Last week, Dr. James Madara, CEO of the American Medical Association, shook the digital health world, or at least the digital health Twitterverse, with a proclamation that digital health is the new "snake oil".
“From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality, this is the digital snake oil of the early 21st century,” he said in a keynote at an AMA meeting over the weekend. “Even those digital products that might be helpful often lack a way of enriching the relationship between the physician and the patient. It's like trying to squeeze a 10-gallon product idea into a 2-gallon health care knowledge base.”
Coming on the heels of the AMA conference, this idea of digital health snake oil helped frame some of the discussion at MobiHealthNews’s inaugural event in San Francisco earlier this week, starting with our two opening keynotes, Kaiser Permanente Chief Medical Information Officer Dr. John Mattison and CareMore CEO Dr. Sachin Jain.
“There’s some truth in what he’s saying,” Mattison said at the event. “And I want to try and parse out what’s the reality, what’s the truth, what’s the hype. So why is there so much controversy? Is it because there’s so little scientific evidence? Are we barking up the wrong tree? Is it all a hoax? Or are we witnessing an impedance mismatch between paradigm shifts, visionaries, and the overwhelmed and regulation-mired healthcare delivery systems?”
Mattison delivered a sweeping talk, but the crux of his point was that digital health looks like snake oil because what we’ve seen so far have often been incomplete innovations — just monitoring with no intervention, or tracking with no clear strategy for behavior change.
“Information therapy on its own does not work,” he said. “Everyone knows a Big Mac isn’t good for your health, but McDonald’s continues to sell a lot of Big Macs.”
Instead, Mattison advocates using technology in a way that internalizes the desired behavior. One example he gave involved step tracking.
“Over half the people who wear an accelerometer stop wearing it in two months,” he said. “So what I recommend to people is instead of saying ‘I need another 200 steps’, stop looking every two hours, stop looking every day, and gradually develop your ability to be aware of and self-consciously mindful of your steps. So instead of counting steps, when you see an elevator or an escalator you intuitively say ‘Where’s the stairway?’ You take the path of most resistance.”
CareMore CEO Dr. Sachin Jain’s tack was similar — that there was something to Madara’s words, but rather than a condemnation of the space, we should take them as a call to action toward meaningful interventions. He pointed out that the original snake oil was a folk remedy — oil from Chinese water snakes — that had a real therapeutic benefit for arthritis. Chinese railway workers shared it with their American coworkers, who tried to use local rattlesnakes instead of Chinese water snakes. They shared it with American conmen, who eventually sold bottles of water and turpentine with no snake oil to speak of.
“The kernel in this story I want to draw attention to is that the original snake oil, the water snake oil, used in the right way, in the right context, for the right medical conditions, actually worked,” Jain said. “That snake oil actually worked is a fact that has been obscured for generations on account of the fraudsters who sought short-term profit instead of real patient benefit.”
He fears the same thing could happen if we allow digital health technology that is high on promises and low on evidence to dominate the public awareness of the space, rather than complex systems-based approaches that use the technology to accomplish a real benefit.
“In other words, just like water snake oil works when you apply it to the right patients under the right conditions, the same could be said of most of our digital health,” he said. “Claims that extend beyond that more specific narrative threaten the credibility of our industry as a whole, and it’s our collective responsibility to work together to actually preserve and protect that credibility. I think we need to maintain the hope that technologies like remote monitoring can transform healthcare by acknowledging the complex factors that actually enable their success. Digital health will only become our generation’s snake oil if we let it.”