ILLUSTRATION: ALEX NABAUM
As a mentor I’m seeing more and more attempts to use technology – usually smartphone apps – to help people monitor and manage their health. While these founders are very smart, technically accomplished, and highly motivated they most often run into a brick wall. That brick wall is the assumption that their customers will change their behavior in order to take advantage of the wearable or other tech the founders are working on.
I encourage all founders, not just those focused on consumer health care, to read the Wall Street Journal article The Hype of Virtual Medicine – High tech health care hasn’t proved effective at changing patient’s bad habits by Ezekiel J. Manuel. Dr. Emanuel is the vice provost and chair of the department of medical ethics and health policy at the University of Pennsylvania and venture partner with Oak HC/FT. His most recent book is Prescription for the Future.
Here’s a classic medical problem and a high tech attempt to solve it:
Consider the problem of patients who do not take their medication properly, leading to higher rates of complications, hospitalization and even mortality. Researchers at Harvard, in collaboration with CVS, published a study in JAMA Internal Medicine in May comparing different low-cost devices for encouraging patients to take their medication as prescribed. The more than 50,000 participants were randomly assigned to one of three options: high-tech pill bottles with digital timer caps, pillboxes with daily compartments or standard plastic pillboxes. The high-tech pill bottles did nothing to increase compliance.
Many years ago I worked with Professor Christopher A. Bartlett of The Harvard Business School to turn his book Managing Across Borders: The Transnational Solution into an interactive CD-ROM case. Harvard had, and still has, a highly profitable business selling reprints of its cases to other B-schools. I still remember the one caution I received from Professor Bartlett as we embarked on the project: People hate change! And of course that is exactly what we were trying to do, get professors and students to move away from passive, text/paper-based business cases to using technology to improve learning by creating interactive cases. And despite our best efforts we hardly made a dent in the sales of print cases.
Dr. Emanuel goes on to cite numerous studies whose conclusions are all the same: technology has failed to help patients change their behavior to improve their health. He has one good reason for this failure:
Why is virtual medicine falling short of the techno-optimists’ expectations? Most medicine isn’t about closely monitoring every passing physiological change. Except for patients in the ICU, moment-to-moment numbers on blood pressure, weight or heart rate often don’t really matter. After all, people don’t become obese by overeating for one meal or go into heart failure from one extra-large sugary soft drink. And with the exception of insulin and drugs administered intravenously in the hospital, most medications work over 12- or 24-hour cycles, so the continuous monitoring promised by technology is largely a waste.
The only interventions that seem to change the behavior of patients in a lasting way are financial incentives (mainly to stop smoking) and long-term, face-to-face relationships with nurses and health-care coordinators. These interventions are decidedly not high-tech. They are high-touch, and they remain our most effective prescriptions to treat chronic illnesses.
Of course being a reformed serial entrepreneur I feel like the problem of changing patients’ behavior on a long term basis is great opportunity, not an insoluble problem.
If financial incentives work, why not sell a subscription service and use a portion of that revenue to financially reward patients for changing their behavior? If long term face-to face relationships with health care providers are effective, why not try using Skype or other visual/virtual meeting technology to provide frequent patient/care giver personal interactions in a much more cost-effective, efficient manner? Finally, founders need to target the right customer segment. Chronic disease is most common amongst the elderly, who also are the least technological adept segment of the patient population.
So here’s a great entrepreneurial opportunity: figure out how to use technology to help patients change behavior, whether it is eating habit that lead to obesity or failure to take their medications regularly. Image a socio-medical network of patients tackling a similar health care problem, such as obesity, that combines financial incentives with frequent and helpful tech-enabled interactions with caregivers? From what I’ve seen there has been far too much emphasis on collecting patient information via devices like the FitBit and Apple iWatch. But as Dr. Emmanuel points out we have learned from behavioral economics, information alone doesn’t change behavior.
In fact a former colleague of mine attempted to build an app to help people change their habits based on the book The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg. But that project failed, for at least two reasons, one, I learned decades ago that simple transcoding media – turning a book into an interactive case – doesn’t work. Secondly, founders need to focus on a small niche which they can dominate, then move out from there to a wider population.
There have been three major successes in the past decade when it comes to changing people’s habit: smoking has gone down dramatically, hydration has gone up even more dramatically, and to my amazement, people have been trained to pick up their dog’s waste and dispose of it properly!
While Dr. Emmanuel’s article may seem discouraging it is actually presenting an opportunity for the right team: an experienced health care provider, a social anthropologist, and skilled software/hardware engineers to find how to help patients change their behavior to improve their health care – even if it takes financial incentives!
Finally I can personally attest to the success of using high tech to treat a chronic health problem. I have suffered from idiopathic peripheral neuropathy for about the past three years. Having seen five different neurologists, taken innumerable pills, and tried virtually everything I could find to help ameliorate this very painful disorder, which has no cure, I finally landed on a successful way to ameliorate my pain: a TENS machine called Quell Relief from a VC-backed startup called Neurometrix,
The company’s mission is improve health through technology. While it’s far too early to declare victory in my particular case as I’ve only used the device for the past three weeks I can attest to the modest change in behavior the TENS device requires is a no-brainer given the level of relief it supplies. NeuroMetrix has tackled one the world’s largest problems – chronic pain. Here’s their origin story:
Founded in 1996 as a spinoff from the Harvard-MIT Division of Health Sciences and Technology, NeuroMetrix is a commercial stage company that integrates neurostimulation and digital medicine innovations to address chronic health conditions including chronic pain, sleep disorders and diabetes.
And how did I discover this very helpful solution to my chronic pain problem? Not from the many doctors and other healthcare providers I’ve seen, but from reading about them in tech news! Again, it’s probably too early to declare victory for NeuroMetrix, but their story is a great counter to Dr. Emanuel’s dour article.