Digital health perspectives: David Shaywitz
In our health technology themed month, Rebecca Aris speaks with David Shaywitz on the future of digital health.
David Shaywitz, a physician-scientist, works in strategic and commercial planning at a small public drug development company in the Bay area, where he also leads a project team for a clinical stage asset. Having immersed himself in the culture of technological innovation he is tremendously excited about how it might be applied to healthcare. He appreciates the opportunity to advise both recent start-ups trying to develop the technology as well as larger organisations trying to figure out what to do with it.
David has co-founded the Centre for Assessment Technology in Continuous Health, (CATCH), an innovative digital health initiative at MGH and MIT, and is also actively involved in UCSF's Clinical and Translational Science Institute (CTSI), particularly the digital health track led by Doctor Aenor Sawyer.
Here he shares with pharmaphorum his thoughts on digital health and what he hopes the future will look like in this space.
Interview summary
RA: With the rise of consumer health devices do you think we're actually seeing a change in people's health habits?
DS: We're certainly seeing an explosion of consumer devices that are aimed at making the pursuit of healthy activities more fun and engaging. This includes things like activity monitors, or apps that try to motivate behaviour change by rewarding micro achievements and a huge number of companies in the behaviour space – for example, companies like Retrofit which is a weight-loss programme that uses the internet as a modality. On the other hand, while behaviour change is certainly the Holy Grail, it's incredibly hard to achieve durable, measurable improvements in health.
Not only is such behaviour change incredibly difficult, it's also where a lot of the opportunity is. I'm certainly watching closely the effort of some smart young companies like Omada Health, which is trying to use some of the technology of digital health combined with more traditional methodologies to help real patients achieve better control and measureable improvements in their care of diabetes; I trained as an endocrinologist, so I especially appreciate the unmet need here.
Some people who are drawn to consumer health devices are people who are already motivated to be fit. But to what extent can you start to bring in additional people, aside from the early adopters or true believers? And beyond who you can attract, the real question is to what extent will any of these digital health applications really lead to durable improvements in health? That's really where a lot of the most important work is going.
"I'm far more excited by the opportunities that having a more granular understanding of patients can lead to. "
RA: You've discussed in your book there's an increased academic activity in digital health, can you share some examples of this and tell me why you think we're seeing such growth in this space?
DS: I'm just tremendously excited by the academic efforts, because I have tremendous belief in the transformative power of what Judah Folkman called inquisitive physicians, and that's what academic centres are chock full of, doctors who are passionate and curious, and continuously searching for better ways to improve care. This is important for digital health for two reasons: first as MIT professor, Eric Von Hippel has emphasised, 'field discovery' is an incredibly important driver of innovation. If you want to improve health it's important to speak with the folks who are actually doing the hands-on work, and I think the UCSF digital health initiative led by Aenor Sawyer has done a tremendous job of broadly empowering frontline docs.
There's also a real need to robustify digital health, to explore the technology rigorously and to develop technologies further. And this has been a central goal of the MGH/MIT CATCH programme of which I am a co-founder. Two common features of both the UCSF and the Harvard programmes are, first, they both recognise the value of iteration and of evolving ideas over time and through trial and error, which is a key aspect of innovation. Second, both programmes, to their credit, are seeking to work with a wide range of stakeholders, including those in the private sector, which I think is not just innovative but also an essential way for academic health centres to begin to think. Collectively, we're trying to solve really hard problems, and it's critical to bring to bear the very best minds, wherever they're located.
RA: What do you think it would take to see pharma really embrace digital health?
DS: There is so much for pharma to learn from Silicon Valley, both culturally in terms of how to think about entrepreneurship and innovation, and specifically regarding digital health, which collectively offers a set of approaches that provide a far greater understanding of patient experience in illness, and also offers increased opportunities to provide therapeutic benefit.
We have to remember that drug development, even in areas like oncology, is increasingly going to be focused and defined by the discrete benefit provided to patients. There's a great New England Journal of Medicine commentary by a North Carolina oncologist, Ethan Basch that makes the point eloquently, that talks about the importance of patient-focused drug development specifically in areas such as oncology. The technologies of digital health will be enormously empowering for this.
A lot of the initial focus of digital health has been in areas such as healthcare process improvement. That has been an almost exclusive focus of some companies – incrementally improving medicine through a succession of tweaks. I'm far more excited by the opportunities that having a more granular understanding of patients can lead to. I think it can lead to profound breakthroughs by being able to break down seemingly complex illness into perhaps a variety of different sub-categories that may have very different molecular drivers or respond differently to therapies. Phenotype is the new genotype, and integrating the two promises to be exceptionally powerful.
"...I think that the space is still awaiting its first real breakout success."
RA: In April you wrote an article in Forbes that 'digital health is finally being taken seriously by investors', can you please expand on this?
DS: Absolutely. Rock Health, the digital health accelerator in San Francisco has reported that digital health is garnering increasing amounts of money and interest. But what I found most striking is not just the amount of dollars, but also the diversity of investors who are coming to this field. These include blue chip VCs like Sequoia and Venrock, healthcare VCs like Aberdare, tech VCs like Emergent Capital, Social+Capital, and Khosla Ventures, and strategic investors from a range of industries, including pharma such as Merck, telecoms such as Qualcomm, and payers such as Blue Cross Blue Shield. At the same time I characterise a lot of this interest as still relatively cautious and exploratory, and I think that the space is still awaiting its first real breakout success. But I also think that once this happens, that serious investments will soon follow.
RA: Finally then what do you think the digital health space is going to look like in the future?
DS: My real goal would be that the term digital health will become obsolete, and that instead of talking about the technologies of digital health, the approaches and particularly the mindset will become enfolded into the way we instinctively think about health and the caring for patients.
RA: Great, David thank you very much for your time.
About the interviewee:
David trained as a physician-scientist and management consultant, he is a strategist and product developer at a San Francisco-based biopharmaceutical company, and is passionate about entreprenurial innovation in medicine. David is also co-author of "Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare With Technology?", 2013.
Closing thought: When will the term 'digital health' become obsolete?
