Emergent, Fringe Behaviors in Healthcare

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New Discussion Post

Today I have a new post and discussion topic. To reiterate the rules:

I’ll pose a question and give my thoughts. In a future newsletter, I’ll include ~three of my favorite replies. I’ll possibly even make a meme related to your answer.

Good answers are ones with a novel viewpoint, data to back up their claim, personal stories, and avoid clearly shilling something.

Please reply with your thoughts and let me know if you want to have your name included or be anonymous. You have to be on the newsletter to submit a reply to it, obviously.

Try to keep answers to two paragraphs or less, please. This doesn’t apply to me because it’s my newsletter and these are house rules.

What are the “Emergent Behaviors” You’re Seeing?

I…spend a lot of time on the internet and weird circles of people. I see a lot of fringe and emergent behaviors before they become a regular part of mainstream culture. If I knew how to financially profit off that, I wouldn’t be shilling courses every week. 

I think a lot of the people on this newsletter have also been seeing behaviors they think are weird/interesting today that will become popular in 5-10 years. So I wanted to put the call out for you to tell me what fringe or novel behaviors you’re seeing in healthcare? Give me your weirdest stuff or the most NICHE community that’s real into it. 

I’ll give a few below I’ve been watching and share yours in the next newsletter.

But first…

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If you or someone you know wants to level up in ops, learn best practices/what’s new, or build a network of other people going through the STRUGGLE…come through. 

Fill out this application by Monday 5/5 - it’s how we get the best people there (it’s about 30% acceptance rate, we’re not a small school in Boston yet). 

Just FYI it’s $850 for a ticket if you get accepted, filling out the form is non-committal to accepting your spot. 

Physician Apps and App Stores

I dunno if you all have heard the term “vibe coding”. Imagine software, but bad. It means that with AI tools, you can prompt them enough that they’ll spit out the code you need or a full working prototype. Then it’ll immediately crash when two concurrent users use it.

We’ve built a few of these in Replit for OOP stuff. You can see how someone builds a brickbreaker game or personal expense tracker. It's pretty cool how usable it is for non-technical people, though it’s not really meant to scale, have best security practices, etc.

I’ve been noticing more physicians vibe code their own workflows and applications. For example, here’s a video of Dr. Christian Pean who built a more dynamic patient intake form that asks the patient to do some movements, follow up questions, and to point to where it hurts. It’s very cool!

Physician-led creation of these apps feel like 1) they can solve niche pain points other physicians know and feel and 2) add some credibility for adoption.

I can see a world in which more physicians are able to quickly spin up their own apps for other physicians to use. For example, a very common one is physicians that share the prompts they use to generate letters of medical necessity, insurance denial responses, etc. These are shared across social media to other doctors already. It’s like the modern dot phrase.

The issue is likely going to be distribution. Non-clinical applications can be distributed via social media, web apps, or iPhone applications. But, what if you want another practice to uptake a tool? You need platforms that take on the data security/implementation work.

You’ll probably start to see more “app stores” for clinician applications to be deployed at other practices. For example, Bunker Hill seems to allow researchers to deploy AI algorithms they’ve built into other hospitals in the Bunker Hill network. This can help researchers have no idea how to commercialize and have only seen $ in a python notebook. You can imagine a world in which it expands past clinically validated algorithms and into applications that researchers come up with.

Canvas is a programmable EHR. It has extensions built by a developer community (sometimes other physicians) that are pre-built clinical protocols, workflow automations, etc. which you can then use in your own instance of Canvas.

Hippocratic has a creator program where you can train your own AI agents and sell across its customer base. No idea how this works, who the IP belongs to, or any detail that has just popped into your head. Leave me out of this.

Maybe you’ll even see AI scribes launch app stores or something like that.

People Sharing Biomarkers on Social Media

I was recently hanging out with a friend and he showed me the results of his low-density lipoprotein tests. I don’t know if this brought us closer or further apart.

As I’m getting older, my friends have started sharing more about their health details and tests with each other. Part of this is because we’ve known each other for so long, we’ve exhausted all other mutual interests. 

But also, people are experiencing new things and want to know if anyone else is also experiencing them (or knows someone that has). People want to hear from others that have gone through what they’re dealing with.

But what if you don’t have close friends to share this with, or no one in your immediate circles has answers/cares about your hematocrit levels? Another thing you can do is just post it to social media and see what other people think. There is no such thing as shame anymore anyway!

Sharing your lab values/test results is not totally new, I’ve seen it quite a bit in biohacker forums. But a lot more identifiable people seem more willing to share their biometric data and labs on social media. And it’s not just trying to figure out what their issues are, but also as a means of flexing.

People are trying to learn non-clinical and clinical things:

• How certain environments/foods/supplements impact their lifestyle factors (e.g., sleep). 
• Crowdsourcing answers on what to do next or if people have experienced something that doctors don't have answers to. Here’s someone that shared their genetic test results online because they think they might have underdiagnosed hemochromatosis and other people might be struggling with a similar issue.
• Show off improvements they’ve made in certain biomarkers to like minded people trying to pursue the same goal (e.g. VO2 Max).

I’m not sure where this goes, but it seems like people really want to measure more stuff and see how that compares to other people. This feels like a wedge to turn healthcare from a single player mode where you’re on your health journey solo into a multiplayer game where other people are involved. 

Who’s building the “Strava for healthcare” where you can compare stats to each other? What if this is the wedge into making a new biobank? Bryan Johnson’s “Don’t Die” app actually has leader boards that show people’s measurements of different biomarkers. I’m just glad there’s no leaderboards for the… nighttime measurements he’s been posting.

This probably comes to the chagrin of the clinical community who wonder why this would be useful, but clearly a lot of people think it’s fun and useful for them. Can we do more with this?

[A sub-emergent behavior within this category is that more people seem to be measuring the quality of their living spaces and sharing those online. Everything from air quality, what’s in their water, and even radiation from everyday objects. This thread gives you an example, but even anecdotally within my social circles, you see way more people share concerns about this. This also especially lives outside of the domain of traditional healthcare but clearly impacts health, which is a sweet spot for peer advice].

COURSES STARTING ASAP

My voice is hoarse from yelling in all caps. Please listen closely.

1. EHR data 101 (enrollment ends Monday) - Learn everything about what’s in EHR data, how to manipulate it, and even where LLMs can and can’t be used.

2. How to sell to health systems (enrollment ends next Friday) - People got mad at me for saying if you sell to a provider you need to align with the provider’s business model? Don’t be one of these people - if you sell to hospitals or providers, learn how to do it properly.
3. Pharma and life sciences breakdown (enrollment ends next Friday) - Everyone wants that sweet seemingly endless pot of pharma money and then has 0 idea what they’re motivated by. We’ll explain what pharma cares about and how drugs get to market.

4. LLMs in Healthcare (starts 6/2) - This one keeps selling out. We keep changing and updating this course as the LLMs get better. Learn what LLMs are and what practical implementations actually look like.

Brain “Induced” States

I see a lot of “hardware to induce a brain state” nowadays. Some are trying to help you get into a flow state like Neurode. Nudge is running studies to use low-level ultrasound on your brain to treat chronic pain and addiction. Elemind is trying to induce sleep with a headband. Alphabeats is trying to help athletes get into “high performance mode”. 

I have 0 idea about the science or how/if any of these works. But it’s clear there’s consumer demand and people want to “do stuff to their brain” in ways that modern medicine can’t. Companies are riding that trend and at the edges you’re starting to see people do stuff to induce their brain to do things. Maybe it’ll start in the consumer world and move into more traditional medical device areas.

I miss when we just took stimulants and nicotine to get into a flow state like normal people. Maybe I’m just salty that I don’t look good in a headband, fivehead status.

Parting Thoughts

In addition to telling me what fringe or novel behaviors you’re seeing in healthcare…

I’m curious where people are going to get ideas and feel inspired. Right now I’m feeling a little…stuck in terms of idea generation. Everyone seems to oscillate around the same 5-6 ideas, the internet feels like it’s rehashing the same memes/ideas constantly, and the vibe in my circles is very low energy/pessimistic.

Where are the weirdos and interesting people hanging out? Inspire me.

Thinkboi out,

Nikhil aka. “Neuroemergent”

Twitter: ​@nikillinit​

IG: ​@outofpockethealth​

Other posts: ​outofpocket.health/posts​

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