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Digital Pills


Recently, I have been encouraged to take up more exercise.  I hadn’t exactly been shirking beforehand, but my annual health check suggested I should reduce my cholesterol a bit.  When I got the report, my initial reaction was one of disbelief.  I am probably fitter overall than I have ever been, so my reaction was one of annoyance.  But I fairly quickly turned this into an opportunity.

So, I have made a few changes – rediscovering porridge, and not driving to the station to get the train.  Instead, I am walking (and occasionally, when I am late, running) there instead.  And I have lost weight, and am now even fitter – although that’s my perception; I haven’t actually had an additional test yet.

My companion on this programme has been an app on my phone.  In fact, on everyone’s phone – it’s just the Health app on my iPhone (other devices and operating systems are available) which records how many steps, and how many kilometres, you walk or run in a day.

I heard once that we are supposed to do 10,000 steps a day, so that is my new daily target.  And it can become a little obsessional; if I haven’t quite achieved that target, I will keep the phone in my pocket around the house a bit longer, so I can hit that figure.  And on days when I am well under that number, I will mentally up my target for the next day – or at least over the week, so it averages out.

What’s interesting is that my story, albeit small-scale, subjective and anecdotal, chimes with an increasing amount of medical opinion on the value of apps as a form of clinical intervention.  One of the hardest challenges in medicine is treating chronic conditions, or ones where behaviour change on behalf of the individual is needed; as Dr Phil Hammond, the original “Trust Me I’m A Doctor”, once said “the problem with almost all patients is that they turn up at the doctors’ to get treated so they can go back to doing whatever it was that was making them ill in the first place”.  And, of course, as soon as the patient is out of the hospital or surgery, there’s no way for the doctor to know what the patient is doing, nor to enforce whatever behaviour they prescribed – whether that’s more exercise, fewer calories, or straight-forward medication adherence.

That’s where the explosion of digital data has changed the landscape.  Whilst some medical devices, particularly pacemakers and similar equipment for vital surgical interventions, have transmitted performance data back to Health Care Professionals for some time now, the practical ability to treat or intervene on more regular scenarios has been limited.  But the ubiquity of smartphones, or smartwatches, and their ability to gather physiological information, has changed this.

Now, specific apps can be developed to help combat chronic conditions or encourage adherence to medical regimes.  What’s more, these are increasingly being shown to work, and so HCPs are being educated in how apps can be prescribed as a treatment; they act like “digital pills”.

Crucially, these apps can offer a more psychologically enticing approach, in a way that an occasional visit to the doctor never could; they can help encourage adherence through ongoing positive reinforcement of goals in real-time, during the treatment phase, before any lifestyle changes become a habit.  They can say, for instance, how much better your breathing or fitness is than before, partly because they can track the individual, and partly because they can access the medical research from thousands of similar treatments.

Many of these apps are focused on lifestyle treatments, which often mean at the moment they are focused around alimentary or related conditions – Irritable Bowel Syndrome, Diabetes, but also smoking.  But there’s no reason why this cannot be extended to other long-term conditions, especially as healthcare adapts to incorporate the digitisation of the body.

We are at the very beginning of a new phase of rapid evolution in healthcare, akin to the discovery of anaesthetics in the 1840s or the development of chemotherapeutic “magic bullets” in the early 1900s.  The delivery of healthcare will change, and this highlights some interesting longer-term investment questions in healthcare.

I was speaking recently with a large private health company, which runs a series of private hospitals, who are looking to change the physical layout and configurations of their hospitals, as well as the type of medical equipment they have.  This is because they expect the nature of hospital visits to change in the next 15 years, which will mean that large amounts of their current infrastructure will be obsolete by 2030.  Hospitals will not need to have rows and rows of beds, and lots of operating theatres, with all the capital expenditure related to that; as treatments become digitised, hospitals, GP surgeries and treatment centres will increasingly be data-driven.  Doctors will be armed with patient performance data, so they will spend less time diagnosing, and more time treating, or even predicting diseases; this would lead to more preventative programmes, for which apps again are well designed.

As Yossi Behayoun says in this article, perhaps the biggest challenge for this journey for using “digital pills” comes not from the patients, but from the healthcare professionals, regulators and politicians who will need to change their medical practices, and medical investment decisions to reflect this new landscape.