Clarke’s Three Laws for Digital Health
for digital health to grow, emphasis shifts from technology to solutions.


by Marta Gaia Zanchi & Anurag Mairal
If digital health were an individual, today it would be considered a teenager. And we all know what happens to teenagers in that critical transitional period in the human lifespan, linking childhood and adulthood. They struggle with their own sense of identity. They act one way with their peers, and completely different with another group. They try to establish themselves through prestige. They feel that appearing mature will bring recognition — and engage in practices associated with adulthood, which they are not quite ready to handle yet. And they rebel, a lot.
Seth Frank, in the year 2000, authored “Digital Health Care — The convergence of health care and the Internet” in The Journal of Ambulatory Care Management, and the date has come to signify the official birth of the term. By that reference, digital health is 17 years. Frank, however, was not the first to use the terminology. Michael D’Alessandro published about his work with “Digital Health Sciences Libraries (DHSL)” in 1998, which makes digital health 19 years old. Our thoughtful readers may note that D’Alessandro’s article describes “a prototype DHSL that has been in operation on the Internet since 1992.” We call the early 1990’s digital health’s gestation period, and stick with our thesis that digital health is a teenager.
As digital health enters its young adulthood, it’s a perfect time to revisit its identity. Just like with our own teenagers, it’s obviously not on us to define their identities; kids have to discover it for themselves. We are here to facilitate a conversation about what digital health is, believing the community should come up with that.
In the early 2000’s, the emphasis was predominantly on digital health as healthcare information and services enabled by computer technology. Software had just barely been recognized as worthy of clearance of approval as a standalone medical device by the Food and Drug Administration, preferring to review it as simply an accessory or component of a device (with medical intended use, of course) that included hardware. With the proliferation of new enabling technologies, the definition became broader — the advent of the smartphone; new wearables; advances in wireless communications and power management solutions; the growth of social media platforms and engagement models; robotics. The emphasis has shifted from digital health as characterized by computerized technology to digital health as a way to change health care with digital data — relating to using, or storing data or information in the form of digital signals. As consumerization took hold, the words “health care” were replaced, most simply, by “health” — and digital health solutions run the gamut, providing information and services in support to health conditions from wellness to end-of-life, for the individual as well as for population health management.
As the sector expanded, digital health was divided in application-agnostic sub-specialties or categories, including mobile health, telehealth, big data and personal genomics. While the approach is useful and is practical, it has been misused. Adopted with a focus on what the technology is versus what it does, the risk is to not recognize the great degree of overlap between categories, and that the underlying process of advancing innovation in each may actually be quite similar, as it relates to their use and industry more than to the characteristics of the enabling software or hardware.
An equivalent to Clarke’s three laws could exist for digital health, we believe. According to Sir Arthur Charles Clarke, British science fiction writer, futurist, inventor, undersea explorer, and television series host:
- (1) When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.
- (2) The only way of discovering the limits of the possible is to venture a little way past them into the impossible.
- (3) Any sufficiently advanced technology is indistinguishable from magic.
When it comes to digital health, we know the community of innovators involved in this sector already deeply believes in (1) and (2). Number (3), however, warrants amendment before it can be useful:
- (3) Any sufficiently advanced solution is indistinguishable from magic.
Our argument here is that our growing teenager is finally awakening to the possibility that identity is not defined by the possibilities, by the potential, or — forgetting our analogy, for a minute — by the technology but by the actual outcomes that it demonstrates. Technology is a lever, but magic is achieved when a deep understanding of the reality (of the health industry, of the actual problem, of the population and broader stakeholders it affects) is applied to the design of digital technologies that demonstrably and measurably meet outcome objectives. Therein lies an identity, and its magic.
For digital health, Clarke’s lesser known fourth law may also be beneficial:
- (4) For every expert, there is an equal and opposite expert.
Clarke had a different interpretation in mind; in digital health, this serves us as a reminder that a convergence field cannot be successful without the convergence of talents and backgrounds that we are finally starting to see happen, as demonstrated by the recent migration of our own impressive colleagues from Stanford University to companies like Google and Apple, for example.
We argue clarity around what digital health is will be restricted until and unless the community recognizes that there is a methodology (a process) and a rationale for success, and both should be articulated. And, we expect the enabling technology will be, albeit important, not the fundamental aspect. We expect maturity of process and rationale will foster communication and collaboration. This is not a revolutionary stance, obviously — history is full of similar times of growing pains (oncology is a prime example). Ignited with a better understanding around the objectives that the digital health community is focusing on, and the methodologies to get to these objectives, we expect an prosperous adulthood for this very promising sector.
