The Next Big Thing in Health is a podcast where we explore the new big ideas that will help make health care more affordable, more available, and more effective.
熊猫视频President and CEO Matt Eyles and co-host Laura Evans were joined by Dr. John Whyte, Chief Medical Officer at WebMD, for a discussion on the challenges facing the health care system, and how to reduce health care disparities and boost health equity. Dr. Whyte also addressed the rise of artificial intelligence and how it can influence personalized health care.
Eyles:
Hi everyone, and welcome to the Next Big Thing in Health, a podcast from AHIP. I'm one of your hosts Matt Eyles.
Evans:
Hi everyone. I'm your co-host Laura Evans.
Eyles:
Today we're joined by John Whyte, chief medical officer of WebMD. In addition to his role at WebMD, John is a board-certified internist and he continues to see patients in Washington, D.C. and Maryland. He's also the author of a new book, "Take Control of Your Heart Disease Risk." I'm really excited about today's conversation because one thing we know is that in order to make meaningful changes in our health care system, we need to build partnerships and forge collaboration.
Eyles:
John's role at WebMD is to develop and expand the kind of strategic partnerships that can really move the needle around important and timely public health issues. He's also an alumni of the US Food and Drug Administration and has developed numerous initiatives to address safety and diversity in clinical trials. We're looking forward to talking about the challenges that exist in our system and how we can reduce disparities. John, thanks for joining us today.
Whyte:
Matt and Laura, thanks for having me. It's great to be with you.
Evans:
It's really good to have you with us, John. So everyone knows WebMD of course, and it's really often the go-to for so many Americans, when they or a loved one has an ache or a pain. But WebMD as we know does a lot more than that too. And I know in fact, you're helping lead WebMD to confront some big challenges in our system. So I want to start off with a bit about your role, John, and can you also enlighten us a little about what drives WebMD as an organization?
Whyte:
Sure, and I've been at WebMD for almost five years, and I started before the pandemic, and in many ways the pandemic has changed my role at WebMD. You know, our overarching goal is better information is going to lead to better health. And we really saw that during the pandemic, the importance of quality information that can be trusted, that can also be actionable.
Whyte:
So the other thing, Laura and Matt, that's really changed during the pandemic is people don't search and then want to print it all up with a health condition and bring it to their doctor and say, "What should I do?" After waiting six, eight weeks for an appointment, or during the pandemic not being able to go at all. So it's really empowering patients consumers with good content, and then linking that content to care. So can you get a telemedicine appointment? Right then, after you've searched about rheumatoid arthritis> If you search signs or symptoms of STDs, can we send you a link to get a lab test without first having to see a doctor? So that's what I'm really excited about. This how do we change this idea of just searching content, but instead connecting it to care? And then how do we utilize all the new technologies that I'm sure we'll talk about in terms of empowering people? But bottom line is, if people have better information, they're gonna have better health.
Eyles:
Those are some really great innovations just to think about convenience and access. I think it might also be helpful to start our conversation by talking about just some of the biggest issues facing healthcare right now in 2023, hard to believe we're in the second month already. You've talked a little bit about where we can find solutions. We also know that February is Black History Month, and as we celebrate and really reflect on it, we also know that health inequities are just a plague on our system. How do you think we can help end healthcare disparities and really advance equitable care for all?
Whyte:
And I've met Laura a few years back when we were talking about issues of equity, particularly in the treatment of cancer. You know, again, I think the pandemic has changed our thinking. So a big issue as it relates to disparity is access. But it's access in a couple ways. We always think it's access to the health care system. How do I see a doctor? How do I get a lab test or a procedure that plays a big role? But I have to tell you that something that I really learned during the pandemic, I really should have known this more before. And there's a great phrase: health happens outside the doctor's office. So I care about your blood pressure in the doctor's office, but what I really care about is what's happening at home. How's it on a daily basis? What's your blood sugar on a daily basis? What's your stress level and your mood when you're at home?
Whyte:
And we haven't focused enough on that, and that's where our social determinants of health. So it's about access again, but access to fresh fruits and vegetables. It's about access to a safe environment, where you can be physically active. It's about a job that you don't have to work 60 to 80 hours a week, and then not even be able to afford your rent. You know, it's all of those elements, as well, that we often don't think about in terms of oh, that impacts your health. But if you live in a food desert, where there is not, you know, an easy way to get affordable items for your meals, then that's a big problem.
Evans:
And, John, as you mentioned, you and I've talked about health equity a lot over the years, so I'm curious. Can online self-diagnosis and other technologies actually help promote health equity? I'm curious, what are the benefits here and what are some of the risks in your opinion?
Whyte:
I love that question. Because we do have on our symptom checker at WebMD, which is very popular, that it's not there to diagnose. Right and as you both know, you mentioned I worked at FDA. I worked on the drug side, but on the device side, there's a lot of discussion about what constitutes a device and part of that is whether it gives you a diagnosis. So we're always clear about what we're trying to do is to alert you to what your signs and symptoms might indicate. Because it can be confusing in terms of is a cough COVID, is a cough influenza, or muscle aches, fibromyalgia or thyroid disease?
Whyte:
I'm not trying to get you to be a doctor or nurse practitioner online. What I'm trying to do is to empower you with information, empower you with the questions that you want to ask your doctor, but I don't want you to be a Dr. Google. And I know plenty of patients that have done a lot of self-diagnosis and self-care. Sometimes it's been successful. Sometimes it hasn't been, and that's the real risk.
Whyte:
So I am concerned about people just making their own diagnosis from reading information online. Remember I said it's about connecting them to care, not just about managing it all on their own, but I get it. Why should people have to drive 30 minutes to see the doctor, take public transportation, wait 30 minutes for a 15-minute appointment and then redo it all again? That they can figure it out on their own. But that's, Laura, where technology is going to play a role. It's not just telemedicine and that has really changed things. It's going to be other usages, as well.
Evans:
And we'll get into a little bit more about that in a second.
Eyles:
Yeah, that's a great mention. I'm definitely going to tell my wife that when I get home. Self diagnosis.
Whyte:
I know it's audio so they can see the video, but I saw you chuckling when I said that.
Eyles:
Yep. Yeah,
Evans:
Mom, I'm guilty of it too.
Eyles:
For sure. So at AHIP, here we represent health insurance providers, and I know from a lot of conversations with our member companies that they want to encourage their members, their enrollees to seek care, and that they value the relationships that they build with their health care providers. Do you believe that people are hesitant to seek care because of the costs of medicines, procedures, and other costs that we know are going up?
Whyte:
And you had mentioned I worked at FDA, but I also worked at CMS when I first came to Washington, D.C. and interacted with your members quite a bit. I think there's a couple issues going on, Matt, I certainly think there's the issue of the cost, and sometimes it's not easily transparent in terms of what that cost might be. If you go to the doctor's office, what's going to be the cost of a medicine or visit or a test. So that certainly plays a role and that's where we see disparity. It's also the cost of time, right? Can I take off work? In some ways, it's become a little easier as people are working from home. But it still can be challenging to find that, you know, hour or so, or longer if you have to go somewhere, so that plays a role.
Whyte:
But Matt, something I've learned over the years, there's also something going on that I call both, you know, we know FOMO, fear of missing out. There's also the fear of finding out. And I see that a lot in terms of diabetes, someone who might have been told they have prediabetes, and I'm always surprised by this. A patient's told they have prediabetes. I see this in my practice. They don't come back for years. And I asked them when they come back because they're in short. Sometimes they just don't want to know because it can impact your life. Especially early on. Sometimes people don't do screening tests, let's be honest, because they don't want to know the result.
Whyte:
So how do we help address that with members? Help them understand that there can be a support structure? Everyone doesn't have it. Right? I've had so many patients that will say I don't want to know because I can't take off work. Or I have to take care of my family if I'm sick, right, and now you have a diagnosis. So some ways you're labeled as sick. How are you going to take care of other people? So that's something that we don't spend enough time focusing on. So sure, it's about the cost. Absolutely. It's about access. The amount of time that it takes to to be involved with the health care system. And then it's also that fear of finding out. We certainly can do a better job of customer service, and we all know that no one would typically say interacting with health care system is easy. Right? We're making progress. But that's going to improve the overall idea that we want to diagnose people earlier in their disease states rather than later. Yeah, and we want to make sure that there's follow up.
Evans:
FOFO makes sense. You know, it opens up a can of worms and yeah, starts you down a path you may not want to go. So I'm curious, how do you communicate to users when they should seek help for certain symptoms, as opposed to when they can use WebMD's information, which we know is provided by certified professionals.
Whyte:
A big part is, at the health system that I work at we do make sure about follow up. So if you don't show up for a polyp appointment within six months or a year, we're going to start bugging you. That still doesn't mean that people come in, but at least we have a system to recognize that people haven't come back and they're due for certain things, such as screeing. I think the biggest component is really having that good provider-patient relationship. And that can be hard, because there's limited time during a visit. Right?
Whyte:
You know, I can write things in what's called the after visit summary. But it's really having that discussion. What I often tell patients are, you know, there's lots more treatment options available for whatever the disease is, whether it's arthritis, whether it's diabetes, whether it's heart disease. And they don't always know that, they don't always remember what was said during the appointment. So it's really kind of, Laura, to have more touch points with patients, right, either through the provider, through the plan, through their employer-based insurance. That's what I think is an important component that we haven't focused enough on. To let people know that there is support, that there are opportunities. You know, most conditions we have many more therapeutic options than we did years ago. And really, again, trying to empower patients with the right messaging, which can be hard when we have limited time during that face-to-face whether it's in person or virtually, so to speak.
Eyles:
And maybe to build on that, John, I mean, you touched on how the pandemic prevented many people from visiting doctors seeking proper care. You talked a little bit about telehealth visits. Obviously it's always good to be in person, too, when you're seeing your healthcare professional or your doctor. How can we encourage more people to seek professionals advice after putting off wellness visits for a couple of years and many of these important screenings?
Whyte:
Well remember at the height of the pandemic, we said don't come to the doctor's office, it's not safe to come to the doctor's office, and then it was very hard to get appointments. I think for telemedicine and telehealth, what we're learning now is when is it the right time to use it? And I think early on we all just jumped into it. And in some instances it is the right type of visit, especially for follow-up visits where I may not have to be too concerned about vital signs, even though I can still do that remotely with the right technology, whether it's prescription refills or whatever. So there's lots of times where patients don't have to come in, but other times they do and we need to make that distinction.
Whyte:
I've had lots of patients that their telehealth visit sometimes was telephone, telephonic, because they didn't have the video capability. And I was like "You just can't do a rash over the phone." That wasn't their fault. It should have been communicated to them better, that you're still going to need to come in to that. So I think we have to sort out where it works and where it doesn't. And then I think it's reminding people, the importance of screening.
Whyte:
People always are a little bit reticent about colorectal cancer screening. But the good news is we have a lot more options. Nowadays, everyone doesn't have to have a colonoscopy. We can look for genetic fragments with certain tests and people don't always know that. You know, most of those are covered under the Affordable Care Act. The U.S. Preventive Services Task Force has said it receives a certain grade, so there's no cost to the patient. Other than, let's be honest, the cost of time.
Whyte:
So it's really encouraging people. I always say if I was running a health care system, I would have these billboards with open arms and say come back, bring me all your data. Bring me all everything that you're watch, your smart jewelry is telling you. But then you have to reconcile that. And that with, sometimes it can be long lines, right back to that customer service example. We're not always the best in terms of seeing you on time, making it easy in a parking lot and other places, to come in, be seen, and address all your issues. And to be fair, sometimes I get a bit anxious when patients do come in with that long list. And I'm thinking "Okay, you haven't been here in two years, and I kind of have to redirect. I can't do everything today." And sometimes it's reminding them it's not just coming in once a year, or once every other year. It depends what's going on, but there's no way I can address five or six issues during a 15-minute appointment.
Whyte:
And I think we have to think through how do we do that. Is that follow up with the telephone visit, is with a video visit, is with an in-person visit, is it with a specialist? And realistically, there are some lines, there are some queues to see certain specialists right now, and that's going to take a little bit of time to get through. So the important aspect here is we all have to be good triage-ers, right, whose needs are more urgent in terms of referrals, and then how do we continue to improve capacity.
Whyte:
Medscape we've published multiple surveys about burnout. People are leaving the profession, nursing, medicine, pharmacy. So how are we continuing to provide high-quality service while trying to provide high customer service? And customer service means more than waiting times. I know people tend to focus on that how long they've had to wait. It's also about the quality of care. So there are some challenges ahead.
Evans:
Well, if you want to get them into a colonoscopy screening, just advertise the sleeping, because that's the best sleep of my life. Not really. So we've alluded to this earlier, we've talked a lot on this podcast about this about the increased use of digital tools like wearable devices. And I want your personal thoughts on this trend because I know you're interested in this and going back to our discussions about inequities in health care. By utilizing these devices, do you think we are adding to inequities in health care by utilizing smart devices digital tools?
Whyte:
I've been calling it smart jewelry. You might have heard. It was always like rings. Yeah, watches. There's even some necklaces that are like the old mood rings. You know, I'm really excited about the role of tech in health care. I've been telling people that the future doctor's office is going to be the bathroom. And the reason why, and I visited some of these companies, and Laura knows I've talked about this. A smart toilet that's going to analyze your urine and other bodily waste every day and it's going to check for things like high blood sugar in your urine which could indicate prediabetes, it's going to look for blood in the stools, which might indicate colorectal cancer. I saw a toothbrush that is going to check for strep in your throat So wouldn't that be great? And a mirror that actually looks for skin cancer? Because if you think about it, you look in a mirror every day, multiple times a day, so they're not quite there yet, but they're going to get there. Right?
Whyte:
And that's going to address the issue that health happens outside the doctor's office. The key is how do we connect this all to the health care system? I've been a physician for over 20 years, we have been talking about interoperability for 20 years, and we still have progress. So when a patient comes in, and I'm not making this up, she told me that she's snoring. And I'm like, "How do you know you're snoring?" And she's like, "my watch told me," and I'm like "your watch?" And she has a certain type of watch device. And it actually recorded her snoring. This is as good as, almost, as a test for obstructive sleep apnea, which I sent her and she does have it. But I wasn't able to put that in the record. Remember it didn't diagnose it. It just gave an indication.
Whyte:
But Laura, here's the point. Everyone can't afford that fancy watch that she had. Everyone's not going to be able to afford that smart toothbrush and that smart mirror and that smart toilet. So that's what I'm concerned about. Not everyone can have a smart watch that's tracking calories, and I've been using it. And I learned a lot because, like you, I was walking like 2000 steps a day and thinking why am I gaining weight? I feel like I'm in the home walking, but I'm not walking far. And that type of personalized feedback, that's what I love about these devices. It's your personal data. Right? If I'm not comparing you to some norm, I'm looking at your data, and I'm looking at trends over time. That's phenomenal. And that's only going to get better.
Whyte:
But if you can't afford those devices or you don't have access to high speed broadband internet or your phone, cellular service, you're limited based on the amount of data, you're gonna be left behind. That's what's concerning. We like to think all ships rise, no they don't. Right. So those that can afford all these devices and tools are going to be in a better place. So how do we democratize that? That's where there's going to be the real issue going on right now. But it's amazing how technology is going to continue to iterate.
Eyles:
Those are some remarkable examples. I don't know if that's too much information or excited for the future.
Whyte:
It depends if your fear of finding out or you want to get on top of things early on.
Evans:
That's right. That's all over that smart toilet.
Eyles:
Well, let me think about how we use wastewater now for public health surveillance. We could talk about it in a way that pre-pandemic we never did. But maybe just to build a little bit more on this notion around equity. And I know during your time at FDA, that you worked on initiatives with respect to health equity, but can you maybe elaborate on some of the health care disparities that stop or prevent people from seeing doctors and ways we should maybe think differently about ensuring equal access and improving health equity?
Whyte:
And Laura knows, I'm passionate about this, so I'm just going to be transparent. And I think whether it's at FDA as a regulator, I think whether it's plans or others. We have these aspirational goals, right, a certain percentage of people that we want enrolled in clinical trials, a certain percentage of African Americans where we want their A1C, this or that, or to have colorectal screening. Goals have to stop being aspirational and we actually have to have consequences of not meeting goals, right.
Whyte:
So we need to have these thresholds. And we need to make every measure to meet it and really put these markers in the sand and say this is what we're going to increase by such and such a time and then measure against it, right. For the vaccine, we said up front for COVID, that this is our goal to percentage, and then they changed things along the way to make sure they met that goal. We don't do that in most clinical trials. We don't do that in most systems, in terms of making sure that the workforce represents the people they serve, that when we have these goals and let's be honest, everyone's been talking about equity and disparity for the last few years, which is a good thing. But let's stop talking about it. And let's start doing something about it and finding the solutions. We don't need 10 more meetings on it. What we need are 10 different ideas of how we're going to solve it and then measure how successful they are.
Evans:
And it takes everybody to make a difference, everybody's work to make a difference. Hey, John, I want to shift the focus really quickly and talk about your new book, very exciting. "Take Control of Your Heart Disease Risk," which Heart Disease Month it is right now. I know this is the third in your series. You also have to "Take Control of Your Cancer Risk" and "Take Control of Your Diabetes Risk." So I have read the first one, so I'm looking forward to reading the next two. So tell us a little bit about the your book, and heart disease is the leading cause of death in America. We've made a lot of progress in treating heart disease, but what can we do to further mitigate the risk?
Whyte:
And what's important is it's the same concept that information is power. Right? So a lot of people think that heart disease is mostly genetic. Although there is a genetic component to heart disease. Most of it's caused by lifestyle. It's that unhealthy food that we're eating that physical activity, it's still smokin. A significant percentage of people still smoke. It's about even things like rheumatoid arthritis can put you at risk for heart disease. COVID has increased the risk of heart disease. And there's a lot of factors, stress and depression, which we tend to ignore, thinking that the mind and body are separate. Well, the mind and body are connected. And we need to start recognizing that.
Whyte:
So it's really about talking to people, what can they do? Because people always say to me, "Okay, Dr. White, tell me what to eat and I'll do it. Tell me what exercise I should do. And I'm on it." And I'll tell you that doesn't always work. This is the time of year everybody tells me they're taking up swimming. And I'll be like, "do you like to swim?" And they'll be like, "well I heard it's really good for you." But I'm like, "if you don't have a pool, I don't have a pool." Yeah, you got to drive somewhere. You got to change. You got to shower, you got to do it all. Do you have two hours of your day? And they'll be like "No," so I'll be like "choose something that you enjoy that so you don't see exercise as a chore."
Whyte:
Yeah. So what I tried to do, Laura, there is to really show them that they have the power to reduce the risk. And really it's about patterns of behavior, and getting their mindset to change. And you know, just map back to when we talk about quality. I talk a lot about cardio, cardiovascular risk calculators, heart disease risk calculators, ECCHA has one, there's Framingham. I can't tell you how many doctors don't do it. With patients to say okay, here's your 10-year risk of developing heart disease if you haven't already had a heart attack in the next 10 years. That's really helpful. Now, I'll tell you it's all relative. So usually around 7.5% 9% if that's your risk of developing heart disease in 10 years, depending upon other issues, we will talk about starting you on perhaps a statin. And sometimes patients will say to me "9%, that's not that high." 20% is technically high, but I'm like, "Okay, well, that's a good framework. Let's have that discussion." Yeah, but largely, it's about data. And that's what I focus on in the book, your personalized data, right and how can I help you develop your personal plan? Too many doctors just say, "You need to lose weight. You need to exercise." Okay, what how does that help anyone? So here's it's really about providing practical strategies to reduce your risk.
Eyles:
I'm going to my annual physical tomorrow actually. Have to go and do my health heart risk calculator before I go see my physician.
Whyte:
You should ask them to calculate what's your risk of having a heart attack in the next 10 years? You should come up with your list of questions ahead of time and write them down and don't leave until they're all answered.
Evans:
That's such a good point, I always forget and I need to prepare because if you have such a limited amount of time, and yeah, so those questions are important, Matt.
Eyles:
Absolutely. They are and so one last question. We always love to ask all our guests. So here's the wind up. John, what is the next big thing in health?
Whyte:
I think it's all about this generative content, this ChatGPT. So how do we use artificial intelligence to create content? And the reason why I think that's so important is that's going to change how people search for information. That's going to change how people are going to base recommendations, right. I can say, give me the five exercises that I should do as someone who's over 65 and overweight and has diabetes, and provides me that personalized plan. I think that's what's really exciting. There's a lot to work on that in terms of transparency, misinformation, but AI specifically in generating content around to help could be transformative to what we're all doing.
Eyles:
That's really the thing about it.
Evans:
Love it, fascinating.
Whyte:
Good and bad, good and bad. We have the good then bad on it. So we have to sort a lot of things out. But that's not going away, and we can think oh, let's not pay attention to it now. Now's the time to pay attention and get involved and how we're going to use it. Because it's just going to get better. It's now where it needs to be right now. But you're asking about the future. And I think that future is to three years, Matt, not 5, 10. How are we going to manage that?
Evans:
I got to get my head around that one.
Eyles:
Absolutely. John, thank you so much for joining us today. This was a great conversation. Fascinating stuff.
Whyte:
Thanks so much for having me.
Evans:
Thanks for enlightening us, John, as always.