August 2009 - Creative Connectivity

Chip Jenga – Playing with Scotland’s Health

Every August I spend a couple of weeks at the Edinburgh Festival, taking in the best Arts festival in the world. There’s not much to learn about healthcare amongst the 2,000 different productions, but it’s an interesting opportunity to look around the City to see how healthcare initiatives in Scotland are developing.

Scotland is an interesting country in terms of health, as it contains a number of anomalies. At one end of the spectrum it boasts some of the best examples of Telecare and Assisted Living practice anywhere in the world. In the middle are some excellent preventative initiatives. And at the other end it has issues with lifestyle and diet that are propelling its population towards an increasingly unhealthy future

The issue of diet is a long-standing one that starts at an early age. Whereas England is embracing chefs like Jamie Oliver who are leading high profile campaigns to improve the quality of school meals, Scotland largely ignores them. If you’re in Scotland at lunch time, you’ll see queues of school kids outside the local chippies and bakers downing their daily intake of carbohydrates as they start on the route to weight related health problems. For most, lunchtime means a trip to the local obesiary, which is typically Greggs – the chain of bakers who feed a large percentage of the population.

Usability through Dance

It’s August, so I’m doing what I do every year and spending a couple of weeks at the Edinburgh Festival, seeing as many shows as I can manage. It’s rare to see much that says anything about technology or design, but this year I was blown away by a show that should be compulsory viewing for anyone concerned with product design. Even more surprising is the fact that it was a dance piece.

ME (Mobile/Evolution), written and performed by Claire Cunnigham is about crutches. Since a bicycle accident at the age of fourteen she has been using crutches. Four years ago she took up dance and since then has rapidly gained fame as a disabled performer. I should add that, having seen her, the adjective disabled seems utterly inappropriate, as what she manages to do far surpasses most people’s physical capabilities.

FDA – mHealth’s Angel or Demon?

In the rush to get a chunk of Obama’s healthcare billions, any industry with the slightest idea about remote healthcare is doing their best to claim that they are the rightful recipient of the cash. The latest of these is the CTIA, who recently held a policy forum featuring medical experts and government officials. In it they touted the promise of mobile health applications that would drive down costs and improve the quality of care. They admitted that they didn’t have a policy yet, but they certainly want a chunk of the action for their members when the $19 billion dollar treasure chest is opened. They’re not alone, but amongst all of the feverish lobbying going on in Washington there seems to be a total neglect of the role of the FDA. Instead there’s a general opinion that a good PowerPoint and drinks for enough politicians will overrule any regulatory requirements.

mHealth has been (and still is) a long time in coming. There’s a whole host of reasons for that. It’s trying to grow up in a room full of 800 pound gorillas, amongst them technology, resistance from the medical profession and a lack of standards. But hiding behind the visible 800 pounders is the big brother of invisible gorillas – the Food and Drugs Administration, fondly know as the FDA.

The FDA is responsible for regulating medical devices and services in the U.S. If they say a product or service can’t be offered, then it’s effectively dead. It provides a barrier to entry for manufacturers and services in the medical and health arena. So far, it’s had little to say about many of the visions of the mHealth industry, but there is no doubt that it will. I recently saw a presentation that outlines just how wide its powers and scope are. And they are wide. If the FDA enforced the most aggressive interpretation of its rules it could probably stop sales of the iPhone today.

I’m sure it won’t. This isn’t a rant against the FDA, but about the relative naivety of many of the organisations claiming to offer solutions in their quest for a part of the new healthcare pot. The future of mHealth would be far better served if organisations like the CTIA concentrated less on the high level fanfares and started engaging in informed debate about how the regulatory regime needs to change.