The health tech tidal wave

I am no Luddite. Unless you count me as one because I am wedded to The Church of 苹果 . I like things that look nice, work effortlessly, and when rarely need attention, get it just as easily. An ecosystem that I don’t think about but works. I get on with life, made a little easier with the ecosystem.

Therein lies one of the many challenges for the health tech industry trying to find problems, customers and the answer to the forever question of market fit. Where is the effortless functioning ecosystem that doesn’t demand an array of apps, alerts, and the promise of a better healthier life?

If the health tech tidal wave is to be believed, we are on our way to solving everything everywhere all at once.

The first bit of due diligence is working out what is snake oil, and what is real. We know how easy it is to fool the world and many clever people with the magic of a drop of blood, secure hundreds of millions, and when the wave destroys all in its wake, put it down to the risk of investing. An industry that has put and will put peoples lives at risk. If it is real, so what?

What’s on sale

In 2010 I was in 微软 ’s HQ in Seattle exploring a space they called future home. The place was filled with concepts, tech experiments and fully functional stuff that looked and felt like the future. A medication taking process was demonstrated that included a pill pot, a kitchen top, LEDs and data swirling around encouraging and checking adherence. I am sure there was more, but I have aged since. Who knows what today’s future home looks like, but nothing I recall in 2010 is in play today. Of course every great scaled innovation comes out of a trail of many necessary failures that are in fact best described as experiments.

I am sure there are some brilliant solutions afoot for clinicians, once the hospitals get past Windows95, and someone works out genuine seamless interoperability without multiple apps scattered over untidy computer screens. Certainly the electronic patient record solves something in exchange for new problems. In any case, anything that leads to effortless information flow is to be welcomed.

This is about what this tidal wave is doing to the needs of the citizen and patient. The journey to everything every where all at once is currently disease specific, process specific, wellness soaked. I have two apps from two hospitals, I have another that promises to collate appointments but from a select few, unrelated to my needs. I have the NHS app which is getting better. I get letters in the post telling me I missed an appointment I never received, and letters telling me about a new appointment at a time that suits them, which if I don’t attend they will assume I have made a choice, but please call this number to rearrange... I get texts reminding me I have an appointment… My GP responds to my emails. My watch reminds me why I am fat.

Now we have a brilliant bit of tech advertising heavily on social media targeting and exciting healthy young people to monitor how their glucose profile changes if they eat a muffin, drink a sugar filled something… healthy people interested in their health who may make better food choices, choices we already know about, is always a good thing. Tech that aims to reach many more healthy people (a huge market compared to single organ diseased humans) will build an undercurrent of hidden health anxieties, which loop back into more sales. The consumer gets bored looking at the sugar graph profiles, and the kit will end up lost in a drawer. The shiny thing will lose lustre. Until then sell, sell, sell. Brilliant.

Startups often think they know the patient, the customer, the consumer. They design a solution, which will be a variation of something else, and obviously so special it will definitely blow the market, and make millions for the investors. Investor and consumer millions, and billions will be spent, then wasted. That’s capitalism and risk.

A life well lived

There is an assumption by a host of experts, startups, and people who should know better, that patients want to spend every waking hour focused on their health. Or even once a day. Whether you are young and healthy, or living with diabetes, heart failure, chronic lung disease… or all three. The patient must surely want to spend time on all the apps, every day. The tech company will collect the data, some of which you have to submit, some of which you didn’t know you were submitting. The company adds another revenue stream selling your data. Brilliant.

All to help you lead a better life. Not the same as a life well lived. There will be an app for that somewhere.

Health tech is missing something that matters.

The human connection

As Medical Director, going into the building at insanely early hours I noticed a trickle of elderly patients waiting in a makeshift waiting area in the faceless poster filled hospital atrium. Chatting with the folk over a number of mornings I discovered a hidden truth.

The patients were waiting for the anti-coagulation blood testing clinic. A simple finger prick blood test to check that the dose of warfarin (blood thinner and rat poison) was safe and if not, doses get adjusted. Taking warfarin is typically life long, needs several blood tests a year to keep the blood thin at a safe level. Too little, and clots happen. Too much, and you will bleed away.

They didn’t come early to beat the queues.

What’s this got to do with health tech?

I tested the idea that they could avoid the trip in, the wait, test, wait and all the communication tangles by changing to new anticoagulant drug types that required zero testing. Almost all had been offered the option, but declined. Then there was the option of an easy home testing device if warfarin was to remain the drug of choice. Do the test at home, and call in the result and get the drug dose adjusted if necessary. Offered, but also declined. Why?

Staying on warfarin, and coming into the hospital building was one of the few things in their retired lives where they came out, met fellow patients, made connections, shared teas, coffees, and stories.

New drug technology was going remove a human connection. A tech device was going to remove the human connection. No thanks.

We already live in individualised lives, no longer connected as communities of old. Through Covid we learned that what we took for granted really mattered. The human connection. The real, analogue, old fashioned human connection. We need connections. We need meaning.

Health tech is reinforcing the disconnections, and adding to the isolation of the individual. Health tech needs to understand why the excitement of their solution comes with a price we might not want to pay. The new shiny app will go the way of almost all apps - forgotten and then deleted, probably by the Ai that detects zero usage.

If the exponentially growing providers with real solutions in amongst the snake oil sellers really understood the principle of meeting patient and citizen needs we might find we generally want to get on with living, connecting, trying and often failing to shape our health needs into daily habits, part of an ecosystem that doesn’t demand much effort, out of sight and mind. Otherwise we will stop living and just exist at the behest of health driven anxieties driven and amplified by health tech. A tethering tech that will ask for feedback as we are palliated to our last breath.

Our health is 80% impacted by social determinants. On that evidence alone, the greatest value will come from expending effort in the things that will make the greatest difference - Education - Environment - Economics - Culture. All dependant on humans connecting with humans, individuals coming back together to reformulate communities, rebuilding connections, building meaning.

Health then becomes part of the lived community ecosystem, benefiting everyone and the individual. Health tech might then have to rethink how it plays, if the communities are interested.

Perhaps I am a Luddite, at least in terms of the original 19th Century intention - protesting against changes they thought would make their lives much worse.

As a consultant paediatric nephrologist my aim was to keep the patient and family away from the hospital as long as possible - enabling as normal a life as possible. Family, friends, school, neighbourhood… If I couldn’t, then my second aim was to try and keep the patient away from the surgeons - a sort of professional joke, mostly.

As I matured my understanding of needs, I shared my contact details with families. Not the office landline or app, but my mobile number and email address - questions and anxieties that the family needed listened to, engaging with, and solved now, not at the next clinic - no health tech today could resolve. Not one.

Because medicine and health that has meaning is a human to human meaning.

X @Nadeem_Moghal

Not a kiss, just Twitter wanting to be loved.

Notes:

• AI has no hand in any of my writing. Hence the typos.
• Happy to fix errors on notification.
• Always up for a conversation, connection, and coffee.