Bad Blood: Trusting Numbers with a Grain of Salt

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Bad Blood: Trusting Numbers with a Grain of Salt by Amy Lai Digital health may be well on its way toward becoming the next “it” trend in technology. Over the past few years, the presence of consumer health technology companies has boomed. In 2010, digital health companies received roughly $1 billion in total investment funding, a less than hefty amount compared to other sectors (1). However, fast-forward just 6 years later, and that investment has jumped by nearly 810% (1). That’s right. In 2016, digital health companies received nearly $8.1 billion in investment funding (1), with significant investments in wearable and biosensing technology (2)—a move that perhaps echoes the increasing promise of digital healthcare. Health investment categories Indeed, the time seems ripe for a long-overdue revolution of traditional healthcare. With an ever-growing pool of data about our lifestyles captured through our smartphones, social media accounts, and even online shopping preferences, coupled with rapid advances in computing power and recommendation systems, it seems like technology is at the cusp of transforming how we think, perceive, and quantify our health. And we’re just starting to see its effects…and consequences. Fitness trackers such as Fitbit and health-tracking apps like Apple Health Kit quantify an impressive range of our physical health. From our weight, to the number of steps we take, flights of stairs we climb, calories we burn, and to the duration and quality of our sleep, it appears that there are increasingly more tools to track nearly every aspect of our lives (3). Anyone else also slept for 7 hours, 18 minutes last night? As we curiously go through the colorful line graphs and bar charts that show our activity levels, have you ever wondered whether we can fully trust these metrics? How accurate are the numbers? If a fitness app recorded that you burned 100 calories when you actually burned 90, how upset would you be? Probably not too upset because mistakes happen. However, if you learned that a medical device determined that you had diabetes when you really didn’t, how distraught would you be now? Most likely more than a little distraught. Notice the difference? Depending on context, it appears that consumers have different expectations of health-related product efficacy and tend to place greater trust in certain types of products such as medical devices. Although somewhat anticlimactic, results from medical devices should warrant some skepticism as they can (and do) have measurement error that goes wrong…and in some cases, very wrong. Founded in 2003, Theranos was touted as a revolutionary breakthrough in the blood-testing market. The company reinvented how blood-testing worked by introducing a “proprietary technology” that purportedly could detect numerous medical conditions from high cholesterol to cancer using a finger pinprick that only needed 1/100 to 1/1,000 of the amount of blood required by current standard blood-testing procedures (4). Theranos seemed unstoppable. Valued at $10 billion, the company raised more than $700 million in venture capital and partnered with national pharmacy chains including Walgreens and Safeway to open testing clinics for consumers and patients (4). However, the company quickly unraveled as its product turned out to be nothing more than a facade. After probing by the US Food and Drug Administration, Securities and Exchange Commission, and Centers for Medicare and Medicaid Services, the “proprietary technology” was found to be underdeveloped and inaccurate, reporting erroneous blood-test results with marked error (4). Consumers worried about supposed new tumors while others celebrated their allegedly improved cardiac health by stopping medications (5). Theranos fooled us and we (just might have) helped them do that. Theranos Theranos teaches us a subtle yet important lesson about privacy as contextual integrity. Because consumers don’t often seem to question the efficacy of health-related products, it behooves corporate executives to scientifically and ethically validate their products. It’s important that such integrity plays a key role in organizational culture, and is embedded at all management levels to keep business leaders in-check and minimize consumer harm. Doing so helps prevent violations of consumer expectations and gives them a reason for continuing to place their trust in products. However, health-related products are not perfect and infallible. Because products inevitably have some margin of error, it also behooves consumers to understand that product metrics may not represent the whole truth and nothing but the truth. Those numbers aren’t likely to be wholly correct. It’s essential that we adopt a more realistic set of expectations about health-related products, as well as a healthier level of skepticism the next time we’re told we only burned 10 calories or only a few droplets of blood is needed to detect cancer. These shifts in the mindset and expectations of businesses and consumers may be needed to help keep both sides accountable to each other. References: 1. https://www.forbes.com/sites/forbestechcouncil/2017/05/05/why-digital-health-startups-have-yet-to-reach-unicorn-status/#3b5f23188cdb 2. https://rockhealth.com/reports/q1-2017-business-as-usual-for-digital-health/ 3. https://www.nytimes.com/2017/12/26/technology/big-tech-health-care.html 4. https://www.vanityfair.com/news/2016/09/elizabeth-holmes-theranos-exclusive 5. https://www.wsj.com/articles/the-patients-hurt-by-theranos-1476973026