Digital quackery is a thing. It’s the big thing right now.
The hype on health apps. Here’s an overview of systematic reviews of trials on their impact. You’ll be astonished to hear there are very few trials, and gazillions of apps making health claims.https://t.co/yPbAy10leP
It’s all given me an idea to compile a list of the best examples of “Digital Quackery”. I’ll kick off the list with a few I’ve seen and please feel encourage to add your favorites in the comments (with the reasons):
CNBC have it captured well: A MAN IN WHITE COAT WITH A STETHOSCOPE TAPPING AT HIS MOBILE is a perfectly valid and useful depiction of telemedicine today. But watch a Patient using their own ECG machine and having their medical data read by a computer and referred if necessary to a Doctor (who may be casually dressed working from home while her children are at school) and you’ll realise just as video killed the radio star the incredible sensors in the super computers in our pockets have removed the tele (meaning is ‘distant’) and we now have to understand that healthcare is becoming a mobile experience (this is why it’s wiser to use the ‘mHealth’ term I coined 10+ years ago) because the potential for medicine/care is now always with us, continuously carried within arms reach and never turned off.
At the end of watching that video ask yourself do these Patients look like they are ‘distant’ from their medicine/care?
We have elderly Patients using these mHealth devices for years and when you ask them about their experience they’ve never felt closer to their medicine/care. There is no doubt that the convergence of healthcare to mobile (mHealth) has enabled us to evolve from TeleMedicine/Telecare.
“Telemedicine, or apps that let you consult with a doctor via video, was supposed to be the next big thing in health care But lack of awareness, questions about cost and reimbursement, and the human desire to talk to another person when sick have hampered the sector. Tech giants like Apple may ride to the rescue… Billions of investment dollars have been poured into apps and websites that offer this virtual consultations with physicians, ranging from Doctor on Demand to American Well. The theory behind them is that millennials would opt for a digital alternative to an in-person physician’s visit, if the option were available. And patients in remote, rural areas who are miles away from the nearest doctor would have few alternatives… …But telemedicine is still far from mainstream. Even a study sponsored by a telemedicine provider from late 2017 still found that 82 percent of U.S. consumers do not use it”
I think this is an easy to have predicted outcome of telemedicine meeting with the needs of the USA’s Insurer led SickCare model. VC money has unsuprisingly been haemorrhaging from failing ventures because a subsidised video consult isn’t a substitute for a Doctor visit.
People may be gullible when it comes to sharing their data in exchange for online services (just look at the level of personal health info sharing that Patients provide to advertising networks like Facebook or Google) but most of the more experienced older people (who have healthcare needs or care for children or elderly Parents with them) realise there is value in sharing info with a Doctor who isn’t in the business of trading their personal health data.
Yes you can obviously bluff some naive people with the offer of cheap or free chats with a Doctor advice call but communities dominate brands and Patients/Carers are increasingly becoming aware that it’s not smart to subsidise/exchange your incredibly personal and revealing information with unnamed corporations for the advice of a Doctor.
“Why the lack of adoption? Several factors are to blame. The biggest, and most important, is that many U.S. consumers are still not aware they have the option to chat with their doctor over the phone or via video”
“The awareness piece is a big problem,” admits Ian Tong, a physician and the chief medical officer at Doctor On Demand, an app that offers smartphone consultations for $75. Tong believes that part of the problem is the branding of the term “telemedicine,” which isn’t particularly descriptive, so he’s opting to use the term “video visits” instead when he talks to patients about it”
I think this is a mistake and is not realising the additional value that can be offered now that +100 million Americans can connect via video calls on devices that they always carry with them.
“Another setback: Patients heard of telemedicine apps often fear the expense, especially if it’s unclear whether they can use their health insurance. And in some cases, the apps are offering cash prices that are out of reach. $75 might be a stretch for some”
“Another common theme is that the doctors who are willing to work with app makers are inexperienced, or low-quality. Companies like Doctor on Demand will say they go out of their way to vet — and pay for — the best clinicians. But there is some merit to this concern, especially with the lower-quality services”
“In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren’t licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions”
but I think the websites tested were quite scammy eg. they published “a variety of disclaimers that they do “not provide health care services,” and do “not create a physician-patient relationship,” but we found that they did make diagnoses and offer specific treatment recommendations (without sending prescriptions to pharmacies)“.
I can’t see how Dr Resneck hasn’t been obliged to report the Doctors involved to their credentialing authorities before/at same time as publishing a public paper about how they are working dangerously and without licensure.
“Finally, even in the digital age, a lot of people simply want to see their doctor in person. They’re not Luddites. But sick, vulnerable people often need in-person reassurance from another human being in the room. A smartphone app simply won’t cut it”
“Will this ever change? Roy Schoenberg, the CEO of American Well, believes that doctors, insurers and employers will increasingly inform their patients about the option to use telemedicine, which will help consumers get over many of their fears. If they’ve already got a relationship with that doctor, a virtual consult might seem like an easier alternative to getting across town to a doctor’s office and sitting in a waiting room”
I think this is a very good measure of how wedded the USA healthcare system is to serving health insurers. Amercian Well has taken $210million in venture funding over 6 rounds yet still hasn’t realised the big opportunity is in offering services direct to Patients. Imagine the CEO’s at Uber/AirBnB/Spotify thought that the Taxis/Hotels/MusicLabels would inform their customers about the option to use their mobiles to get their product via their mobile phones!
“But getting doctors to jump on board is easier said than done, and takes time. Many are afraid of liability, as it’s possible to miss something during a remote visit. And for years, it wasn’t clear whether they would get paid as much as an in-person visit. Reimbursement questions are still getting resolved across different states, but most of the commercial and government plans are on board with the idea of telemedicine — at least in specific circumstances.Another marketing boost for telemedicine could come from the big tech companies. American Well got its a plug from Apple, which announced it would work with the company for its heart-health study, so that participants could get easy access to a doctor’s office if they needed it.”
“Finally, many consumers who use high-quality telemedicine apps are spreading the word. “Consumers are realizing that it can all be done via an app, whether it’s getting a prescription, an exam or ordering labs,” said Doctor On Demand’s Tong. “There’s no need to sit in that waiting room anymore.””
Tomorrow at 11am GMT I’ll be discussing this post in a FaceBookLive video discussion with Dr John Bennett MD (and guests) from InternetMedicine.com.
Follow InternetMedicine on Facebook/Twitter to get updates. Click back here after the discussion and refresh the page and you’ll be able to replay the video recording of the discussion.
Some interesting feedback via Twitter chat with Irish GP Valerie Morris MD who has now for some unknown reason deleted her tweets which is a great shame as I was going to enjoy hearing Dr Morris explain how a ‘fully computerised’ GP doesn’t yet have a website nor offer Patients any access to Healthcare Records:
@DrVBMK: David, don’t kid yourself. Telemedicine won’t replace the traditional Dr-Px consultation which includes EXAMINATION. Vocationally trained GPs know the risks involved if you don’t examine a patient. And guess what, Medical indemnity is higher for those engage in telemedicine.
@mHealthInsight: I think the issue is so many presume telemedicine must be about diagnosis & prescribing. You can also provide care, management, followup etc
@DrVBMK: Quick comment: Busy surgery all day – 2 emergencies this morning – child & adult – managed here then sent the ED. And I’m only halfway through my morning list. of patients. Lunchtime is for home visit to see palliative patient. How on earth do you provide care using telemedicine
@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.
@mHealthInsight: I think you’ve presumed that I think the benefits of telemedicine is an excuse for under resourcing GP services.
@DrVBMK: It’s your words, not mine. You haven’t answered my question In earlier tweet.
@mHealthInsight: Video of the discussion with Dr John Bennett is now posted on @InternetMeds (skip the first 30 mins) http://internetmedicine.com/mHealth-studio/
@DrVBMK: Are you a GP? Your tweets don’t reflect that you are one nor does it reflect real life General Practice.
@mHealthInsight: would you like a job?
@DrVBMK: Medical indemnity for full time Irish GPs is no less than €20,000 per annum (more if you provide telemedicine, OOH, minor surgery etc). Will you pay that upfront???
@mHealthInsight: How big is your HSE list as if 500+ it’s well worth us meeting up as I’m sure I could save you a small fortune
@mHealthInsight: Probably best to email me as documented video consults with Patients that aren’t enticed with offers of prescription drugs is very low risk
@DrVBMK: 98% of GP practices are fully computerised. The only time I use a pen is to sign my name. I am from the old School of Medicine. A computer will never be the interface between me and my patient. I respectfully decline your offer. I love my job.
@mHealthInsight: Do you really think there is a single “fully computerised” GP practice in the whole of Ireland?
At the Apple World Wide Developer Conference (WWDC) today Apple announced that the latest iOS12 software update for the iPhone, iPad and Mac (expected to be live later this year) will support FaceTime group video calls with the ability to coordinate video calls with up to 32 participants supported by messaging features during the calls. FaceTime call participants can be added at beginning or mid-conversation and can select to join via video or audio only.
Imagine how powerful this will make FaceTime calls for Healthcare uses? Imagine how much more efficiently 911/999 Emergency FaceTime Calls would be? Imagine how amazing it would be for GPs to be able to dial up other Carers, Family Members and Specialists when they need assistance during a Consultation? Imagine how much more effectively Video Consulting services are going to be able to perform?
What uses and new services can you think of for this new mobile video calling service?
“The Global Clinical Trials Connect 2018 conference focuses on introducing pioneer technology, developing better patient engagement and collaborating strategies in clinical trials. With the right commitment and attention to detail, contract research organizations (CROs) and pharmaceutical companies can drive collaboration with greater efficiency.
The global pharmaceutical industry has seen a downturn in recent years because of the challenges and cost associated with pharmaceutical development, procrastination in drug development, etc. Clinical trials field is also faced with such challenges. Cases of failures, cost and delay are high. It is high time that we look into innovative strategies, new technologies, effective and quality collaborations to address these issues, which can cater to the needs of the patient and the industry. Due to complex clinical trials and bygone data standardization methods, we need algorithms and lucrative strategies that will enhance the clinical trials outcomes. There are vast data collected across clinical trial process, the standardization of these data will turn into an opportunity for companies to trap the information and raise clinical trial design, patient recruitment, monitoring insights and augment decision-making”
Key Topics:
Partnership & Collaboration – Sponsors, CROs, Sites and External Vendors
Outsourcing strategies and models
Patient centric clinical trials
Real World Clinical Trial Strategies
Electronic Clinical Outcome Assessment and Electronic Patient Reported Outcome
Clinical Technology and Driving Innovation
M-Health, Wearable and Consumer Technology
Artificial Intelligence Technology in Clinical trials
Patient Recruitment and Site selection
Keeping the Patients Informed After the Trial – Post-Clinical Trial closed communities
How to future proof your clinical operations
Data Quality & Technology
Big-Data and IoT in Clinical Trials
Clinical Data Strategy & Analytics
Implementing Risk Based Monitoring
Streamlining R&D and lower costs in clinical trials
Adaptive Trial Model
Clinical Trial Auditing
ResearchKit & Mobile First Clinical Trial Design
Get in touch via the comments if you’ll be in London and would like to meet up. Refresh this page on Friday April 27th 2018 for my slides and a video of the talk. In the meantime you might like to watch a presentation I gave a couple of years ago on the topic of “What would happen if we took a Mobile First approach when designing Clinical Trials”:
It’s horrific to see new private only pay clinics springing up in areas of the UK where poverty is the highest and it’s because immigration offenders have realised that the supposedly ‘confidential’ NHS GP and Hospital records relating to them and their families are being used to shop them to the Home Office.
Of course there are a million other more effective ways to trace immigrants (they are mostly young and have mobile phones that are accurately identifiable by location or they are being homed/employed by citizens who have mobiles and all of this monitoring can be easily done by the Home Office) so I think it’s clear the NHS is doing this because it thinks they’ve concluded that there is a short term economic benefit.
It should be clear that it is vastly cheaper to give every immigration offender free NHS care than it is to try and care for them when they get really sick and turn up with a false identity in a hospital. By sharing details (that include Patients’ names, date of birth, address) the NHS is driving growth in criminal gangs who are stealing citizens identities and this is putting Patients (and the Professionals trying to care for them) at much greater risk of making very expensive mistakes (treating a Patient based on completely inaccurate information in their NHS Record).
No individual Doctor is going to speak out, refuse or complain against the Home Office because they will probably just turn their investigation to the ‘non-compliant’ Doctor so please support the British Medical Association and Royal College of GPs call for a suspension of a memorandum between the Home Office and NHS which has given them access to data that is undermining the ethical principles underpinning confidentiality and the determination to act in the best interests of Patients.
“The AMA is working to unleash a new era of patient care through its Integrated Health Model Initiative (IHMI) by pioneering a common data model for organizing and sharing meaningful health data like patient goal, state and functioning, and assembling an unprecedented collaborative effort across health care and technology stakeholders” said AMA President David O. Barbe, M.D., M.H.A.”
“The winning ideas will demonstrate how the applicant uses patient-generated health data in meaningful ways to have maximum impact on improving physician workflow, improving clinical outcomes, and reducing cost in the health care system. The three best ideas that are submitted to the Challenge by June 7, 2018 will be selected to share $50,000 in credits for Google Cloud”
What a bizarre set of zero-actual-cost prizes. Google is highly profitable and is generating over $100,000,000,000 in annual revenues so why are the prizes being given to promising start ups being paid in ‘monopoly’ money?
I have no doubt the AMA shopped this collaboration opportunity around with Apple, Facebook, Microsoft and Amazon and in deciding to work with Google they didn’t agree to be paid for the collaboration with Google Cloud Credits (I doubt most of the executives at the AMA even know what they are).
“assembling an unprecedented collaborative effort across health care and technology stakeholder”
CHICAGO – The American Medical Association (AMA) today announced the AMA Health Care Interoperability and Innovation Challenge sponsored by Google to inspire novel examples of mobile health technology—such as wearable devices and applications—that effectively monitor and share medical data between patients and physicians to improve the management of chronic diseases.
“The AMA is working to unleash a new era of patient care through its Integrated Health Model Initiative (IHMI) by pioneering a common data model for organizing and sharing meaningful health data like patient goal, state and functioning, and assembling an unprecedented collaborative effort across health care and technology stakeholders” said AMA President David O. Barbe, M.D., M.H.A. “The Challenge we’re announcing today is an extension of the AMA’s work and will explore possible uses of mobile health technology to provide patients and physicians with a rich stream of medical data that is important for improving care and long-term wellness.”
The Challenge invites the health and technology sectors to present solutions that demonstrate how patient-generated data is captured by mobile health monitoring technology, transferred to a medical practice, and transformed into accessible and actionable information for the patient and physician to improve health outcomes.
Specifically, entrants are asked to present ideas on how to:
Import (or transfer) patient-generated health data from a mobile device or a mobile application into one or more phases of clinical care. Examples of phases: Assessment of current condition, risk stratification, goal definition (both patient and physician), treatment plan, intervention(s), recording of observed outcomes, re-assessment.
Extract (or transfer) data from one or more phases of the clinical care and send it back into a mobile application or mobile device so patients can view, track and ultimately act upon the information relative to their goals or share it with other physicians.
The winning ideas will demonstrate how the applicant uses patient-generated health data in meaningful ways to have maximum impact on improving physician workflow, improving clinical outcomes, and reducing cost in the health care system. The three best ideas that are submitted to the Challenge by June 7, 2018 will be selected to share $50,000 in credits for Google Cloud.
To learn more about the AMA Health Care Interoperability and Innovation Challenge sponsored by Google, go to: https://ama-ihmi.org/googlechallenge
# # #
Media Contact: Robert J. Mills AMA Media & Editorial Phone: (312) 464-5970 Email: robert.mills@ama-assn.org
About the American Medical Association The American Medical Association is the premier national organization providing timely, essential resources to empower physicians, residents and medical students to succeed at every phase of their medical lives. Physicians have entrusted the AMA to advance the art and science of medicine and the betterment of public health on behalf of patients for more than 170 years. For more information, visit ama-assn.org.
Imagine how Patients would cross examine healthcare provider organisations that don’t provide Patients with access to Health Records:
“(PATIENT) Would you be comfortable sharing with me the name of the conditions you have diagnosed me with and the results and treatments you have provided to me?
(HEALTHCARE PROVIDER) …um… er no.
(PATIENT) If you shared my info with anyone else or messaged any colleagues would you share with me the name of these people/companies?
(HEALTHCARE PROVIDER) …no I would choose not to do that.
(PATIENT) I think that might be what this is all about. Your right to withhold information relating to my care. The limits of your rights and how much I’m having to give away in order to ‘get healthcare services that I am ultimately paying for’. The question I want answered is what information is the healthcare system collecting on me, who are they sending it to and whether they’ve ever asked me in advance for my permission to do that? Is that a fair thing for a user of healthcare services to expect?”
RT @DrDave01: Imagine what most folks thought when I left medicine in the 1980’s to become an entrepreneur? Today, those folks hold me up a… 1 week ago
RT @mHealthInsight: Happy 70th Anniversary NHS #NHS70 Who could've possibly imagined in 1948 that one day Nurses would be saying "Here's my… 2 weeks ago
