Thursday, June 30, 2011

Why Pharma should invest in delivering mHealth

There are at least two global industries that share the vision of a powerful, integrated and interoperable, person-based, digital health system — powered by the wireless explosion — that touches every person in rural areas and slums in the world (particularly the billions of people in developing countries). These are the wireless and the pharmaceutical industries.

It won’t just happen. Pharma needs to invest in the systems vision for mHealth.

Most people would not scratch their heads about that assertion regarding wireless. But pharma?

Yes, pharma.

As the Executive Director of the mHealth Alliance for the past two years, I focused on how to get mHealth designed and deployed in the most impactful way possible. One part of that mission was looking for those businesses that might help lead this transformation and why they might do so in their own business interests – not just for PR or charity. I became increasingly convinced that the pharmaceutical industry should benefit enormously from the success of mHealth in four ways, described below.

But it won’t just happen. The US is a perfect example of the horrible that happen with willy-nilly investment in digital technology. Pharma needs to invest in the systems vision. Concurrently, those of us seeking to improve health for disadvantaged people would do well to overcome whatever suspicions we might have about drug companies and seek some common ground.

The first area of major intersection between mHealth and pharma is supply chain. This is a terrible problem for public health providers. Drug stock-outs are absurdly common, even when the aggregate supply in a country is sufficient. For much of the developing world, companies don’t know where their products are flowing, or at what price (nor do public health leaders). Simple data tracking using mobile devices is already proving to be the solution for both sets of problems, for example, SMS for Life has had a major positive impact on stock-outs of anti-malarials in Tanzania.

Those of us seeking to improve health for disadvantaged people would do well to overcome whatever suspicions we might have about drug companies and seek some common ground

In the future, mHealth can be used to prevent corruption, the paying of bribes to get quality drugs that should be available, or overpaying. People will be able to check prices as well as pay by cell phone, thus taking cash out of the transaction, and reducing transaction costs and opportunities for corruption.

The second area is quality. Counterfeiting is an enormous and very dangerous health problem. Across the developing world, very high percentages of drugs are fake or adulterated. The US-based Center for Medicines in the Public Interest projected a few years ago that by the end of last year, US $75 billion worth of counterfeit drugs would be sold annually.

A recent report said that more than 13 key anti-malarials in Ghana were substandard or counterfeit.

Counterfeit drugs damage people’s health; they also harm corporate brands and reputations. A handful of innovative mHealth solutions are being adopted that allow providers and consumers to use their cell phones to find out immediately if a drug is genuine.

See and Both emerged from sub-Saharan Africa.
The third area where the pharmaceutical industry stands to benefit enormously from the success of mHealth is adherence. Both public health and drug company profits suffer because high percentages of patients do not comply with their drug regimens.

The following is one of thousands of articles written on the subject.

Some don’t fill the prescription initially; others don’t get refills. Some stop when they feel better. We don’t have the answers yet, but experts are excited about using the new wireless pathway to people to measure and improve compliance, both directly and through social networks and reminders. The key to figuring out what improves compliance is a lot of field tests and research, which are much easier to do if the fourth key interest of pharma in mHealth (an electronic record systems tracking all of a person’s health events and information) is in place.

The fourth area is usage. A core component of any digital/mHealth system has to be a record of who the patients are, what issues they have, what is done for them, and what the outcomes are – in other words, a personal, persistent, comprehensive electronic health record. A primary goal of mHealth initiatives is to get systems deployed at scale so that hundreds of millions of people in emerging economies have electronic health records (EHR), accessible to them and their providers through cell phones as well as computers.

Simple mHealth systems can have a major positive impact on the delivery of care by linking an EHR to relatively simple features like a calendar, reminder messages, patient interview/screening templates and checklists. In most developing countries, the absence of legacy health information technology systems means that these new systems could capture a patient’s record in its entirety, not merely the slices and dices available in the developed world from any single source.

The byproduct of this more efficient care system will be an enormous amount of extremely valuable data about health. And that will be end-to-end data about patients, unlike the US, where our entirely balkanized system (each doctor, lab and hospital have their own paper or electronic data silo on the patient) makes it difficult or impossible to get the full picture for one patient, much less millions. We will have to establish policies and systems to properly anonymize this data to protect privacy.

From a researcher’s point of view, whether they are an academic, a WHO specialist, or a pharmaceutical developer, this will create a gold mine of data on actions and outcomes that can be reviewed efficiently, effectively in real time. Very large test cohorts can be created cheaply and rapidly.

We are excited because this basic mHealth system will allow us to learn which interventions work and which don’t, and learn fast (e.g. how we can motivate people to take all their pills correctly). We will be able to establish systems of continuous improvement using our operations data – just like every other serious enterprise in the world. We won’t have to spend large amounts of additional money creating tests and special test data. Most importantly, we won’t have to wait years for analysis as we do today.

Pharma can piggy back on systems delivering care, and get appropriate usage and outcome data about patients

And pharma? They will get the same benefits. They spend large amounts of money to achieve equivalent results today: creating field trials, and buying usage data of various kinds from disparate sources. But here they can piggy back on systems delivering care, and get appropriate usage and outcome data about patients. (Obviously, policies and systems will have to be put in place to protect individual rights.) This is particularly important as the costs of research/trials are rising just as the need to replace blockbuster drugs with expiring patents becomes more acute.

In the future, I imagine pharma will be just one of several important business players in the digital health eco-system at the base of the pyramid. In the future, they will probably be happy to pay substantial sums to others for appropriate anonymized data for research, thus contributing to sustainable systems.

But today, if I were pharma, I would adopt a much more activist “make it happen” role to ensure that these integrated, interoperable systems are developed and deployed. Those of us who care about health at the base of the pyramid have some very good reasons to work with the pharmaceutical industry as one of the critical initial investors in these promising new technologies.


I wrote these comments at the request of SARPAM, a neat organization funded by the UK foreign aid agency focused on public health in Africa. Check out their website.

Monday, June 13, 2011

The New Economy Movement

Gar Alperovitz just wrote an interesting article in the June 13 issue of the Nation about how growth economics needs to be re-thought in the face of environmental crisis and distributional inequities.

Here is a link to the article.

This is worth reading as a survey of interesting experiments going on in the US. And there are some very interesting ideas here, e.g. new forms of measuring GDP that measure all the real costs of production, versus allowing many companies to export many of their costs onto society in the form of pollution, abuse of workers, etc. That would be worth funding, and then making a big deal issuing restatements of financials for large international companies every quarter based on this green, sustainable standard. “If you really paid the real costs of your business, you would have lost money” etc. This would infuriate some companies and get others to respond.

I find the article lacking in three important areas:

a. 1. It dismisses the incredibly powerful wealth creation engine of capitalism as if that argument is not worth having. I think it is worth having a serious discussion as to whether a combination of regulation to make production reflect its actual costs (e.g. taxing they type of energy used to cover the costs of global warming), and redistributional taxation (to eliminate inequalities, within countries and between countries), might capture the obvious wealth generation benefits of capitalism, while cutting its costs.

b. 2. It only implicitly talks about the elephant in the room: convincing the top half of Americans to live with less, and the bottom half not to aspire to more than that. I have helped establish and run worker-owned companies. Merely changing ownership doesn’t change motives. There is a fundamental value change that has to happen related to the sizes of our houses, cars and closets. How do we do begin that conversation?

c. 3. Most important, the article is entirely US-centric, and thus North/developed country-specific. It mentions a British group once in passing. A good socialist like Gar needs to remember the International. Seriously, how can we think about the developing world? The answer that poor villagers in India and Mali should be happy with Jeffersonian sustainable rural agriculture won’t fly. That pure capitalism has just delivered wireless communications into the hands of most people world wide might give us pause here. However, that happened in part due to a leap frog (over wired communications). In the same way that we are pursuing leapfrogging the western system in health for these countries, using the new information and communications technologies, maybe the absence of entrenched traditional corporate structures presents an emerging economy option to leap frog destructive, unsustainable practices (although India and China appear to say “no”).

Who are the serious people like Gar Alperovitz working on this for the developing world?