GoodBehavior: No Killer Apps in Health Information

No Killer Apps in Health Information

A B O U T_U S

The Center for the Advancement of Health translates to the public the latest research on prevention, chronic disease management and health care, with an emphasis on how social, behavioral and economic factors affect illness and well-being. The Center is an independent nonprofit corporation that receives core funding from the John D. and Catherine T. MacArthur Foundation and The Annenberg Foundation.

D I S C O N N E C T

Amid concern that bird flu could cause a deadly global epidemic, a recent study of health care providers in Toronto during the 2003 SARS outbreak found that many of them continued to work despite having symptoms of the highly contagious disease themselves. Of the 193 physicians surveyed by mail, 35 reported experiencing SARS-like symptoms and 21 of them continued to work. More than 50 percent of the Toronto SARS cases involved health care providers.

T O P_M E D I A_H I T S

An American Journal of Health Behavior study looking at the future sexual behavior of Cleveland area middle schoolers after they had an “abstinence-only” unit in school was picked up by the Cleveland Plain Dealer, the Akron Beacon Journal¸ the CDC Web site, the Blade newspapers (with a gay audience) and lifesitenews.com(with a “pro-life” audience.) The same journal’s article about smokers not visiting dentists as frequently as others was played in the New York Times, International Herald Tribune and Pittsburgh Post-Gazette.

I was at an international science and technology meeting recently in Kyoto and had breakfast with Rick Lazaridis, the inventor of the BlackBerry.

The BlackBerry is an extraordinary example of mass diffusion. Three years ago, he had 200 employees and no customers. Today he has three million subscribers for a device that works in all but two countries in the world.
Naturally, as the father of this new technology, Mr. Lazaridis waxed poetic about the potential of his BlackBerry and predicted, “Information is soon going to be more important than reality!”

The answer is summed up as “access.” Those who have access to all the information in the world will prosper and those who have not will not.

Now, I really appreciate the genius of the Blackberry. And I appreciate the reality of the commercial enterprise, which requires Mr. Lazaridis to pack every conceivable function – phone, Web, e-mail, TV, whatever – onto his elegant little device.

But I really don’t believe that information is ever going to be more important than reality, because the BlackBerry is only a device, a little computer. It will only ever be one of the tools we use to communicate with one another, to send and receive information. It will never be the only one. The health care needs of human beings are too varied, our preferences too strong, our abilities too diverse for one mode of information to suffice.

At the same meeting, Dan Goldin, the former NASA administrator, cautioned, “We must at all cost avoid the zero-point solution. I learned that in spades with the Space Shuttle. You always need redundant, flexible, varied solutions to any given problem, whether that is in planning a response to a natural disaster like Hurricane Katrina, a terrorist attack or curing cancer.”

Avian flu is “a time bomb waiting to go off,” says Anthony Fauci of the NIH. Yes, vaccine production will be important, but so will isolating high-risk people, washing our hands and using face masks.

It strikes me that economic incentives dictate packing more stuff in to each high-tech program or intervention, but making them complex beyond understanding will cause people to reject them.

In facing each health risk, we need to fully comprehend the size and complexity of the task when we seek to provide the right information to the right people at the right time to support their
decisions.

In response to that understanding, we have to recognize that there is no “killer app,” because everyone’s receptivity to information, everyone’s fears and hopes, everyone’s treatment preferences are unique. In the absence of a single program or solution that will do everything, the trick is to find the balance between efficiency and effectiveness.