In 1994, I eagerly accepted my first full-time position in research at the Columbia-Presbyterian Medical Center. Part of my job was to find patients willing to participate in a prostate cancer study. After meeting these men, I got a glimpse of how their diagnoses had changed their lives.
Specifically, I observed a stark difference in behavior between sick and healthy patients. The cancer patients obsessively tracked results of a blood test for circulating prostate-specific antigen, or PSA, which is typically elevated in men with various prostate conditions, including cancer.
I realized that every man old enough to be screened for prostate cancer knew whether or not his PSA score was “okay.” However, every man diagnosed with prostate cancer knew his PSA score down to the decimal point.
I remember one man in particular – an engineer – who arrived at the clinic with his PSA score charted over time on graph paper. It seemed that tracking PSA gave him a sense of control in a stressful situation. I began to wonder if the very act of tracking this data improved his overall mental well-being and quality of life.
While life science companies have been largely absent from the wearable health landscape, the intersection of drugs and these technologies is an obvious place for them.
What motivates people to become fastidious custodians of their own health? Clearly, a medical emergency – a cancer diagnosis, heart attack, or trip to the hospital – can be a powerful motivator. However, I left my university job thinking more broadly about the science of behavior change. Can tracking basic biology create positive reinforcements for health-related behaviors?
Twenty years ago, graph paper, a pencil, and commitment were the only option. Today, however, the solution is something everyone has in their pocket, or on their wrists. Modern wearable sensors can track heart rate, calories burned, sleep patterns and so much more. The data and trends can be presented on our computers and our phones every day.
Early adopters of 24/7 monitoring are already seeing the benefits. As one of them, I can attest that my own behavior has changed as a direct result of activity tracking. I use resting heart rate as a basic proxy for my overall health. It is a well-documented indicator of cardiovascular fortitude, and the positive reinforcement I get from my activity tracker is perfectly aligned with health habits my doctor wants to see.
And yet, those who actively track their health metrics, including myself, still represent a minority of consumers. The reality is most people who should be keeping track of health metrics don’t – until something goes wrong.
Ironically, while life science companies have been largely absent from the wearable health landscape, the intersection of drugs and these technologies is an obvious place for them. So far, tech firms – like Samsung, Apple and Google – have been filling the void. Shouldn’t companies making drugs, medical devices and therapeutics also have skin in the game? I believe they should, and I suspect they soon will.
The opportunity for technology and medicine to intersect and make a meaningful impact on patient behavior is immense. According to the Consumer Technology Association’s (CTA) semi-annual industry report, the wearables segment will be dominated by fitness activity trackers where volumes are expected to hit 17.4 million units in 2016 and revenues reaching $1.3 billion.
And CES this year, wearable technologies focused on health and fitness dominated the show floor and went beyond devices to include clothing, ultimately making tracking one’s well-being as simple as putting on a T-shirt.
The National Institutes of Health estimates that unhealthy behaviors account for almost 40 percent of the risk of preventable, premature deaths in the United States. However, studies have demonstrated that behavior change programs work to improve health but are vastly underutilized in healthcare.
Medication non-adherence is one of those behaviors. For a number of reasons, many patients either forget to take medications or decide to forgo doses altogether. Nearly half of Americans are on at least one prescription medication, and at least 20 percent are taking three or more, according to the CDC.
For example, statins are one of the most commonly prescribed medications for decreasing the risk of heart disease. If more patients with high blood pressure took their medication as prescribed, 89,000 premature deaths could be avoided in the United States per year.
The National Institutes of Health estimates that unhealthy behaviors account for almost 40 percent of the risk of preventable, premature deaths in the United States.
According to Pew Research Center, more than 60 percent of American adults own a smartphone. Why doesn’t every pharmaceutical company that sells a statin have a behavior change program aimed at improving medication adherence? This could be as simple as a smartphone app that reminds patients to take pills on time, or that works as a companion to a medical device, such as a home blood pressure cuff. Integration with social networks, such as PatientsLikeMe or Facebook, could also give patients a social support system that helps reinforce behavior change.
But I understand it’s not just about any old app – it’s about the right app. The same way it takes a lot of careful research to pinpoint the perfect dose for each drug, it requires a lot of feedback from patients to determine exactly how these apps should work most effectively.
Still, the time has come to directly address the behavior change questions I started thinking about 20 years ago. Today we can reliably study the science of behavior change. Mobile and wearable technology has replaced the graph paper and pencil, and most patients – not only engineers – already have.
Everyone wants better outcomes for patients. The techniques, data and infrastructure necessary to democratize the science ofbehavior change exist today. Insurance companies, life sciences companies and patients all stand to benefit.
So what are we waiting for?