broaden the possibilities for feedback by creating an agreed-upon open standard for app development that makes it easier to tap into rewards of all sorts. Basically, ask everyone creating any kind of app that includes user feedback and rewards (that is, pretty much every app) to agree to include an API allowing that app’s reward to be called when a healthy behavior occurs.
There are two threads I’m intertwining here: the Jeff Bezos doctrine of “everything must have an API” and the rise of precision medicine.
Amazon Web Services basically works under what I think of as the LEGO idea—lots of parts that can snap together in different ways. And Amazon can do that because APIs for interoperability are mandated. Are fitness trackers built this way? Not so much. But they could be. Many of the kinds of programs and apps that could be used to generate rewards are also closed now, but that doesn’t mean they couldn’t be opened up as well in this specific way.
Once the applications are opened up through an agreed-upon open standard, suddenly the possibility for personalized rewards and positive reinforcement for achieving goals is much greater. Because you know, everyone is a snowflake, and everyone responds differently to different kinds of incentives. This is where precision medicine comes in.
Imagine that your primary care physician would like you to walk every day for 30 minutes. You’re not into Facebook posting, and don’t have enough of a rivalry going with your friends or family to make a competition that motivating. But you do really enjoy playing Plants vs. Zombies. And you’ve been having trouble beating some of the higher levels. And you could really use a bunch of jewels to power up your plants. Your Doctor takes your phone, keys in a link between your Apple watch and the Plants vs. Zombies app, and now every time you meet your daily walking goal you get a reward of 50 jewels. Immediately.
Maybe in a few months your interest in Plants vs. Zombies wanes. But you’ve started listening to the collected works of Leonard Cohen. You could buy the albums easily, but instead your doctor suggests linking single-song iTunes downloads to your activity for a while and you agree. Now, every day you listen to your new music while walking, you earn the next song. Save a little money, get a little exercise, get the positive feedback that helps you keep doing something you know you should but really would rather not.
Of course there are a lot of hurdles to clear to achieve all of this, not least of which is convincing various corporations to make some part of their product free to be used for these purposes. I can think of a few arguments, while freely admitting I don’t know if any of them would hold water with the Tim Cooks and Jeff Bezos’ of the world.
First, research: What products, features and rewards does a company have that are so sticky, so useful, so desirable that they can actually get people to change their behavior? Second, advertising and reputation: Are computer games being blamed for childhood obesity and inactivity? Fine, turn that around. Third, this is a logical step in the progression of the internet of things (IoT). Creating a system of interacting apps, tools, and devices that will work together seamlessly is already ongoing. I’m proposing a specific application of that concept, but the IoT will happen. Better to be on top of that trend than left behind.
And, of course, who’s to say profit wouldn’t be the eventual result? If linking specific app rewards can be shown to positively influence individual health, there’s a path to getting reimbursement via payers or maybe even individuals.
There are other problems with this kind of API-driven approach to behavior modification, including privacy, FDA oversight, the technical challenges of minimizing reward exploitation, and figuring out the best ways to motivate individuals. I just saw a great talk by Dr. Bonnie Spring showing that mobile health tools have a lot of nuances and surprises. Still, I think it’s an idea worth exploring and a natural extension of what’s already going on in digital health. The goal of precision medicine is that people be treated in ways specific to their genetics and medical history–their specific biology–to reach their optimum state of health. To that framework I would add understanding and using each person’s unique personality and culture. Medicine–and health–would only be the better for it.
