The Social Media Sphere

Most people I know, while not exactly secretive about their personal health issues, are at least selective about who they share with. I mean, I don’t see people with t-shirts or bumper stickers that say, “I’m a diabetic” or “Ask me about my gall bladder operation.”

That’s why I was a little taken aback by some of the data presented in a recent article in MEDCITY News headlined, New report finds one-third of U.S. adults use social media to discuss health issues.

In some aspects, I totally get it. Monitoring Internet social media is simply making it easier to see something that has always existed:  patients comparing notes on physicians and healthcare services. We see in the article that 42 percent of consumers have used social media to check reviews of treatments and physicians. More interesting perhaps is the high degree of trust consumers put in the information they find through social media, with 40 percent claiming what they read there would affect how they manage their conditions.

“…hardly a day goes by without news of privacy concerns…”

What stood out to me was that fully one third of those surveyed indicated they would “allow monitoring of their social media conversations if data could be gleaned to improve their health or better coordinate care.” This seems remarkable in light of the fact that hardly a day goes by without news of privacy concerns relating to Facebook, Google+ and others.

One more thing that stuck out to me:  Not only are many people willing to share their health concerns on social media, their expectations for reciprocation are high. More than 75 percent reported they “would expect healthcare companies to respond within 24 hours or fewer to requests for appointments via social media.” Nearly half expected a response within a few hours.  Now that’s something for medical device, medical technology and healthcare companies in general to take note.  Expectations are rising but I don’t think most companies in the healthcare sector are prepared for it or resourced to support it, the way patients and healthcare consumers expect.

DNA Strands

No one is likely to mistake me for Condoleezza Rice. And you’re probably not often mistaken for George Clooney. (Unless, of course, you are George Clooney. In which case, thanks for reading!) It’s obvious from the time we’re infants to readily recognize differences in outward appearance from person to person.

Of course, there’s no reason to think that physical differences are limited to our skin, size and shape. To a trained and experienced pathologist, internal organs are as unique as faces. And yet, much of modern medicine takes a “one size fits all” approach that is often a very bad fit for an individual.

This is the among the first insights of a fascinating interview I read recently with Doctor Eric Topol, conducted by Frank Smith for Frost & Sullivan. Dr. Topol notes, “The fundamental problem is that all we do in medicine today is at a population level, which is remarkably imprecise and doesn’t take into account each individual’s unique aspect, so we practice medicine in an altogether imprecise and inefficient way and that’s why we have so much waste and that so many things that we do are ineffective or backfire.”

This year, you’ll be able to obtain your complete genetic sequence for about a thousand dollars

Topol sees a profound change on the horizon, predicated on availability of massive amounts of information being gathered, in large part, by newly developed (and increasingly affordable) individual evaluation and monitoring technology.

This year, you’ll be able to obtain your complete genetic sequence for about a thousand dollars. Although that data in itself is not yet subject to reliable interpretation as to your potential for health problems, the emphasis has to be on the world “yet.” More immediately practical data gathering techniques include using mobile devices to monitor glucose or heart rhythms.

Doctors, of course, will not be capable of continuously monitoring and evaluating all the information coming in. That responsibility will fall increasingly on the patient, who, after all, has the highest interest in his or her own health.

Dr. Topol sees one of the first important benefits of this information revolution manifesting itself in effective illness prevention. He cites minute-by-minute glucose monitoring, by phone:  “There are a lot of people who would really benefit from that just for a week or a month to train them as to what is it that they’re eating or not doing as far as their exercise goes and starting to see how to get their glucose in a narrow, healthy range.”

It seems clear that the largest change in prediction, diagnosis and treatment will be in individualizing medicine, a change possible in large part by breakthroughs in mobile health technology.  And while I personally haven’t had my own genes sequenced (yet), I may seriously consider it when I see products on the market with proven predictive benefits. And a recent poll on LinkedIn’s Digital Wireless Group showed that 84% of respondents said ‘Yes” to the question: Would you have your genome sequenced?

What about you?

Effective Targeting

In America, more money is now spent on online advertising than on radio or print. The heavy hitters here are auto manufacturers and big packaged goods companies. Their dollars are gravitating in that direction because expensive research is showing them it’s money well spent. Many other businesses can read the signs, and are redirecting their advertising budgets accordingly.

Significantly, online budgets are being further delineated between ads delivered to those using computers versus searching on mobile devices. Use of mobile devices, of course, is skyrocketing.

Health care companies have ventured into online advertising quite slowly, making up only one percent of all online ads. Pharmaceutical companies in particular have to wrestle with presenting required side-effect disclaimers on small screens.

To my mind, however, the greatest challenge to mobile health advertisers is accurate targeting.

I don’t want an ad for an AED served to me on my iPhone when I’m searching for an emergency room to bring a loved one.

One trend that helps better define delivery targets is the growing disparity in age between users of home-based computers and those who are coming to rely on Smartphones and tablets for searches. Folks above 50 years old or so have settled in with their desktops, while younger people are going mobile. Young people research health-related issues such as STDs and pregnancy; older (computer-using) Americans want to know more about heart attacks and IBS. Further, studies show that 18-40 year olds are far more likely to download and use apps that aid in monitoring diet and exercise than are older people.

Every company will have to address the targeting issue, and it’s not going to be easy to make the fine delineations that can make the difference between making a sale and wasting money. For example, I’m working currently with the orthodontic device company OrthoAccel and their product AcceleDent (which accelerates tooth movement so braces can come off faster). OrthoAccel may have an opportunity to effectively advertise their products to potential patients by targeting adults, teens and parents of teens who are searching for local orthodontists. But the company shouldn’t advertise to those searching for information on dental implants – an entirely different category of patients.

Of course, any discussion of targeting advertising through analysis of web browsing behavior and online profiles brings up vexing privacy issues – a subject for another blog.

AdAge recently published a fascinating and potentially very valuable graphic. As part of their American Consumer Project, AdAge commissioned GfKMRI to combine their data on 25,000 American households through the Patchwork Nation segmenting system, which breaks down areas of the country (in this case, counties) in to 12 different kinds of community. This categorization, which includes factors such as economics, culture and politics, goes far beyond overly simplistic terms such as “blue and red” in an attempt to bring more detail and nuance to demographic information.

In this case, the result was a map of the United States that shows the prevalence of major illnesses by county. I’ve reproduced a static version of the map below. For an interactive version that reveals data by county, click here.

Prevalence Map Major Illnesses by County

I, for one, was surprised at the irregularity of illness distribution. What’s with the apparent prevalence of cancer in Northern Iowa/Southern Minnesota? I didn’t know Mormons in Utah suffered so much from ulcers. And speaking of irregularity, look at the pattern of those suffering from Irritable Bowel Syndrome that follows a swath from Virginia through the Deep South.

The information in the map has been further augmented by a partnership with Modern Healthcare that examines how different generations want to receive health care marketing messages and the increasing relevancy of cross-generational caregivers. A summary is included in white paper available here.

This data should prove extremely useful for medical device and medical technology companies (i.e. digital health/mHealth) in their efforts to more effectively target their efforts in prevention and disease treatment.

Digital health saturation point?

Each time I’m tempted to prognosticate, I recall the observation often attributed to Yogi Berra:  “It’s tough to make predictions, especially about the future.” Alas, I’ve chosen to be in a field – mobile healthcare technology – that seemingly compels speculation. How else to anticipate market trends and prepare accordingly? We all do the best we can.

Exacerbating the difficulty of accurate prediction is the astonishing speed at which the industry is growing. According to MobiHealthNews’ 2011 apps reports, over 13,000 consumer health apps for the iOS platform (used by the iPhone and iPad) will be available by this summer, along with 6,000 professional medical apps. About the only thing one can say with certainty about medical apps is, like ants at a picnic, more will be coming.

In the very near future, using mobile health applications will be nearly as common as playing Words With Friends is today

Of course, every app developer is making predictions as well, leavened with great hope that theirs is the “breakout” app that will be embraced by the public. But such an outcome assumes the public will first embrace the concept of using mobile health applications at all. And that’s where I’m going to go out on a (admittedly very sturdy) limb and say, “Yes. In the very near future, using mobile health applications will be nearly as common as playing Words With Friends.” But I will not be so foolhardy as to predict which applications will achieve lasting popularity.

In fact, I’m more interested in speculating – not on the popularity of mobile health applications – but rather where such use will reach its saturation point. At what stage will physicians and the patients for whom they provide care come to a common agreement as to threshold where the use of the app is insufficient at advancing care, and the patient will be compelled to visit the doctor in person.

This threshold is anything but well defined. You might, for example, feel that tests that require bodily fluids would necessitate an office visit. But it’s reported that a team of South Korean scientists has developed technology that reliably diagnoses some diseases from analysis of a drop of blood or saliva on the touchscreen of a smartphone.

Instantly accessible online health information and personal monitoring (and even diagnosis) is having a profound and permanent affect on the patient/doctor relationship. My take is that both parties will arrive at consensus on a case-by-case basis. Mobile health apps will become a vital part of an equation where patients and caregivers will determine if use of an app is as good as (or even better) than an office visit.