Not another AI Health Coach: Why Healthcare is Human, and Always will be

Healthcare would be a lot better off if we stopped trying to solve human problems with pure software solutions.

At its core, healthcare is human, and driven by relationships. No amount of AI can ever replace this foundational aspect of our industry. I don’t say that to gatekeep others from building and entering healthcare, but simply to understand what a patient wants when he or she interacts with our healthcare system.

Healthcare is a doctor taking extra time, with empathy and compassion to help someone understand a cancer diagnosis treatment.

It’s a nurse entering the home, building trust by having face-to-face interactions with an elder who might not otherwise have seen anyone that day.

It’s a patient seeing his PCP for the first time in 5 years, voicing his health concerns, and actually being heard.

It’s a caregiver sacrificing time, energy, and perhaps her career to care for an aging loved one.

Healthcare is not cold software masquerading as a human, constantly nudging you to make better decisions.

What spurred this discussion? Yesterday, Arianna Huffington and Sam Altman co-penned a piece in TIME on AI’s potential to change behaviors, and the transformative impact this behavior change could have on our healthcare system, officially announcing the launch of Thrive AI Health. Together, they argue artificial intelligence can be a developed into a hyper-personalized health coach, catering recommendations and support to each person’s specific needs. Ultimately the AI coach would help those individuals optimize healthy habits and behaviors in 5 core pillars: sleep, food, movement, stress management, and social connection.

Of course, the venture is headed up by an ex-Google employee. Here’s Huffington’s announcement on Twitter:

The TIME piece goes on to argue AI’s core differentiator – and one that will drive sustainable behavior change in its users – involves AI-driven, hyper-personalized recommendations based on the health data you feed into the software and your individual lifestyle:

• *With personalized nudges and real-time recommendations ****across all five behaviors—helping us improve our sleep, reduce sugar and ultra-processed foods, get more movement in our day, lower stress, and increase connection—AI could help us be in a stronger position to ***make better choices that nourish our mental health. It could also use our health information to make recommendations based on what motivates and inspires us.
• …Using AI in this way would also scale and democratize the life-saving benefits of improving daily habits and address growing health inequities. Those with more resources are already in on the power of behavior change, with access to trainers, chefs, and life coaches. But since chronic diseases—like diabetes and cardiovascular disease—are distributed unequally across demographics, a hyper-personalized AI health coach would help make healthy behavior changes easier and more accessible. For instance, it might recommend a healthy, inexpensive recipe that can be quickly made with few ingredients to replace a fast-food dinner.

What the essay doesn’t mention – at all – is any sort of human involvement for the sake of ‘democratizing’ access and scalability, all in the name of health equity to help underserved populations. Notably, Thrive wants to sell the product into employers and pharmaceutical companies – not underserved populations.

These authors are out of touch from the day to day reality of hundreds of millions of Americans. The way Huffington and Altman describe AI’s potential for behavior change in this article is so far off the mark it burns my retinas to read. And that’s likely because they are successful, driven, disciplined individuals who think the technology hasn’t been built yet – that most folks just need a little better-personalized nudge or micro habits to drive real change.

Sadly, that’s far from reality for most individuals. AI can’t stop a stressed individual from grabbing fast food, or falling into familiar habits once willpower has run dry after running on fumes all day from little to no sleep.

Do you really think you’re going to obey a command from your AI coach telling you to eat healthier after a stressful day? The answer is no. I don’t read my notifications half the time. The iOS notification center is a disaster.

• “We would never scale enough human coaches to reach these populations. AI gives us the scale and precision possibility,” Huffington says.

Maybe they didn’t ask – or don’t want – a life coach. Maybe, despite their obvious disagreement, AI could be better used to scale human-centric experiences to drive meaningful behavior change in individuals.

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How to REALLY Drive Behavior Change in People: It’s Tough

What drives real behavior change in humans? How does one overcome an addiction, find motivation, or form habits? I’ve been in more life ruts than you can count. Habits broken, lack of exercise, damaging relationships, engaging in harmful behaviors or forming addictions (screen time, doom scrolling, substance abuse)…we’ve all done it, because we are all broken people.

Driving real behavior change involves significant, intimate investment from other humans, requires time and sacrifice, and includes a variety of other factors. What does this look like in practice? Here are some frameworks:

Accountability: Accountability has been the biggest differentiator for behavior change in my life. Acknowledging there’s a problem or desire to change, and then enlisting the help of others – who are required to sacrifice time and energy on your behalf – to give you some tough love. There’s a reason why Alcoholics Anonymous or other addiction treatment help exist in this format. Individuals rarely – if ever- overcome addiction (or even bad habits) alone, and the same is true for manufacturing motivation. You have to want change, and there’s an incredible amount of inertia needed to fight current lifestyles or behaviors. Our brains have been hardwired in certain ways based on the decisions we’ve made for years. For that reason, finding a sponsor, or true accountability partner – an entirely human component – is one of the biggest steps someone can take to drive meaningful behavior change. Unless we start developing humanoid robots, this dynamic isn’t going to change anytime soon. An AI nudge or a benefit offered through an employer doesn’t solve for hard conversations had or a hard rap at the door.

How does one find true accountability?

Through Community: We’re all more isolated than ever before. I feel it often. I – and many others – work from home, and the only facetime I get with colleagues is virtual. We crave friendship and intimacy. To be truly known and accepted. Finding a community or peer support – whether that’s a friend group, a church group, or a career-based group of individuals – is powerful and something you’ll hear in any self-help blog recommending ways to build good habits. The ability to be vulnerable and grow/foster intimate relationships cannot be understated as a factor in behavior change. Apps like Humans Anonymous or platforms like Healthy Gamer are being built to facilitate and foster community. That’s what democratized access looks like.

Other aspects of behavior change include:

• Environment: Changing up your routine, sunlight, coffee shops, bookstores, working from your office with work clothes on, and what you eat are all things AI can recommend, but not control.
• Clinician Support: Nutritionists, life coaches, primary care physicians, therapists, trainers all play a role with supporting positive change and includes medication-assisted treatment
• and finally, AI and Software: AI and software solutions hold a major role in the healthcare system of tomorrow. An app or technology is there for you to understand your care plan, connect disparate providers together to coordinate or share treatment plans, connect and communicate with your accountability partner(s) / community, receive useful, personalized nudges, and more. But to reiterate: AI is a helpful, connective layer to help facilitate a person’s overall health & wellness. AI and software alone cannot drive meaningful behavior change.

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I can respect an effort in healthcare to expand access to something good. But what Thrive seems to be doing commercially doesn’t line up with its discussion of health equity and democratization. For that reason, the announcement comes off as creepy and dystopian.

Instead of trying to create pure AI solutions to human problems, let’s supercharge the actual humans instead. For instance, build for nutritionists so they can take on double the number of clients with the same amount of workload. Supercharge food-as-medicine programs. Support local communities and caregivers. We have countless programs and projects happening doing way more with way less than another AI-enabled health coaching app. Unfortunately for us, they’re simply less sexy, and so therefore here we are stuck with another fitness pal.

AI has a ton of potential to extend existing physicians or enhance productivity, provide efficiencies in admin tasks or find insights in data. But we should never let it replace the human element in healthcare – our industry’s greatest strength.