Consumer Health’s Digital Convergence – And What’s Still Missing

Consumers are taking increased ownership of their health.

As Laura Landro recently described in the Wall Street Journal, this trend is driven in part by necessity — specifically by “a shortage of doctors, long wait times for appointments and an increasing prevalence of chronic diseases such as diabetes earlier in adulthood.”

But our push to manage our own health is also motivated by a number of interrelated, encouraging factors as well, including:

• Increased sense that our healthspan, and perhaps even our lifespan, is malleable, and that through our actions – our agency – together with some good luck, we can realistically hope to inflect it for the better (teaser: I discuss this topic in depth in a forthcoming commentary – stay tuned!).
• Compelling new digital technologies, including increasingly powerful wearables and apps, that may provide greater insight into our physiology.
• Continued advances in molecular characterization of human biology including the biology of aging, offering the promise of improved risk identification, and more precise mitigation approaches. A prosing example here is the use of polygenic risk scores, as Dr. Eric Topol emphasizes in Super Agers (my WSJ review here), and as Dr. Pradeep Natarajan and colleagues have recently implemented at Mass General Brigham.
• Increased recognition that many diseases of aging are exacerbated by a shared mechanism — chronic low-grade inflammation – which typically takes years to exert its baneful effect, offering the opportunity, as Dr. Peter Attia and others emphasize – to identify this risk earlier and potentially take preemptive action.
• Dramatically enhanced appreciation of the importance of so-called “lifestyle” factors – like movement, nutrition, and sleep – in impacting health.
• Meteoric rise of AI that offers the promise of both integrating a range of lab and behavioral data, and then delivering relevant, customized health and coaching insights in an infinitely scalable fashion. I’ve recently discussed Google’s just-published work around an AI health coach, including the exciting hopes, and very real limitations, as well the over-the-top promises often associated with many supposed “precision” interventions.

Towards a “Personal Health OS”

The result of this convergence – or collision – of increased patient need and science-and-tech enabled opportunity has led a range of digital platforms to pursue what’s seen as the Holy Grail of consumer health, a “personal health operating system” (personal health OS) — a single dashboard you turn to that continuously integrates and helps you optimize multiple health parameters. 

The current model, first discussed with TR readers in June, is summarized in the figure below.

Once we recognize that a personal OS is the goal, we can understand why wearable manufacturers Oura and WHOOP have each recently announced partnerships with Quest enabling members to obtain a battery of clinical labs, with results that read out in the associated app; these wearables already capture and leverage physiological data; now they want to add lab data to approach what they would view as the complete picture.

WHOOP CEO Will Ahmed has elegantly described the company’s ambitious vision for a “health operating system” that leverages technology and AI to monitor relevant health parameters.

This platform of the future, he writes,

 “…will track how sleep fuels recovery, how recovery shapes performance, how performance generates stress, and how stress cycles back into sleep. But the technology won’t stop at observation: it will intervene, nudging behaviors, adapting routines, and even initiating care when risk rises. In this way, new technology will transform hidden feedback loops into an intelligent, always-on system for extending vitality and preventing crisis.”

He anticipates that in the near future, “Care will no longer be episodic and institution-centric, but literally centered and personalized within each person and driven by the continuous biometric signals their own body produces.”

Ahmed acknowledges many companies are working towards this goal, and anticipates,

“Success will belong to the few that can fuse massive, continuous health data with cutting-edge AI and deliver daily, trusted engagement that becomes inseparable from people’s lives. It is easier to envision the Health OS than actually build it, but there is no question this will exist in just a few years time.”

He concludes, “At WHOOP, we believe we have the ingredients and the team to tackle this opportunity.”

A few reactions.

First, I emphatically share Ahmed’s enthusiasm for the moment we’re in, for the promise of technology, and the believe in the promise of digital health  – as Denny Ausiello and I envisioned back in 2013, when we wrote:

“Digital health [enabled by sensors and other mHealth tools] provides a way for medicine to break out of its traditional constraints of time and place and understand patients in a way that’s continuous rather than episodic, and that strives to offer care in a fashion that’s anticipatory or timely rather than reactive or delayed.”

I’m also thrilled that so many consumers find themselves inspired to improve their own health.  As Harvard professor and primary care doctor Tom Delbanco tells Landro, “The evidence shows that the more a patient gets involved in their own care, the better the outcomes” – a sentiment that aligns with the focus on agency this column has been emphatically championing, as well as a piece I wrote for the New York Times in 2006 embracing the engagement of patient families as well.

Appropriately, digital health platforms have come in for their fair share of (generally deserved) criticism because of their approach to comprehensive evaluation, in particular their promise these evaluations will lead to meaningfully personalized health guidance. 

As University of Pennsylvannia researcher Anna Wexler tells Landro, lab tests “often don’t meet validated clinical standards and may mislead consumers or lead them to buy products that they don’t need.” 

This echoes a frequent warning about many of these comprehensive lab testing and/or imaging approaches, reviewed by Eric Topol in his “Ground Truths” blog highlighting the perils of false positives, and the associated evaluations they can gratuitously trigger.  

The problem of comprehensive genetic testing leading to potentially abnormal findings of uncertain significance – the so-called “incidentalome” – has been classically described in JAMA by Kohane, Masys, and Altman in 2006.

Unfortunately, far less attention has been devoted to what I suspect may be an even greater limitations of these platforms: their reflexive embrace of a remarkably reductionist view – it might be uncharitably characterized (or more accurately, caricatured) as an engineering mindset, a technologist mindset, or a managerial mindset — that essential treats us as if we’re merely pieces of factory machinery that can last longer if constantly mechanically surveilled, with performance scrutinized and parameters tweaked by AI algorithms.

The word “merely” is important here, since rigorously monitoring health parameters of course can be valuable, especially when enabling potential problems to be headed off before they cause real damage.  To the extent digital platforms integrate useful metrics, help us stay on top of our health, and motivate us to engage in health-promoting activities, digital platforms can be enormously beneficial. 

But what platforms like WHOOP, Peloton, Oura, Tonal, and others seem to have astonishingly overlooked – as I’ve discussed with TR readers and in the Boston Globe – is a more capacious vision that recognizes the difference between metric optimization and true flourishing, a pursuit that involves connection and purpose, meaning and engagement.  The substantive stuff that matters to most people. 

This deeper vision of consumer health, shared with TR readers in June, is summarized in the figure below.

The apparent inability of digital platforms to embrace attributes that they can’t measure almost certainly has a negative impact on the metrics they’re so keen to quantify and optimize. 

For example, major studies of longevity — such as the Harvard Study of Adult Development, as well as Northwestern’s “Super Agers” study– find that the quality most strongly associated with longer life is warm relationships with others.  Yet most digital platforms remain strangely indifferent here – as if the topic too soft, too woo-woo, or (most likely) not easily quantifiable with a watch, strap, or ring.

In overlooking what truly matters, digital platforms are missing out on meaningful opportunities to significantly expand their user base and improve the health of more people. 

I’m not sure most of us want to be relentlessly optimized, but I think most of us would embrace the opportunity to flourish and would welcome a platform with the vision and insight to appreciate the synergy between improving health metrics and deliberately cultivating connection, purpose, and agency. 

Expanding from counting steps to cultivating agency (which I’ve described as “the motivational currency of behavior change) and enhancing our sense of connection and purpose feels like an important and, frankly, obvious opportunity that just happens to sit in a real blind spot for many metric-obsessed digital entrepreneurs and investors.

Purpose

The health impact of purpose has been nicely highlighted by the work of Victor Strecher, who has spent his career studying the subject.

A professor at the University of Michigan School of Public Health, author of Life on Purpose, and the founder and CEO of Kumanu, a digital tool focused on “purpose-powered wellbeing,” he recently spoke at The Harvard School of Public Health, in a lecture series organized by the Lee Kum Sheung Center for Health and Happiness; you can find the video here.

Key health-related takeaways include:

• In a study of 1,666 adults Strecher did with University of Michigan colleague Ethan Kross (author of Shift), a stronger sense of purpose was linked to more adaptive coping (e.g., seeing the big picture, finding a silver lining) and less maladaptive coping (notably, drinking alcohol when stressed).  These coping patterns tracked closely with better emotional self-regulation — the ability to “change your own emotional weather.”
• In other research, Strecher found that about 68% of people can write a purpose statement, and those who do report higher happiness and lower depression (PHQ-9) in his analyses.
• Moreover, the content of purpose matters: purposes centered on success/wealth/hedonic aims are associated with lower well-being and willpower, whereas multi-theme or relational/transcendent purposes show higher well-being across studies he cites.

When Purpose Meet Analytics: Boston College’s Inspiring Example

On a more personal note, I’ve been struck recently by the impact a sense of purpose can have on an organization, in this case an institution of higher learning.  One our children recently started attending Boston College (BC), which describes itself as a “Jesuit, Catholic University…rooted in a world view that calls us to learn, to search for truth, and to live in service to others.”  (The school conspicuously welcomes a range of faith traditions, including ours.) 

What’s been most striking in our early interactions with BC is how deeply this commitment — and clear mission — permeates campus life. Purpose seems to infuse everything they do, and belief, along with values like service and gratitude, isn’t trotted out as a buzzword but lived in a personal, palpable way.

Consequently, BC has a markedly different feel from many campuses, and its authentic, purpose-driven approach seems especially well-suited to the fractious, often divisive moment in which we live. 

Many universities today seem both rudderless and reactive, existing (like a number of companies) merely to continue to exist. They feel more managed than visionary, and (as I’ve argued) could use a dose of the inspirational leadership Bart Giamatti brought to the university president role.

Particularly against this backdrop, a learning environment like BC’s, guided by a powerful, positive, and substantive sense of purpose and mission is a palpably powerful thing.  

Moreover, by thoughtfully integrating a lived sense of mission with an admission and financial aid policy guided by strategic intentionality and informed by data, Boston College, the New York Times recently reported, transformed itself from a “struggling commuter school running a deficit” to an ascendant institution with “a $4.1 billion endowment [that] rejects 87.5 percent of applicants.”

It’s an integrated approach to attracting and inspiring college students– combing a true sense of purpose with deep analytics – that could and should serve as a model for digital health platforms seeking a similarly profound impact.

Note: Readers seeking additional reading and resources on health and agency might find this site I’ve created useful.