What Two Healthcare Visionaries Get Right And Wrong
Personalized medicine will become reality, but why do we think technology will motivate people to start taking care of their own health?
Predictions are funny things. Sometimes they're rare insights into the future by a visionary who can see things no one else in his generation can. But other times, they're the ideas of an activist who, by evangelizing or invention, tries to force the future they see.
Two IT thought leaders come to mind in this context: Eric Topol as evangelist, and David Ferrucci as inventor.
Eric Topol, MD, is director of the Scripps Translational Science Institute and author of the popular book The Creative Destruction of Medicine. Topol envisions a personalized, patient-centered style of medicine in which physicians play a much less important role and patients play a more important one than they do today. In his scenario, consumers will employ a rapidly proliferating array of mobile health apps and body sensors to diagnose and treat the majority of their own ailments. They'll start tracking their vital signs, brain waves, heart rhythms and other bodily functions, and partner with their physician, taking far more control of their healthcare than anyone today can imagine.
Topol will have to do a lot more evangelizing before I can imagine this future, and here's why: All these IT tools still require a good deal of work, as well as a left-brained analytic mindset that's not all that common. And people just don't show a great deal of passion for managing their own healthcare.
Granted, there's a relatively small segment of the American public that likes to measure their pulse and heart rate or keep track of the number of miles they cycle each day. And a growing number of chronic ill patients are willing to monitor their blood glucose on a digital meter and send it off to a physician through a patient portal. But most Americans prefer to take the course of least resistance.
Leana Wen, MD, and Joshua Kosowsky, MD, take a similar position as Topol in the book When Doctors Don't Listen, encouraging patients to "participate in your physical exam" and "make the differential diagnosis together."
Let's get real. The vast majority of patients -- especially those who are acutely ill -- don't have the inclination, the specialized knowledge, or, in some cases, the intellectual skills to become that involved in their own care.
Two-thirds of U.S. adults are overweight or obese and as many as 4 out of 10 Americans are physically inactive. We can talk all we want about "activated patients," but these statistics speak volumes about Americans' real interest in taking care of themselves. Can technology really change that?
On the IT side of the equation, a recent paper in the Journal of Medical Internet Research (JMIR) found that only about 10% of Americans use a personal health record. Of course, the JMIR article makes it clear that there are lots of reasons the public has not become enthusiastic about PHRs, but one of them has to be apathy.
That said, Topol is spot on when he sees personalized medicine in our future. Evidence has been mounting for decades that this approach will significantly improve clinical outcomes. Decades ago, Roger Williams, a biochemist and past president of the American Chemical Society, established the principle of biochemical individuality, showing that humans can vary widely in the size of their internal organs, the concentration of hormones and their need for various nutrients. More recently, oncology researchers have shown that cancer is not a small collection of neatly classifiable diseases but thousands of diseases with individual genetic footprints. And IT is playing a key role in developing this new model.
The growth of EHRs, which help integrate huge collections of clinical data, allows clinicians to monitor patients' molecular and genetic profiles in creative new ways. Similarly, with the help of big data analytics, researchers are gradually collecting the genomic data that will let providers tailor each patient's drug prescriptions to a patient's unique needs, while at the same time spotting mutations that could increase the risk of life-threatening adverse effects.
Some Sci-Fi Fantasies Come True
David Ferrucci, the scientist usually credited with creating the IBM Watson supercomputer, also comes to mind when talking about visionaries. Ferrucci, who leads the Semantic Analysis and Integration Department at IBM's T.J. Watson's Research Center, isn't a futurist by job title, and yet the future of artificial intelligence he and his team are forging is so far-reaching that it will likely revolutionize medicine, finance and a host of other industries.
Memorial Sloan-Kettering Cancer Center has joined forces with the IBM Watson team to improve the medical center's diagnostic prowess. The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University is also tapping Watson's skills to assist clinicians in diagnosing and treating patients. The list goes on.
In the final analysis, all good futurists are both visionaries and activists, not only seeing the future but creating it through their blood, sweat and tears.
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