On 6 October 2015 I had the opportunity to address key global policy makers and top consumer health executives on exciting trends about the new profile of the consumer in health at the World Self-Medication Industry (WSMI) annual conference sponsored by the Association of Producers of Non-Prescription Drugs in Mexico (AFAMELA). Consumers are taking full ownership of their health as digital technologies in the form of medical devices, applications, wearables, smartphones and tablets take over the lives of individuals. Within this context, I presented trends showing the next evolutionary step of the consumer health industry: The merger of the traditional approach of consumer health with the new possibilities for growth using digital technologies.
The transformation of self-care and responsible self-medication
The consumer health industry has evolved in three different stages since the 1950s. In the first stage, the recommendation of a healthcare practitioner on the proper use of over-the-counter (OTC) drugs was the main driver of retail sales. In the second stage, an empowered consumer is able to self-select options at the point of sales for the prevention or treatment of his/her symptoms, especially in countries where self-selection is allowed, or where retail channels have extended outside the pharmacy/chemist channel. Today, the consumer health industry is entering a new era where an empowered consumer in responsible self-selection will benefit from the virtual accessibility of his/her electronic health records (EHRs) via a pharmacist or healthcare practitioner that may allow for a safer dispensing of novel OTC therapeutic drugs while boosting benefits and minimizing risks in the self-care setting.
The Evolution of Consumer Health Retail Value by Region 2010/2015/2020
Source: Euromonitor International
Note: Consumer health is the aggregation of OTC drugs, vitamins, dietary supplements, weight management products, and sports nutrition.
Setting up the stage for a new frontier in OTC switches
Electronic health (eHealth) and mobile health (mHealth) continue to strengthen as health systems across the world digitize patient records based on global and local initiatives steered by organizations such as the World Health Organization (WHO). The International Classification of Diseases (ICD-10) is the most recent application used to harmonize the digitalization of records across countries. The WHO first endorsed this classification and technology back in 1990. The next version ICD-11 is expected to be released in 2018 and will bring features such as web-based editing and personal use. Initiatives like this can be used to solve interoperability problems so as to reduce backlogs in communication and to create a more effective use of eHealth records (EHRs) across health providers. This initiative may generate significant savings in healthcare delivery while improving the health outcomes of individuals. In terms of mHealth, the WHO in partnership with the International Communication Union (ITU), a United Nations agency, presented “mHealth – new horizons for health through mobile technologies” in 2011. Most recently they introduced the Be He@lthy Be Mobile programme as the next bastion of the mHealth initiative that concentrates on the management of non-communicable chronic diseases (NCDs), and to be implemented in eight countries during the first four years from launch. So far, it has been adopted in Costa Rica, Senegal and Norway.
The Green Paper on Mobile Health launched by the European Commission in April 2014 stated that mHealth revenue projections are expected at US$23 billion in 2017. According to the report, the downloads of free-of-charge health, sports and fitness apps reached 231 million in 2013, while an estimated 68,000 health apps are targeted directly at consumers. Results of the public consultation on The Green Paper were made available in January 2015 summarizing the following concerns:
- Assure the protection of personal data, privacy and security
- Deal with interoperability issues with the sharing of big data
- Improve the legal framework to regulate mHealth apps and EHRs
- Guarantee patient safety with the use of mHealth apps
- Promote equal accessibility to mHealth in the monitoring of NCDs
- Facilitate reimbursement for the use of mHealth services
- Support improved market access to web-based start-ups
Alternatively, consumers are being smitten by the advent of wearable devices and web-based applications that help them track and monitor their health from many different angles. By using their smartphone, tablet or computer individuals cannot only track their diets, fitness, weight loss, and sleep patterns, but also monitor their blood pressure, blood glucose, testosterone level, body temperature, allergies, mental health, ear care, eye health, and see their lab results with a simple click. The list keeps getting longer each day. Consumers are not only taking a more proactive role in their health, for the first time they are fully-owning it. They are recording and uploading their personal health records (PHRs) to digital spaces that will eventually merge with their EHRs to create an amazing and comprehensive view of their individualized health.
From the industry perspective, eHealth and mHealth are becoming key allies in clinical studies, patient adherence protocols, and the tracking or monitoring of health and epidemiology patterns across populations. Yet, their effective use to promote OTC switches to balance benefit vs. risk is yet to be seen. Although these technologies may be used as part of actual use, self-selection and labeling studies, the missing link is connecting EHRs and PHRs at the point of sales for the safer dispensing of novel OTC therapeutic categories that comply with the reduction of risks of OTC drugs as required by regulators in the self-care setting.
A number of cloud –based technologies are anticipated to emerge as health records get digitized, consumers monitor and track their health, and the industry embraces the benefits of digital connectivity for research, product development and consumer engagement. Microsoft’s Health Vault has been at the forefront for several years, yet other cloud-based solutions are being launched. H2 Wellness is a new start-up solution developing cloud-based apps that gather PHRs and EHRs along with digital and live coaching capabilities, a direct communication channel with the healthcare practitioner, and e-commerce solutions that enhance the digital health space. In September 2015, IBM announced the expansion of the IBM Watson Health Cloud capabilities to include a Life Sciences Compliance component apart from their current IBM Watson Care Manager that integrates Apple’s HealthKit amongst other platforms. The Life Sciences component claims to help companies better manage the safety and effectiveness of new potential therapies to be brought to market.
Retailing trends: New drug dispensing formats and retail clinics becoming the extensions of health systems across the world
The future vision takes us to a scenario where a relatively healthy consumer can gain access to new therapies in OTCs and where a pharmacist can quickly see on a screen if the health status of an individual is satisfactory based on a safety rank metric based on the backend virtual monitoring merging EHRs, PHRs and the general practitioner approval. If this scenario becomes a reality, then it will lead way to an individualized approach in the dispensing of certain novel OTC therapeutic drugs for erectile dysfunction, hypertension, incontinence, asthma, diabetes, etc. as long as the individual’s risks are minimized based on his/her current health status. A virtual safety net could potentially allow the industry to conquer new possibilities for the expansion of self-care and responsible self-medication. This approach may bring a wider array of savings to the parties involved in the delivery of health. For health systems, savings are represented by a decrease in costs of care and consultations that take time away for general practitioners to spend with sicker patients. For retailers, dispensing costs can be significantly reduced if pharmacists do not have to spend time gathering information or filling out questionnaires before dispensing a drug to an individual. For consumers, they will have the ability to gain access to therapies or treatments when they need them. They will save money by not paying for a consultation or spending time waiting to see a general practitioner to get a prescription. For payers, new OTC therapies can generate savings in reimbursements costs. Finally for the industry, it can represent a new source of revenue in times when the use of traditional OTC drugs flatten out and when there is a big need to bring therapies that will benefit more consumers in the self-care setting.
Retail or walk-in-clinics at pharmacies and drugstores continues to expand across the world. These channels are becoming an extension of health systems as healthcare practitioners are now available for consultation at the point of sales. This trend is not unique to developed economies as this model has existed successfully in emerging markets like India, South Africa and Mexico for years. Public and private health systems are partnering with retailers to expand the clinics and wellness centers – e.g. Walgreens Boots Alliance and the National Health System (NHS) in the United Kingdom; however, some challenges persist in terms of patient flow limitations, retailing space constraints, and hours of operations. Some retailers are placing big bets on telemedicine to help alleviate some of these challenges. Particularly, Walgreens Boots Alliance partnered with MDLive, an app and telemedicine service app that helps people schedule virtual appointments with general practitioners.
Take your selfie of health!
There is no doubt that smartphones are becoming an extension of our lives. Digital health is becoming available to millions of individuals and health practitioners in real time: 24 hours a day, 365 days a year. Therefore, emerging technologies available in mobile devices such as smartphones will become an extension of our health. We will see our health reflected in these devices and will serve as reminder on how much we own our health at our fingertips.
In November 2015 Euromonitor International will publish a global report on The New Profile of the Consumer in Health expanding insights on these trends in addition to the concepts of holistic health, ageing and the optimization of health from the prevention and treatment perspectives.