Apple, Amazon, and Uber are moving in on health care. Will it help?
Big tech is making its opening moves into the health care scene, but its focus on tech-savvy millennials may miss the mark.
- Companies like Apple, Amazon, and Google have been busy investing in health care companies, developing new apps, and hiring health professionals for new business ventures.
- Their current focus appears to be on tech-savvy millennials, but the bulk of health care expenditures goes to the elderly.
- Big tech should look to integrating its most promising health care devise, the smartphone, more thoroughly into health care.
Health care spending in the United States reached $3.5 trillion in 2017, roughly 18 percent of the nation's GDP. With so much to gain, big tech companies like Apple, Amazon, and Uber are making incipient moves into the space. Such moves from large economic players will alter traditional models of health care, no doubt in ways we can't fully envision.
But will it help? Potentially. In recent years, big tech has gathered the resources and creative minds to change the way we approach many aspects of our lives, even in conservative fields like health care. But to create lasting change, big tech will need to collaborate with traditional health care players to ensure all patients, not just the tech savvy, benefit.
Big tech's opening moves
Last year, Amazon purchased online pharmacy service PillPack for a cool $800 million. This has Angela Chen at The Verge wondering if we'll see PillPack integrated into Amazon's other services, allowing Prime members to order medication through the company's website. Such a prediction makes sense, but it's some ways off. Amazon just recently announced that Nader Kabbani, an Amazon veteran, would lead the pharmacy initiative.
Other tech giants have been making their opening moves, too.
Apple added a Health Records section to its iPhone, allowing users to view their medical records from participating health systems, and the FDA recently cleared an electrocardiogram accessory for the Apple Watch. Uber hired health consultant Aaron Crowell to head its health business venture to offer medical transport. And Microsoft has introduced a Healthcare Bot to provide virtual health chatbots to assist medical personnel.
Alphabet, Google's parent company, has made several health-centric efforts. These include investing in companies like 23andMe and Oscar health, collaborating with Fitbit to create patient-generated electronic health records, and experimenting with its AI platform Deepmind to improve health services and records.
Eyes on the patient, not the prize
What does telemedicine look like? Dr. Maurice Cates, Orthopedic Surgeon, conducts a live Orthopedic consultation remotely by video with a patient.
(Photo by Brooks Kraft LLC/Corbis via Getty Images)
As is evident, big tech's opening moves are less about disruption and more about positioning. Although we aren't seeing grand overhauls yet, we can predict where these companies plan to make their entry point. And the focus appears to be on their traditional base: tech-savvy, middle-class millennials.
That's a potential problem as Michael Dowling, CEO of Northwell Health, told Big Think:
"I welcome all of these players. Because the more players that you get coming in with a different perspective, the better we can get. But it's important for people to understand that most of these players are focusing in on the easy parts of health care. They're focusing in on non-hospital business. They're focusing in on people that are not that sick primarily. And they're dealing with the consumer who's 30 years old, 40 years old, 25 years old."
But the bulk of health care expenditures, Dowling notes, go to the elderly, specifically people in the last year to year-and-a-half of their lives. And because people are living longer, into their 80s and 90s, they'll spend more years drawing upon health care.
Devising apps for digital watches that generate electronic health records is amazing. But how many people do you know own a Fitbit or Apple Watch? How many elderly people take an Uber to the hospital, and how many Ubers are wheelchair accessible? The market for such devices remains niche, if growing, even among millennials.
Another consideration: Would Medicare cover such costs?
Even when tech is designed for the elderly or ill, it rarely considers their needs and partialities. In another Verge article, Chen surveyed the growing category of "aging tech" to discover airbag belts, smart shoes, and smart lamps, all designed to assist in the case of a fall.
As Chen notes: "So many of these devices seem to rely on the ability of caregivers to coerce their elderly relative or patient into using the solution. But if someone doesn't want to wear your shoe or your belt or your watch, it's hard to make them."
Despite these hurdles, big tech can still be a benefactor for health care, and its most serviceable offering is already here. The smartphone.
Unlike other devices trying to break in, the smartphone has already been widely adopted. Seventy-seven percent of Americans own smartphones, and 46 percent of Americans over 65 own one. Comparatively, only 18 percent of Americans own a fitness tracker and 13 percent a smartwatch.
The result is a health care device that requires little training for any demographic. Americans already use their smartphones for finances, travel, communications, reservations, photography, and a host of other daily activities. Adding health care to the mix would be a small ask, even for the elderly.
In his book Health Care Reboot, Dowling discusses a Northwell initiative that had patients televisit with their nurse through tablets and smartphones. The initiative hoped to better serve patients at home while limiting unnecessary travel and hospital visits. Initially, there was concern that older patients would have trouble adapting, but even patients in their 80s found the connection intuitive and helpful.
"The use of technologies such as smartphones, tablets, and laptops signals the beginnings of the age of the consumer in health care," writes Dowling. "In a general sense, as patient, a person is subservient to the provider. As consumer, the person is more empowered with greater access to information and an ability to behave as consumers do in other fields."
Like big tech, health care revolves around data — a patient's family history, their medical records, their current prescriptions, and the ever-evolving medical literature. The easier and faster it is to collect and coordinate this data between patient and provider, the better health care can become.
Smartphone architecture is already designed to collect and deliver data in a user-friendly manner. By pointing it in the direction of health care, big tech can help expand its definition beyond hospital visits to make the patient an active participant.
Why health care should start long before you reach the hospital
Climate change and artificial intelligence pose substantial — and possibly existential — problems for humanity to solve. Can we?
- Just by living our day-to-day lives, we are walking into a disaster.
- Can humanity wake up to avert disaster?
- Perhaps COVID was the wake-up call we all needed.
Does humanity have a chance for a better future, or are we just unable to stop ourselves from driving off a cliff? This was the question that came to me as I participated in a conference entitled The Future of Humanity hosted by Marcelo's Institute for Cross-Disciplinary Engagement. The conference hosted an array of remarkable speakers, some of whom were hopeful about our chances and some less so. But when it came to the dangers facing our project of civilization, two themes appeared in almost everyone's talks.
And here's the key aspect that unifies those dangers: we are doing it to ourselves.
The problem of climate change
The first existential crisis that was discussed was, as you might guess, climate change. Bill McKibben, the journalist and now committed activist who first began documenting the climate crisis as far back as the 1980s, gave us a history of humanity's inability to marshal action even in the face of mounting scientific evidence. He spoke of the massive, well-funded disinformation efforts paid for by the fossil fuel industry to keep that action from being taken because it would hurt their bottom lines.
It's not like some alien threat has arrived and will use a mega-laser to drive the Earth's climate into a new and dangerous state. Nope, it's just us — flying around, using plastic bottles, and keeping our houses toasty in the winter.
Next Elizabeth Kolbert, one of America's finest non-fiction writers, gave a sobering portrait of the state of efforts that attempt to deal with climate change through technological fixes. Based on her wonderful new book, she looked at the problem of control when it comes to people and the environment. She spoke of how often we get into trouble when we try to exert control over things like rivers or animal populations only to find that these efforts go awry due to unintended consequences. This requires new layers of control which, in turn, follow the same path.
Credit: Jo-Anne McArthur via Unsplash
At the end of the talk, she focused on attempts to deal with climate change through new kinds of environmental controls with the subtext being that we are likely to run into the same cycle of unintended consequences and attempts to repair the damage. In a question-and-answer period following her talk, Kolbert was decidedly not positive about the future. Because she had looked so deeply into the possibilities of using technology to get us out of the climate crisis, she was dubious that a tech fix was going to save us. The only real action that will matter, she said, is masses of people in the developed would reducing their consumption. She didn't see that happening anytime soon.
The problem of artificial intelligence
Another concern was over artificial intelligence. Here the concern was not so much existential. By this, I mean the speakers were not fearful that some computer was going to wake up into consciousness and decide that the human race needed to be enslaved. Instead, the danger was more subtle but no less potent. Susan Halpern, also one of our greatest non-fiction writers, gave an insightful talk that focused on the artificial aspect of artificial intelligence. Walking us through numerous examples of how "brittle" machine learning algorithms at the heart of modern AI systems are, Halpern was able to pinpoint how these systems are not intelligent at all but carry all the biases of their makers (often unconscious ones). For example, facial recognition algorithms can have a hard time differentiating the faces of women of color, most likely because the "training data sets" the algorithms were taught were not representative of these human beings. But because these machines supposedly rely on data and "data don't lie," these systems get deployed into everything from making decisions about justice to making decisions about who gets insurance. And these are decisions that can have profound effects on people's lives.
Then there was the general trend of AI being deployed in the service of both surveillance capitalism and the surveillance state. In the former, your behavior is always being watched and used against you in terms of swaying your purchasing decisions; in the latter, you are always being watched by those in power. Yikes!
The banality of danger
In listening to these talks I was struck by how mundane the sources of these dangers were when it comes to day-to-day life. Unlike nuclear war or some lone terrorist building a super-virus (threats that Sir Martin Rees eloquently spoke of), when it comes to the climate crisis and an emerging surveillance culture, we are collectively doing it to ourselves through our own innocent individual actions. It's not like some alien threat has arrived and will use a mega-laser to drive the Earth's climate into a new and dangerous state. Nope, it's just us — flying around, using plastic bottles, and keeping our houses toasty in the winter. And it's not like soldiers in black body armor arrive at our doors and force us to install a listening device that tracks our activities. Nope, we willingly set them up on the kitchen counter because they are so dang convenient. These threats to our existence or to our freedoms are things that we are doing just by living our lives in the cultural systems we were born into. And it would take considerable effort to untangle ourselves from these systems.
So, what's next then? Are we simply doomed because we can't collectively figure out how to build and live with something different? I don't know. It's possible that we are doomed. But I did find hope in the talk given by the great (and my favorite) science fiction writer Kim Stanley Robinson. He pointed to how different eras have different "structures of feeling," which is the cognitive and emotional background of an age. Robinson looked at some positive changes that emerged in the wake of the COVID pandemic, including a renewed sense that most of us recognize that we're all in this together. Perhaps, he said, the structure of feeling in our own age is about to change.
Let us hope, and where we can, let us act.
New research shines a light on the genetics of sudden cardiac deaths.
- Soccer player Christian Eriksen of Denmark recently collapsed on the field from a cardiac arrest. Thankfully, he survived.
- A new study examined the genetics underlying unexplained sudden cardiac death.
- About 20 percent of these unexplained deaths are likely due to genetics.
The football world was rocked recently when Denmark's Christian Eriksen collapsed while suffering from cardiac arrest on the field during a European Championship match on June 12. The 29-year-old star has won the Danish Football Player of the year five times. Doctors are still baffled as to why an athlete in prime shape would experience sudden cardiac arrest.
While Eriksen's case remains a mystery, a large team of researchers from the University of Maryland School of Medicine recently looked into the reasons a person with no apparent health problems dies from sudden cardiac death (SCD). Their study, published in JAMA Cardiology, found that roughly 20 percent of unexplained cases involve genetics.
The mystery of sudden cardiac death
SCDs are common, with between 180,000 to 450,000 occurring every year in the United States. While coronary heart disease is involved in between 50 to 75 percent of these cases, doctors are uncertain of the reasons in 30 to 40 percent of cases.
The team notes that most research on SCDs, such as in New Zealand, Denmark, and South Korea, tend to focus on homogenous populations of people under age 35. One study based in New York investigated a racially diverse cohort but included a number of infants. While these studies looked at genetic components of SCD, they write, "No systematic comparison of the genetics underlying cases of unexplained SCD between adult White and African American descendants has ever been conducted."
The State of Maryland's medical examiner's office has been collecting data on SCDs for over two decades, which gave the team a rich collection of data to pull from — over 5,000 such cases. From that data set, the researchers looked at 683 African American and white adults (median age: 41). In total, the DNA of 413 patients who died from unexplained SCD was genetically sequenced. Thirty different cardiomyopathy genes and 38 arrhythmia genes were examined.
Genetic screens for sudden cardiac death
Clinical associate professor of medicine and corresponding author Aloke Finn explains the importance of rooting out the cause of SCDs: "Genetic screening isn't routinely used in cardiology, and far too many patients still die suddenly from a heart condition without having any previously established risk factors. We need to do more for them."
One surprising finding was the large number of the deceased that carried the genetic variant for hypertrophic cardiomyopathy (HCM), which causes the heart's muscle tissue to be abnormally thick. This could explain why people with no apparent heart disease experience cardiac arrest seemingly out of nowhere. While HCM is a somewhat common heart disorder (with a prevalence as high as 0.2 percent), we're only just now learning the role of genes in determining who suffers from a fatal attack.
What is clear, however, is that those with particular genetic variants are likelier to die from unexplained SCD earlier in life than others who die from unexplained SCD.By identifying these genes, researchers hope this information could be used in future medical screenings. E. Albert Reece, Dean of the University of Maryland School of Medicine, believes this could save lives.
"This is a fascinating study that provides important new insights into devastating deaths due to unexplained cardiac abnormalities. It certainly makes the case for more research to address this urgent health need and save lives in the future."
Stay in touch with Derek on Twitter. His most recent book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
A new device cured the hiccups 92 percent of the time in a recent study involving more than 200 participants.
- Hiccups are an occasional annoyance to most people, but some get them frequently. Others suffer from episodes that last days, months, or even years.
- A new "suction and swallow" tool stops hiccups 92% of the time by activating the same muscles and nerves that are involved during the hiccup reflex arc.
- Although the new tool may be convenient, you can probably mimic its function with a glass of water and a straw.
In 1922, an Iowa man named Charles Osborne was preparing to butcher a hog. As he was lifting the 350-pound carcass, he fell. He didn't report any pain to his doctor. But he did walk away with a strange medical condition that earned him a spot in the Guinness Book of World Records: the longest bout of hiccups.
Osborne hiccuped for 68 consecutive years. In total, he hiccuped an estimated 430 million times, at a rate of up to 40 hiccups per minute. He tried numerous home remedies. None worked. Then, one year before his death in 1991, his hiccups mysteriously stopped.
That's an extreme example of a hiccup attack. But even for much shorter episodes, called transient hiccups when they resolve within 48 hours, it can be hard to find a home remedy that works reliably, if you find one at all.
A new remedy recently had its hiccup-quashing abilities put to the test. The "forced inspiratory suction and swallow tool," marketed as the HiccAway, is basically a drinking device with a specialized straw that requires forceful suction to draw liquid.
The idea is to stimulate the same body parts that execute the involuntary hiccup response, so much so that they stop triggering hiccups. (The official medical term is singultus, from the Latin word "singult," which means gasping while sobbing.)
What happens during hiccups?
When you hiccup, your diaphragm — a large, dome-shaped muscle beneath the lungs — involuntarily contracts. This spasm causes the sudden closure of your epiglottis, a flap of cartilage at the root of the tongue that closes when you swallow so that food and liquids don't enter the lungs. The shutting of your epiglottis is what makes the "hic" sound during hiccups.
Two major nerves are involved in the hiccup process. The phrenic nerve helps contract the diaphragm, while the vagus nerve shuts the epiglottis. By forcefully sucking on the tool's straw and then swallowing water, you contract the diaphragm and close the epiglottis. These two actions stimulate the phrenic and vagus nerves, which interrupts the hiccup reflex arc.
The tool has a mouthpiece on the top, a body in the middle, and an adjustable cap with a pressure valve on the lower end.Alvarez et al.
"HiccAway can instantly stop hiccups by generating enough pressure while sipping from the device to lower the diaphragm while simultaneously activating the leaf-shaped flap in the throat, known as the epiglottis," the company writes on its website. "Doing this stimulates two key nerves, the phrenic and the vagus nerves, which are responsible for the hiccups. This allows the brain to reset and stop hiccups."
Testing the device
To test the efficacy of the tool, researchers with the University of Texas Health Science Center at San Antonio sent the HiccAway to more than 600 people who reported having hiccups at least once a month. The results showed that the tool stopped hiccups 92 percent of the time for the 249 participants whose responses were validated in the study. More than 90 percent of participants said it was more effective than home remedies.
"Many home remedies consist of physical maneuvers designed to stimulate contraction of the diaphragm and/or closure of the epiglottis," stated a study published in JAMA Network Open. "These maneuvers lack clear, standardized instructions and can be cumbersome to perform, and there are few, if any, scientific studies of their effectiveness."
Still, it's worth noting that the results were based on self-reported data, and the study didn't feature a control group. Future research could compare the efficacy of HiccAway with a device that looks similar but doesn't function.
It's also worth pointing out that you don't need a $14 device to stimulate the vagus and phrenic nerves. You may just need a glass of water and a straw. A 2006 article published in the British Medical Journal noted that "plugging both ears tightly, pushing both right and left tragus, and drinking the entire glass of water through the straw without pause, without releasing the pressure over the ears" is a "nearly infallible" method to stop hiccups.
What if nothing stops your hiccups? Consider consulting a doctor: Persistent hiccups can signal underlying medical conditions, including pancreatitis, pregnancy, and liver cancer, among others.
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