Sunday, September 27

Digital Medicine: Digital Health, Plus Evidence, Plus Humility

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After breathlessly ascending the peak of inflated expectancies, and careening down thru the trough of depression, digital fitness seems poised to re-emerge, battered but no longer crushed, within the shape of the virtual medicinal drug: virtual fitness plus proof plus humility.

That became my key take-faraway from a captivating and positive meeting, the Harvard Digital Medicine Symposium, I turned into privileged to participate in advance this week at Harvard Business School, organized by way of Business School Professor Ariel Stern, Brigham & Women’s health practitioner Will Gordon, and Elektra Labs CEO Andy Coravos.
As Coravos mentioned on her latest Tech Tonics podcast (right here), and explains (at the side of co-authors) in an extra element in an exquisite primer, lately posted here virtual medicine:
“describes a field, concerned with the use of technology as equipment for size, and intervention in the provider of human health…. As a subject, digital medicinal drug encapsulates each wide professional understanding and obligations regarding the use of these virtual tools. Digital medication makes a specialty of the proof era to aid the use of these technologies.”
In his welcoming feedback, Gordon discovered that in our each day lives, digital has arrived; he defined, tongue in cheek, the “phone signal” utilized by some medical doctors whilst identifying if a patient is healthful sufficient to be discharged from the sanatorium: in the event that they’re the usage of their phone, they’re healthy sufficient to leave. (There’s even an e-book in this – here.) The project addressed with the aid of the symposium was a way to bring the virtual and data fluency we see within the rest of our lives, along with integration so deep we don’t even reflect consideration on it, to healthcare – now not as treasured innovation projects however as a foundational enabling era that advances the desires of sufferers, physicians and different caregivers, and builders of therapeutics.

Rather than provide a complete recap of the conference, I thought I may rather contact on several key issues that stuck with me (and for which I seem to have vaguely legible notes – apologies in advance for the worth content material no longer adequately captured).
Context, Ethics, and Evidence
In a considerate speak of big breadth, Eric Perakslis of Duke University (his Tech Tonics episode here) mentioned that maximum of the statistics approximately sufferers isn’t in their health statistics, however instead, it’s within the virtual exhaust of their every day lives – the styles round in which they stay, eat, and journey, and save.
The significance of context changed into additionally emphasized through neurosurgeon Jonathan Pomeraniec, who referenced Harvey Cushing’s famous quote, “A health practitioner is obligated to recall more than a diseased organ, extra than even the complete man – he needs to view the person in his international.” (As an aside, a Cushing quote is needed in all neurosurgery talks, a good deal as a Fuller Albright quote is essential in endocrinology lectures, and a Francis Peabody [if in Boston] or William Osler [everywhere else] quote is wanted in any dialogue of the exercise of medicine.)
Perakslis additionally emphasized the significance of balancing benefit and risk from using virtual technology, asking “how will we maintain the positive energy [associated with digital] from main to harm?” He specifically emphasized the need for aspiring fitness tech entrepreneurs in Silicon Valley and elsewhere to familiarize themselves with “the subculture of bioethics and evidence” wherein physicians and scientists are steeped, a fluency he regarded to treat as desk stakes for engagement with healthcare stakeholders. Not best is that this the proper aspect to do, he argued, however, it’s within the first-class interest of the marketers, who need to realize, Perakslis said, “you may get to monetization without evidence.”
Relevance
Another key subject matter was that adoption of digital era calls for relevance (to avoid the pervasive “your solution isn’t always my problem” state of affairs).
Dr. Bill Wood, of the University of North Carolina, is a most cancers researcher who is interested in characterizing the performance fame of sufferers. He emphasized that the key for digitalization is “relevance to clinical problems,” and highlighted the need to “assemble an evaluative framework” for digital technology that consists of size verification, attention of cybersecurity and data governance, attention of usability from both patient and scientific trial studies web site perspective, and validation within the intended context of use.
Lara Mangravite, President of the non-income Sage Bionetworks (disclosure/reminder: I was a founding advisor a decade in the past), emphasized the significance of relevance to patient-participants. She talked about that one of Sage’s key learnings has been that digital research has astonishingly steep retention curves – i.E. Many participants are fascinated, to begin with, however then there’s a mind-blowing drop-out charge. Initially, Mangravite says, the Sage group idea this was an anomaly related to the uncommon publicity their first take a look at acquiring, whilst it becomes promoted through Apple when ResearchKit becomes unveiled, however then they diagnosed it turned into a prominent function of subsequent research as properly. “Participating in these studies research is a day by day choice,” Mangravite determined, adding that in case you need to growth retention, then participants ought to get a fee out of it as well – preferably statistics that influence their day by day lives.
Not fantastically, relevance is also an excessive priority for regulators; Francesca Cerreta of the European Medicines Agency (Europe’s FDA), as an example, emphasized that “statistics should be related to meaningful clinical advantage.”