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Esther Dyson Headshot

Release 0.9: Health, Not Health Care!

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Whatever you think of the new health-care legislation, it is focused more on who pays for health care, than on how we maintain health in the first place. It doesn't address the primary health problem in this country: that too many people need care in the first place. The problem isn't just the cost of their care: It's blighted lives, low productivity, burdens on care-givers. Millions of people are hampered in their ability to earn a living, care for their children and enjoy their own lives to the fullest because they are ill or afflicted with some health-related condition. Many of these conditions are preventable.

It's economics: There's a big market for health care, there's a big market for (things that lead to) bad health, but there's not that much money in health itself. Fewer than 20 percent of US adults are members of a health club; they spend much more on movies, clothing. . .and of course on fast food. Most of the things that are bad for you in the long run are pleasant in the short run. . .and they generate profits for someone.

Pit billions of dollars of food, alcohol, cigarette and other stuff against a small amount for health clubs and sports activities of all kinds. Pit bikes and sports equipment against millions of TV sets, cars and, yes, computers that encourage you to sit immobile for hours on end. In short, the market works.

Fortunately, promoting health is about to become a profitable endeavor as well -- perhaps not as fast as the venture capitalists and the health start-ups hope, but soon enough to attract hundreds of companies selling some kind of health maintenance devices or online services. Every week I hear from new start-ups that are collecting data for users rather than about patients, and who want to help those users monitor and analyze themselves. Ultimately, their services should help to change the behavior of millions of Americans, starting with the techies and the influencers, but eventually spreading more broadly.

A new industry is coming into being: one that makes money by selling what's good for you -- devices and services that let you track your vital signs and help you to change your own behavior. Three interacting developments are reinforcing each other: Consumers' ability to track and share their own behavior and health data. Companies' interest in selling or sponsoring the tools and online services for consumers to do so -- as well as employers' and insurers' growing interest in keeping people healthy if the effectiveness of these approaches can be proved. And finally, the promise of sharing and aggregating the data (with consumers' informed consent) -- providing value for individuals sharing it, and justification for vendors and insurers to design and support the services in question.

The market for consumer self-tracking (the "quantified self" movement) is growing quickly -- spreading out from Silicon Valley, Boston and New York, all of which have periodic Meetups where members show off their devices and share their data. Traditional scales are so last-century. Now we have scales hooked up to the Internet, sleep monitors, direct-to-consumer genetic data, Text4baby for pregnant women and even (if you hook up through the right institution, for now) consumer accounts for blood tests and the like with Quest and Labcorp. People can monitor their activity with tools from Nintendo (WiiFit) and Nike, and count their calories or their overall nutrition with a variety of ad-supported or cheap iPhone apps such as LoseIt. They can share their data with others, either striving to succeed in health games (Contagion Health), or collaborating and supporting others in reaching their own goals (CureTogether). And on PatientsLikeMe, sick people share and compare their treatments -- both the kind that are sold and the kind that are almost free, such as diet and off-patent or homeopathic remedies.

Indeed, this is one of those mythical viral markets, where people market to one another and give value to one another. Companies ultimately want to turn consumers' attention into purchases. Facebook friends, however, are eager to trade attention for. . . attention. One of my favorite health apps is Contagion Health's GetUpandMove -- a Twitter and Facebook application through which Juan offers, say, to swim for 50 minutes if Alice will do crunches for 3 minutes. That kind of attention, far more than a computerized reminder, can motivate people to do the right thing. The tools and the data are just catalysts for what people can do for themselves and for one another. Much behavior change is driven by people interacting with one another, rather than with a computer. The computer is only the medium that makes the personal interaction easier while focusing it around healthy behavior from exercising more to eating less.

Personally, I now use the Zeo sleep monitor -- a sleek alarm clock with a dock for a headband that I wear at night. The headband sends signals from my brainwaves to the clock, and in the morning I can assess my sleep - how many minutes overall, and how many minutes of restorative deep sleep and REM (rapid-eye movement) dream sleep. The point, of course, is that I can see the effect of alcohol, a cup of afternoon coffee or perhaps a sleep deficit from the night before...and so I now assiduously resist temptation in order to earn a good report from Zeo. From time to time I report my results on Twitter, hoping for approval or sympathy from friends.

Self-tracking and the associated obsession with one's own health may sound frivolous and inconsequential, but it is social emotional and factors, not rational risk assessment, that determine so much of our behavior.

So how can the start-ups make money off this? Well, that's a question investors are asking about Twitter. I can imagine many companies who might want to sponsor GetUpandMove, for one example. In other areas, there are actual devices to sell: the Nike+ SportBand (with iPod), the $99 Fitbit motion sensor (I just got mine), the WiiFit and the myZeo sleep monitor; services to offer: genotyping, lab testing; and anonymized research data to sell to the medical establishment.

Overt time, this trend will feed itself. As users collect data about themselves and share it with others, they will encourage adoption. . .and also encourage one another to engage in healthy behavior. For example, TweetWhatYouEat.com uses a combination of information-sharing and public self-reporting (under real names or pseudonyms as users prefer) to encourage people to eat right. Users solicit information: "How many calories in Granola?. . .does anyone know? Also is it bad for you as it's very sugary?" "I go to so many work dos in the evenings -- I need to find the will-power to not eat the canapes -- any suggestions...they always look so yummy!" They tweet their triumphs and their binges, and get sympathy, support and also disapproval from people who face the same struggles. (That's often easier than getting it from a spouse or workmates, where other tensions may interfere....)

Over time, this user-driven behavior and data revolution may actually generate enough data to have an impact on the calcified hairball that is our institutional health system. More employers and even some insurance companies may start thinking long-term and focus on prevention, buying services from these companies to offer to employees or insurance customers. The data these users generate for themselves may help to force a change not just in who pays, but in what they pay for: health instead of health care.

NOTE: Esther Dyson wrote a seminal article on the impact of the Internet on intellectual property in 1994, and later became an active and successful investor in Internet start-ups. Now she has turned her attention to the impact of the Internet on public and personal health. On the health side, she is a director of 23andMe and an investor in HealthWorldWeb, Keas, Polka.com, PatientsLikeMe, PatientsKnowBest, Organized Wisdom, Ovusoft, Resilient Networks and Voxiva. She is not (yet) an investor in any of the companies mentioned above.