, let's say?

  Lisa Ernst                            

  I think it's going to be really exciting 10 years from now. If you just look at what's happening in the industry in terms of disruption, there are so many things that I think could be available to consumers at that point. We all know that genetics and the analysis of the human genome is changing at a very rapid pace. I think that we will continue to see the miniaturization of diagnostic capability that could be built into products. You can see much more personalized medicine. Some of the wearables that are being developed now that we've seen in their infancy in some of the past couple of CESs is could be much more advanced by that point.

  Lisa Ernst                            

  I just hope that our regulatory framework will enable us at that point to fully deliver to the consumer what the technology could enable, and that is, if I think about oral health as the gateway to your body's health, really figuring out what's happening in your mouth is just a precursor for the health you have as a total human being. So, I think there could be a lot of really exciting things happening in 10 years, provided the regulatory boards of health around the world keep up with it.

  Tyler Suiters                      

  Lisa Ernst is with Procter & Gamble, where she is Vice President of Oral and Personal Healthcare Research and Development. Lisa, awesome conversation, and your passion comes across clearly. We'll see you in just a few months at CES 2020.

  Lisa Ernst                            

  I'm really looking forward to it. Thanks for the time today.

  Tyler Suiters                      

  Joining us today in studio is Brendan Mullen. He is the American College of Cardiology's Executive Vice President. Brendan, not a doctor [crosstalk 00:17:03]. Joking aside, very well-versed in this field in the intersection of digital health and technology and all it means, so thanks for being with us today.

  Brendan Mullen               

  My pleasure. It's good to be here.

  Tyler Suiters                      

  A bit of a cross section to start with. What exactly is the American College of Cardiology? We have all sorts of trade associations here in Washington D.C., and the Consumer Technology Association is one of them, but your name probably requires a little bit of a deeper dive into who ACC is and what exactly your membership represents.

  Brendan Mullen               

  Sure. So we're a medical specialist society, originally founded in 1949 by a group of ex-pat cardiologists actually fleeing from Nazi Germany, as a matter of fact. We, over the intervening 70 years, have grown to about 52,000 members. We certainly represent practicing cardiologists, 20-plus thousand of them, both domestically and internationally, but also the broader cardiovascular care teams, so nurses, technicians, administrators, and of course the doctors who are going to be caring for patients that are suffering with heart disease.

  Tyler Suiters                      

  Right. So what do you hear from your members right now about the state of digital health and their either excitement or potentially apprehension in terms of where things are right now?

  Brendan Mullen               

  Yeah. Physicians and particular cardiologists, obviously these are pretty sophisticated consumers of information. They're constantly being bombarded by changing innovation. I think if you look back across the last 50 years, the reason why we've done better and better with heart disease is because of a steady progression of technologies and innovation. But they're struggling with this, I think just like most people are struggling, with figuring out how technology can be utilized to achieve their ends of helping patients that have heart disease do better, prevent disease, cure disease and so forth, but not being overwhelmed by this huge flow of information and technology.

  Brendan Mullen               

  The big departure I think for doctors is that up to literally the last couple of years, most of these technologies would have been cleared through some sort of federal agency, right? And there would have been a whole background of peer-reviewed literature that was conducted based on big trials and the doctors and the care teams would have pretty good confidence that, okay, this device, technique, therapy does what it says it does, right? And now there's a whole sort of proliferation of technologies that are out there, often coming from the consumer space into medicine, and they're struggling with how to make sense of that and often look to the ACC but look to each other to figure out how to sensemake and to make decisions that are best for the patients.

  Tyler Suiters                      

  So, what's the right way to reconcile these, not divergent points of view necessarily, Brendan, but when you look at the tech sector, innovations happen at the speed of light, right? Whereas in a more traditional field, medicine, and thankfully so for so many reasons, that there are, as you said, the peer reviews, the clinical studies, the times and trials and analysis, but we are moving faster and faster. And I think that it seems that the healthcare system is being pulled along, as well. So where is that space where those discussions happen and where is the middle ground?

  Brendan Mullen               

  Well, I think the first thing that we need to acknowledge is you don't stick your head in the sand about these technologies, right? So this is coming. It's going to happen faster. There's nothing that physicians or the ACC or the medical community can do about it. So if you don't go out there and embrace that and help try to sensemake, usually with the partners, I mean, with the technology companies themselves to figure out how to apply these advances back to medicine, I think you're going to be in deep trouble.

  Brendan Mullen               

  But the same token, we often have to remind tech companies and startups that we're working with that there are consequences here that are more meaningful than potentially just clicks or ad revenue or whether your tech works. People's lives can be in the balance with these technologies. So I think what we try to do is to try to stratify into tech that based on the risk profile that it presents back to the patient and those technologies that are fairly low risk to the patient, like we would approach anything in medicine, we're more accepting that that's just going to evolve as it does based on the interaction between a company and the marketplace and individual consumers.

  Brendan Mullen               

  There are technologies, though, that are in this increasingly hybrid area that I think you could argue are actually medical devices or are having therapeutic value, and that's where we tried to engage and make sure that we're managing both the speed that it's happening, but the risk that presents to patients and make sure we're doing the research and the critical thinking that needs to go along so that people don't get hurt with this.

  Tyler Suiters                      

  Right. We'll try and avoid getting too deep into a regulatory discussion about boundaries and opportunities as well from a public sector standpoint. It seems that it's a bit more about what we don't know from a treatment aspect. In other words, clearly cardiovascular care continues to evolve and has come so far in, depending on the timeline you look at, a relatively short amount of time, but that half-life can continue to shrink and shrink and shrink and shrink with the digital health aspect of it driving, with technology being available and an understanding of that technology, right? So is it a bit informational, driving awareness, driving understanding of the possibilities that are out there? Is there a recognition aspect to your membership and the physicians that there is more out there if you are able to investigate?

  Brendan Mullen               

  I think me personally, and I think the team at the ACC that works in innovation, I think we're much more ambitious than that. So this is not just about awareness for consumers or even awareness for doctors. We actually think these technologies have transformative potential.

  Tyler Suiters                      

  Hear, hear!

  Brendan Mullen               

  And I think they have transformative potential in cardiology first, and there's a reason for that, right? The heart, as complicated as it is, we can still think of it pretty well as an electromechanical device, right? And with an electromechanical device, you can measure pulse waves. You can measure a variety of things that many of these devices like the Apple Watch, like the Fitbit, like AliveCor, are really well-equipped to be able to synthesize and to calculate and provide information back. Think how different that is from cancer, which is really happening at a molecular genetic level. And so the technologies today, who knows 10, 20 years from now, but the technologies today that consumers are interacting with don't have as much direct applicability to that.

  Brendan Mullen               

  So if you think about the heart being electromechanical, right, and the types of devices, there is real work that we can do in heart failure in particular in atrial fibrillation, which is arrhythmias with the heart beating in a potentially dangerous sort of way, that is readily available to both consumers and physicians right now, as long as we're working with both to understand what that technology can and can't do and how to make sense if that information it's providing. Does that make sense?

  Tyler Suiters                      

  Oh, it does. It does. Is there a larger picture, too, Brendan, about the importance of value-based healthcare, that regardless of what the specific applications are of a technology in cardiology, in cancer treatment or prevention, whatever the field might be, that this is a way to potentially lower costs for those involved to offer better and more advanced treatments for a larger percentage of the population to make physicians and their entire care team's time used more efficiently, their bandwidth expanded a little bit, right?

  Brendan Mullen               

  Yeah. And I think there's that sort of technical inside Washington view of value, and then there's that sort of day-to-day, all of our lives.

  Tyler Suiters                      

  Oh, the practical application.

  Brendan Mullen               

  My wife and my kids, how do I get to my doctor and how do I make sure that everyone's getting the care that they need without bankrupting us in terms of time and money? So let me take that, the two segments.

  Tyler Suiters                      

  Oh, please.

  Brendan Mullen               

  There's the technical side of it, where we think the device is remote monitoring, really are even now and certainly in the very near future because of the low cost and high-fidelity biosensors and the networked technology that we can put in people's homes fairly simply. We're going to be able to pick up, for example, decompensations in heart failure that land a lot of Americans in the hospital each year. Incredibly expensive. They never quite recover from each hospitalization. They get a little worse each time, and there's plenty of information that says now, okay, these sensors combined with artificial intelligence is able to make sense of a huge volume of information. It's going to help doctors to remotely pick up what's happening with those patients and keep them out of the hospital. You can intervene early. Once upon a time, if you picked up a patient two or three days before they were going to come into the hospital because they were gaining weight, retaining water, that was a big deal. We think now we might be 10, 15, 20 days in advance.

  Tyler Suiters                      

  Wow.

  Brendan Mullen               

  Completely changing... I mean, it's even changing, what does the word diagnosis mean and what does the word symptomatic mean? Because we're able to compile these streams of information into knowledge in a way that we knew was feasible 10 or 15 years ago but just didn't have the technology.

  Tyler Suiters                      

  And almost a redefinition of what normal is for you versus normal for me or anyone else. Individualized care.

  Brendan Mullen               

  Well, and that's going to be one of the most interesting spaces. We have a lot of technology like the Apple Watch that's capable of dealing with arrhythmias of the heart based on the rate and the rhythm of the heart. The one that's going to change the game is when we can continuously, 24/7, monitor blood pressure because so much of cardiovascular disease and morbidity and mortality is associated with blood pressure. But think about it. We take a reading, maybe two readings and your doctor twice a year. That's a variable that is constantly going up and down. My blood pressure I'm sure is elevated right now because I'm talking to you, right, as opposed to—actually, driving over here in Washington traffic, it's probably [crosstalk 00:26:36] elevated, too. Does that mean I'm more at risk right now? No, it probably means that I have a little bit of adrenaline going through me, and so that is a complete game changer.

  Brendan Mullen               

  But the other side of it, as I said, is the convenience factor, right? So most of our infrastructure that makes healthcare so expensive, you see it when you go to the hospital, huge bricks and mortar buildings, legacy technology and plant, if you will, that needs to be paid for. And that's rough on the physicians, too. And so imagine a world where these telehealth and the ability to virtually network with patients allows patients not to have to drive as far to be able to make their visits more often. Imagine being able to see your doctor from your office, and because of all these root biosensors and high fidelity video cameras and so forth, the physician, maybe 50, 60 percent of the time is going to be able to do everything he or she needs to do with a patient in that setting. And I think that's going to hopefully both make care less expensive, make the physician's life more valuable because they're spending more time interacting with patients, less time documenting and so forth, and hopefully improving health because patients are going, "Yeah, I can make it to that appointment because I don't have to fight 45 minutes across Washington to get to see my doctor."

  Tyler Suiters                      

  Well, isn't there an intangible woven in there, too, in that, say we're using telehealth and remote care, and that visit is substantially less time intensive because of the lack of driving time or no waiting room time, whatever it might be, that if you can somehow quantify, say five extra minutes with your cardiologist that you wouldn't normally get in an appointment for her or him to lean in and just say, "How are you? What's going on in your world?" or these seemingly innocuous questions, those can potentially open a door, right, open a gate. And that's where I was going with the efficiency idea, that there are these tangible ancillary benefits that will be driven by this.

  Brendan Mullen               

  And this is one of these ironies that in cardiology, I absolutely love about technology, and that is when we work with our doctors and they're worried that technology is going to displace them, first of all, just look back over the last hundred years. Doctors have become more important and more relevant as has exploded, not less. But the irony is that we think is that technology will actually rehumanize the field, right? So technology doesn't do ethics. Technology doesn't make difficult trade-offs. Technology doesn't hold people's hands. Technology doesn't have empathy, right? Those are what humans do. And so much of what makes a good care plan, so much of what makes perhaps one patient's course of treatment more successful than another patient is having that trusting relationship with a physician, and leaning in as you said. And it means the patient's more likely to take their drugs. They're more likely to lose a few pounds of weight. They're more likely to eat healthier because they have that human relationship. If the technology enables the human aspect to be more meaningful, then I think we're all winning.

  Tyler Suiters                      

  Yeah. Excellent point, Brendan. Looking ahead just a bit to CES 2020 and speaking of the human element, right, the engagement, the American College of Cardiology is working closely with us at CES to develop the programming suite. What's the value prop there, the real delivery for those in attendance, in your mind, of what this program will be?

  Brendan Mullen               

  Yeah, I think it's when you start—for example, we working in medicine, the more we work with colleagues that are computer scientists and working in technology and working in these devices, we're learning so much about how we can use and manage information, but we also realize that folks that are in that consumer technology space also need to learn about medicine, right? It's complex and it can be very, very difficult to navigate. So I think bringing those two aspects together where we can be learning from each other is really, really powerful. So Particularly participants at CES can understand how these breakthroughs they're making with the technology can be used to change the trajectory of health for patients, but also to learn some of the cautions about where we need to be mindful of where real hard science needs to be done to make sure we're fulfilling medicine's oldest motto, "First do no harm," right? And I think this type of setting is actually pretty rare and it's really exciting for us to be part of.

  Tyler Suiters                      

  And you layer on the elements of continuing medical education credits, right? Another reason to get involved, not just for what the takeaway might be, but a tangible byproduct of attending, being there.

  Brendan Mullen               

  Yep. Physicians, nurses, most technologists that work need to continue to get CMEs, continuing medical education credits, in order to fulfill their licensure and as part of their professional obligations. And for us, what's really interesting is recognizing that physiology and our understanding of physiology is changing and how we treat it. But these technologies are a part of our community now, and so clinicians need to be able to understand those technologies and how it impacts patients, how we're thinking about where it's going, just as much as they do physiological and hard science changes. And so to be able to offer CME credits so physicians and nurses in the care team can balance understanding science with technology because that is the future of medicine, cardiovascular medicine certainly, we think it's a really, really positive opportunity.

  Tyler Suiters                      

  Brendan Mullen is the Executive Vice President of the American College of Cardiology, and to hear you say game changing and associate it with tech is certainly exciting. Brendan, great conversation. Thanks so much for the time.

  Brendan Mullen               

  Thanks. Really appreciate being here.

  Tyler Suiters                      

  All right, coming up next time on CES Tech Talk, smart cities. This is a rapidly growing area of CES, and whether you're actually in a city or just rolling through urban areas, I bet you've seen some changes or at least have a hint of the possibilities of what's to come for smart cities and the power of technology to help us be safer, healthier, more efficient, and also more effective all through conductivity and a smart approach to how we live and travel in our cities.

  Tyler Suiters                      

  Hey, we want you to be CES Ready in 2020 and of course, that means starting now in 2019. So do yourself a favor. Subscribe to the CES Tech Talk podcast. That way you won't miss any episodes as we're gearing up for the big show. Speaking of, CES 2020 is January 7th through the 10th in Las Vegas. Just go to ces.tech to get what you need in terms of planning and preparation, getting your show together. That's all at ces.tech.

  Tyler Suiters                      

  As always, none of this is even remotely possible without the true superstars of our podcast, our executive producer, Tina Anthony, and our senior studio engineer, John Lindsey. You all are the very best in the business. I'm Tyler Suiters. Let's talk tech again soon.