The Rapid Expansion of DTC Healthcare

Preventive care is recognized as the most effective strategy for health care cost reduction. Screening for early signs of heart disease, cancer, maintenance of diabetes and allergies and prevention of infectious diseases can be done without a supervising physician. Direct-to-consumer (DTC) laboratory testing allows individuals to order tests directly from a laboratory without going through their healthcare provider, and often at lower cost. The number of companies providing direct-to-consumer diagnostic testing is rapidly growing, along with the range of health information provided by these tests. Ancestry (genealogy) testing is an example. And so are new devices for cardiac monitoring. 

Experts anticipate a near-term explosion in the DTC marketplace. DTC healthcare already was a US$700 billion industry in 2020, including over-the-counter drugs. The Mark Cuban Cost Plus Drug Company, PBC (MCCPDC) is nearing one million customers. An analysis of 2011-1019 records from Rock Health Digital Database, showed that 252 (21%) of 1214 digital health companies pursued a direct-to-consumer strategy. The pandemic has accelerated this growth. According to research by Deloitte, the number of people using virtual healthcare rose from 15% to 19% from 2019 to early 2020, then jumped to 28% in April 2020. On average, 80% were likely to have another virtual visit, even post COVID-19 and said they will use this type of care again. Latest data showed that consumers’ appetite for virtual health and digital health tools continued to steadily increased, although there was significant variation in physician adoption. 

Human touch remains central to care delivery. In the 2022 Deloitte Survey of US Health Care Consumers, 70% of respondents who had a virtual visit in 2022 (vs. 67% in 2020) thought that the quality of virtual care was as good as in person, but only 73% (vs. 82% in 2020) thought they were able to connect with the clinician the same way they would in-person. Integration of data from patients' wearables and their self-reported outcomes into health records also experienced a setback. 

The global market for Direct-to-Consumer (DTC) testing was predicted to grow from $1.4 billion in 2020 to $2.6 billion by 2025. There were cautionary cases of uBiome and Theranos, there are quackery labs, but as the industry matures and moves toward utilization of clear clinical metrics, and as the capabilities of technology advance, DTC testing will me more and more impactful. There are DTC companies that offer the tests and biometric screenings that a physician would typically order as part of a routine annual physical, such as a complete blood count, comprehensive metabolic panel, urinalysis, and cardiovascular and diabetes risk assessment. Ultalabs, JasonHealth, discounted labs, drsays and privatemdlabs all allow to self-order laboratory tests and Quest and Labcorps locations. 

No more uncomfortable questions for a blood test prescription. No doctor visit needed to gettest results - they will be emailed instead. Consumers pay up front and know exactly what they are paying for. Unfortunately, the same cannot be said for many other healthcare services.

Genetic counseling for patients who are pursuing genetic testing in the absence of a medical indication, referred to as elective genomic testing (EGT), is becoming relatively common. More people are using technology to monitor their health, measure fitness, and order prescription refills. Before COVID-19, there was a slight decline in people who were willing to share their health data—but during the pandemic, new data showed that people are more comfortable sharing data during a crisis

REFERENCES

Cohen AB, Mathews SC, Dorsey ER, Bates DW, Safavi K. Direct-to-consumer digital health. The Lancet Digital Health. 2020 Apr 1;2(4):e163-5.

Stoffel M, Greene DN, Beal SG, Foley P, Killeen AA, Shafi H, Terrazas E. Direct-to-Consumer Testing for Routine Purposes. Clinical Chemistry. 2022 Sep;68(9):1121-7.

2022 Global health care sector outlook | Deloitte

deloitte-nl-healthcare-consumer-centered-future-of-health.pdf

https://www.beckershospitalreview.com/lab/lab-test-market-shifting-from-provider-driven-to-consumer-driven.html

The Curse of the Internet

It's hard to imagine our lives without the

Internet  - either mobile or desktop.

The Internet has become a catalyst of innovation, an essential tool in business and social life. It brought new levels of participation and access to knowledge. It enabled new forms of interaction, albeit mostly utilized for entertainment purposes (as in the famous answer of a Reddit user to a now deleted question captured in the figure on the right).

But despite all the advantages and conveniences, does the Internet really serve us or is it the other way around?

Internet companies, large and small, are quietly but forcefully collecting our life's data hoping to have us "on the leash."

If people want to use a web service, the service gets away with almost anything. Google knows about our friendships, content of gmail and google voice conversations. They see the places we go or want to go on maps and how we spend time on millions of websites. Amazon knows about our tastes and interests, phone carriers have nearly minute-by-minute accounts of months and years of our lives, credit card companies are building our psychographic profiles. Target stores can figure out their customers' health conditions before they do... and if you think other companies are better protecting sensitive information (remember the giant data breach?), think again.

Discovered this week, major security flow dubbed "Heartbleed" had existed for over two years. The defect in encryption technology used by many websites and networking equipment makers have put millions of passwords and other sensitive information at risk. Just another reminder of why you should scrutinize the security on the Internet and other web-connected gadgetry.

Vulnerabilities can be found everywhere. The network of a big oil company was hacked through the online menu of a Chinese restaurant popular with employees. Target was breached through its heating and cooling system. Printers, thermostats, videoconferencing equipment, household items, even vending machines and gas pumps can be used to gain access to your data. And so can employees of the companies collecting data. Last year there were multiple cases when stolen patient identification information was used to file unauthorized income tax returns.

Recently published SANS healthcare cyberthreat report reveals that health care networks (hospitals, insurance carriers, pharmaceutical companies, web sites, software and devices) - have been and continue to be compromised by successful cybercriminal attacks. Health networks seem to have the weakest Internet security among sites dealing with sensitive information, often not addressing very basic issues, vulnerable to off-line password guessing and user impersonation attack.

Trust is especially important in health care. As the days of blind trust that 'doctor knows best' are becoming a distant memory, new cases of security breaches can lower the trust further discouraging use of digital health services and disclosure of important medically relevant information.

At present, most digital health products and corporate wellness programs fail both companies and patients. There are many fundamental flaws responsible for that. And the lack of trust is not going to make it any more successful.

Paraphrasing Derek Thompson's passage about Facebook and Amazon, for the Internet of Things for Health and Wellness to succeed, we have to embrace a new version of intimacy that felt natural when the good old-fashioned country doctor made house calls. The machines have to know us. Will we let them?

REFERENCES

Pogue D (2014). The curse of the cloud. Scientific American, 310 (2) PMID: 24640327

Wu F, & Xu L (2013). Security analysis and Improvement of a Privacy Authentication Scheme for Telecare Medical Information Systems. Journal of medical systems, 37 (4) PMID: 23818249

The SANS-Norse Healthcare Cyberthreat Report: http://norse-corp.com/HealthcareReport2014.html

Close your eyes and tap your heels

How can you tell an extroverted engineer? When he talks to you, he looks at your shoes instead of his own. And now there is a good reason to do it - as new "No place like home" GPS shoes will be pointing to where the person is going. And displaying the progress bar - marking the beginning of the journey with one red light and indicating successful arrival to the place of destination with a green light on the top of the right toes. A red light on the other shoe will  display the correct direction to walk, illuminating on the circle of LEDs like an arrow of the compass. How will the shoes know where to go? By consulting the map uploaded via USB and its own GPS receivers, wirelessly communicating with each other. For future models, you could probably set up WiFi to let your shoes download more information, talk with other people's shoes and modify your route on the go.
So your footware might need its own network access, like agent Maxwell Smart's left shoe with a mobile subscription plan.
The "No place like home" shoes are built around two microcontrollers called Arduinos: A magnet in the right shoe and sensor in the left shoe communicate with each other and with the GPS antenna in the red tag at the back. Clicking the heels starts the GPS. So all you need to do is to close your eyes and tap your heels together. And there will be no need to follow the yellow brick road or say the magic words.

The smart shoes - designed by artist Dominic Wilcox and custom-made by Stamp Shoes might be a bit costly: £1,100 (about $1,750). A bit less sophisticated Aetrex Navistar GPS shoes developed for sufferers of Altzheimer's disease and dementia cost $299.99, and come with two monthly subscription plans - a basic 30 minute tracking plan, which reports every 30 minutes ($34.99) and for an additional $5 per month a premier 10 minute tracking plan. Nike was offering their own GPS footware too, for fitness enthusiasts, but decided that it's cheaper to use iPhone's location sensor to figure distance and serve as a pedometer.

Yet, sensors in high-tech shoes could be helpful. For example, they could detect if their owner is tired or exhausted. Fatigue Monitoring System (FAMOS, recently developed and tested in patients with multiple sclerosis (MS) and healthy individuals) continuously measures motions of feet, in addition to electrocardiogram, body-skin temperature and electromyogram. And the system can reliably distinguish the symptoms of fatigue. The shoe sensors could provide a wealth of information about motion and assess such things as the risk of falling. And this information can be combined with data collected through other channels.  Aurametrix, for example, can determine how food, air quality, the weather and various activities affect energy levels and generate suggestions on what to do - at the right time and right place. Systems like Aurametrix could eventually integrate our observations with data coming from smart objects such as shoes and heart monitors, to speed up not only walking but also the understanding of the human body, for a healthier world.

PUBLICATIONS

Yu F, Bilberg A, Stenager E, Rabotti C, Zhang B, & Mischi M (2012). A wireless body measurement system to study fatigue in multiple sclerosis. Physiological measurement, 33 (12), 2033-2048 PMID: 23151461

Marschollek, M., Rehwald, A., Wolf, K., Gietzelt, M., Nemitz, G., zu Schwabedissen, H., & Schulze, M. (2011). Sensors vs. experts - A performance comparison of sensor-based fall risk assessment vs. conventional assessment in a sample of geriatric patients BMC Medical Informatics and Decision Making, 11 (1) DOI: 10.1186/1472-6947-11-48