An app a day keeps the doctor away may very well be what our children hear as they grow up in the 21st century. During my research, I found that the origin of the familiar phrase, "An apple a day keeps the doctor away", may have originated 148 years ago in Wales, UK .
A Pembrokeshire proverb. Eat an apple on going to bed, And you'll keep the doctor from earning his bread.
Before I talk about apps replacing apples, I'd like to share some of the feedback that's been generated from my last blog post on tech making doctors unemployed. It's triggered a healthy debate within & outside the medical profession. I'm not sure doctors like me anymore!
I've had docs email me saying stop pushing this kind of talk, I need to put my kids through college. Some of the younger doctors have responded positively, understanding that they might benefit by having digital skills as a doctor. Many older docs seem to be terrified, and some docs of all ages seem to be responding to the threat with at attitude of "Bring it on!"
All of this has really made me think deeply about the choices we face in society in this increasingly automated world. A visit to a London supermarket this week compelled me to ask this question.
My choice at the supermarket, do I take the faster route using self-service machine, or use the human cashier and help them keep a job?— Maneesh Juneja (@ManeeshJuneja) March 26, 2014
Whilst some doctors may be outraged that I have the audacity to even challenge the notion that their work cannot be automated by machines, there are deeper questions facing ALL of us in society. This recent Guardian article which has the headline, "When robots take our jobs, humans will be the new 1%. Here's how to fight back."
Even much of the work I've done for the past 20 years, in the realm of data analytics, is being handled by machines and software now. In fact, as a Futurist, I may be joining the doctors at the unemployment office in 2025, given that robots are now writing news stories, and some believe that 90% of the news could be written by computers by 2030.
Is the future that we're heading towards really the future we desire? If it isn't the future we desire, whose responsibility is to intervene? Should governments create policies that encourage institutions to retain human workers, even when the human is more expensive than the machine? Should the CEO of a corporation also wear the hat of Chief Ethics Officer?
Will getting an app on prescription become the norm?
Many people including patients in rich countries may roll their eyes at using their mobile phone for healthcare, but patients in low and middle income have been using mobile phones in healthcare for several years, frequently using text messages with more basic phones, not apps with smartphones.
In fact, Africa is home to the largest number of mHealth projects in the world. A list with examples of projects can be found here. Patients in the US during 2014 will be able to download the world's first doctor prescribed app, Bluestar, for helping them to manage Type 2 Diabetes. This is a massive step, and could it be a signal of times to come?
Well, a recent poll of physicians in the US revealed that "37% have no idea what apps are out there."
According to research conducted by Digitas Health in 2013, 90% of chronic patients in the US would accept a mobile app prescription from their doctor. Do you know what proportion of those patients said they would accept a prescription of medication? Just 66%!
So, this is the future, right? Well, doctors have a right to be wary of apps. In a previous blog post, I mentioned how a certification program for health apps allowed an app to be certified which had flaws relating to protection of data in the app. We are heading into uncharted waters, and mistakes are to be expected. Looking beyond the hyperbole, the key question for me (and the regulators) is, do the benefits outweigh the risks?
The conclusions of the first ever cross-stakeholder Pan-European seminar on Health Apps & how patients, policy-makers, healthcare professionals and industry see the future was recently published in a white paper. What I find encouraging in the paper is the that EU has made it clear that it does NOT want to discourage the burgeoning market for health apps by producing excessive red tape.
As Digital Health becomes more prevalent, the scenario of doctors everyday weighing up whether to prescribe an app or a medication to a patient is entirely possible in just a few years. However, as this recent paper in JAMA remarks, we will need an unbiased review & certification process for health apps, if this is to happen.
Exciting stuff, but I can't help but also wonder, exactly how much of an impact will prescribing of apps really make on healthcare, given that just 18% of Americans aged over 65 own a smartphone? That figure drops to 8% for those over 65s with annual household income of $30,000 or less!
Should we be asking innovators to focus their energy on technologies that solve the problems of the biggest users of healthcare, those aged over 65? Will many basic problems in healthcare remain unresolved, as the 'worried well' develop amazing technology, to be used primarily by the 'worried well'?
What role will community pharmacies play in public health if prescribing of apps takes off and fewer people actually walk into a physical pharmacy? Will apps cause pharmacists to also become unemployed in the long term?
What is the impact on the future of the pharmaceutical industry which is not just slower than other sectors to adapt, but also employs considerable numbers of people around the globe? IMS Health, the world's largest health data broker, has launched AppScript, a platform that offers doctors easy, secure and evidence-based app prescribing.
What about absurdly simple problems, such as being prescribed an app, but your smartphone's battery barely lasts the whole day, and the battery could die just as you really need to use the app to manage your condition. A tablet doesn't need a power source.
What about the impact on our eyes? Opticians have recently warned that overuse of smartphones may damage your eyes.
What's the impact on the fabric of our society if in the future, we can both be diagnosed & treated from the comfort of our own home just using a our smartphone combined with an app & a tricorder?
Not long to wait to answer that question! The combination of the long awaited Scanadu Scout and their app on Monday may indeed make the phrase, an app a day keeps the doctor away, part of our everyday vocabulary. The latest blog post from Scanadu, mentions "placing it over the forehead to take a composite, multi-parameter biometric signature that pulls in several vital signs in seconds: diastolic and systolic blood pressure, body temperature (core temperature is coming in a couple of weeks), SPO2 (blood oxygenation), and heart rate."
I should be getting my hands on a unit soon, and look forward to sharing my feedback with you!
One more thing, what if the apps in our cars in the future 'prescribed' us a different route home to improve our health? Given Apple's development of CarPlay, I mocked up a possible scenario of the world we could be heading towards. The question again - is this a desirable world?
Asking Siri to navigate home may never be the same again.
My next talk - Boston!
I'm going to be passing through Boston, MA in 2 weeks time. It's last minute, but I'm hoping to be able to give a talk there on whether tech will make doctors unemployed and also share some of my ideas & thoughts on how the medical profession could adapt to this rapidly changing world of Digital Health. As soon as it's confirmed, I'll share the details on Twitter. If whilst I'm in Boston, your organisation wishes to book me as a speaker, please see my Public Speaking page.
[Disclosure: I have no commercial ties with any of the companies mentioned above]