A Note of Caution on mHealth: Q&A with NIH's Robert Kaplan
Robert Kaplan, PhD, the director of the Office of Behavioral and Social Sciences at the National Institutes of Health was a recent keynote speaker at the mHealth Summit that focused on new mobile technologies for tracking and potentially improving health behaviors. NewPublicHealth spoke with Dr. Kaplan about these early days of the mHealth industry and research needed to support the field.
NewPublicHealth: What's the contribution of mHealth to thestudy of health outcomes?
Robert Kaplan: It allows us to bring the laboratory to people. For a lot of years we have had to study people under laboratory conditions. Mobile technology can let us study people in the environments in which they live. For example, a simple question such as, on average, how much pain have you experienced over the last thirty days, requires memory over thirty days and we expect them to remember equally across those days and then ask them to average that. We think responses to that question are not meaningful. But, with a little electronic device, people can be asked how much pain they’re experiencing right then, at predetermined or random intervals over 30 days, and that would be more meaningful data.
Other uses include epidemiologic studies. We often ask people to recall what they ate over the last 24 hours. If I had to do that, my recall of what I ate and portion size would not be that accurate. Now people can use a cell phone to photograph their various meals, which are then analyzed for protein, calories, carbohydrates and fat. It’s not as good as it will be, but it can store the data and give a history that shows what a person is eating and how that might impact their health. Other uses of mHealth technology include satellite technology that tells us how much people move as they travel around their community, which helps estimate whether certain parks are designed for more physical activities that others.
NPH: Are you concerned about overpromise when it comes to mHealth?
Robert Kaplan: This is our biggest concern for two reasons. We don’t have much evidence yet that these devices result in better health outcomes. In order to be persuaded, we have to have studies and most of those studies have not been done yet. When I was at the recent mHealth conference, very few of the vendors had evidence. Those that did, the evidence weren’t persuasive from a scientific perspective. We think we have a very long way to go in systematically documenting the results.
Our second concern is that many of these devices are built on the assumption that more care is better. A lot of the devices are reminders to go out and use more health care and that by itself may result in increased cost but not better outcomes.
NPH: Some vendors say they choose venture capital funding instead of grants because the grant requirements are too cumbersome. How would you respond?
Robert Kaplan: The NIH in good faith has tried to shorten that interval. But in order to have all the levels of objectivity we have for NIH reviews, it does take time. Very good minds have addressed this issue and are still thinking about it.
NPH: Do you think there might be shared space between NIH and industry on these reviews?
Robert Kaplan: We’re always interested in those relationships and are hoping to do some public-private initiatives in this area, but we are governed by statute and it’s difficult to change without a public review. And, importantly, our objectives are different from those of the venture capitalists, who want to invest because they think they will make a profit. We are just interested in how they will affect the health of the population.
At this stage, the electronics industry is different from the pharmaceutical industry. In that industry, companies have come to appreciate the value of developing objective evidence and we don’t have a parallel track in electronics right now. There they see research as significant to their marketing, but what they don’t appreciate is that we really need to go through our objective scientific review to see if there is real evidence of outcomes.