Supporters of the Big Data movement argue that data will change everything, but only once we break down the institutional and technological barriers that prevent us from getting at it. In his talk at TEDMED 2012 at the Kennedy Center, Stanford’s Atul Butte argues that the we already have more than enough to do real science, if only we know where to look.

As we trudge forward into various iterations of what and how ‘accountable care’ strategies can be sensibly configured and locally seeded for Medicare, Medicaid as well as commercial markets, attention is often focused on the ‘necessary’ but ‘not sufficient’ contribution(s) from health information technology (HIT). It is rare that a conversation centered on accountable care or ACOs in particular doesn’t shift to HIT, where EHRs, HIE’s (heath information exchanges) or other data banking or connectivity solutions aren’t a material part of the dialogue. Often posited as the central spine enabling the required coordination and integration essential to accountable care, the technology side of the challenge frequently preempts other issues including physician culture, clinical and financial risk management tolerance and sophistication, or the history of successful physician/hospital joint ventures, in the local market.

Yet in the paradigm shift from volume to value via accountability many are focused on the presumptive return expected from consumer empowerment and electronic health information connectivity. Whether couched as informed choice via up-leveled health literacy, e-patient activism, ‘data liquidity’ or the litany of supportive ‘apps’ including mhealth, wireless or other prevention and wellness oriented platforms, the consumer empowerment movement incentivized by HITECH and further challenged via the triple aim quest are energizing many entrepreneurs, healthcare providers and even regulators.

In June we’ll witness another round of broad based healthcare stakeholder engagement during Health Innovation Week in Washington, D.C. For context, check out Wil Yu’s post on THCB titled: Breaking Down the Process of Innovation: The Value of Community.’

Starting with the Health 2.0 sponsored code-a-thon and [coincidentally] ending with the 3rd Annual National ACO Summit, with HealthCamp DC, Regina Holliday’s ‘The Walking Gallery‘, and the jointly sponsored Institute of Medicine’s and Department of Health Services HDI Forum aka ‘the Health Data Palooza‘, the week will be full of learning, networking and collaboration opportunities.

I intend to be onsite and reporting from several of the venues. Where possible I’ll broadcast recaps, and even livestream all or portions of select events. Minimally you can expect a generous outbound tweetstream via @ACOwatch, ACOalliance or @2healthguru.

The Food and Drug Administration is considering removing prescription requirements for medications that treat common conditions, such as high blood pressure, diabetes, asthma, migraines and high cholesterol. This means that you would be able to go to your local pharmacy, fill out a questionnaire, receive a diagnosis and purchase a medication, all without intervention or direction from a physician.

As a doctor, I think this is a very bad idea. Although it is true that diagnoses are often missed — reports estimate that as many as 7 million diabetics in the U.S. remain undiagnosed — and although easier access to drugs could theoretically encourage patients to take their medications, I am concerned that expanding over-the-counter access will lead to wrong diagnoses with improper treatments, which carry side effects.

Remember, medicine is an art, practiced on an individual basis. A medication that works for one person doesn’t always work for another. I am constantly changing cholesterol or high blood pressure medications for my patients because of unanticipated side effects such as muscle aches or dizziness.

Lack of follow up

What would happen if I weren’t involved to monitor treatments and make necessary changes? The upfront cost savings from cutting out doctors and their office fees will be more than made up by longer term costs of improper diagnoses or unmonitored complications.

Advocates of expanding over-the-counter medications point to aspirin or allergy drugs as examples that have proved successful without a doctor’s prescription. But for every patient who is glad not to have to visit my office for an allergy prescription, I can point to another patient who has suffered side effects like fatigue that he or she didn’t realize were due to that same pill, or where the allergic reaction was due instead to food.

The fact that common painkillers have been available over the counter for decades also doesn’t provide a convincing argument for bypassing prescriptions. Consider that more than 100,000 Americans are hospitalized every year due to bleeding from aspirin or other OTC non-steroidal anti-inflammatory pills, and acetaminophen is the No. 1 cause of acute liver failure.

Insurance coverage unlikely

Although the FDA‘s goal is to reduce health care costs by improving access to treatments, remember that both public and private insurers are not likely to cover these treatments if a prescription isn’t involved. Insurance companies typically rely on a doctor’s authorization to document medical necessity. This is another way the FDA plan could backfire, as patients might not be able to afford the out-of-pocket expense and could even go without treatment altogether.

For decades, many pharmacists have felt under-utilized when it comes to advising patients on medical needs. Pharmacists do have a great deal to offer and play a very important role when it comes to knowing about the drugs they dispense and monitoring for drug interactions that physicians might have failed to consider.

But a doctor’s appreciation of a pharmacist’s acumen is not the same thing as saying that he or she should replace a physician. The American Pharmacists Association is wrong to back the FDA proposal, and the American Academy of Family Physicians is right to oppose it.

Easy access to powerful drugs sounds tempting, but it will only add chaos and confusion to an already dysfunctional system.

Marc Siegel, MD, is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of USA TODAY’s Board of Contributors and the author of The Inner Pulse. This post first appeared at USA TODAY.

There I was, going one-by-one through a list of doctor and hospital groups that had volunteered to be one of the “accountable care organizations” authorized by health care reform, when I inexplicably found myself breaking into song. I know: it’s a really strange way to react to ACOs, but bear with me.

You remember, “This Land is Your Land,” don’t you? Written by Woody Guthrie in 1940, it caught the folk music wave of the 1950s, and has been sung ever since by performers ranging from Pete Seeger to Johnny Cash. Odds are you at least know the first verse:

This land is your land, this land is my land

From California to the New York Island

From the Redwood Forest to the Gulf Stream waters

This land was made for you and me.

ACOs are not obviously song-worthy, although they are significant. One of the Affordable Care Act’s signature initiatives, they initially drew bipartisan support as far back as…well, 2010. In April, the government announced that thousands of doctors serving more than 1.1 million Medicare beneficiaries had voluntarily joined ACOs, giving up fee-for-service reimbursement for some patients in exchange for a paycheck that’s based on measurable standards related to high-quality, cost-effective care. They’ve made the switch because it’s the right thing to do and because they’re getting ready for a day when Medicare’s fee-for-service money dries up.

But I was not singing about financial savings.   What inspired me was geography. At a time when political hyperventilators portray Obamacare as an evil government plot, the diversity of locations where ACOs have voluntarily formed shows that people outside Washington know that health reform is about making care better.   So get out your guitar and follow along with me:

From California, the ACOs include Sharp HealthCare, situated in San Diego (where the local GOP boasts that “the Republican Party is proud to be the majority party“), and HealthCare Partners, a Southern California mega-medical group sprawled over a political landscape ranging from ultra-liberal to ultra-conservative.

To the New York Island, which has my favorite ACO, the Chinese Community Accountable Care Organization, serving the elderly population of New York City’s Chinatown. It’s a locale that undoubtedly includes illegal as well as legal immigrants. There’s also a Bronx ACO (not technically on the New York “island”), but alas, no ACO for Little Italy, the Lower East Side or Spanish Harlem. I also searched in vain for, say, a Palm Beach ACO for affluent retirees who’ve gone from a golf handicap to a real handicap.

From the Redwood Forest. Really, who besides gnomes, sprites and a few tree huggers lives in a redwood forest? Fortunately for the nature-loving elderly — perhaps aging ex-hippies worried about their artificial hips? — there’s the Heritage California ACO, whose eight-county area includes the redwood forests of San Luis Obispo.

To the Gulf Stream Waters. This one was easy: the Accountable Care Coalition of the Mississippi Gulf Coast. No word on whether its doctors are conveniently located near the slot machines of a local casino.

So there you go: This land was made for you and me.

The moral of this story is clear: Americans who love this great country should sing out their support for Obamacare and ACOs. If Woody Guthrie’s left-wing past concerns some would-be crooners (I’m looking at you, Antonin Scalia — we know you sang in a chorus before joining the Supreme Court), they can comfort themselves that “This land is your land” has been embraced by the Mormon Tabernacle Choir singing along with the United States Air Force band. You don’t get more patriotic than that.

Speaking of patriotism, look at this version of “This Land is Your Land” with a background track by Bruce Springsteen underscoring a speech by a guy who’d just won the 2008 Democratic presidential primary in Iowa.

No red states, no blue states — just the United States of America. Woody Guthrie and the Air Force band. Hey, Supremes, sing it out for Obamacare: “This land was made for you and me.”

Michael Millenson is a Highland Park, IL-based consultant, a visiting scholar at the Kellogg School of Management and the author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age. This post originally appeared at opednews.com.

I saw a gentleman in my office recently.  He was having severe pain radiating from his lower back, down to his calf.

I was about to describe my plan to him when he interrupted me saying, “I know, Doc, I am overweight.  I know that this would just get better if I lost the weight.”  He hung his head down as he spoke and fought off tears.

He was clearly morbidly obese, so in one sense he was right on; his health would be much better if he would lose the pounds.  On the other hand, I don’t know of any studies that say obesity is a risk factor to ruptured vertebral discs.  Besides, he was in significant pain, and a lecture about his weight was not in my agenda.  I wanted to make sure he did not need surgery, and make him stop hurting.

This whole episode really bothered me.  He was so used to being lectured about his obesity that he wanted to get to the guilt trip before I brought it to him.  He was living in shame.  Everything was due to his obesity, and his obesity was due to his lack of self-control and poor character.  After all, losing weight is as simple as exercise and dietary restraint, right?

Perhaps I am too easy on people, but I don’t like to lecture people on things they already know.  I don’t like to say the obvious: “You need to lose weight.”  Obese people are rarely under the impression that it is perfectly fine that they are overweight.  They rarely are surprised to hear a person saying that their weight is at the root of many of their problems.  Obese people are the new pariahs in our culture; it used to be smokers, but now it is the overweight.

The fear/disdain of obesity has reached into areas where it should not be.  I regularly have to tell mothers of chubby babies that it is perfectly fine for their child to be that way.  Children under three generally regulate their eating to what they need.  I do not believe a baby can become obese on breast milk or formula.  Now, if they are giving the child french fries and burgers, that is a different matter.

Instead of patronizing obese patients with a lecture, I try sympathizing with them.  Just because something is simple doesn’t make it easy.  How do you quit smoking?  You just stop smoking.  We should just pull out of Iraq.  There should be peace in the middle east.  People should stop hurting each other and start being nice.  All of these are good ideas, but the devil is in the details.  Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.

Don’t get me wrong, I don’t deny the health risk of obesity.  I do my best to work on weight loss with my patients.  But the idea that their personal worth lies on their BMI is extremely damaging.  There are a lot of screwed-up skinny people out there; just look at super-models.  It is a lot easier to lose weight when you actually like yourself and want to do something about your health.  Our culture of accusation and shame simply makes obese people hate themselves.  If you hate yourself, why should you want to take care of your body?

Is obesity a problem?  Sure it is.  But we need to get off of our self-righteous pulpits.  Obese people should not be made into a group of outcasts.  The “them” mentality and the finger-wagging are no more than insecure people trying to feel better by putting down others.

It sounds a lot like Junior High.

If we really want to help with obesity, we need to grow up.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind) where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player.  He is a primary care physician.

A frightened Diane called me today.  She was in big trouble.  Her primary doctor’s office had called with terrible news.  The MRI showed Diane had a lesion.  Desperate, she reached out to an Oncologist for help.

A lesion?  Yes, a lesion.  What could that mean?  What did she need to do?  What was going to happen?  With trepidation Diane asked, “Do I have cancer?”

Medicine prides itself on accurate, specific, scientific analysis.  We have delineated more than 50 sub-types of lymphoma.  We measure toxin in parts per million.  We use complex Latin based terms like hemoglobinopathies to describe red blood problems, or ER positive Her-2 negative lobular carcinoma in situ with microinvasion to define a tiny breast cancer.  We adjust drug flow in micrograms per kilogram per minute.  Thus, you know we have a very specific delineation for “a lesion.”

Nahhhhhhh…. there is no absolute definition for “a lesion.”  In fact, if there ever was a useless, confusing and therefore frightening term, it is “lesion.” Perhaps Aristotle said it best, when he explained, “ To say of what is that it is not, or of what is not that it is, is false, while to say of what is that it is, and of what is not that it is not, is true.”   Certainly clears things up for me.

The MedicineNet dictionary defines “lesion” as “almost any abnormality involving any tissue or organ due to any disease or any injury.”  The emphasis being on “any.”  Farlex notes that a lesion might include any “pathology, tubercle, ulcer, wound, harm, hurt, injury, trauma, stigmata, abrasion, excoriation, scratch, scrape, gash, slash, slice, cut, laceration, or (and this is my favorite), bite. “  I suspect that my Aunt Hilda qualifies as a lesion.

The point is this.  The term “lesion” fills in the blank in any medical sentence for “not normal.”  However, most of us when we hear the term lesion, we think cancer.  This is not what lesion means. We use this vague term when we are too apathetic to be precise.

Therefore, the next time someone (i.e. a doctor) uses the word “lesion,” go into action.  Raise one eyebrow, lean forward, raise a finger and say, “I do not know what you are talking about, you must be more clear.”  The speaker owes you an exact explanation and not this lazy descriptor. Obviously, most “lesions” are not terrible disease, and they often do more damage to psyche then body.

Oh, and Diane?  She is fine. Her “lesion” is a 1.2-centimeter pocket of cartilage in the bone next to her knee, known as an Endochondroma. She has carried this benign change in her fibula from childhood.  It requires no medical care.  This is fortunate, because the anxiety of the word almost gave Diane a real lesion, like a heart attack.

James C. Salwitz, MD is a Medical Oncologist in private practice for 25 years, and a Clinical Professor at Robert Wood Johnson Medical School. He frequently lectures at the Medical School and in the community on topics related to cancer care, Hospice and Palliative Medicine. Dr. Salwitz blogs at Sunrise Rounds in order to help provide an understanding of cancer.

My preceptor would call this a “Pandora’s Box” case. Do not open the conversation if you are not prepared to grapple with all of its consequences. This is what I am thinking as I interview Ms. L.

I have a standard set of social history questions. Ms. L screens positive for nearly all of them. Victim of domestic violence. Victim of sexual violence. Poverty. Addiction. Depression. Thoughts of self-harm.

I try not to cringe as she pulls down her gown to show me scars on her chest where an ex-boyfriend burned her with cigarettes. I am looking at deep bruises, not at the hands of some common enemy we call illness, but at the hands of another human being. What compels someone to do that? We are in a hospital, but this is far from strictly a medical problem.

A few weeks earlier, she had tried to take her own life. Wrapped cord around her neck. Saved only by a fortuitous visit from a home health aide, who convinced her to untangle herself before she could do anything she would be unable to reverse.

Now she is crying. I feel like crying with her. There are only so many times I can say “I’m so sorry to hear that” and “that must have been really difficult.” My words sound trite. I feel inept. She looks at me through tears, waiting for me say something more helpful.

***

First-year medical students occupy a unique niche in the hospital. My classmates and I wear white coats and ask people about their lives and illnesses, but we cannot answer medical questions or offer anything in the way of treatment. We are in limbo: on our way to becoming caregivers, but unable to provide care.

The hospital is a rehearsal. Patients are practice. I collect their information to hone my ability to conduct an interview, give an oral presentation, and do a write-up. I am not helping anyone. On the contrary – by giving us their time, patients are helping us; they are teaching us how to be become better doctors.

This disruption from expected roles can understandably lead to confusion. Though I always introduce myself as medical student and explain that I am not part of the patient’s care team, Ms. L was not the first patient who has said things suggesting she did not truly understand my role. Some patients ask for advice. Others probe for clues about prognoses. “What are you going to do with all this?” a previous patient asked me at the end of our interview, when I was packing up my notes.

People come in and out of patients’ rooms all day long. It can be difficult for anyone to keep track of who does what. In fact, a common critique of the medical system is that while individual providers are high quality, the problem lies in lack of coordination and gaps in continuity of care, as patients find themselves explaining the same stories over and over, unclear on why.

For someone like Ms. L, misunderstanding hospital relationships could have serious consequences. Sitting across from me is a profoundly depressed woman who spoke bitterly about caregivers abandoning her. I prolonged the interview for as long as I could, but eventually I had to report back to my preceptors. Would she perceive me as abandoning her, too?

***

I must have looked upset after I presented Ms. L’s case, because my preceptor picked up on it. He told me that it’s easy to “spiral” after an encounter like this – to start questioning whether medicine is worth it, or whether we do any good at all. He told me to do something fun that evening to take my mind off what had happened.

I tried but was unsuccessful. Instead, I thought more about the Pandora’s Box analogy. Sometimes it is not up to you whether it opens. I walked into a room on a general medicine ward, asked a patient a few simple questions, and wound up in an emotional minefield I felt wholly unequipped to navigate.

The challenge in the hospital-as-practice setup is that does not prevent emotional rapport from developing. The hospital dynamic, where one person is vulnerable, and another comes across as a professional, practically guarantees it.

Once a difficult conversation is opened, you cannot just close it. So what do you do?

The answer from my preceptors reminded me of what I was instructed to do when I was a kid and saw someone in trouble: tell a grown-up. In this case, that translated into informing Ms. L’s medical team of her issues so that she could receive appropriate care. In most cases, you probably should not follow up yourself, as it is better to err on the side of not doing further damage when you are not even supposed to be involved in the first place.

Still, it is strange to think in terms of not doing damage. Aren’t I supposed to be actively helping people? Are the only impacts I can have at this stage of my training neutral – or worse than neutral?

My experience with Ms. L shook me. I was fortunate that her medical team was already aware of her emotional health, but I realize there will be cases where I might be the only confidante of privileged and delicate information. And that can happen during any stage of medical training – regardless of how qualified I am to handle it. I am afraid that is the inevitable price of practicing on human beings. On my way to becoming a doctor, I am frankly terrified of doing more harm than good.

(Note: certain details of this story have been modified slightly to protect the privacy of the patient.)

Ilana Yurkiewicz is a first year medical student at Harvard Medical School with a developed interest in mass media and science journalism. This piece was originally featured on her Scientific American blog, Unofficial Prognosis.

Recently, I’ve met with several internet startups, web thought leaders, and venture capitalists.

There’s one word that’s come up in every conversation and it’s not Plastics.  It’s Gamification.

Gamification, described by Wikipedia is applying gaming principles to non-gaming applications and processes,

“in order to encourage people to adopt them, or to influence how they are used. Gamification works by making technology more engaging, by encouraging users to engage in desired behaviors, by showing a path to mastery and autonomy, by helping to solve problems and not being a distraction, and by taking advantage of humans’ psychological predisposition to engage in gaming.”

Whenever technologists create a cool new application, they often focus on the innovation necessary to solve a hard engineering problem rather than the user experience or how to ensure the ongoing use of the software.

Many internet companies have tried and failed (such as Google Health) to create highly usable healthcare sites, but failed to engage customers over the long term.

Although the biology behind gamification is controversial, the claim is that the human brain inherently enjoys problem solving and the dopamine-mediated emotional rewards that come with it.   Sticky platforms like Facebook implement many gamification features to keep users coming back.   Group competitions, customer loyalty programs, and goal achievement are all examples of gamification strategies.

We’re in the midst of a redesign of the BIDMC Personal Health Record, Patientsite.  Not only do we want to make it easier to use and more visually appealing, we want to ensure it adds value and becomes a destination that patients want to revisit.   We’ll certainly keep Gamification principles in mind.

So next time you’re faced with a software redesign, think about its use more than its engineering.  Replace Plastics with Gamification in your lexicon.   There’s a great future in it.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer at Harvard Medical School, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. He’s also the author of the popular Life as a Healthcare CIO blog.

Reviewing “The Myth of The Paperless Office” for the New Yorker in 2002, Malcolm Gladwell argued that if the computer had come first, and paper didn’t exist, someone would have had to invent it.  Paper, it turns out, is a lot more useful than we typically appreciate.

It occurred to me that perhaps the same might be said of another product we seem to take for granted in the digital age – medicines.  (Disclosure: I work at a company that makes them.)

Medicines – you know, those little white pills that everyone loves to critique – are in many cases remarkably effective solutions to very difficult problems; it’s actually kind of amazing how useful some of these products can be.  What an incredibly powerful idea – addressing a difficult and complex health problem with a simple pill you can pop before breakfast.

I read a tweet recently asserting that physicians may soon prescribe health apps as an alternative to medications; my initial reaction: good luck with that one.  It’s certainly easy enough to envision how magical thinking about the power of health apps will soon be replaced by disappointment as app developers realize something drug makers have known for years: it’s hard to improve health, and it can be very difficult to get patients to stick with a treatment long enough to make a difference.

At the same time, it’s clear there are profound opportunities in digital health; I imagine the most effective applications will find a way to complement and enhance traditional therapeutics, rather than position themselves as “alt apps” – the alternative medicines of the digital age (you can just see the eBook now: “Health Apps ‘They’ Don’t Want You To Know About”).

There are at least two major areas where digital medicine might be expected to play a significant role.  The first opportunity is in helping to motivate behavior change by spurring patient engagement, whether in something as basic as completing a full course of antibiotics (I could easily imagine a motivational app being useful here) to a task as monumental as achieving sustained weight loss (a goal of many apps, of course, though it’s not clear any have proved to be broadly game-changing).

The second key area is in measurement, a topic I’ve discussed extensively (see here, here, and here), and around which I’ve co-founded a new academic initiative, the Center for Assessment Technology and Continuous Health (CATCH), together with MGH Chief of Medicine Dennis Ausiello and several Boston-area colleagues.  The basic idea is that improved phenotypic measurement – measurement of relevant parameters in a fashion more comprehensive and more continuous than typical patient data – could immediately improve care while also advancing future science.

An interesting underlying challenge associated with both of these areas that we must confront is the need to figure out how to do more than preach to the choir – see this characteristically elegant discussion of this phenomenon by Duke University’s Mark DeLong.

The specific issue for digital health is that the costs and burdens of healthcare are not evenly distributed, and a relatively small number of people drive most of the costs and also bear most of the suffering.  I’m not sure these patients are always the ones who are eagerly sampling the new health apps or at the leading edge of the quantified self movement (although the participants in PatientsLikeMe and similar communities may represent important exceptions).  Finding a way to bridge this gap will be important to demonstrate a meaningful impact on health – and also to provide a sustainable business model in this cost-focused era.

The flip side is that the need for improved measurement of real people is so pronounced that if you embarked on a serious effort here – as CATCH plans to initiate – and could achieve more comprehensive measurements in a broader selection of people and patients, there’s a good chance it could generate results that might improve health delivery almost immediately. The key hurdles will be the logistical obstacles associated with actually collecting these data, as highlighted in Chapter Two of this recent Kauffman Foundation report, and discussed extensively at the recent Sage Commons Congress.  But if acquired, these data are likely to render healthcare more efficient and effective, and can help us ensure we do a better job of understanding current practices and getting a better sense of what works best – acknowledging, importantly, that there’s usually not going to be a single best approach that should be applied reflexively to every patient, as discussed here and here.

Less certain, however, is how these digital approaches can help us improve care in a revolutionary, not just evolutionary, way (as I’ve previously discussed in context of Steve Jobs).  It’s terrific to understand what sorts of approaches to antibiotics and physical therapy work best for cystic fibrosis patients (see here), but how much better would it be for patients to have a new medicine that fixes the underlying problem completely and permanently?

To put it crudely, the development of an effective vaccine did a lot more for the treatment of polio than applying the best design thinking to the construction of an iron lung ever could.  I worry a bit that in our fascination with technology and design – which matter a lot for patients in the here and now – we’re neglecting the need figure out some way to get at the difficult biological questions that remain at the root of disease.  I really don’t believe a clever app is going to cure cancer – though one might improve and help optimize the experience of patients now suffering from the disease.

What I can imagine, however, is that the focus on patient measurement will highlight the importance of understanding disease in the context of person, rather than in a petri dish or a model organism, and beyond that, will lead to the development of technologies that make the study of human physiology, and pathophysiogy, increasingly robust.  Perhaps the ability to characterize cancer cells more precisely in a living patient could help identify more effective treatments, for example.

The good news is that there seems to be a lot of interest now in balancing classic reductionism with a more physiologic perspective; this includes a renewed emphasis on phenotypic screening (see here and here), and an interest more generally in understanding diseases though patients rather than model organisms.   For example, a scientist responding to a previous piece noted that the development of the recently-approved Vertex drug for a variant of CF reflected a more patient-based approach than was typical for industry.

A final point to contemplate is how big pharma should view the nascent efforts in digital health; I think Avado’s Dave Chase (who certainly gets my vote as contributing the most consistently insightful writing about the evolving digital health landscape) nails it in this recent piece, in which he describes the pharmaceutical industry as essentially watching with bemused interest and applauding politely from the sidelines.  On the one hand, they’ve more than a sneaking suspicion they need to change their business model, but on the other hand, they’re sitting on a ton of cash, and seemed inured by this point to the endless invocations of a burning platform – it’s almost as if they’ve decided this is more of a PR problem than a core business issue.

The thing is, biopharma companies may be positioned better than almost anyone to take advantage of the opportunities in digital health; as I’ve suggested, they have a unique understanding of the complexities of the healthcare system, and have a deeper familiarity with the many stakeholders.  They also would be operating in a space where many potential competitors fear to tread.

Bottom line:

1. Digital health is not a magic answer but an important part of an integrated solution
2. Key opportunities for digital health are behavior modification (patient engagement) and phenotypic measurement, and both activities must involve more than just self-selected early adopters
3. We still need to focus on understanding the biological basis of dreadful diseases; hopefully, improved patient-focused technologies will help.
4. Big pharmas could evolve to become leading players in digital health, but are likely to continue to observe from the sidelines — in their luxury boxes — at least for the foreseeable future

David Shaywitz is co-founder of the Harvard PASTEUR program, a research initiative at Harvard Medical School. His a strategist at a biopharmaceutical company in South San Francisco. You can follow him at his personal website. This post originally appeared on Forbes.

When most of us think about Facebook, the first phrase that comes to mind probably isn’t “good Samaritan.”  Facebook is an easy way to keep in touch with friends, and it can be a gigantic time-suck, for sure, but last week the site did something that could truly benefit a lot of people. On May 1, Facebook launched an initiative to encourage users to become organ donors, and within 24 hours there had been a spike in the number of people volunteering their body parts for the good of others.

California’s registry saw almost two months’ worth of people sign up within the first day after the Facebook put up the feature.

Organ transplantation is one of the miracles of modern medicine, but there simply aren’t enough organs to go around for all the patients who need them. According to the United Network for Organ Sharing (UNOS), there are 72,900 people on active lists waiting for an organ. Compare that number to the 2,263 transplants that took place between January 2011 – 2012. Last year, more than 6,000 people died waiting for an organ.Obviously, increasing the number of organ donors could have a huge impact on the number of transplants – and on the lives of thousands of people.

Why don’t more people become donors? Some object on religious grounds, but the biggest obstacle is inertia. Most of us who sign up to be organ donors (I’m one of them) do so when we renew our driver’s license, by checking a box on a form saying we want to donate our organs. If you don’t mark the form, it’s assumed you don’t want to donate. Most people only encounter this choice every few years, when their driver’s license is up for renewal, and it’s hard to think about such a decision while standing at a Department of Motor Vehicles counter.

Some countries, such as Spain, Australia and Germany, have opt-out systems. It’s assumed that you are willing to donate unless you’ve said you prefer not to. Rates of donation in those countries are sometimes higher than in the US, although some presumed-consent countries have much lower rates. (Factors other than the number of donors, like the availability of surgical facilities and transplant surgeons, can affect the number of actual transplants in different countries.)

Another way to get more people to donate would be a “mandated choice.” This idea was proposed by behavioral economist Richard Thaler, in his book Nudge: Improving Decisions About Health, Wealth, and Happiness (with Cass Sunstein). Instead of a form that you can simply leave empty if you don’t know whether you want to donate, you have to choose between “yes” and “no.” There’s psychological evidence that even having to make that choice could get more people to think about their preferences and choose to donate. Israel has yet another incentive to get people to donate: those who are registered as donors get priority if they later need an organ themselves. Facebook’s effort depends on another psychological effect, the power of social persuasion. If your friends are all donors, maybe you should sign up, too.

Whether or not Facebook’s initiative will have a sustained effect on the number of available organs remains to be seen, but there’s a side to this issue that deserves at least a mention. Organ transplants are expensive. The surgery itself can cost as much as a million dollars, and that’s not including the drugs and other care transplant patients require for the rest of their lives. Granted, that’s money well spent in terms of lives saved. But imagine if there were enough organs for every person who needed one. We’d have to find more than $100 billion a year in addition to what we’re already paying for health care.

I’m not suggesting more organ donation is a bad idea, or that we shouldn’t do more transplants. Just the opposite. It would be money well spent. It’s also yet another reason to weed out the trillions of dollars we are on track to waste over the next decade on health care that doesn’t help patients or improve lives.

Joe Colucci is a research associate at the Health Policy Program of the New America Foundation. Shannon Brownlee, MS, is a nationally recognized award-winning journalist and author who has written for the New York Times Magazine, The New Republic, British Medical Journal and The Huffington Post, among many others. The post first appeared on the New America Foundation’s blog.