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A Skeptic Takes On Mobile Health

Is technology for monitoring sick people in their homes good medicine? One Yale cardiologist says the case hasn’t been proved.
September 16, 2011

Excitement over the iPhone and its family of miracle devices is rubbing off on health care, with doctors, policy makers, and especially companies touting a mobile-inspired technology called remote health monitoring as the next big thing in medicine.

Doubter: Harlan Krumholz found no benefit to heart patients from remote monitoring.

The idea: hook up patients at home so their health statistics, such as weight and blood pressure, get beamed to doctors via the Internet or mobile devices. The purported benefits: fewer hospital visits, better care, and much lower costs.

But enthusiasm for remote health monitoring is conspicuously absent among a group of physicians at the Yale School of Medicine in New Haven, Connecticut. Armed with a recent study, the researchers say that claims for the technology have gotten well ahead of the evidence that it works.

“On the face of it, it seems to be a valid approach. But it’s not enough for something to just seem to be valid,” says Harlan M. Krumholz, a Yale cardiologist who has become the most outspoken skeptic. “Right now, there isn’t a lot of evidence to prove that remote monitoring is actually beneficial.”

Remote monitoring has been hailed as a better way to approach care for everything from diabetes to heart illness to lung disease. Among the biggest boosters of the idea are medical-device makers and IT companies, including Intel, Philips, and IBM; they foresee home health care becoming a large new market for semiconductors and software, much like cell phones and computers today. Some employers are enthusiastic too, seeing the technology as a potentially cheap fix for skyrocketing health costs.

What worries Krumholz is that the United States may be repeating a familiar pattern: spending billions on a technology backed with slick marketing, only to find out after the checks have been written that the purported benefits do not materialize.

An outspoken advocate for “evidence-based” medicine, Krumholz has made his name by questioning fellow doctors for prescribing expensive drugs or performing complex procedures that he thinks don’t work—or that may cause harm. In 2005, he looked into an expensive computer-aided physician assistance system developed by the Pentagon and concluded that it had little or no benefit.

Last November, Krumholz and some of his Yale colleagues, including Sarwat I. Chaudhry, another cardiologist, rocked the world of remote health monitoring when they published an article in the New England Journal of Medicine involving 1,600 patients recently hospitalized for heart failure. Their conclusion: remote monitoring provided no benefits.

The result followed a parade of positive studies—including some funded by companies—suggesting that home monitoring of similar groups of patients with chronic heart disease could reduce either deaths or unnecessary hospital readmissions.

Some proponents of home monitoring technology, including Intel, criticized the New England Journal study for its methodology. For example, patients were required to weigh themselves every day and then phone in the results to a computerized answering center so that doctors could look for the sudden weight gain that often precedes a heart crisis. Critics said that requiring patients themselves to take that step, rather than having their weight transmitted effortlessly by some form of Wi-Fi-equipped bathroom scale, was an ineffective means of monitoring. Chaudhry, though, says there were pluses and minuses to every approach the researchers might have come up with. What’s more, the Yale study was larger, and involved more hospitals, than many of the previous investigations.

As it stands now, remote health monitoring is a battleground for dueling studies, with each side able to point to articles supporting its point of view.

Krumholz says that despite his public skepticism, as a practicing cardiologist he is rooting for researchers to find a remote technology that really works. “There is no question this technology is cool,” he says. “We are trying to remind people that you can’t assume the benefits of something without actually proving them to be real.”

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