Silicon Valley's product strategy won't work with health care, says Apple veteran
Robin Goldstein, a former Apple executive who served most recently as Senior Manager of Health Special Projects, assails the tech industry's approach to health tech.
In an opinion piece published to CNBC's website Thursday Robin Goldstein, who served in a wide variety of roles in her 22-year career at Apple, argues tech companies need to take a different approach to product failure when it comes to health-related devices. In particular, the "fast fail" strategy is not an option.
"This is the mindset Silicon Valley has brought to every space it enters: A bad product or poor user experience doesn't have any ramifications beyond that particular product or experience, and they can always wipe the slate clean and start again," Goldstein writes. "In the world of digital health this is a big problem."
There are three reasons for this, according to the author. The functionality of digital health products is often a matter of life and death, the health products "require buy-in from both the user and their health care provider," and that the old adage, "You don't get a second chance to make a first impression," applies especially to the health sector.
She mentions Theranos, the controversial blood testing startup that collapsed last year in scandal and indictments, leading to the company's official dissolution earlier this week. Theranos sought to emulate Apple, while its founder Elizabeth Holmes saw herself as a new Steve Jobs, but the company not only failed to come up with a working product, but was allegedly committing fraud.
"Every new microfluidics testing venture is now subject to both increased scrutiny and has to to overcome a general suspicion regarding the technology, its effectiveness, and actual benefits," Goldstein writes. "In other words, everyone who follows Theranos has the burden of proving they're not Theranos before even getting to the question of whether their product will pass the risk/benefit analysis discussed above."
Goldstein's piece, aside from the sharing of her credentials, does not mention Apple directly, nor does it refer specifically to any of Apple's initiatives. Apple has launched some ambitious health-related products in the last year, including a huge health records digitization effort, while numerous news stories have had Apple Watches literally saving users' lives.
"The size of the healthcare market and relative ease with which products can be developed, as well as the current appeal of applying algorithms and machine learning to the imprecision of the human body, requires that extra care be taken," Goldstein writes. "High tech cannot view digital health as simply the next great market opportunity.
Goldstein, according to her LinkedIn page, left Apple after 22 years in November 2017. Her final title was Senior Manager for Health Special Projects, and she had previously served principal counsel, and senior engineering manager and NewtonOS product marketing manager.
Some emails that surfaced in 2016 had Goldstein, then an attorney for Apple's health division, expressing interest in cardiac monitoring hardware, and Parkinson's support.
In an opinion piece published to CNBC's website Thursday Robin Goldstein, who served in a wide variety of roles in her 22-year career at Apple, argues tech companies need to take a different approach to product failure when it comes to health-related devices. In particular, the "fast fail" strategy is not an option.
"This is the mindset Silicon Valley has brought to every space it enters: A bad product or poor user experience doesn't have any ramifications beyond that particular product or experience, and they can always wipe the slate clean and start again," Goldstein writes. "In the world of digital health this is a big problem."
There are three reasons for this, according to the author. The functionality of digital health products is often a matter of life and death, the health products "require buy-in from both the user and their health care provider," and that the old adage, "You don't get a second chance to make a first impression," applies especially to the health sector.
She mentions Theranos, the controversial blood testing startup that collapsed last year in scandal and indictments, leading to the company's official dissolution earlier this week. Theranos sought to emulate Apple, while its founder Elizabeth Holmes saw herself as a new Steve Jobs, but the company not only failed to come up with a working product, but was allegedly committing fraud.
"Every new microfluidics testing venture is now subject to both increased scrutiny and has to to overcome a general suspicion regarding the technology, its effectiveness, and actual benefits," Goldstein writes. "In other words, everyone who follows Theranos has the burden of proving they're not Theranos before even getting to the question of whether their product will pass the risk/benefit analysis discussed above."
Goldstein's piece, aside from the sharing of her credentials, does not mention Apple directly, nor does it refer specifically to any of Apple's initiatives. Apple has launched some ambitious health-related products in the last year, including a huge health records digitization effort, while numerous news stories have had Apple Watches literally saving users' lives.
"The size of the healthcare market and relative ease with which products can be developed, as well as the current appeal of applying algorithms and machine learning to the imprecision of the human body, requires that extra care be taken," Goldstein writes. "High tech cannot view digital health as simply the next great market opportunity.
Goldstein, according to her LinkedIn page, left Apple after 22 years in November 2017. Her final title was Senior Manager for Health Special Projects, and she had previously served principal counsel, and senior engineering manager and NewtonOS product marketing manager.
Some emails that surfaced in 2016 had Goldstein, then an attorney for Apple's health division, expressing interest in cardiac monitoring hardware, and Parkinson's support.
Comments
I feel like Apple has a better moral center as a company than most, but being so large they probably have to be more careful because there's so much focus on them and lawsuits are more likely to happen as a result.
Newton was a flawed product that eventually worked, but too late. Palm capitalized on the handwriting recognition using a simplified solution.
The last Newton I used at a PC Expo tradeshow booth in 1998 in NYC. It was coupled to an IR scanner that would read barcodes of visitors to our booth who were interested in our tech product. Clunky by today’s standards, but it worked.
That said, Apple needs to, and is, following a very careful and cautious strategy toward medical devices. I would expect other companies will announce wrist band/watch devices for blood pressure, glucose, and other monitoring just so they can beat Apple to market. They will fail. The real competition will then come from the established medical device makers, who you can be sure are working very hard to get a working, reliable, tested, product to market. It very well may come down to would you rather buy a needle-less glucose monitoring wrist device from Apple or Accu-Check. The latter is a known company in that space.
"There's no money in dead people. There's no money in healthy people. The money is in the walking dead."
And, that DiseaseCare industry is supporting itself in every way that it can -- including blocking tech devices that promote health by not recognizing their utility to promote health. They want to keep "healthcare" under their control and their umbrella. And, they use the FDA as cover to block consumer grade medical devices from becoming "medical devices". Another strategy is to create a culture among healthcare professionals to not trust these devices or recognize their utility. So: you go to a doctor and show him your results and he disses them and ignore them.
Please. You can't force people to lead a healthy lifestyle. There are millions of people in this country who rarely eat much besides high-fat, high-salt, high-sugar processed carbs and who never exercise beyond walking around a shopping mall, if that. In 2015-16, the incidence of obesity in the U.S. was 39% and it's continually rising.
Walk into a Walmart or big-box store that sells food and watch what people load into their shopping carts and the size of their bodies. 33 million Americans ate 16 or more bags of potato chips in 2017. In 2016, 15% of adults over 18 still smoked in the U.S. There are plenty of people in this country who never really walk at all as they live and work in environments where they drive everywhere. A CDC study found that almost 90 percent of adults in the United States failed to meet government recommendations for vegetable intake.
That's not to say that health care in the U.S. isn't a disaster, but it's not the fault of the medical profession that Americans don't take care of their health. It's their own stupidity, the culture of instant gratification, an addiction to fat and sugar and the refusal to take responsibility for their own actions. While it may be true that doctors and medical institutions make their money from treating disease instead of preventing, how could a doctor or hospital help Americans lead a healthier lifestyle? The reality is they can't. I don't know of any doctor who doesn't regularly say, "you should lose some weight" or "your blood pressure would be lower if you lost weight" or "you're going to be diabetic unless you lose weight and reduce carbs."
GBM, we all know the healthcare industry has some serious problems when it comes to accounting/billing practices, patchy use of actuarial data, and an emerging reproducibility crisis in medical research. But your’s is an exceedingly negative view of the industry. Healthcare is likely the single most regulated industry in the US. By its nature it is subject to multimillion dollar lawsuits on a regular basis. These factors would take their efficiency toll on any industry.
You will always find bad actors in any industry. But to paint the entire healthcare industry as a corrupting influence on the nation’s health is deeply misguided and rather one-sided as well. The vast majority of people in healthcare (and I include managerial leadership) are good people who are committed to providing the best services and care possible to their customers. They do this in spite of the many burdensome regulations they must comply with and the constant risk of lawsuits.
From my own experience, my company’s healthcare provider offers ample incentives for employees to maintain their health through several different rewards programs. My provider knows full well that it costs much less to fund preventative care than to fund emergency care or care for those already suffering from disease or injury.
It's America. You can choose to make bad decisions if you want to––don't study, don't brush, don't move, drink and eat poorly, etc. As always, there are consequences, both personal and societal, but you're still free to eat what you want, weigh what you want, and be as stationary as you want.
You can't say you've never been told to shape up in all those regards because doctors are in some secret industry cabal to undermine your health. They usually have much better things to do.