Is digital health bad news for academic medicine?

Here’s an interesting piece about the emigration of medical students from top-tier West Coast medical schools and into digital health startups.

Bay Area-based medical students from Stanford and UCSF have among the very lowest rates of pursuing residency programs after graduation compared to the rest of the country. Stanford ranked 117th among 123 U.S. medical schools with just 65 percent of students going on to residencies in 2011…UCSF is 98th on the list, with 79 percent of its graduating students going on to residency…“We’ve seen that many of these Bay Area-based medical students are drawn to startup opportunities,” said Jeff Tangney, CEO of Doximity. “It used to be biotech, and now it’s more often digital health.”

This is tough news for medicine – both clinical and academic.

It will be tempting for some to de-trend these findings, questioning whether these emigrees should’ve ever entered medical school in the first place. Others might argue that these departures are actually good news for future patients. But these perspectives miss the underlying trend.

It used to be the case that if you were interested in improving patient care and creating better, more efficient treatments, you went into academic medicine. If you found innovation more compelling than full days of patient care, you could find an academic position, secure a more limited clinical role, and start creating. Today, given funding restrictions, beauracracy, and the long [long] road to impact, the startup economy is a more attractive option.

In short, I wonder if people are running to digital health, or running away from academic medicine.

What do we need from digital health science?

Not another app. There I said it [again]. The market is crowded and science can’t (and shouldn’t) compete on design, updates, integrations, marketing, etc.

So what is there for a behavioral digital health scientist to do?

Answer the tricky, confounding, unanswerable questions that are constraining the growth and utility of digital health.

Like this.

Vanessa Friedman wrote great piece in the Times last week about breaking up with her Apple Watch (I’ll take it). Amidst her litany of concerns was this:

Likewise…the fitness-app aspect — the tracking of my steps, the measuring of my heart rate, the telling me to stand up when I am in the middle of an article — seems more like a burden than freedom…I have worked hard to wean myself from a reliance on exercise machines telling me how hard I had worked…because I knew I was cheating pretty much all the time anyway and thus could not trust the results, and in part because it became an excuse to modify, or not, my ensuing behavior…But the truth is, I know when I am in shape… The watch threatened to drag me back into a numbers-driven neurosis, and that’s a temptation I would rather not have.

Her comments are no surprise for anyone who’s helped a patient to change her behavior (especially the masses who aren’t interested in the quantified self approach). It’s dangerous to treat anecdotes as data, but I suspect her experience is widely shared. I’ve yet to meet a patient who was motivated by the reams of data that we scientists like to provide.

So, how do we fix this? That’s the question.

Africa may lead the way with mHealth

I'm guessing that Africa is where we'll see the most exciting breakthroughs in mHealth. Need some evidence? Take a look at the latest Pew data on cell phone adoption.

Landline use is almost non-existent (and importantly, were really never used):

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Cell phone use is surging.

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Importantly, people are using their phones for texting. This is critical. We have dozens of evidence-based texting interventions for a wide range of conditions.

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And we'll see rapid penetration, because people smartphone penetration is lagging. This may seem disadvantageous, but we've shown that you can deliver highly personalized, fully automated, health system linked interventions through regular old feature phones (who came up with that name). This means that there are no pesky [expensive, time intensive, expertise-demanding] visual interface issues to get in the way.

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It's hard to overestimate how important these changes could be. When have we seen such rapid changes in infrastructure that can revolutionize the health system in low income countries?

The only Apple Watch review you need

Lots of Apple watch reviews are out today.

(If you’re short on time, read Gruber’s review)

Taken together, the early reviews have been the tech equivalent of the multipurpose Southern maxim, “bless your heart.”

Apple Watch apparently needs work, even if no one wants to say it directly. From the NYTs Manjoo):

“The most exciting thing about the Apple Watch isn’t the device itself, but the new tech vistas that may be opened by the first mainstream wearable computer…For now, the dreams are hampered by the harsh realities of a new device.”

From Gruber:

“To me, the breakthrough in Apple Watch is the Taptic Engine and force touch. Technically, they’re two separate things. The Taptic Engine allows Apple Watch to tap you; force touch allows Apple Watch to recognize a stronger press from your finger.”

“And without taps, Apple Watch is rather dull.”

Call me contrary, but I think these reviews are pretty exciting. They sound precisely like those of the first iPhone.

We want What’s App! [API, that is]

Faceboook flustered many in the programming community this week, by not releasing an API for its popular WhatsApp service.

Here’s a sentiment shared by many developers:

“Implementing chat features is hard, especially when it comes down to sharing pictures, sounds etc.,” London-based iOS engineer Kevin Mindeguia explained to Mashable. “It’s actually one of those features you try to avoid as a developer, because of its complexity. Having a ready-to-use API and an SDK would save us great time and money.”

Count me among the flustered flock. WhatsApp is the conduit to vast populations globally — many of whom reside in areas that are resource constrained and have been historically disconnected. A WhatsApp API would be a huge win for digital health science efforts like ours. We would immediately be able to provide remote, disconnected, medically vulnerable global populations with access to health interventions that would otherwise be inaccessible. Help us out, Facebook!

Kinect for fun, not weight loss

(Note: I’m about to date myself).

As a kid, I was a geek pioneer. That’s right, I was part of the first generation of children to be transfixed by the beeps, blinks, and bouncing pixels of video games played on devices like the TI-99/4A, ATARI 2600, (remember that attached audiocassette “drive”?) and Commodore 64. That means I was also part of the first generation that considered staying inside as a reward, not a punishment. For us, there was a linear association between sedentary time and video game proficiency. And I was very proficient.

Every generation since has basically put us to shame. With advances in technology, screens have increased in number, and as screen time has grown, so have our kids’ waistlines.

That’s why so many were excited by the release of Microsoft’s Kinect (and the Wii). Many thought these active gaming approaches would be like those funky vegetable pastas — sneaky ways to get kids to be more healthful (still working on my metaphors).

A fascinating new study suggests that much of our exuberance was premature. The study found that adolescent boys (and only boys, unfortunately) burned more energy while playing Kinect games, compared to playing non-Kinect games or just sitting. But after a day, there was no difference in energy expenditure. This means that at some point, the boys were compensating for the extra exercise they got while playing Kinect.

Compensation is common when we exercise. There’s good science that we tend to eat a bit more after being physically active (and sometimes, more than a bit). Interestingly, in the study, when researchers offered the kids food, there were no difference in the amount that kids ate. This suggests that kids compensated, but we’re not sure how, or when.

TL; DR: Kinect is great fun. Nothing beats using a game as an excuse to hurl yourself around the room dance. However, if you want your kids to do meaningful exercise, turn off the TV.