David Van Sickle: Creating a Company to Promote Respiratory Health at the Individual and Population Level

David Van Sickle, a medical anthropologist by training, is the co-founder and CEO of Propeller Health, the leading mobile platform for respiratory health management. As a Health & Society scholar at UW-Madison, his knowledge exchange project involved piloting some of the elements he would later use to launch his company.

Can you describe your knowledge exchange project?

I’m a respiratory scientist by training, and while I was in the program I became interested in how technology could be used to better research and understand asthma in the community. My knowledge exchange project involved the development of a digital approach to improving the individual care and treatment of respiratory disease, while also collecting information that is useful for more applied and appropriate public health practices. It’s been a different type of adventure than what happens on the traditional academic path. After the postdoc, I started a digital health company called Propeller Health, which has grown up in Madison and employs about 50 people now.

How did you feel about getting involved in this project?

It felt like something I had to do, though it was often a little bit disorienting and scary, kind of unknown… But it was also exciting, and it has been really rewarding.

It felt like something I had to do, though it was often a little bit disorienting and scary, kind of unknown. Ambiguous may be a better word for it. But it was also exciting, and it has been really rewarding. I’ve learned a lot. I’ve met incredible people, and I continue to devote my life to it. I love a lot of things about it.

Who were and are your exchange partners?

There is significant patient, family, and caregiver participation in what we do. In addition, we routinely work with and learn from clinicians, not just physicians but also with care managers and practice nurses and physician extenders—people who are trying to improve population health day-to-day. Quite a lot of work we do involves collaborating with the health plans and systems, trying to help them define and build credible and compelling digital health approaches to respiratory health in their populations.

Did you build these relationships while you were still a scholar?

When the project first began, we started working with patients and physicians on campus to help define the approach and the scientific basis for the product and service, and we involved them in formative research and small proof of concept studies that collected important feedback for future iterations. These relationships have continued to grow over the years, after the organization was set up off campus as a commercial entity.

How did you initiate your relationships with the patients and physicians?

When I was a scholar, we did some trials on campus of early prototypes of the technology: sensors that attach to inhaled medications. Essentially these were small-scale qualitative, ethnographic, and epidemiological studies designed to assess the receptivity of patients and caregivers to these types of digital tools. A number of physicians became interested in the approach and contributed their perspective to the program as it grew and took hold.

How difficult was it to get the project started?

The most challenging part was just overcoming imaginary obstacles. As an academic, you are shown a pretty clear path to follow in terms of your career progression. My route is not one that is often articulated, so it was easy for me to try to talk myself out of it or to listen to other people try to talk me out of it.

With support from the program faculty it was not difficult to get it started, but it was difficult to grow it beyond an adolescent level and turn it into a sustainable project. I found enthusiasm for the objectives and approach, and there was great support and encouragement from the site leadership. The Robert Wood Johnson Foundation program mentors at Wisconsin were remarkably supportive given what an unusual and unconventional idea it was at the time.

The most challenging part was just overcoming imaginary obstacles. As an academic, you are shown a pretty clear path to follow in terms of your career progression. My route is not one that is often articulated, so it was easy for me to try to talk myself out of it or to listen to other people try to talk me out of it. That was one of the more difficult obstacles: understanding that this was not a decision about risk but was much more about manageable ambiguity in my career path.

What did you learn from the exchange?

We continue to learn from interactions with patients and clinicians about what they are interested in and what they think they want and what they might be likely to use; what aspects of day-to-day patient self-management and clinical practices and population health efforts could lend themselves to digitization; how we can use technology to enable us to close the gap between what we should have been able to achieve in respiratory care and treatment, and what we’ve so far accomplished; how we can support better patient-physician communication about the burden and management of disease. We learned from our efforts with patients and physicians that there was both interest in these solutions and a major economic proposition.

Did you get the results you hoped for?

What I got was creative and intellectual support from the program, from RWJF, all along. It has been a steady enthusiasm and encouragement and an interest in helping me be successful in building a company that has population health as part of its mission, and a team who sees that goal as a core part of its values. It has been a powerful few years of self-discovery and support, and I’m really grateful for that experience and guidance.

Do you see what you’re doing now as a big knowledge exchange?

I do. For better or worse, we have been early in the development of digital health. Which means we have to make the market. That means if you are a health plan or healthcare system, you do not necessarily have a budget for apps and devices yet. So Propeller has to go out and convince physicians that digital tools can actually improve patient self-management and improve care and treatment. As a result, we are often evangelizing, educating, and studying and publishing what is working in our programs and what is not. Knowledge transfer is another way of describing the market development work you do when you’re a young company. And we do it internally as well, of course.

If you could do it again, what do you wish you knew to begin with?

One thing we’ve learned in building the market, all the way from individuals to organizations, is that there’s a lot more to it than just transferring knowledge… This gap between knowledge and outcomes remains formidable, and I think we underestimated it when we started the business.

This is embarrassing to say as an anthropologist, but I expected the knowledge we created about digital approaches to respiratory health to more rapidly and conclusively change patient and clinician behavior. Instead, one thing we’ve learned in building the market is that there is so much more to it than just transferring knowledge. We can teach a person with asthma an endless amount about the disease and how to treat it and so on, but all of that can often amount to zero change in the burden or management in daily life. This gap between knowledge and outcomes remains formidable, and I think we underestimated it when we started the business. We probably still underestimate it.

What was the most important thing you learned about communicating with nonacademics?

Communication outside of academia is often more straightforward. Despite the demands of the market, I find most communication characterized by a plain-spoken, common-sense, want-to-work-together, want-to-figure-out-the-right-things approach that sometimes gets lost in jargon and complexity in academia. It feels refreshing. But, again, I was in anthropology, and the shelf of postmodern ethnography that I had to slog through in my career probably measurably shortened my life.

What type of scholars do you think would benefit from the knowledge exchange program?

I think many scholars would benefit from more explicitly considering how the development and conduct of their research can be stretched and strengthened by knowledge exchange. Whether the activity remains an academic investigation or is designed to be applied and tied to the broader community, the kinds of perspective and lift available from others can sharpen and augment the process and results.

What have been your best and worst experiences?

My best experiences continue to come from the daily opportunity I have to work with smart and motivated people who have developed a personal commitment to the mission we share around respiratory health. There is nothing like the feeling that comes from working alongside the team and sharing the ups and downs of building a company together.

But it is frequently hard. It can be pretty lonely, and disorienting, and it can be a bit tough on your family and the people you care about.

What effect did this knowledge exchange process have on your career?

It’s totally changed my career. I’m no longer an academic scientist. I’m out in the market, running a company.