Monday, March 26, 2012

The Mobile Health App Revolution: Why and How

A simple glance at James McGinnis's famous pie chart shows that behavior has dramatically more impact on health (measured by premature death) than does the quality of one's health care. 

McGinnis et al. Health Aff (Millwood) 2002;21(2):78-93

Yet, our nation's health expenditures continue to be directed disproportionately at the 10% slice. The simple reason for this is that we have tangible tools to deal with this fraction; we build facilities and fill them with personnel equipped to diagnose and treat this 10%, and we use medical schools to train physicians to run these facilities. We might do the same for the 40%, but we lack the tangible tools to do so (illustrated by the question mark below).

With effective behavior modification tools,
we could train for both the 10% and 40%.
What if mobile health apps are the tools to affect health behavior patterns? If so, we could begin to marshall the engines of health care against a much bigger piece of the pie.

Are apps the behavior modification tools we're looking for?

Since apps and other digital technologies have had such dramatic impact on other behaviors (witness all those hunched over their phones in elevators, streets, and dinner tables), it's certainly worth a try to apply them towards health behavior.

What about the role of medical school?

SUNY Upstate's teaching hospital is proudly constructing a new cancer center (illustrated in the graphics above), which is a welcome development for many in Upstate New York. It is inconceivable that a medical student will develop a new chemotherapy treatment or diagnostic modality, although they most certainly may help such developments in the lab.

Yet, it is entirely conceivable that a med student might develop an effective smoking cessation app, thereby preventing a number of cases of cancer. And we don't even have to build new facilities to achieve these results. This is even more impressive when we consider that the cancer center can only help those patients who can get themselves there, while the smoking cessation app can be accessed anywhere in the globe at almost no extra cost.

How? Please allow the obligatory reference to The Medium is the Message.

This crazy phrase means that if we teach medical students with books and lectures, they will treat their patients by reading books and lecturing them. This method has a poor track record; content in print is old, and patients don't remember lectures. If instead, students are taught with apps and other digitized tools, they will use apps and digital tools to treat their patients.

Medical schools need to put app development in the hands of medical students, point them at the 40%, and press play.


Ken Willett said...

It has been pointed out that there's an inexpensive and effective healthcare device that can provide excellent information for addressing part of this 40%. It's called a bathroom scale. Unfortunately, most people ignore what it is telling them.

Behavioral patterns are extremely hard to modify, and it's not clear an iPhone app is going to make much difference.

astupple said...

Exactly- it's not at all clear iPhone apps will work.

BUT, since behavior is, as you say, extremely hard to modify (even with the efficacy of bathroom scales staring us in the face), and since it's a full 40%, and since apps are so cheap in comparison to traditional healthcare infrastructure, it's worth a try.

Regardless of speculations one way or the other, the only way we'll know if it works is to try it.

Thanks for commenting!

iDoctus said...

Smartphones are ubicuous and extremely effective in changing human behavior. Wanna proof? Hide yours for 48h and then post here your experience. Powerful, righr?

avsethu said...

This makes a lot of sense. Its amazing that 40% is due to behavior issues. What is the source of this statistics?

I will agree with Ken about the difficulty of changing behaviors and that is exactly why this idea might make a difference! People are hooked on to their digital devices for everything these days. In fact they are dependent on these devices for even guiding them about which exit to take on the highway! So with a little thought and a lot of optimism, this idea might be worth trying.

astupple said...

Avsethu- We're clearly in agreement, the difficulty of behavior change argues to try digital media. Thanks!

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