Christina Farr was the first host of KQED Future of You, but today she’s better known as a technology and health reporter for CNBC, where she continues to break stories. She’s been covering digital health for years, and she’s one of the more influential media voices on this beat — in 2016, venture fund Rock Health named her digital health reporter of the year.
As Chrissy’s successor at this site, I thought it would be cool to get back to our roots and pick her brain on where digital health is going and where it’s been. I interviewed her at CNBC’s San Francisco office, located in skyscraping Salesforce Tower. Here’s our chat, edited for length and clarity.
First off, how should we define digital health?
People have attempted to come up with a good working definition, and sometimes it ends up sounding very vague, like “the intersection of health and technology.”
I think the term will forever be associated with wearables and telemedicine, and now AI and a couple of other trends. I don’t really see a problem with that, because it’s still connected with innovation in a lot of people’s minds.
What have been some of the successes in the digital health space?
I see a lot of potential in digital therapeutics. Companies like Propeller Health and Omada Health are studying the effect of apps that attempt to change behavior for purposes of disease prevention and management. Propeller Health, for example, is thinking about connected inhalers and how to combine them with data like the weather to figure out when a person with asthma should take medicine.
Virta Health is going after Type 2 diabetes reversal with a digital system that encourages a massive behavior change around diet, which it thinks could actually replace medicines.
AliveCor is a super-interesting company. They have a mobile EKG that a lot of doctors really like. I think it’s something that a lot of seniors will use when they find out they’re at risk for atrial fibrillation, because it means they can check on their heart from home and not have to go to the doctor every few months.
You mentioned wearables, like Fitbit and Apple Watch. How’s that business going?
I‘m really still quite bullish on wearables, and I think they have become mainstream. It’s not just millennials and the “worried well” that are using these devices; a lot of seniors love them. You’re also starting to see insurance companies think about partnering with companies like Apple, and the reason they’re doing that isn’t necessarily to get their already healthy populations to exercise more; it’s about getting to those really sick and costly people that have multiple chronic conditions.
Do you think investors in the digital health space are more circumspect after the Theranos debacle?
Some are. Others don’t necessarily want companies to invest the time into building a base of evidence before they start selling the product; these investors are looking for their money back in three to five years, like they would get with a consumer internet company.
It’s hard to find another company like Theranos, which put patients in danger. But in a lot of ways, Theranos is just the worst example. More companies are still failing to provide proper evidence. Often they say, “We’re wellness. We’re not making claims around disease, so we don’t need to bother.”
What’s the biggest disappointment of the digital health era to date?
This is going to be controversial, but I don’t think telemedicine has panned out to the extent people expected it would by this time. People thought it was going to revolutionize all health care. But I’m not seeing every physician say this is something they want to incorporate into their medical practice, because there’s a perception they’re not going to get paid as much.
Also pretty overhyped in terms of what we’re actually seeing out there: AI and big data. Diabetic retinopathy, for example, is an area where you see a lot of people investing in AI research. Could we take a pile of medical images that have been labeled as showing diabetic retinopathy or not, and then you train AI to do that job in triage?
There’s been some great results, but that does not mean we’re on the cusp of a robo eye doctor, because an actual eye doctor would need to know every single medical condition out there that could be affecting this person. I think we’ve been too quick to look at one disease and one use case and say, well, this is evidence that doctors will be replaced.
Do you think the Food and Drug Administration and other regulators can keep up with all this? And does the industry want them to keep up?
I think at the birth of this digital health movement, people thought of the FDA as the big bad wolf. The prevailing narrative was that it’s obstructing innovation. Now there seems to be more nuance around that; people recognize that the FDA does have an important role to play. Many of the digital therapeutics companies, for instance, see the FDA as a potential stamp of approval that sets them ahead of a mass of apps that are making false claims and essentially peddling snake oil.
So there needs to be a watchdog, but that’s not the FDA’s role. They’re not out there policing companies and investing time into looking through the app store and thinking, “This dermatology app doesn’t look quite right.”
As a result, you get this huge quality variation, and I do sometimes fear that doctors will start prescribing or patients will start using apps that are of lower quality. I think someone needs to step into that role in 2018 so we have a better way of figuring out which apps work and which don’t.
Last question: Occasionally you hear the complaint about digital health that these are primarily tools for young, rich people. Do you think that’s valid?
The true problems of health care, which are particularly an issue for underrepresented groups and minorities, are around how it’s paid for. We need massive payment reforms. There’s also a lack of investment around social determinants, things like social services and affordable housing, which improve outcomes. All of these problems are not going to be solved with an AI Band-Aid or by handing someone a Fitbit.
That said, I don’t think it’s fair to label this entire group of companies as purely helping the rich, wealthy, paranoid types who are just dying to live forever.
A lot of these companies are going after Medicaid populations, and that absolutely makes sense; that’s more than 12 million people in California alone. Even Apple, which hasn’t traditionally been a health care player, is working with Aetna on a study with Stanford about whether or not they can use the Apple Watch to detect afib. That’s not something a young or healthy person would necessarily worry about at all. It’s something that over-65, more vulnerable populations with a history of stroke are more at risk for. So you can see even Apple saying this is a tool that we expected would be mostly about consumer delight, but we’ve found that it can help save lives.