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
The distances between the stars are so vast that they can make your brain melt. Take for example the Voyager 1 probe, which has been traveling at 35,000 miles per hour for more than 40 years and was the first human object to cross into interstellar space. That sounds wonderful except, at its current speed, it will still take another 40,000 years to cross the typical distance between stars.
Worse still, if you are thinking about interstellar travel, nature provides a hard limit on acceleration and speed. As Einstein showed, it's impossible to accelerate any massive object beyond the speed of light. Since the galaxy is more than 100,000 light-years across, if you are traveling at less than light speed, then most interstellar distances would take more than a human lifetime to cross. If the known laws of physics hold, then it seems a galaxy-spanning human civilization is impossible.
Unless of course you can build a warp drive.
Ah, the warp drive, that darling of science fiction plot devices. So, what about a warp drive? Is that even a really a thing?
Let's start with the "warping" part of a warp drive. Without doubt, Albert Einstein's theory of general relativity ("GR") represents space and time as a 4-dimensional "fabric" that can be stretched and bent and folded. Gravity waves, representing ripples in the fabric of spacetime, have now been directly observed. So, yes spacetime can be warped. The warping part of a warp drive usually means distorting the shape of spacetime so that two distant locations can be brought close together — and you somehow "jump" between them.
This was a basic idea in science fiction long before Star Trek popularized the name "warp drive." But until 1994, it had remained science fiction, meaning there was no science behind it. That year, Miguel Alcubierre wrote down a solution to the basic equations of GR that represented a region that compressed spacetime ahead of it and expanded spacetime behind to create a kind of traveling warp bubble. This was really good news for warp drive fans.
The problems with a warp drive
There were some problems though. Most important was that this "Alcubierre drive" required lots of "exotic matter" or "negative energy" to work. Unfortunately, there's no such thing. These are things theorists dreamed up to stick into the GR equations in order to do cool things like make stable open wormholes or functioning warp drives.
It's also noteworthy that researchers have raised other concerns about an Alcubierre drive — like how it would violate quantum mechanics or how when you arrived at your destination it would destroy everything in front of the ship in an apocalyptic flash of radiation.
Warp drives: A new hope
Credit: Primada / 420366373 via Adobe Stock
Recently, however, there seemed to be good news on the warp drive front with the publication this April of a new paper by Alexey Bobrick and Gianni Martre entitled "Introducing Physical Warp Drives." The good thing about the Bobrick and Martre paper was it was extremely clear about the meaning of a warp drive.
Understanding the equations of GR means understanding what's on either side of the equals sign. On one side, there is the shape of spacetime, and on the other, there is the configuration of matter-energy. The traditional route with these equations is to start with a configuration of matter-energy and see what shape of spacetime it produces. But you can also go the other way around and assume the shape of spacetime you want (like a warp bubble) and determine what kind of configuration of matter-energy you will need (even if that matter-energy is the dream stuff of negative energy).
Warp drives are simpler and much less mysterious objects than the broader literature has suggested.
What Bobrick and Martre did was step back and look at the problem more generally. They showed how all warp drives were composed of three regions: an interior spacetime called the passenger space; a shell of material, with either positive or negative energy, called the warping region; and an outside that, far enough away, looks like normal unwarped spacetime. In this way they could see exactly what was and was not possible for any kind of warp drive. (Watch this lovely explainer by Sabine Hossenfelder for more details). They even showed that you could use good old normal matter to create a warp drive that, while it moved slower than light speed, produced a passenger area where time flowed at a different rate than in the outside spacetime. So even though it was a sub-light speed device, it was still an actual warp drive that could use normal matter.
That was the good news.
The bad news was this clear vision also showed them a real problem with the "drive" part of the Alcubierre drive. First of all, it still needed negative energy to work, so that bummer remains. But worse, Bobrick and Martre reaffirmed a basic understanding of relativity and saw that there was no way to accelerate an Alcubierre drive past light speed. Sure, you could just assume that you started with something moving faster than light, and the Alcubierre drive with its negative energy shell would make sense. But crossing the speed of light barrier was still prohibited.
So, in the end, the Star Trek version of the warp drive is still not a thing. I know this may bum you out if you were hoping to build that version of the Enterprise sometime soon (as I was). But don't be too despondent. The Bobrick and Martre paper really did make headway. As the authors put it in the end:
"One of the main conclusions of our study is that warp drives are simpler and much less mysterious objects than the broader literature has suggested"
That really is progress.
The Black Death wasn't the only plague in the 1300s.
- In a unique study, researchers have determined how many people in medieval England had bunions
- A fashion trend towards pointed toe shoes made the affliction common.
- Even monks got in on the trend, much to their discomfort later in life.
Late Medieval England had its share of problems. The Wars of Roses raged, the Black Death killed off large parts of the population, and passing ruffians could say "Ni" at will to old ladies.
To make matters worse, a first of its kind study published in the International Journal of Paleopathology has demonstrated that much of the population suffered from another plague — a plague of bunions likely caused by a ridiculous medieval fashion trend.
If the shoe fits, it won't cause bunions
The outlines of a leather shoe from the King's Ditch, Cambridge. It is easy to see how these shoes might be constricting. Copyright Cambridge Archaeological Unit.
The bunion, known to medicine as "hallux valgus," is a deformity of the joint connecting the big toe to the rest of the foot. It is painful and can cause other issues including poor balance. The condition is associated with having worn constrictive shoes for a long period of time as well as genetic factors. Today, it is often caused by wearing high heeled shoes.
The medieval English didn't care for high heeled shoes as much as modern fashionistas, but there was a major fashion trend toward shoes with long, pointed toes called "poulaines" or "crakows" for their supposed place of origin, Krakow, Poland.
This trend, already silly-looking to a modern observer, got out of hand in a hurry. According to some records, the points on nobleman's shoes could be so long as to require tying them to the leg with string so the wearer could walk. At one point, King Edward IV had to ban commoners from wearing points longer than two inches. A couple years later, he saw fit to ban the shoes altogether.
But, just knowing that people back in the day made poor fashion choices doesn't prove they suffered for it. That is where digging up old skeletons to look at their feet comes in.
Beauty is pain: the price of high medieval fashion
To learn how bad the bunion epidemic was, the researchers looked to four burial sites in and around Cambridge. One was a rural cemetery where poor peasants were buried. Another was the All Saints by the Castle parish, which had a mixed collection of people that tended toward poverty. The Hospital of St. John's burial ground contained both the poor charges of a charity hospital and wealthy benefactors. Lastly, they considered the cemetery of a local Augustinian friary, home to monks and well-to-do philanthropists.
The team considered 177 adult skeletons that were at least a quarter complete and still had enough of their feet to make studying them possible. The remains were classified by age and sex by observation and DNA testing. Each was examined for evidence of bunions and signs of complications from the condition, such as falling.
Those buried in the monastery's graveyard were the most affected. Nearly half, 43 percent, of the remains found there had bunions. This includes five of the eleven members of the clergy they found. Twenty-three percent of those laid to rest at the Hospital of St. John had bunions, though only 10 percent of those at the All Saints by the Castle parish graveyard did.
The rural cemetery had a much lower rate of instances, only three percent, suggesting that these peasants were able to avoid at least one plague.
Overall, eighteen percent of the individuals examined had bunions, with men more likely to have them than women. Those at cemeteries known for exclusivity were more likely to have them as well, though it is clear that the condition also affected members of other classes. This makes sense, as it is known that these shoes had mass appeal.
The authors note that the rural cemetery having fewer cases is partly because that cemetery "went out of use prior to the wide adoption of pointed shoes, and it is likely that those residing in the parish predominately wore soft leather shoes, or possibly went barefoot."
Those skeletons with evidence of bunions were more likely to have fractures indicative of a fall. This was more common on those estimated or recorded as having lived past age 45.
In our much more enlightened times, 23 percent of the population currently endures having bunions, most of them women, and one of the leading culprits behind this is the high heeled shoe.
Some things never change.
Being mortal makes life so much sweeter.
- Since the beginning of time, humans have fantasized over and quested for "eternal life."
- Lobsters and a kind of jellyfish offer us clues about what immortality might look like in the natural world.
- Evolution does not lend itself easily to longevity, and philosophy might suggest that life is more precious without immortality.
One of the oldest pieces of epic literature we have is known as the Epic of Gilgamesh. It's easy to get lost in all the ancient mythology — talking animals and heroic battles — but at its heart lies one of the most fundamental and universal quests of all time: the search for immortality. It's all about Gilgamesh wanting to live forever.
From Mesopotamian poetry to Indiana Jones and the Last Crusade, from golden apples to the philosopher's stone, humans, everywhere, have wanted and sought after eternal life.
And yet, perhaps the secret to immortality is not as elusive as we might think. Rather than holy objects or science fiction, we need only look to the animal world to see how nature, that most magical of places, might be able to answer one of the oldest questions there is.
If you ever find yourself at Red Lobster or about to munch into a lobster roll, take a moment to consider that you might just be eating a clue to perpetual youth. To see why, we have to know a tiny bit about aging.
As you get older, it's impossible not to notice how everything creaks a little more, how easy jobs now require great effort, and how hangovers are no longer a laughing matter. Our bodies are designed to degrade and wear away. This deterioration, known as "senescence" in biology, occurs at the cellular level. It's when the cells in our body stop dividing, yet remain in our body, active and alive. We need our cells to divide so that we can grow and repair. For instance, when we cut ourselves or lift weights in the gym, it is cell division that replaces and rebuilds the damage done. But, over time, our cells just stop dividing. They stay around to do the best they can, but like the macroscopic humans they make up, cells get slower and more error-prone — and so, we age.
But not lobsters. In normal cases of cell division, the shields at the end of our chromosomes — called telomeres — are remade a bit smaller, and so a bit less effective after each subsequent cell division at protecting our DNA. When this reaches a certain point, the cell enters senescence and will stop dividing. It won't self-destruct but will just carry on and wallow as it is. Lobsters, though, have a special enzyme (unsurprisingly, called telomerase) which makes sure that their cells' telomeres remain as long and brilliant as they've always been. Their cells will never enter senescence, and so a lobster just won't age.
However, what evolution giveth with one hand, it taketh with another. As crustaceans, their skeleton is on the outside, and having a constantly growing body means they are always outgrowing their exoskeletal homes. They need to abandon their old shells and regrow a new one all the time. This, of course, requires huge reserves of energy, and as the lobster reaches a certain size, it simply cannot consume enough calories to build the shell equivalent of a mansion. Lobsters do not die from old age but exhaustion (as well as disease and New England fisherman).
The jellyfish that reverses its life cycle
Although lobsters might not have perfected immortality, perhaps there's something to learn.
But there's another animal that does even better than the lobster, and it's the only creature recognized to be properly immortal. That's the jellyfish known as Turritopsis dohrnii. These jellyfish are tiny — about the size of a fly at their biggest — but they've mastered one ridiculous trick: they can reverse their life cycle.
An embryonic jellyfish starts as a fertilized egg before hooking onto some kind of surface to then grow up. In this stage, they will stretch out to look like any other jellyfish. Eventually, they will break away from this surface to become a mature, fully developed jellyfish, which is in turn ready to reproduce. So far, so normal.
Yet Turritopsis dohrnii does something remarkable. When things get tough — like the environment becomes hostile or there's a conspicuous absence of food — they can change back to one of the earlier stages in their lifecycle. It's like a frog becoming a tadpole or a fly becoming a maggot. It's the human equivalent of a mature adult saying, "Right, I've had enough of this job, that mortgage, this stress, and that anxiety, so I'm going to turn back into a toddler.". Or, it's like an old man deciding to become a fetus again, for one more round.
Obviously, a fingernail sized jellyfish is not immortal as we'd probably want the word to mean. They're as squishable and digestible as any animal. But, their ability to change back to earlier forms of life, ones which are better adapted to certain environments or where there are fewer food sources, means that they could, in theory, go on forever.
Why do we want to live forever?
Although the quest for immortality is as old as humanity itself, it's surprisingly hard to find across the diverse natural world. Truth be told, evolution doesn't care about how long we live, so long as we live long enough to pass on our genes and to make sure our children are vaguely looked after. Anything more than that is redundant, and evolution doesn't have much time for needless longevity.
The more philosophical question, though, is why do we want to live forever? We're all prone to existential anguish, and we all, at least some of the time, fear death. We don't want to leave our loved ones behind, we want to finish our projects, and we much prefer the known life to an unknown afterlife. Yet, death serves a purpose. As the German philosopher Martin Heidegger argued, death is what gives meaning to life.
Having the end makes the journey worthwhile. It's fair to say that playing a game is only fun because it doesn't go on forever, a play will always need its curtain call, and a word only makes sense at its last letter. As philosophy and religion has repeated throughout the ages: memento mori, or "remember you'll die."
Being mortal in this world makes life so much sweeter, which is surely why lobsters and tiny jellyfish have such ennui.Jonny Thomson teaches philosophy in Oxford. He runs a popular Instagram account called Mini Philosophy (@philosophyminis). His first book is Mini Philosophy: A Small Book of Big Ideas
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