In a ‘post-partisan’ 2.0 world, Neil Seeman, JD 1995,  wants to shake up how Canadians—and everybody else— think about health-policy innovations

Story by Sheldon Gordon / Illustrations by Patrick Ledger

Illustration of The medium as the medical messageNeil Seeman, JD 1995, could be the University of Toronto’s latest ‘McLuhanesque’ savant. You can almost sense the neurons firing as the law school alumnus applies his rigorous intellect to issues of public health policy.

Researcher, lawyer, entrepreneur, consultant and essayist, Seeman, 41, is a prolific idea-monger who insists that free markets and open minds can bring a “bottom-up Reformation” to Canada’s emblematic Medicare system.

Seeman is the founder and CEO of the Health Strategy Innovation Cell, a think tank based at the U of T’s Massey College where he  oversees a staff of 20 researchers. A contract research outfit, it is funded by clients, philanthropists and healthcare NGOs.

His mission is to foster Health 2.0 innovation in the country’s— indeed, the world’s—healthcare systems. This means patient-accessible electronic health records. It also means medical institutions tapping into the online discussions of healthcare consumers and providers for insights on quality improvement. And it means a new, patient-led antidote to the obesity epidemic.

“He’s a Renaissance man,” says Dr. Steven Marc Friedman, associate professor in the Faculty of Medicine and assistant director (research)  of emergency medicine at the University Health Network. “The breadth of what he does is incredible. I could see him becoming a deputy minister  of health—or better. But at heart, he’s an intellectual. I see him wanting to think and move in academic circles. It’s his ability as a supreme  listener that makes him such an effective thinker.”

Increasingly, his free-market ideas for improving healthcare are finding disciples. The Cell’s clients include the Health Council of Canada, Healthy Minds Canada (formerly the Canadian Psychiatric Research Foundation), Centre for Addiction and Mental Health,  Providence Healthcare, The Change Foundation and parts of the  Ontario Ministry of Health and Long-Term Care.

In June, Seeman’s Cell and The Change Foundation (another health-policy think tank) co-published Using Social Media to Improve Healthcare Quality. The paper urged hospitals and other medical institutions to “crowd source” the online comments of both patients and medical caregivers on how to upgrade the delivery of services.

Two groups of e-patients will drive this change, Seeman says. The baby boomers are demanding better quality in health care as they retire. And the under 35s “don’t understand why it isn’t possible to get an email or text message from their clinician that explains to them what the meaning of the lab results are, instead of having to visit the clinic.”

Among his major concerns is that patients in Canada don’t “own” their medical records. He is a keen supporter of a more “transparent” system of maintaining the history of a patient’s diagnostic care and medications. Despite a 1992 Supreme Court of Canada ruling (McInerney v. MacDonald) that held patients were entitled to reasonable access to their medical information, “the amount of information accessible to the typical patient is limited by a [largely] paper-based record system,” says Seeman. It’s an especially inefficient system for those who are chronically ill, and have multiple providers needing to share information on a regular basis.

As a model of innovation, he cites Denmark’s medical system, which has 98 percent of doctors connected online with their patients. “Patients have access to their personal health information. They can schedule [appointments] in real time with their physicians, and they can access their test results and medications in real time. All of that information is shared between patient and healthcare provider, and between providers.”

Ironically, he says, Canada’s healthcare organizations are using social media to fundraise, to disseminate new research to stakeholders, and to share information internally, yet “we found an early-stage trepidation  to dip into the waters of quality improvement using social media.”

(An exception is a “small subset” of Canadian MDs who are using Twitter and Facebook to communicate with patients, though even Seeman warns that the use of these social media “potentially frays the trust relationship” between doctor and patient.)

While it’s difficult to oppose the principle of greater “patient engagement,” some public health analysts offer cautions. For young, healthy patients, e-contact with the healthcare system could be a positive  development, says Raisa Deber, professor, health policy, management and evaluation at U of T’s Faculty of Medicine.

But relying on social media users for input means “it’s going to be a skewed sample,” she says. “If you’re a caregiver for someone who’s  really sick, how much time are you going to be spending on social media?” And, she notes, it is the very ill who consume the major share of health care services, much of it associated with end-of-life care.

Seeman also advocates a bottom-up approach to battling obesity, in an effort to tackle its economic and health burdens. In 2005, according to the Public Health Agency of Canada, obesity-related chronic illnesses accounted for $1.8-billion in direct healthcare costs and another $2.5-billion in costs to the economy through loss of productivity. Last March, he co-authored (with Patrick Luciani) a book called XXL: Obesity and the Limits of Shame, which argued government advertising was failing to shame the overweight into healthier lifestyles. 

Instead, the authors urged governments to provide Healthy Living Vouchers (HLVs) to everyone 16 years or older, obese or not, allowing them to buy the service or product most likely to help them get fit, e.g., gym membership, a bicycle, nutrition counselling, a diet regime, etc.

He modeled the HLV proposal on the American experience with school vouchers, but Prof. Deber says the analogy is false. “If you’re  a child, you have to go to school. The issue that vouchers address is where you will go to school. No one is forced to eat healthy or go on the treadmill.”

To Seeman’s dismay, even some “self-declared libertarians” who like school vouchers trashed his HLV proposal in the National Post. (Columnist Barbara Kay slammed the plan as “breathtakingly naïve and unworkable.”) “They’ve fallen into an ideological trap,” Seeman says of his right-wing critics.

Seeman, true to the mantra on his LinkedIn profile, is “not letting the obstructors get me down.” Instead, he’s working on a modeling research experiment to estimate the return on investment for the healthcare  system of enrolling 2,000 Canadians in a Healthy Living Voucher system. If funded, he’s interested in running a pilot project of about  200 low-income families, each with $1,600 in vouchers to spend on any of several accredited providers.

The emphasis on low-income families is because they have fewer choices, whether in food or in sports activities. “And we know they’re receptive to vouchers in education,” Seeman adds, citing Children First: School Choice Fund, a Fraser Institute initiative that fosters parent choice by providing low-income families with funds for their children to attend an independent elementary school of choice.

Participants would receive counselling from a family health team and support from religious leaders. The accreditation of providers, by  a “team of experts from various fields” is “to address the challenge of quackery as it relates to obesity interventions,” he says.

The bottom line in tackling obesity is “we’ve got to deal with individuals on an individual level, as they each confront their obesity challenges differently. And we need to offer them meaningful choice.”

(Seeman has fought his own battle with obesity, shedding 80 lbs. with the help of boxing at local gyms, distance running and a healthier diet.)

Developing ideas and tools for Health 2.0 and advocating for the Healthy Living Vouchers are only two of the items on Seeman’s sprawling to-do list. He is a consultant to various non-profits, foundations and healthcare companies. He advises RecapHealth Ventures, a new  private equity firm that invests in privately-held healthcare companies.

The under 35s don’t understand why it isn’t possible to get an email or text message from their clinician about lab results, instead of  having to visit the clinic.”

—Neil Seeman

In his first job, as an editorial writer for the National Post, Seeman “was frustrated by the junk thrown at me by the legacy polling companies, often using small samples and presenting the data as if it were sacred.” Last March, he started up The RIWI (Real-Time Interactive Worldwide Intelligence) Corporation, an opinion polling firm that gathers global responses online, in real time and which claims to do more accurate and reliable polling.

Today’s polling industry, contends the new firm, increasingly depends upon online and in-person panels comprising an ever shrinking group of survey respondents who are compliant due to participation incentives, and biased due to time availability.

In contrast, RIWI deploys patented software called TimeTrender to elicit survey responses from a “widely distributed, non-biased sample frame of Internet users.” RIWI surveys can collect data from 50,000 or more Internet users from every jurisdiction in the world. Everyone  with access to the Internet (whether by computer or mobile device) “has an equal random probability of being exposed to the polling  question.” says Seeman.

When pressed, he concedes that RIWI “cannot capture people who are not web-enabled”—an estimated two billion of the world’s seven  billion inhabitants—“but we are not claiming to eliminate all biases.”

RIWI plans to publish its first North American Healthcare Confidence Index in the journal Electronic Healthcare, a survey comparing the confidence levels of more than 81,000 Canadians and Americans in their respective healthcare systems. The findings were somewhat counter-intuitive. “This is a good news story for Canada, and a bad news story for the U.S.,” says Seeman. The Index revealed that “every reporting Canadian province surpassed every reporting American state in perceptions of the quality of their healthcare systems.” 

Healthcare has always interested Seeman. His parents are both MDs and neuro-scientists. Having seen the profession’s bureaucratic toll on their personal lives, however, he decided against becoming a physician. “I didn’t see it as a cultural fit for me,” he says.

He did, however, earn a master’s degree at Harvard’s School of Public Health following his JD. While the Harvard studies equipped him with the scholarly tools to generate new ideas in public health policy, Seeman says his legal training sensitized him to the importance of assessing  issues with an open mind.

His recreational boxing reinforces that outlook, he says. “There’s nothing like being in the ring, with the possibility of being hit, to strip away the cognitive biases.” 

So, without disavowing his faith in free-market solutions, he advocates  a “post-partisan” emphasis on approaches that are evidence-based rather than purely ideological. “We’ve got to enable the collection of data at the individual level to know what works and what doesn’t in public policy.”