Despite ranking first in healthcare spending, the United States currently ranks 26th in life expectancy. Although no clear answers can either explain or improve this ranking, investigators of a viewpoint article published in JAMA Cardiology suggest that medicine should mirror other industries in customer targeting by tailoring therapy based on patient behaviors.

One theory that may possibly explain the gap between healthcare spending and low life expectancy in the United States includes the low adherence rates of effective medications. Investigators suggest that improvements in communication may subsequently improve overall patient engagement, resulting in greater survival rates in patients with high-risk diseases. In addition to creating more effective therapies, leveraging wireless technology, improving access to electronic patient data, and implementing recently discovered techniques in behavioral science may be effective for improving adherence among patients.

Technology is consistently used to identify retail customers and to customize products for specific customers according to their social media and Internet footprint. Precision medicine provides similar customization, with targeted therapy based on molecular and cellular characteristics instead of product advertisements. The article authors suggest combining the 2 approaches: the use of data on patients’ social, behavioral, and environmental characteristics may help drive understanding or prediction of adherence, enabling the customization of the most appropriate therapeutic approach that will be highly adherent in the selected patient.

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Patients using tobacco who have concomitant hypertension and hyperlipidemia, for example, may be offered statins, hypertension medication, social support, feedback via wireless technologies, and tobacco cessation aids to improve adherence and overall outcomes. Wireless technology is becoming commonly used in improving therapy adherence as well, such as in the case of remote monitoring or remote social support from family and friends.

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According to the authors, a tailored program to improving patient care and outcomes “would mimic the successful paradigm of online retailing to anticipate consumer needs using prior actions and the experiences of similar people.”


Volpp KG, Krumholz HM, Asch DA. Mass customization for population health [published online March 7, 2018]. JAMA Cardiol. doi: 10.1001/jamacardio.2017.5353