Three digital health hypotheses for 2024
Ghosts from the Preprint past, present, and future tell us what’s next in health care
The only thing surer than the fade of an old year into a new one, is the corresponding drizzle of predictions lists. Especially in health tech.
If you’re reading this newsletter, you’ve likely already received many others this year proselytizing about a variety of trends. A.I. will replace. Climate will displace. Our economy will soften…or harden. The election will…who knows.
The nice thing about science is that incorrect hypotheses prove just as helpful as correct ones. In some ways, you can get it right, even when you’re getting it wrong. And what is a hypothesis if not a prediction? What is a prediction, if not a priority?
Here’s what my team and I see coming:
Demographic trends will force the hand of health care progress.
Or: if the argument for better care doesn’t win with equity, it will win with numbers.
Demographers, journalists, and politicos talk a lot about the increasing diversity of our country, but say less about what truly accounts for it: changing fertility rates. The coming year is likely to be the first time that the CDC’s National Vital Statistics System registers less than 50% of newborn babies in the United States as white.
This poses a moment of reckoning for a system that, by all measurements, fails at producing equitable outcomes by race. The maternal mortality rate among Black and Native people in the U.S. is nearly three times that of white mothers. The relative increase in maternal mortality among Hispanic people in recent years was 74%—greater than any other group.
What happens when people of color become the majority of birthing families in the country? What happens when the majority of people in labor and delivery rooms are also those most at risk of being neglected by those rooms? Payers, insurers, and employers will face insurmountable pressure to build a more just system.
There is already evidence that the groundswell of advocacy among communities of color has become impossible to ignore. Last week I was honored to participate in a roundtable at the White House, during which the Federal government announced a series of new investments designed to improve outcomes and reduce disparities. I’m hopeful we’re nearing a crescendo.
We have entered the age of point solution consolidation.
Or: the market will reward taking the whole pie, not a piece of it.
Everybody sees it: health tech investments will be leaner in 2024, and so entrepreneurs will be scrappier. Last year I said we’d officially departed from the pandemic cash flush. Lo and behold, U.S. digital health startups experienced their second-lowest quarter by funding since 2019.
More than most, the world of health care is sensationally complicated, bureaucratic, and fragmented. There are a lot of ways to enter a problem this big. That can be a great thing, but in the past, it means it’s been all too easy to drum up excitement for point-solutions. Think: remote monitoring for diabetes, as divorced from teletherapy for weight loss. These two products should live in harmony together not because consolidation occurs in a soft economy, but because that’s how doctors administer care.
In an ideal world, we treat the whole problem. At Maven Clinic, members come to us because they want to start a family, not because they want to start IVF. Our platform reflects that. From a user experience too, patients are fatigued by seven apps for seven specialties, and providers are fatigued by the lack of integration.
Point-solutions nibble at systemic issues, when we need to be finishing the whole plate. Health care can be personalized and agile on the same platform—indeed, going into 2024, it will have to be.
Misinformation will rise, as will the burden of proof for good data.
Or: It’ll become easier to spread old lies, and harder to prove new truths.
In case I haven’t been abundantly clear, I care deeply about the crisis of medical misinformation (and disinformation) in this country. I wrote about it here. I tweeted about it here. I podcasted about it here. I talk about it more on Slack than most of you will have the pleasure of witnessing. I believe it to be an existential problem for our times. And unfortunately, in 2024 I think it is going to get worse before it gets any better.
Bad actors have always preyed on the innate instincts of mothers to protect their children. But as we reckon with the ongoing consequences of Roe v. Wade, enter an election year, and watch the powers of generative AI metastasize, even voters agree misinformation is liable to skyrocket in 2024.
This moment dovetails with one of my end-of-year predictions from 2023—that health tech has entered our “prove-it” era. Which means something sort of remarkable will happen: even as low-quality health information spreads, the standards for tech solutions rise. After all, as we see tech further the problem, investors and consumers alike require more evidence that technology-oriented health care can also be part of the solution.
If this widening gap sounds demoralizing, I hear you. But chin up. It’s our job to meet it, and I look forward to meeting it alongside all of you.
As a New Year’s greeting, in lieu of our recent reads, we've decided on an annual round up. So here are some of my favorite reads from 2023.
In general, any Katherine J. Wu original is worth your time. Her missive in The Atlantic on the seasonality of fertility is a helpful synthesis of centuries of documentation, and at the end, a nice meditation on the power of humans.
The Covenant of Water, a sprawling epic following a South Indian family across decades, was written by a doctor—the legendary Abraham Verghese. And you can tell. Not because of his precise, surgical attention to anatomy, (though I love that), but because of his understanding that generational stories travel through the body.
Nothing makes the epidemiology of racism hit quite like the interactive graphic that accompanies this article from the New York Times, explaining how money protects white mothers and babies but fails to protect Black ones.
What if we gave patients the same kind of support we give elite athletes? Much like sports performance, the road to value based care requires medicine rooted in goal-setting and emotional reinforcement. A thorough piece in NEJM convincingly advocates for the broad adoption of health coaches in hospital rooms—just like doulas.
This New York Times Magazine opus on menopause is many things: a thorough primer on menopause misconceptions; a cautionary tale of scientific communication gone wrong; and a stunning interrogation of the ways we forever ignore women’s pain.
Common Sense: A Political History is not a new book, but it’s an evergreen one. As intellectual historian Sophia Rosenfeld notes, humans love the idea of “common sense.” Her findings are helpful context for medicine, where we must likewise learn how to offer evidence-based care that affirms patients as much as familiar wisdoms do.
For New York Magazine, Simon van Zuylen-Wood takes us down the wild rabbit hole of the male fertility industry. He zig zags between politics, health care, Silicon Valley, and pop culture, in the process revealing just how many powerful people have something to gain from reinforcing men’s fears about their own masculinity.
I received “The Boy, the Mole, the Fox and the Horse” from a former student of mine (and later, a fellow at Maven Clinic!). She’d pinned a note to the page where the aforementioned boy asks the aforementioned horse: “Sometimes I think you believe in me more than I believe in myself.” The horse replies, “you’ll catch up.” I think this is both the task of being a good mentor, and being a good start-up. So long and thank you, 2023.