This piece also ran today in Healthcare IT News.
We all like to think we are one-of-a-kind, but the truth is, not so much. In the past month I have found myself among the (estimated) <5% of women who attended the JP Morgan conference, the <10% of women who are partners in private equity firms, and, apparently, one of the 100% of working people who play Scrabble-related games during working hours, but today I find myself one of the 35%. According to a new a Pew Research Center survey of about 3,000 people, released today, about 35% of Americans are “online diagnosers,” meaning people who consult the Internet to self-diagnose a medical condition. See related article HERE.
Not looking for sympathy, seriously, I am feeling sorry enough for myself to cover all of us; but I found myself, after weeks of media hysteria and the most congested head on earth, reading this article entitled How to Tell If You Have the Flu. I read this as I helped the Kimberly Clark Corporation have a record quarter due to extreme Kleenex consumption. Here is a tip: go out and buy Kimberly Clark stock as I think this may last a while. Incidentally, according to Kimberly Clark, I am thus one of the 25% of people worldwide who use their products every day. I guess I am in good company.
I think the idea that 35% of Americans are attempting to self-diagnose in order to determine if they should go to the doctor is very interesting. Of course it is free to do this–doesn’t cost the patient anything–so why not? And the Pew study found that 53% of those who sought Internet self-diagnoses went to a clinician for follow-up; incidentally, 41% of these had their self-diagnosis confirmed by said clinician, so the online-diagnosers are doing well below average.
The quest for home diagnostics has been a long and fruitful one for the medical industry (and venture industry) and has become the sine qua non of the mobile health movement. As I have written in the past, Qualcomm has sponsored a whole Tricorder XPrize ($10mm prize) based on this premise and there are at least 719,578 companies who have come through my office promising to use cell phones to diagnose everything from diabetes to cancer to sexually transmitted diseases (not mine). My trip to Russia, previously reported in great detail, was focused very much on this topic, as that country has the kind of lack of consistent access to healthcare that we Americans only fear we could have, so taking care of yourself at home isn’t just convenient, it’s essential.
But as I look at the Pew data I wonder: is it true that 47% of office or ER visits were avoided by those 35% of people who self-diagnosed due to information on the Internet? Or that the right visits were avoided? Very hard to say. Is there money to be saved as a result of this information being available to patients and how will we ever know?
Deloitte just published a report stating that “Mobile technology will transform the healthcare industry with increased productivity gains saving $305 billion over the next 10 years.” Now 66% of this savings was associated with tele-monitoring/tele-medicine technologies, not self-diagnostics (in fact the opposite of self-diagnostics), but theoretically some portion of the rest comes from some form of patient empowerment/engagement that takes cost out of the system, at least in theory.
This is a very nice idea and I sincerely hope it to be true, but access to self-diagnostic tools could just as easily drive up costs as reduce them. In the medical device diagnostics world we have seen exactly this correlation: make it easier and cheaper for diagnostics to be used and you get a lot more patients getting screened for whatever illness du jour, real or imagined. Always the question must be asked, “Who Pays?”
Some of my fellow healthcare venture capitalists (no surprise I am referring to Vinod Khosla) have posited that 80% of doctors will be all but obsolete in the next few years, going the way of the rotary phone and the brontosaurus as machines take over. On the other hand, others of my colleagues (you know who you are and many of you are the potential brontosauri) have said they will believe that when Mr. Khosla is doing his own home colonoscopy. I have to tell you, I’m a big doctor’s office fan when it comes to colonoscopies—I just don’t have a convenient home location to perform one.
As usual, somewhere in the middle lies the truth and we are going to need real studies of outcome and efficacy before we should believe savings estimates thrown around by so many. The level of economic data that accompanies most pitches about mobile health products is akin to the level of leafy green vegetables one consumes at Wendy’s, home of the Triple Baconator, so we are going to need to do better to justify pouring diagnostics into the home. If we don’t we risk seeing the same hockey stick line that accompanied the wide-spread use of ultrasound, MRI and other diagnostic imaging modalities, not to mention all of the other diagnostic tests done at a patient’s insistence, even when the doctor knows it to be unnecessary.
Ps—it’s a cold, not the flu, or so the Huffington Post tells me. So I didn’t go to the doctor. So I hope I’m right…and yes I had a flu shot and I hope you did too.
Pps–great article about applying “big data” to Scrabble HERE.