Sunday, September 1, 2013

On Curbing Your Enthusiasm about Medical Innovation
Curb your enthusiasm.
American Television Series

Don’t get too far ahead of the parade that people don’t know you’re in it.
John Naisbitt, Mindset!  2007
I’ve always been enthusiastic about medical innovation as a vehicle to improve health care and to achieve health reform. There’s always a way to do things better, faster, and cheaper.
In the early ‘70s at the dawn of the Internet,  Russell Hobbie, a physics professor at the University of Minnesota,  and I developed a differential diagnosis program based on  demographic data and multiple abnormal laboratory tests.
In the mid-70s,   I devised a formula for the HQ, the Health Quotient,  to calculate a person’s state of health compared to peers.    
We field tested both concepts on thousands of patients and sent results to doctors.  Doctors and patients accepted the ideas. 
But we were ahead of the societal and Internet parade. Because of medical legal implications,  viz. that doctors might be sued for not following  up on a suggested diagnoses, the company that acquired our laboratory  nixed the idea of a routine differential diagnosis accompanying laboratory reports, And because employers were leery of the new idea of  calculating the statistical health of employees, the HQ did not catch on. 
So,  a word of caution.  Don’t rely too much on innovation as a magical way  to lower health costs and reform care.   Old ways of doing things and fear of change and litigation  die hard. Even though “Creative destruction”   of  existing social institutions is a central principle of free-market capitalism, it  has curbs. 

Due diligence and a team approach are necessary to surmount these challenges, and as every venture capitalist knows,  deliberate consideration of consequences is in order. Adaption to new technologies takes time and thought when disruption of the existing social order takes place, as is happening with pervasive digitization of health aare.
Take Obamacare.   You  might  consider the health law as an innovation on a massive scale  to transform our health  system.  It relies  heavily on digitization of the currnt system.   Its major fault may be that it was not thought through carefully.   If that had been done,  some of its consequences  -  political polarization, overly bureaucratic control of the health system,  dropping of existing health plans,  disruption of traditional doctor-patient relationships, and skyrocketing costs  and  unreasonable restraints of regulations,  mandates, and costs might have been averted or  minimized.
Now  consider  implications of innovations as exemplified by the convergence of events in two fields – the plummeting costs of sequencing a person’s entire genomic code and the flurry of innovations leading to ubiquitous spread of smartphones, now owned by half the U.S. population.
It is now possible to  personalize and to design care for each individual, as opposed to acquiring  and applying data to populations and the statistical”average patient.”  Patients themselves can record their own physiological metrics – blood glucose, blood oxygen,  and ECG tracings, to name a few tests  – and to use  smartphones to transmit results  to physicians, who in turn, can track impacts of treatments.  This is a revolutionary advance on the telemedicine frontier and a precursor of virtual medicine not requiring the physical presence of patients in doctors offices.  It combines personalization with depersonalization.
Sounds great if your a physician,  doesn’t it?  You can track an individual person’s bodily response from a distance,  and you can begin to control and monitor chronic disease .  You can even listen to a person’s heart and lungs without being there and observe and interview patients on Skype.
But according to Eric Topol, MD, a California physician leader at Scripps,  there’s a big problem – physician resistance to change.   He says it takes 17 years on average for physicians to adapt and adopt  to a major change on the health care landscape. He is shocked  62% of physicians don’t even use e-mails to communicate with patients.   Yet, he says, genomic sequencing and smartphone technologies  could “reboot the way doctors interact with patients.”   The new tools, claims Topol, are “hyperinnovative.. People are already putting data into social networks, comparing genomic data and competing for best quality tests, best blood pressure…This is a radical transformation to a high plateau of medicine and is inevitable.”
My advice to doctor Topol.  Curb your enthusiasm.  As Naisbitt observed, “In the end, the marketplace will decide: for politicians, the voters; for business and technology, the consumers.  For those who would desire to reveal the future, almost all err on the side of being too far ahead of the parade; rein it in a little.”
Tweet:   Upheaval is coming to medicine as digitization of  human genomes meets wireless smartphones, and patients send data directly to doctors.

Source:    Ron Winslow, “The Wireless Revolution Hits Medicine,” Wall Street Journal, February 14, 2013, Interview with Eric Topol, MD, director of Translational Science Institute, established to apply genetic discoveries to personalized medicine.

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