A couple of years ago I made the mistake of recording and sharing (freely on YouTube) the talk and slides that I was paid/invited to give at the biannual World Diabetes Congress in Vancouver (the world’s biggest diabetes industry conference). It remains the only talk from the entire event that you can find online (and there were over 300+ hours of presentations given by experts who travelled from every corner of the world).
By taking this step we’ve built a little more trust with Patients, Carers and Clinicians but guess who won’t be invited to ever again present at an International Diabetes Federation Congress?
“Connected health is one of the most exciting use cases for 5G with an impressive list of potential benefits for operators, vendors and society. However, with the regulatory complications of dealing with the healthcare industry and the grave implications should something go wrong, can it ever truly meet its potential?”
It’s interesting how this view is just being accepted by analysts. Something is going wrong:
“5G is a great prospect for healthcare, opening the potential for wearables to take glucose readings and remotely monitor patients, virtual appointments, and even remote surgery, but experts – and, vitally, the public – still need convincing”
“At an event on 31 May at King’s College London set up by Ericsson to discuss the issue, a surgeon performed a short demonstration of an operation performed using a mocked-up 5G network, a connected glove and a robotic arm. Impressive stuff. Indeed, Prokar Dasgupta, professor of Robotic Surgery and Urological Innovation at King’s, said 5G will address reliability, security and connectivity concerns to make such remote surgery a reality, though he conceded there remains much work to be done in terms of developing the robotics themselves. However, it is a use case laden with risk. While a stalling 4G network may result in buffering of the TV programme you are trying to stream, a 5G network going down halfway through a robot performing open heart surgery is a very different story”
I think Ericsson have fallen into a trap of thinking the opportunity is in the network – just like everything seems like it’s a nail when all you’ve got is a hammer.
I think it should be obvious that robots will be doing surgery long BEFORE 5G networks will enable surgeons to connect remotely to control a robot to do the surgery.
“Speaking to Mobile World Live at the King’s event, Hanna Maurer Sibley, head of Network Products, west and central Europe at Ericsson, said the use of 5G for deep healthcare applications will require a great deal of cross-industry collaboration and was unlikely until at least 2030″
The way things are going (eg. with Google Fi, Apples software SIM offering embedded connectivity, etc) citizens won’t even have a relationship with mobile network operators in 2030.
“If the liability issues and technical bugs are ironed out, maybe by 2033 we’ll all be under the virtual knife”
Christina Farr at CNBC reports on how a mention at Apple’s World Wide Developer Conference of how the Apple Watch will link via bluetooth with a continuous glucose monitor from Dexcom caused the companies stock to spike by more than 6%.
That’s $373 Million or THREE HUNDRED AND SEVENTY THREE MILLION DOLLARS.
I’m surprised diabetes device investors were surprised by this development (because the bigger opportunity probably lies in a Carer/Parent being able to get notifications on their Apple Watch) but I checked out the prices at rival device makers and any harm resulting from Apple showing favour to a competitor has had on their share prices isn’t so clear as they have much bigger market capitalisations and a spread of different devices/revenues but I think it’s obvious that Apple is now in a position to polarise the medical device market.
An interesting free mHealth paper is published in the latest issue of PharmaVoice magazine including ‘executive viewpoints’ from Gavin Birchnall, Senior Product Manager, ERT, Chris Watson, Director of Product Strategy, ERT, Paul Greene, Senior VP, Clinical Development — CNS, INC Research, Dara Liguori, Digital Engagement Strategist,
Ogilvy CommonHealth Worldwide, part of WPP Health & Wellness and Brandie Linfante, VP, Digital Strategy, Ogilvy CommonHealth Worldwide (part of WPP Health & Wellness).
mHealth Insights
“More pharmaceutical companies are recognizing the potential mobile applications present for improving outcomes”
I think this is accurate and should come as a reality check. In 2017 most Pharmaceutical companies haven’t yet even woke up to the potential of mHealth.
“A core principle in the collection of scientific data is that data about an event are always better if collected in temporal proximity. Put simply, if there is health information you want for a clinical study, it is best to collect it when it happens instead of waiting for a study visit. This might include the collection of adverse events or patient reported outcomes; it might also include the collection of sleep parameters or vital signs. In essence, this is real-time data collection and is the foundation of quality and precise data”
“What’s in it for Pharma? A growing number of pharmaceutical companies are tapping into the opportuni- ties mHealth presents. For example, GSK is committed to increasing use of mHealth data in its clinical trials as one way to try to reduce the cost of developing drugs. Daiichi Sankyo developed a mobile app to help pa- tients with atrial fibrillation by providing tai- lored reminders to adhere to their medication. Boehringer Ingelheim has also been at the forefront with its commitment to apps to im- prove adherence, including a partnership with Propeller Health for a sensor that monitors adherence of COPD and asthma patients. Lilly has developed a mobile app to help patients remember to take their once-a-week diabetes medication Trulicity at the right time and how to use the injection mechanism correctly. And Takeda’s iBData program helps patients with inflammatory bowel disease track their symptoms through a smartwatch app”
A nice summary of apps that Pharma companies are making but when you realise the scale of these companies operate at (eg. GSK has revenues of £28B and employs 100k staff) isn’t it clear that these companies are ripe for disruption by Mobile First competitors e.g. GSK can reduce the cost of their trials but that’s not what it’s going to take to actually compete with Apple who have a 100% commitment to Mobile First Clinical Trials. Pharma brands using mHealth to make their Clinical Trials cheaper is equivalent to dead Music brands using the internet to make manufacture of their CDs cheaper when the real change was coming from iTunes and MP3 playing mobile phones.
“Advancements in technology over the past five years have led to increased interest around the topic of mHealth — the monitoring and delivery of healthcare through mobile devices. Approximately 93% of us now own a mobile phone and, with an increased desire from the pharmaceutical industry to use electronic data capture over traditional paper methods, it’s no surprise that the use of mo- bile phones has become commonplace within healthcare”
The Pharma industry urgently needs to consult those with better understanding of the mobile market. This 93% stat is pretty much irrelevant because the reality is every customer of the Pharma industry has a mobile phone and the importance of this becomes obvious when you realise that the 7% who don’t own a mobile phone largely consists of babies and children who aren’t yet old enough to have a mobile (but do have Parents/Carers who have a mobile).
“The use of mobile devices as a method of data capture has opened the door to an easier, and more effective, way of generating real-world data (RWD). This creates a larger base of real-world evidence (RWE) for pharma to inform decisions about the cost-effective- ness and patient value of a new product to the healthcare system”
Imagine how out of touch you have become when you are in an industry that feels the need to use acronyms for “real world” data/evidence?
“Until recently, sponsors tended to view paper assessments as the most economical means of collecting data directly from patients. Paper questionnaires, it seemed, were much less expensive than the alternative of providing patients with electronic devices loaded with applications for reporting. However, paper involves heavy back-end costs as responses must be manually checked and entered into a database — a time-consuming, labor-intensive chore. Plus, data quality suffers from a combination of waning compliance and data-entry errors”
“In today’s digital world multiple market forces have also converged to create a rising demand for patient-collected data. Firstly, the pharmaceutical industry is making a concerted effort to understand the patient experience over time, recognizing that treatment is not just about epidemiology or biology. To fully serve patients and improve their care, pharmaceutical companies are eager to understand how patients are feeling, how they make decisions, how their lives are impacted by their condition/disease, and what challenges they face functionally and emotionally. Secondly, payers are demanding evidence of a product’s value for cost, and RWD collected from patients can bolster evidence that a product adds value beyond the standard of care. This information may become crucial in an increasingly competitive marketplace. Thirdly, regulators are moving toward a more patient-centered focus, this is particularly true in some therapeutic areas — notably oncology — where regulators are requesting assessments of patient symptomatology that can only be derived from patients themselves”
I continues to surprise me how little appreciation there is in the Pharmaceutical industry for the interest that Patients have for using their data to improve their own care and advance science. How about even just treating me like a statistic?
“Patient-focused RWD programs can be designed to elicit subjective feedback on their symptoms and side effects, response duration, treatment adherence, treatment satisfaction, activity levels, emotional state, lifestyle, quality of life, and any other relevant contextual elements”
I think this is one of the fundamental reasons Pharma brands aren’t able to make the shift and properly embrace the mHealth opportunities. Their share holders don’t want them to be in the actual business of care because that needs you to prioritise trust and the focus needed to build trust would rule out all those profitable tricks they do with pricing and politics.
“Combining data collected directly from patients with other RWD sources provides a more holistic view of the patient’s treatment experience and changing health status. These data enable sponsors to fine-tune their estimations of a drug’s overall value and its impact on efficacy and safety. The most appropriate combination of data sources will likely be different for each given research need, but patient-collected RWD enriches RWE analysis. Hughes et al. estimate that RWE can potentially generate $1 billion for a top-10 pharmaceutical product when it is applied collectively in six major areas”
It amazes me the way the Pharma press ignores the elephant in the room. Surely the availability of this data is going to reduce the imprecision of evidence based medicine and this could just as easily result in a fall in sales of top drugs?
“The tool can be set to accept only data within specified parameters, preventing the entry of outlying data. A patient, for example, would not be able to enter a body temperature of 88° Fahrenheit”
I think it’s hilarious how Healthcare Executives always imply that Patients are the incompetent fools. I see far more mistakes made by medical professionals (who are busy and inundated with the demands of administrivia) entering data than by Patients (who have got the most to lose from it being inaccurate). If you have a tools that accept physically impossible medical data perhaps you should hire someone to build your app who has a clue what they’re doing…
“It is likely that patient engagement and participation in the real world will become more entwined across the entire product lifecycle, from development through to post-approval. Exactly how this will be optimized remains unclear. Yet, what is clear is that electronic data capture solutions and developments to enhance their affordability, rapid implementation, and ease-of-use have made great strides in recent years. Furthermore, the ability of patients to use their own devices”
Powered by AI, the Beautyrest Sleeptracker is the premier and only sleep monitoring device that is Alexa enabled to integrate into your smart home
Make your bed a smart bed: the only non-wearable solution that works with your bed regardless of the type of mattress, boxspring or bedding
Highly accurate sensors: analyze and monitor respiration and heart rates, and unique sleep behaviors such as body movement and wakefulness
Intuitive app: captures precise readings and translates into personalized sleep data; sleep cycle alarm detects the optimal wake time for you
Powerful processor: continuously learns your sleep patterns and rhythms, and delivers the most up-to-date information for effective sleep coaching
Individualized sleep coaching: the only solution in its class to monitor two sleepers independently and separate their sleep data for individualized reporting and coaching tips
If The Sleeptracker® lives up to my expectations I’m pretty sure that at 3GDoctor.com we will soon be launching a specialised sleep advice service for Patients who use the technology. If you’re a GP who would like to work with us to help these Patients (in the UK/Ireland only due to registration/Medicolegal insurance requirements) please ‘make your bed a smart bed’ and get some of your Patients using it and get in touch with us because I’m sure we’ll be recruiting now that this is available at this price point (£155/€178 at today’s exchange rate).
“I usually buy my groceries at Sainsbury’s but only because it’s on my way home I don’t care for cars or own one I don’t like any form of housework and I have a cleaner who lets herself in while I’m at work on Fridays you’ll find me at the pub after work at home I’m far more likely to be browsing restaurant reviews rather than managing my finances or looking at property prices online I like the idea of living abroad someday I prefer to work as a team than on my own I’m ambitious and it’s important to me that my many thinks I’m doing well I’m rarely swayed by others views this motley set of characteristics attitudes thoughts and desires come very close to defining me as a person it is also a precise and accurate description of what a group of companies I had never heard of personal data trackers had learned about me…
…in 2014 when I became curious about the murky world of data brokers a multi-billion pound industry of companies that collect package and sell detailed profiles of individuals based on their online and offline behaviors… …I discovered that online anonymity is a complete myth. Particulars such as your postcode, your date of birth and your gender can be traded freely and without your permission because they’re not considered personal but pseudonymous in other words they can’t be traced back to you without the need for additional information so why does it matter if a bunch of companies you’ve never heard of know your age or your postcode you may think. Well it matters quite a lot about a decade ago Latanya Sweeney a professor of privacy at Harvard University proved that about 87% of US citizens could be uniquely identified by just three facts about them their zip code their date of birth and their gender in the UK where we have far fewer citizens serviced by much longer postcodes that probability is far higher Professor Sweeney proved this in a rather cheeky way when William Weld a former governor of Cambridge Massachusetts in the US decided to support the commercial release of 135,000 state employee health records along with their families including his own these records did not contain a name or a social security number but did contain hundreds of fields of sensitive medical information including drugs prescribed hospitalizations and procedures performed on these employees. For $20 professor sweeney purchased the voter records for Cambridge Massachusetts containing the names zip codes dates of birth and gender for every voter in the area and then cross-referenced this with their health records and within minutes she had pinpointed governor Welds own health record. Only six people in Cambridge shared his date of birth three of them were men and he was the only one living in his zip code. Professor Sweeney sent the governor his health records in the post…
…it’s not just large companies digging into your life it’s free apps and small startups as well I realized on my phone that every time I logged fitness data into the app Endomondo it was sharing my details including my location and gender with third-party advertisers. WebMD a symptom checker app was sharing even more sensitive information including the symptoms procedures and drugs viewed by users within its app with its third parties. Fitbit was sharing data with Yahoo. A pregnancy tracking app was selling on information about its users ovulation cycles and fertility cycles with people or advertisers… …in 2015 Samsung was found to be recording people in the homes as they’d been sold TVs with voice recognition systems…
…that sinking feeling of being watched is not unique to me there have been several anecdotal reports of people being shown adverts based on things and conversations they were having in real life prompting concerns that Facebook and Google are eavesdropping on people via their personal devices to piece together what all these companies knew about me I spoke to a data profiler called iota. iota uses cookies to assign me to thousands of different categories including my job how many children I have and whether I’m likely to buy Star Wars memorabilia they don’t know my name but they know more about me than my neighbours do. iota also buys information from third parties such as the credit rating agency Experian which amasses a massive database of 15 different demographic types and 66 lifestyles all based on people’s post codes…
…in 2014 Ross Anderson a professor of privacy and security at Cambridge University found that the NHS had been sharing its hospital’s database which included details of hospitalizations for every citizen in Britain with the Institute and faculty of actuaries a body that was researching how likely people are to develop chronic illnesses at certain ages. Of course this resulted in an increase in health insurance premiums as the amount of data that is collected increases exponentially it becomes much easier to identify you for example your Fitbit measures your heart rate or your gait patterns and these can be used to estimate things like your height your weight or even your gender these are details that are very hard to mimic or change…”
I think this excellent TedxTalk by Madhumita Murgia (European Technology Correspondent at the Financial Times) explains how the BornMobile generation are slowly waking up to how information about them is being traded between tech companies and brands that are pretending to be in the healthCARE business.
I think we’re a few years from a Communities Dominate Brands reset in the market but it will come and it’s increasingly going to be insulting to underestimate Patients interest in the respectful use of their data.
We’ve been close to running the mHealth for Healthcare Professionals course in flagship Apple stores to coincide with major medical conventions but nothing has materialised as until only recently Apple leadership wasn’t talking publicly about it’s enthusiasm for this area. Hopefully the new #TodayAtApple initiative is going to make it much easier for local Apple branches to initiate and organise meetings for Medical and Patient communities. I think it’s obvious there will be queues around the block to get tickets to these as they’ll be really productive meetings.
RT @mHealthInsight: Overheard in a NHSHospital: "See how I impressed that Patient with a dog eared book & my 4 colour BIC pen?" https://t.c…4 weeks ago
