Digital Health: From Pharma To…Fitness?

David Shaywitz

Astute TR readers might have noticed that I’ve been writing a lot about digital fitness lately, in contrast to digital pharma. 

This is deliberate, and represents an evolution of my thinking.

I was first drawn to digital health over a decade ago, in the context of a translational medicine training program for medical scientists that I developed with Dr. Denny Ausiello at Massachusetts General Hospital.  This initiative was called PASTEUR – Patient-Associated Science: Training, Education, Understanding, and Research. The core tenet was an emphasis on the patient-participant in medical science.  Our tagline was “Our patients as partners in discovery.”

Our focus on better understanding the patient experience led us to an early interest in digital health and digital technologies. Here seemed like an excellent way to connect with patients, leveraging their smartphones and other digital tools to help advance clinical understanding and accelerate biomedical discovery. We established CATCH – the Center for Assessment Technology and Continuous Health — to explore applications of these emerging technologies.

When I moved to California in 2010 for a biotech role, I was also really excited about the opportunity to immerse myself in the culture and expertise of the Valley.  I was especially eager to explore how my sense of the needs of healthcare matched up with the possibilities afforded by the emerging technologies that were being developed all around me.  You couldn’t grab a coffee in town without overhearing energetic pitches and animated discussions; so many smart engineers and entrepreneurs were seeking to extend technology into new markets, including healthcare.

Yet I was struck almost immediately by what felt like a disconnect between my understanding of biology and medicine and the view that seemed so prevalent out here, a solutionist perspective that often underestimated the messiness of biology, the deep humanity of medicine, and the often perverse market incentives of various healthcare stakeholders. I said as much in 2011, with a shot across the bow entitled “What Silicon Valley Doesn’t Understand About Medicine,” and have returned to this theme quite often since.

The potential for digital technologies in healthcare remains extraordinary – and extraordinarily difficult to harness, at least in some of the areas we care most about: using digital technologies to come up with important new drugs, on the pharma side, and iteratively leveraging experience to continuously improve the care of patients (the ideal of the learning healthcare system), on the care delivery side. 

Despite some important, authentic progress (protein folding prediction comes to mind) – and an almost unfathomable amount of extravagant expectation and incessant, endlessly escalating hype, the goals remain largely aspirational, as Derek Lowe, in particular, has expertly chronicled.

In a range of roles – including chief medical officer of a healthtech startup, senior partner at a pharma corporate venture group to which I tried (unsuccessfully) to add a digital vertical, and my current work advising senior pharma execs about digital and data – I’ve developed a deep appreciation of how difficult it is to bring emerging digital technology into legacy organizations. Change is hard. Especially at more senior levels, pharma tends to be extremely cautious and skeptical.

I’ve come away with a particular sense of awe and admiration for the digital/data champions within pharma organizations, who often have nominal, high-level organizational blessing but typically very little ground-level buy-in.  Not only are their efforts often received with polite skepticism, but when something does succeed, there are often others who immediately rush in to take credit. This is the exact response to innovation Safi Bahcall describes perfectly in Loonshots

It’s also, by the way, exactly – exactly – the same thing I’ve heard from top doctors working in leading tech companies.

Stanford Business School professor Jeffery Pfeffer would surely shake his head knowingly and say this represents typical organizational power dynamics. As usual, Pfeffer would be right. The inconvenient truth: if you’re a data science person in a biopharma organization, or a medical person in a tech company, you can find yourself without a meaningful power base, and struggle accordingly.

I remain extremely bullish on the long-term opportunity for digital and data in biopharma and healthcare, though it promises to remain a brutal and painful struggle for the next decade. The good news – the best news – is that we are beginning to train a cohort of physician/data-scientists and biologist/data-scientists, experts who are intrinsically bilingual and who recognize and incorporate data science as an intrinsic and vital component of the medical science of the future.

Erik Reinertsen, director of data science and engineering, Prometheus Biosciences

An example in biopharma is Dr. Erik Reinertsen, a whip-smart physician/data scientist from Emory and Georgia Tech who interned with me in venture capital, went on to do some fine work at the Broad Institute, and is now leading data science efforts at Prometheus Biosciences.

Or consider Dr. Griffin Weber, a physician-data-scientist from Harvard and a standout example in care delivery who Lisa Suennen and I interviewed on our last Tech Tonics episode.

Perhaps not surprisingly, my advisory work has tended to focus less on product strategy than on organizational executive coaching, and I plan to continue counseling data science champions within biopharmas. 

At the same time, I am finding myself increasingly drawn to consumer health in general, and digital fitness in particular, as it seems to represent an expression of digital health that is already positively and palpably impacting lives – right now, today — and seems poised to meaningfully impact so many more people in the future.

Griffin Weber, Associate Professor of Medicine, Beth Israel Deaconess Medical Center
Associate Professor of Biomedical Informatics, Harvard Medical School

It’s difficult not to be struck by the foundational role regular exercise plays in the lives of so many physicians, scientists, and entrepreneurs I know and admire – and the role exercise has played in my own life – including helping me lose 80 pounds several years ago (and keep it off), as well as helping me stay both fit and centered during this last tumultuous pandemic year.

I’ve also been impressed both by the engagement so many have with exercise, as well as by the opportunity that exists to use technology to bring exercise and a sense of community to the many people who’d benefit from exercise but find it difficult or daunting.

The opportunity to leverage emerging digital technologies to improve both physical and mental health by offering engaging and compelling fitness experiences seems too powerful to ignore, and too promising to be reserved only for those who are already athletic.   

For years, doctors have advised their patients to exercise more, with almost zero expectation that anyone actually would. As Harvard anthropologist Daniel Lieberman points out in Exercised, we didn’t evolve to pursue pointless activity. 

Even so, the many physical and psychological benefits associated with exercise (after all, we didn’t evolve to sit at desks all day long either) suggest the wisdom of this timeless medical advice. 

The challenge and the opportunity before us: leveraging digital fitness technology to turn the tedium of prescriptive exercise into engaging, delightful, and healthy activity.

We can do this. Eye of the tiger.

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