Personalized Medicine Preview: Customized App Prescription

MattisonTamoxifen effectively works to treat breast cancer in some patients, but it’s ineffective in others. We know this from genetic testing. Rewards effectively encourage behavior change in some people, but they don’t have any influence on others. We know this from everyday experience. In both cases understanding what works for whom is critical to delivering the right care.

One is a powerful cancer drug and one is a psychological incentive, but each is used to strike at the root of illness. The prevalence of conditions like obesity, diabetes, heart disease and stroke is on the rise, but many of these cases could be prevented through lifestyle choices. A 2012 Urban Institute report said that a 1% reduction of avoidable chronic illness among members of the California Public Employees Retirement System would save the state $3.6 million per year. The institute suggested that a 5% to 15% reduction is achievable, but that outcome depends on how well-designed and targeted the interventions are.

The Personalized Medicine World Conference 2013 will be held in Mountain View next week, and along with talk of personalized treatments will be talk of personalized prevention. John Mattison, MD, chief medical informatics officer of Kaiser Permanente, Southern California, will be there to discuss what he calls the behavioral symphony for wellness.

“What I see as the behavioral symphony for wellness is using whatever means we have available to us to reinforce healthy habits, healthy lifestyles and healthy decisions,” Mattison said. One of the best means for continuous reinforcement is a smartphone, which millions have on them at all times.

There are thousands of available applications geared toward helping people live healthier lives. Many of them use tactics that encourage behavior change. Of them, some are pretty good. Others might even work great, depending on who is using them. And still more could prove to be helpful when used a certain way. Through his involvement with the Open mHealth Initiative, where Mattison serves on the advisory board, he works to sort the clinically effective from the clinically ineffective apps, relative to a patient.

The Open mHealth Initiative is a nonprofit that aims to build the framework for open mobile health software. The organization will soon begin a pilot that studies the psychology behind which apps affect outcomes for which individuals. The hope is that understanding the way people respond to information and cues will ultimately allow doctors to prescribe apps as part of a patient’s care plan.

“Some people, for example, want to get a just a very simple clear directive: do x, y and z three times a day,” Mattison said. “Other people want to have a set of options. And other people want to have an extensive analysis of what the options are, and what the tradeoffs are.”

Also to consider is the best modality for presenting and reinforcing information. Some people respond better to Facebook than they do to text messages, while others rely on personal face-to-face support from friends and family.

Mattison doesn’t think doctors will begin prescribing health apps immediately. Before physicians are able to make those recommendations they need more evidence about what works and what doesn’t. Mattison said that in the meantime apps must become interoperable in order to truly affect the disease they’re targeting. That’s because people with chronic conditions commonly suffer from at least one other condition. Mattison pointed to a portion of diabetic patients who have difficulty achieving a low Hemoglobin A1c result.

“If you look at that population, a very high percentage of them have clinical depression. There’s good literature showing that you cannot get better control of your diabetes until you effectively address the depression,” he said. These health problems are difficult to confront with apps given their current lack of interoperability. A depression app targets depression, and a diabetes app targets diabetes, but the two don’t share information.

Mobile apps aren’t the be-all end-all solution to chronic illness, Mattison said. But they can play a role in echoing healthy information and advice from a patient’s doctor and support network. “We’re starting to see at least the recognition that we need to tackle this on all fronts,” he said.

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