Take Two Aspirin and Ping Me in the Morning

Health care: an oral future

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Davidson: I think if you're a patient with the kind of disorder that your doctor is maybe going to see twice in her career, you're better off going to the Internet to find some answers for yourself. Some of these rare genetic disorders, you're much more interested in finding the solution and you're a much better historian than your overburdened primary care physician who might not even know how to identify what you have. On the other hand, it's very hard for you to know who to listen to. There's really no Good Housekeeping Seal of Approval on any of this information. That's everybody's problem with the Internet, whether you're investing or buying a car or trying to figure out if you should vaccinate your kid. You really don't know who you're talking to. Are they a quack or are they a well-meaning but big-chip-on-their-shoulder kind of person because of something that happened to them?

The challenge with health care in particular, and this goes beyond the Internet, is that clinical trials are done in aggregate, but, individually, you're only going to get one outcome. So, if 90 percent of people have a good outcome, but 10 percent don't, and you're in that 10 percent, 100 percent of you had a bad outcome. When you go online, if somebody had a bum hip replacement, they can make an awful lot of noise and be overrepresented in terms of the statistical risk. On the other hand, you can't really quantify misery, so are they really overrepresented? It becomes a tricky issue. The best way that you can make sense of health care information online, and maybe the best use for it, is as experience by proxy.

Hefner: I think that the tools are being developed and the technologies are being developed that are accessible for everybody. Now, that's not to say that it can't be overwhelming, but it can be overwhelming for anybody, and I think part of the value of great brands, speaking selfishly as someone who built a great brand at Playboy.com, which was the first magazine to go on the Web, and is building a great brand off of the properties at Canyon Ranch, is they do give people that kind of Good Housekeeping Seal of Approval as to what they can trust online. Not just in terms of information, but also in terms of tools and programs, and helping people navigate what can be a little overwhelming. It's something that we have to be conscious of, those of us who want to see a robust intersection between technology and health. I think it's about the intersection of big data and personalization.

Ziegler: It's really hard to know where to go for trusted information. You've got the Mayo Clinic, you've got WebMD, you've got start-ups like HealthTap that are really figuring out how to bridge the divide between doctors and patients in a more scalable way. The reality is, everything we have right now is creating a lot of noise. We have a lot of "Me, too" devices that are in the form and function of a wristband, when it comes to personal tracking. We have a lot of patient-empowerment communities. There's a lot of noise with quantified self; there's a lot of noise with health care in general, a lot of advice. The role of natural medicines and homeopathic care. That's a market that's barely been touched. The real issue is, when managing your health, it's too hard right now. It's too active.

But then you've got products like Proteus, which are really cool. They put microchips on these pills, like a cancer medication, to make sure that patients stick to their treatment. The microchips communicate with a patch that you wear on your arm, which connects to the Cloud, so you know in real time exactly what your patient adherence is if you're a doctor. They're creating a platform that's totally passive; it happens in the background. You're not even paying any attention to it.

CellScope is another really great way to see what personalized medicine will look like in a non-robot way, shifting to a more passive and preventative model overall. CellScope's taking on ear infections, so they've got a clip-on attachment that goes on to your iPhone, Android phone, whatever, and it turns it into an otoscope, so that you can remotely diagnose ear infections. The reason that this matters is that it's a $60 billion business in the U.S. alone. Ear infections cost pediatricians a ton of time: That's one of the reasons it's so hard to get in to see a pediatrician. It's really cool. If you look at things like that, they're really starting to systematize baseline issues that don't need a highly paid doctor to diagnose, which helps patients, doctors, and the system. Those are the kinds of things I get really excited about.

But even though smartphones are getting cheaper, most people are still building products for 1 percent of people, most of whom are already highly motivated and do not have chronic health problems to manage. That's part of why we are doing the work that we are with Rivet. If you start with resource constraints, and you start in a smaller box, and you work on low-cost quality solutions that reach millions of people, as opposed to just thousands of people, then you can start making some real change. There's a company over in Bangalore, American entrepreneurs, but they moved over there because they knew they had to work in that market. And they've got a diabetes strip reader, like a glucose strip reader, for $3. It just plugs onto your Android phone, which over there are really cheap. That's the kind of thing that I want to see more of.

Nosta: Digital health, and the emergence of this type of care, there's an irresistibility to it. There's a clinical inevitability, and I think there's also a clinical imperative. And these clinical imperatives will drive adoption. Is it going to be easy? I don't think so, necessarily, but if you look at the emergence of smartphone technology in Third World countries, in India, these devices are very, very common, and they're used as their primary computer.

Now, part of the equation for me is the ability to monetize mobile health and digital health, so that there is true profit in it. We're seeing, now, venture capital coming into the digital health movement fairly aggressively. We're seeing people like Bill Gates and John Scully, of Apple fame, making real significant comments, and they're also really putting their money where their mouth is. They're seeing dollars moving in that direction. So, we live in a capitalist environment. We have a government that helps manage health and health care, but we also have a thriving entrepreneurial environment that sees that this is gonna happen, that the reality is out there, and it's moving forward at warp speed.

MacLaren-Hall: We cannot fear technology and say we must stay away from it because we can't control it. In the same way that some folks design a digital solution for everything, some folks want us to completely avoid it. The key to getting the balance right is not trying to replace the human element in all of this with a digital one, but rather, view it as one of many enablers that a person can choose from. That is what is really needed: help in navigating all of the options available. This needs to be a contextual discussion about individual people and individual goals, and understanding how those align to the greater goals of a healthy society.

Nosta: Adoption is, in part, a function of the ability to accommodate. Innovation is realized when the technology is there, and I think the technology is certainly there. In some ways, digital health is retrofitting existing mobile technology to solve health problems; it's not even inventing new technology.

Sivak: My personal belief is that we're just at the tip of the iceberg when it comes to this stuff. If you're daunted now by the amount of information that's available, just wait until physical sensors are ubiquitous, and we are personally generating terabytes of data every day about the actions that we take and the things that we do. There's a lot more to come. I wouldn't say that there's too much information out there. But there are lots of ideas out there about how we can make the information more useful.

Think about genetic data, right? The cost of sequencing a human genome has gone down by several orders of magnitude in the last five years, and will continue to, drastically, in the next two years. That blows out the amount of data that's currently available, because we're going to have genetic records available. The capacity for personalized medicine and individual treatments is mindboggling. We're carving on stone tablets here.


A shorter version of this article appeared in the March 1, 2013 print edition.

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KEYWORDS FOR THIS STORY

health care, Dan Diamond, NogginStorm, Doctors, Distasters, & SmartPhone Apps, Christie Hefner, Canyon Ranch Enterprises, Contagious Content: Making Healthy Behavior Stick, Frank Moss, Reimagining Health, Technology, & Design, Jerilyn MacLaren-Hall, It's Patient First, Not Mobile First!, John Nosta, TEDMED, Information Overload & Health Decisions, Dana Ragouzeos

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