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July 29, 2021

Is Digital Health an Ultra Endurance Sport?

By: Dr. Sean Kidd and Amos Adler

A4i Digital Therapeutic co-founders Amos Adler and Dr. Sean Kidd reflect on how their (mis)adventures in endurance sports are a metaphor for the pain, the gain, and, did we mention the pain…of working in the digital health.

Amos Adler is co-founder of MEMOTEXT Corporation and A4i Inc. a Joint Venture between Canada’s largest mental health hospital CAMH and The MEMOTEXT Platform for digital patient engagement and digital therapeutics (DTx).

Dr. Sean Kidd is a Clinical Psychologist and a co-founder of A4i Inc. He’s also a Senior Scientist and Division Chief of Psychology at the Centre for Addiction and Mental Health in Toronto and an Associate Professor of Psychiatry at the University of Toronto.

Scene 1: Sean Kidd >> Ultra Race Day: The start of the race had been sort of okay. The usual waking up at 5am, trying to eat something, then on to get the race package, and having the misfortune of needing to wait in line for the single bathroom along with a bunch of other nervous and queasy runners.

This was the 50km muddy, hilly, Haliburton Highlands Ultra. For people who don’t know, that can sound impressive. In reality, it is the fun run of the ultra-world – where others were suiting up for up to 100 miles. Lovely people, feeling fairly good, enjoying nature as the field spread out and the sun came up. The first half had been pretty good – though the ego kept in check as you see the fastest runners already looping back at superhuman speeds.

30-40km brought the long hills I remembered on the way out. My right hip and knee had an ache that no longer whispered gently but had escalated to a steady low-level scream. Slip in a wave of nausea or two giving a chance to feel those potato chips wanting back out and salty residue of hours of sweating making my skin sore and gritty – and here we find the middle-aged psychologist. He doesn’t know what he’s after – is this a metaphor for life? Defying age? Something profoundly and laughably misguided (if we were to put it to a vote family might land firmly on the last one)? It’s the metaphor bit that has us writing this piece – though instead of life it’s about digital health entrepreneurialism with comparable experiences of mud, hills, great moments, and hard realities.

Scene 2: Amos Adler >> The GoRuck Challenge: “Shit. It’s too late to quit.” It was probably 3 or 4 in the morning and I was shivering in Lake Ontario with a dozen or so “participants” (of which several were active military). After about 5 hours of “Training” burpees, carrying logs, partner carries and probably already 18K worth of traversing, crawling, lugging sandbags, workouts, challenges and time trials I realized it was too late to give-up. The GoRuck challenge is a 12 hour event all done with a soaking wet 60pound “Rucksack” backpack full of bricks. (Yes, I paid to do this.) Participants trot through the city starting at 9PM for 11-14 hours, carrying other participants, sandbags and generally experiencing a night of what the military coins “hell week”. It was a next level obstacle course and after many Tough-Mudders I thought I would train for something a bit more. Well I got more, and in the process, learned much about myself, training, “embracing the suck,” and the meaning of teamwork.

The buildup to this particular event and most other endurance events involve hours of training, pissing off family members, working, running, and building up a general tolerance for pain in the hopes of increasing speed and distance covered. The parallels in the life of digital health entrepreneurialism are astounding. TLDR: the ability to “embrace the suck” is directly related to the ability to endure the pace, obstacles, pain and challenges of digital health entrepreneurialism.

If you’ve ever done a marathon or a triathlon or an ultra of any sort, the parallels are clear. And this, in so many ways, sounds a lot like the digital health journey. Let’s compare:

1. A solid foundation of ignorance at the start. Just like reading Born to Run or seeing some ex-Navy Seal spout life lessons, digital health is peppered with the fairy tales of building apps that can change the world. The worst may be the CEO grit, determination, and brilliant strategy fireside chats. This is what turns the casual jogs into a training plan – and the dinner table ramblings into seeking introductions to building a start-up.

2. Then you start getting committed. Like paying the registration fee for an event and starting to train. There are the brainstorming sessions and the first splash of cold water when you realize the costs of that beta – just like the realization about how different 15km is from 5km. You can’t just think yourself to 15km – let’s just take a total pass on 50km and beyond.

3. Here begins the real grind. Training, training, recovery, training some more – and all the compromises needed to make it happen. Maybe you have a life with no kids or other work and can dedicate – here we get to those annoying icons itching to tell you how to live – you are living the zero-sum game. This is most of us. Putting in the time while trying to find balance…….pitches, rounds of fund raising, number crunching, research, outcomes, usability, and adoption trials.

4. This all sounds like a cautionary tale! But the good parts…..the steady progress, the breakthrough moments – running 30km and it feels easy. Here are the early grants, winning competitions, getting kudos from figures big in the field, getting those early wins and results. Here is a bit of a split in the metaphor. Running a strong ultra or getting through an endurance event is mostly about the athlete (read masochist?). Getting a strong digital health innovation out can save people’s lives. Though maybe we are wrong – it is no small thing what people can take away from watching others do extreme things – but that is getting a bit too philosophical for km 39 or maybe too for the startup that is on its 28th pitch to a venture investor who keeps looking at her cellphone .

Some of us engage in intense physical activities to challenge ourselves, prove to ourselves, prove to others, compete or whatever….the rich tapestry of why we do these events are somehow linked to our needs, in how meaningful they are to us, not dissimilar to the plight of the digital health entrepreneur. Somehow masochistically driven, semi-conscious beings repeatedly challenging ourselves 5-6 days a week attributing meaning to why we do what we do.

We know we could do other healthier things, likely more lucrative, lower impact endeavours with potentially better outcomes, yet we endure, trying to explain ourselves to people who look at us and wonder what we’re talking about and why we do it. We seek others that understand us understand our methods, our nomenclature our results our focus. It’s remarkable really.

The breakthroughs are positive and significant but the climbs and challenges getting there often leave us too exhausted to properly celebrate. It’s only when we see other’s reactions that sometimes we realize the magnitude of our successes. In the case of digital health, after the grind, some hard landings as various myths get shattered, blind alleys and time wasters, those bursts of momentum are getting us a lot more than a drawer full of medals – maybe less tangible, but fewer people suffering unnecessarily and riding the cutting edge of a new field are huge motivators!