We’ve conducted many health tech studies over the years, and we’ve become quite opinionated in the process. Check out our expertise in this area below, and who knows, you might even learn something new!
chapter one: genomics can change the fabric of society
A world divided
We live in an increasingly divided world, and it’s not just about our social media algorithms. One only has to look at recent and pending electoral outcomes in the West. These have yielded (or are threatening to yield) unpredictable and surprising results that leave some breathing a sigh of relief, while others groaning in despair. Yet both sides share a sense of uncertainty of how the pendulum will swing:
“Will things finally go our way?”
OR
“How long will things stay in our favour?”
One critical reason for this divided society is the underrepresentation of certain cohorts (such as gender, race, sexual orientation etc.) We can observe this across all aspects of society, but one of the most profound impacts can be seen in how people are treated and cared for within healthcare. After all, this can quite literally be a matter of life and death.
Taking the helicopter view, one major problem is the historical one-size-fits-all approach to clinical trials and medical research. As market researchers, we often witness healthcare professionals’ enthusiasm towards clinical trial data being dampened by the focus on patients from countries other than their own. This is not just a matter of frustrated physicians, because neglecting the right cohorts can lead to misdiagnosing or underdiagnosing various conditions among unrepresented sub-groups, particularly women and ethnic minority communities.
Just to give you one recent example: Addyi (flibanserin) is sold as the female equivalent of Viagra; a treatment for low sex drive in women. The product’s interaction with alcohol has been tested in a clinical trial. Guess what proportion of the trial subjects were women! Go on, have a guess. What’s your number? 100%? That would make sense, wouldn’t it? It’s a drug for women, after all. Well, the actual figure is 8%.
That’s right, 92% of trial subjects
for a women’s drug were men.
Such exclusion of certain groups has been ever-present during drug development. But discrimination is even more apparent at the individual level, with certain patients receiving sub-par treatment compared to others, or being placed fully outside the reach of adequate healthcare provisions.
A particularly worrying and heart-wrenching example of discrepancies in the delivery of healthcare is maternity care for African American women in the U.S. These women are up to four times more likely to die from pregnancy-related complications compared to white women. Why is this? Much of it is down to delayed diagnoses, lack of responsiveness to complaints and symptoms, and overall inadequate prenatal care.
There is also evidence that pain reported by women is more likely to be dismissed, and the pain of women of ethnic minorities especially so.
For instance, a study amongst Parkinson’s sufferers in the UK has shown that white (male) patients were far more likely to receive painkillers than those of African or Asian origin. Parkinson’s patients typically live with severe chronic pain, and they shouldn’t be made to suffer. And yet...
43% of white patients received strong painkillers, while only 4% of African and Asian patients had received the same treatment.
Better representation through advancements in genomics
Genomics has come a long way, with scientists now being able to peer through our biological keyhole and identify a whole array of vulnerabilities and health risk factors. As a result, we can now dissect patient populations into more meaningful sub-categories, which allows for targeted therapy. For example, it’s no longer just ‘ovarian cancer’. We can now distinguish between HRD and HRP patient subgroups, leading to differentiated treatments.
In the past, cost and time barriers have made it tricky to put to genomics to good use in healthcare. However, with second and third-generation sequencing technologies, we are now able to process and analyse much larger DNA fragments at a really impressive pace, dramatically cutting processing time as well as cost.
Developments in robotics, such as liquid handling and sample processing are expected to lead to even further reductions in time and cost, eventually giving rise to an opportunity for real-time sequencing and point-of-care applications. This will facilitate rapid diagnostics and monitoring across a wide range of settings.
So how do genomics fit in with improving inequality in healthcare? We shouldn’t expect advancements in genomics to suddenly solve the poor treatment of African American women during their prenatal and postnatal journey. However, it can help to improve how minority groups are represented, for example by identifying ethnic-specific disease risks, or by understanding how different ethnic groups metabolize certain drugs.
As genomic technology progresses further, we can envisage a near future where ethnicity becomes less relevant. Treatment decision-making will increasingly happen at a genetic level, thereby democratising healthcare services.
It won’t matter if you’re black or white, it’ll all be down to what biomarker you have!
Healthcare can do more than just mend broken bodies and prevent illness. With emerging genomics technology, it can empower us to build social cohesion and inclusion, by ensuring that effective and fair diagnosis and treatment is available to all, regardless of their gender, ethnicity or any other minority status. Genomic healthcare can help all members of society to feel equally included, heard and cared for.
And that’s something to celebrate and look forward to!
P.S. If this article has sparked your interest, check out the DE&I section on the #BHBIA website:
https://www.bhbia.org.uk/resources/diversity-equity-inclusion
References:
https://movementdisorders.onlinelibrary.wiley.com/doi/full/10.1002/mdc3.13430
https://medicine.yale.edu/news-article/a-drug-for-women-tested-on-men/
chapter two: wearables
Wearable tech. It’s pretty exciting stuff!
If you were born in the 90’s or before, you’ll likely remember dreaming about the kinds of technologies the future might bring, most certainly starting your sentence with “will we ever…” or “imagine if…”.
Today, it’s less a matter of ‘if’ and more ‘when’. Our hopes and expectations are wide open, and with innovation moving at breakneck speed, we can envisage endless possibilities to our future that feel both real and likely. Just look at Neuralink’s Blindsight, a brain-chip implant that has been granted “breakthrough device” designation by the FDA and heading into human clinical trials. Not only does it promise those with optic nerve damage to regain their sight, but those born with a defect of the nerve to be able to see for the first time!
The endless possibilities in our future can make us giddy with excitement, which is compounded by a plethora of articles from both conventional and social media, that will have us believe that a seamless transition into a human-machine cyborg world is just over the horizon.
But is patient engagement with wearable tech guaranteed?
Wearable tech in healthcare already incorporates a wide range of applications, including monitoring ECG, blood oxygen levels, blood pressure and blood glucose. These are of course quite different from bio-integrated technology such as Neuralink, yet the narrative tends to cluster wearables as a group, potentially leading to unrealistic expectations on how useful these technologies will be to HCPs in the short to medium term.
Current wearable tech suffers from several barriers. Reliability is one of them; e.g. inconsistency in results and/or connectivity issues. Data privacy concerns are another; i.e. the ever-lingering threat of a major data breach of users’ biometric information. But possibly the single greatest barrier to the use of these technologies is users’
long-term loss of engagement and interest.
We see this time and again with consumer products, where the initial spark ignited by a clever new piece of kit or app inevitably wanes. How many of the smartphone apps you have downloaded have been collecting virtual dust on your phone? And if you are a smart watch user (which, on the balance of probability, you are), how many times have you checked your sleep cycle or your heart rates in the past month? And there it is.
Of course, users whose running or cycling is an integral part of their identity, will continue to regularly monitor their activities for long periods of time, aided by social platforms where they can share and celebrate their accomplishments. But not the rest of us.
We expect that engagement with wearable tech in healthcare wanes even faster than in lifestyle applications. Look no further than adherence with life-saving treatments in chronic diseases such as high blood pressure or high cholesterol. Speak to any pharmaceutical manufacturer or physician, and they’ll tell you: adherence is the bane of their lives.
In a recent study, we at B+C spoke to Chris from the UK, a diabetic patient who has lived with the condition for many years and is well versed in the causes and prognosis of his condition. He's been prescribed an SGLT-2 and understands the protective benefits the treatment provides. And yet, he is a self-confessed intermittent complier… “I know it’s important, I know it’s prolonging my life but sometimes I just have enough of it all. I’m getting a bit older now and I want a break. It’s a constant reminder that I’m ill, and in any case, I feel fine and I have no symptoms”.
Now imagine asking patients to keep wearing a wristband that’s looking out for an MI that MIGHT happen. Or might not. Oh, but the device needs to come off in the shower, and it needs to be charged every week.
Good luck with that.
It’s true that non-intrusive gadgets, which better integrate into the body and require no active participation from the patient are likely to fare better. Neurolink, and NFC chips are good examples.
But, even with full NICE/FDA approval of in-body and on-body tech, we can reasonably expect late adopters to be a sizeable segment of the market. They’ll say they want it… just not quite yet. In the meantime, more conventional, but more effective wearable approaches will be needed.
Looking to the consumer sector for inspiration
We know that telling patients that something will save their life is not enough to keep them interested! Healthcare providers and tech developers would therefore do well to learn from the consumer sector, particularly from app developers who have come up with tried-and-tested measures to secure long-term use and commitment from their users.
App developers have used several tools to make their technology ‘sticky’ or even addictive. Many of these could also be suitable in the wearable health tech sector:
Personalisation – wherever possible, the wearable should leverage user data to personalise usage and experience. Feedback on the metrics measured and what this means for THEM will be critical.
Push notifications and alerts – well-timed notifications to bring the user back to the wearable kit. This can, and should also be tied in with the personalisation aspect where the patient is actively notified of a reading and its relevance to their potential condition. In addition, progress updates on milestones such as period of usage and how this improves the effectiveness of keeping the patient safe, would serve well here.
Social features and community engagement – allow users to opt into data sharing functions and engage with peers sharing experiences and knowledge. Receiving feedback from others with the same condition or the same gear can add to the ‘stickiness’ of the equipment.
Gamification – provide game-like elements to increase engagement, such as a points system or rewards on reaching milestones. These could be extended to incentives and commitment loyalty programs. I know what you’re thinking: who’s going to pay for all this? For instance, cost savings made by the health service from the preventative impact of monitoring could be reinvested back into the system.
Bottom line
Until the bio-integrated (in-body and on-body) tech we fantasise about comes to fruition, so that patients can forget about the devices they are using, wearable tech is here to stay. And, if wearables are to stay relevant and have a tangible health benefit, they will need to ensure maximum patient engagement.
chapter three: hand-held diagnostics: are we in Star Trek territory yet?
The past
Go back far enough in history, to the times before hospitals were the norm, and you will find that the point of diagnosis and care was the patient’s home. For the past 200 years or so, for the more serious illnesses, this has shifted to hospitals. But the trend is reversing, and today, patients themselves are increasingly becoming the point of diagnostics again, with the spread of portable diagnostic devices.
Now, I’m sure we’d all love one of those ‘Tricorder’ devices that were carried by Star Trek exploration parties, which could identify anything that was wrong with a person (or a sufficiently humanoid alien).
So let’s see… are we at the dawn of the Age of Tricorders?
And more to the point, can we buy one and be automatically promoted to ‘Medic’ status by wielding it, or must we continue to rely on specialists to interpret its readings? And where does that leave physicians, who have spent decades honing their craft, only to be supplanted by a cheeky little gadget?
Single-function devices, such as portable blood pressure monitors, blood glucose meters, pulsoximeters, thermometers, step counters, fertility tests, pathogen tests, eye tests and clever BMI scales have been in circulation for decades.
However, with miniaturisation comes convergence, and today, we already have devices that can do a lot of these functions in an all-in-one device.
The present
Consider the Viatom CheckMe Pro. It feels suspiciously Star Trekky, with an on-device display, cable free connectivity, and a list of features that already includes 24-hour ECG, heart rate and oxygen level monitoring, an infrared thermometer, blood pressure and blood glucose meters, as well as a step counter.
Viatom CheckMe Pro
- aka. Tricorder prototype?
Add just a few other functionalities which are already available in hand-held size, such as a digital stethoscope, a portable ultrasound, an otoscope (for microscope-grade ear inspections), eye tests, fertility and pathogen assays, and you could arguably claim to have created a Tricorder v1.0. The device itself need not be larger than your smartwatch, complemented by a small set of external appendages. Even the legendary Tricorder had one of those.
Tricorder plus
external dongle
Having accomplished that, all you need to provide is a quality video tutorial and a thorough handbook, and most of us could do our initial diagnostics ourselves, receiving advice from our friendly Tricorder about whether to visit a healthcare professional, and if so, which one.
The future
Used by patients and carers, the Tricorder could help alleviate pressures on healthcare systems, speed up diagnosis, be used in primary and secondary prevention, as well as provide a wealth of data for physicians when patients DO need to see them.
Healthcare professionals are more and more difficult to access. Home diagnostics will help fewer doctors do more, faster, and could play a key role in making healthcare systems more resilient and sustainable for the future.
Will the Tricorder replace the diagnosing physician? That seems unlikely.
This is mainly because doctors are trained and certified to hold the risk involved in pronouncing diagnostic judgment, and for making the ensuing treatment decisions. Manufacturers of the Tricorder are unlikely to want to shoulder that responsibility. Even in Star Trek, the Dr. McCoy, the medic on the Starship Enterprise, is the ultimate arbiter.
However, can home diagnostics make healthcare professionals’ lives easier? Most definitely.
Rather than bringing their suspicions, anxieties and google search results to the consultation, patients will be bringing reliable data. This will accomplish two things: first, it will speed up the diagnostic process; and second, it will help doctors diagnose conditions previously left undiagnosed.
There is no technological or cost barrier to this kind of solution. The component functions of the Tricorder are already FDA-approved, quality-certified, and importantly, affordable medical devices. The only factor is time. And the time of the Tricorder is near.
Afterword
If you thought you could be rid of AI for just a few minutes of your waking life, here’s the kicker. Marry these clustered diagnostics with an AI engine, and you will find that your device can recognise the patterns behind your test results, and provide immediate analytics beyond even the imaginations of hard core Star Trek fans.
Reference:
