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Tag: Innovation

Why Getting to a Digital Health Care System Is Going to Be Harder Than We Thought Ten Years Ago

A leading scientist once claimed that, with the relevant data and a large enough computer, he could “compute the organism” – meaning completely describe its anatomy, physiology, and behavior. Another legendary researcher asserted that, following capture of the relevant data, “we will know what it is to be human.” The breathless excitement of Sydney Brenner and Walter Gilbert —voiced more than a decade ago and captured by the skeptical Harvard geneticist Richard Lewontin [1]– was sparked by the sequencing of the human genome. Its echoes can be heard in the bold promises made for digital health today.

The human genome project, while an extraordinary technological accomplishment, has not translated easily into improved medicine nor unleashed a torrent of new cures. Perhaps the most successful “genomics” company, Millennium Pharmaceuticals, achieved lasting success not by virtue of the molecular cures they organically discovered, but by the more traditional pipeline they shrewdly acquired (notably via the purchase of LeukoSite, which ultimately yielded Campath and Velcade).

The enduring lesson of the genomics frenzy was succinctly captured by Brown and Goldstein, when they observed, “a gene sequence is not a drug.”

Flash forward to today: technologists, investors, providers, and policy makers all exalt the potential of digital health [2]. Like genomics, the big idea – or leap of faith — is that through the more complete collection and analysis of data, we’ll be able to essentially “compute” healthcare – to the point, some envision, where computers will become the care providers, and doctors will at best be customer service personnel, like the attendants at PepBoys, interfacing with libraries of software driven algorithms.

A measure of humility is in order. Just as a gene sequence is not a drug, information is not a cure. Getting there will take patience, persistence, money and aligned interests. The most successful innovators in digital health will see the promise of the technology, but also accept, embrace, and ideally leverage the ambiguity of disease, the variability of patients, and the complexities of clinical care.
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E-mail from TEDMED

It’s the kind of event where you might find yourself (as I did) seated between the Surgeon General and a Nobel Prize winner in Chemistry, with a singer/actor/model type across the table. Yet somehow, everyone finds common ground.

Once again, a who’s who of people descended on San Diego for TEDMED – three days packed with smart, provocative folks discussing how Technology, Entertainment, and Design play out in the healthcare field.

We’ve been attending TEDMED for a few years now, and this one might just be the best we’ve seen yet. From my perspective – an engineer at heart who’s devoted the past twelve years to growing a healthcare technology and communications company – TEDMED boiled down to this: the challenge of managing a range of increasingly complex systems, the need for collaboration, and a clear call to action to effect change.

We’re not kidding when we talk about complexity. A few highlights:  Dean Kamen (one of my  former bosses and current mentors) of Deka Research &  Development and David Agus of the University of Southern  California made their respective calls for a more responsive  regulatory environment in the face of more complex and sophisticated medical breakthroughs, as well as an approach for documenting  the social cost of not approving them.  Eric Schadt of Mount Sinai School of Medicine described the dizzying complexity of genetics the way an engineer might model a network – think of a GPS for your DNA – helping even those (like  me) who can’t grasp the genetic system understand how it works and how personalized medicines interact with  it.

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Orphan Innovations

If someone has invented a successful, innovative, cost-effective social program, doesn’t it seem likely that it would spread quickly to other communities?  Susan Evans and Peter Clarke have written a fascinating article detailing why many programs become “orphan innovations” that no one else adopts.

The authors describe a program started by a retired produce wholesaler in Los Angeles, who convinced distributors to donate slightly spoiled produce to food banks.  Before long, poor families were receiving fresh fruits and vegetables that would have been dumped in landfills.  Evans and Clarke took it upon themselves to make sure that this program was adopted in other cities, but ran into many roadblocks, such as skepticism from overworked local officials that the program would work.  Eventually, through sheer determination, they succeeded: the program spread to dozens of communities.  But it took 20 years of hard work, creativity, cajoling, and financial support.

Their conclusion?  A social program cannot simply be transferred from one locale to another.  Instead, it has to be customized at each new location.  Unlike a fast food chain, that plops a carbon copy of a restaurant down in every community in American, social programs have to be adapted to the particular staff, clients, and ecology of each setting.

There are valuable lessons to be learned here for those of us interested in social psychological interventions that improve human welfare.  There is a growing movement to translate social psychological theory into interventions that help people in the real world, including ones that help people recover from traumatic events, prevent child abuse, reduce adolescent behavior problems, and close the achievement gap in education (as I chronicle in my book Redirect).  Critically, these interventions are being tested with well-controlled experiments, to see if they work. This is a huge advance over relying on common sense, which has led to the wide-spread adoption of programs that don’t work or do harm (see my earlier post, Testing, Testing).

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