No contemporary discussion about healthcare and tech is complete without addressing the work currently sitting on top of Amazon's Health Care Delivery bestseller list.
The book by Eric Topol, MD, The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care, published in January, supposes that a combination of patient activism and sheer technological innovation can largely get us out of our current healthcare mess.
I respect Topol's long track record in medicine, and his ability to crank out an entire, fact-filled book about the revolutionary changes technology is bringing to healthcare. But I'm leery of going as far as he does. As a book title from another bestselling author on disruptive innovation suggests, healthcare definitely needs to be disrupted. But I would stop short of creatively destroying it.
Why? Mostly because the many innovations Topol describes in this book are not quite ready for prime time. It's not that they won't set the theme for many years of medical innovations to come. They will. And this book, among others, will provide a blueprint for this innovation.
But science takes time, even in the Internet age. I learned this when I completed a certificate in clinical trial design and management at the University of California San Diego Extension last year.
The rush to develop new healthcare solutions is littered with stories of failure. Some of them made Topol's book. Vioxx, an anti-inflammatory drug that Topol challenged, is only one of the latest failures of the regulatory system to reign in innovation when its side effects turn deadly.
An essential paradox of The Creative Destruction of Medicine is that personalized medicine will avoid the Vioxxes of the future by tailoring drugs, therapeutics, and devices to the targeted populations that will be effectively treated, yet it does not adequately explain how the U.S. healthcare system, in its critically impacted current condition, will manage to pay for these new personalized solutions.
Topol supposes that the power of the Internet, the digitization of the human body including genomics, and the reduced need for large-scale populations for clinical trials, will eliminate sufficient waste and save sufficient money to make such personalized medicines affordable and cost-effective. I guess Topol thinks the free market, radiating from today's concierge medicine, will take care of the rest.
I am not so confident. My basis for saying so does not originate solely in my 220 hours of study of clinical trials, although my study of that badly broken system of innovation was illuminating.
Instead, I am leery because some of the assurances from academia and industry sound eerily reminiscent of assurances of the tech industry of the 1980s and 1990s that technology advancements would vastly increase worker productivity.
The fact that productivity gains remained largely flat through a period of vast investment in technology improvements meant that predicting such gains solely on the basis of Moore's Law, and the proliferation of sensors everywhere, is a risky business.
Moore's Law, as a reminder, states that the number of transistors that can be placed inexpensively on an integrated circuit doubles approximately every two years. Today's iPhones and iPads are a product of 50 years of Moore's Law.
Topol's book starts out by celebrating the many advances that Moore's Law-driven technologies have brought to so many industries—with the notable exception of healthcare, an industry he characterizes as having "hardening of the arteries."
But in the pages that follow, I find many examples of suggested innovations that I just have a hard time believing are really here yet.
For every genome sequence mentioned in the book, one could ask: How many genomes remain unsequenced? And although the cost of sequencing is dropping, what does the total tab look like for sequencing all the genomes that need to be sequenced?
Since disease management is moving to a personalized perspective, that number is bound to be astronomical. And I'm aware that in treating things like tumors, the genome of the tumor can mutate in its evolution, requiring repetitive sequencing of just a single tumor. That sounds like a lot more sequencing to me. Even if, as Topol suggests at one point, we start by looking at every base of particular regions of the genome, it's a daunting task.
It's always a struggle to know how much of a particular present-day technology to teach to students. Topol suggests that medical students no longer need to learn much biochemistry and physics, and would instead substitute learning on genomics and social networking technology, among other things. It makes good copy, but is it good science?
I'm mildly surprised that a book this recent doesn't pay more attention to the impending role that machine-driven algorithms will play in decoding the secrets of genomic medicine. I question the utility of having one's genome to browse on an iPad, even though as Topol points out, a browser for this exists.
To his credit, at one point Topol notes the risk that a new generation of digital hypochondriacs may be in the offing. I share his disgust that organizations such as the American Medical Association have opposed giving patients their full medical records, for fear of misinterpretation.
But it's also true that the vast amounts of personal medical information being liberated by electronic medical records, sensors, and remote monitoring, could unleash a new wave of medical quackery like nothing we've ever seen. A host of already-existing Web sites are leading that unfortunate vanguard.
The most problematic portion of the book may be where Topol triumphantly predicts the creatively destructive effect that social networking will have on medicine. First of all, he pays inadequate attention to the very real privacy risks that today's commercial social networks represent. A company such as Facebook is not getting rich by protecting the personal information of its members to the greatest extent possible.
Although Facebook's privacy controls are more sophisticated that any of its rivals, its arbitrary changes to its privacy policies and continued friction with governments and privacy groups is an indicator that storing one's health record in a social network is a courageous act, unless the patient is the equivalent of a digital exhibitionist.
To return to my key point, it is all well and good to say that "it will not be long until digitizing a person unlocks the root cause for what is wrong." But such short-term expectations are unrealistic.
Back when I wrote about technology strictly for an IT audience, we journalists dreaded the so-called airline magazine article effect, where a promising new technology was touted. CEOs rushed into immature technology based on those articles, and often got burned.
My heart goes out to doctors who are encountering patients who expect too much too soon based on reading Topol's book. It is the equivalent, albeit highly informed and documented, of one of those airline magazine articles.
To those who simply say it's the new taking over from the old, I'm 54 years old and still learning many new tricks. So are many of the 50-something healthcare executives and doctors I talk to weekly here at HealthLeaders. We don't need to be replaced by the digerati generation in order for healthcare to be fixed.
We are part of the solution, not part of the problem. There are bad doctors, bad executives, and bad technologies. But we the experienced ones don't need to be lined up in front of some metaphorical wrecking ball.
I was born with esophageal astresia, a condition where the esophagus ends in a blind-ended pouch rather than normally connecting to the stomach. When I was three days old, a surgeon whose name I do not know at the University of Michigan Medical School saved my life. So I guess I'm biased when I say that the U.S. healthcare system, with all its faults, doesn't need creative destruction. But it does need to be shook up, and that process is underway.
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Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.