Will technology revolutionize health care – or overwhelm us?

The other day I listened to a radio program on NPR called Can Technology Deliver better health care?“. The premise of the show was based on Dr. Eric Topol’s book, The Creative Destruction of Medicine, which argues that new technology and the personalized medical information it delivers will revolutionize health care and “destroy” institutionalized medicine as we know it.

The description of Dr. Topol’s book on Amazon illustrates the future he envisions:

What if your cell phone could detect cancer cells circulating in your blood or warn you of an imminent heart attack? Mobile wireless digital devices, including smartphones and tablets with seemingly limitless functionality, have brought about radical changes in our lives, providing hyper-connectivity to social networks and cloud computing. But the digital world has hardly pierced the medical cocoon.

Until now. Beyond reading email and surfing the Web, we will soon be checking our vital signs on our phone. We can already continuously monitor our heart rhythm, blood glucose levels, and brain waves while we sleep. Miniature ultrasound imaging devices are replacing the icon of medicine—the stethoscope. DNA sequencing, Facebook, and the Watson supercomputer have already saved lives. For the first time we can capture all the relevant data from each individual to enable precision therapy, prevent major side effects of medications, and ultimately to prevent many diseases from ever occurring. And yet many of these digital medical innovations lie unused because of the medical community’s profound resistance to change.

I have mixed feelings about this. While empowering individuals with timely, relevant and personalized information about their health will undoubtedly lead to better outcomes in some circumstances, these innovations do not come without potential downsides.

When does more information become too much information?

In the age of the internet, we have an almost infinite amount of information at our fingertips. The benefits are obvious. With a few keystrokes we can learn about a condition we might be suffering from, connect with other people in the same boat and even read the relevant scientific literature on the topic.

New smartphone apps can give us a continuous stream of data on our heart rhythm, blood sugar, brain waves and more. We can even have our DNA genotyped, with the promise of revealing our risk of disease and alerting us to problems before they occur.

But what do we do with all of this information? Do patients have the training and analytical skills to translate it into better outcomes? Or might this explosion of unfiltered data have unintended effects, like an increase in unnecessary tests and procedures or growing angst amongst patients about their health?

A recent article in the New York Times discussed research showing that annual physical exams are not only unnecessary, but potentially dangerous because they lead to unneeded procedures. Prostate specific antigen (PSA) tests, routine EKGs, annual pap smears are no longer recommended by groups like the United States Preventative Task Force for this reason.

And while the ability to genotype our DNA for a couple hundred bucks is neat, we’re nowhere near being able to confidently use this data to predict disease or personalize treatment. A relatively small number of diseases are caused by single nucleotide polymorphisms (SNPs, pronounced “snips”). The vast majority of diseases we suffer from – diabetes, obesity, heart disease, autoimmunity, etc. – are multifactorial lifestyle diseases. Genetics may determine our predisposition to these conditions, but those genes must be activated (or silenced) by environmental triggers such as diet and stress in order to cause disease.

If you order a 23andMe profile, you’ll get a report that lists your risk of a variety of diseases based on your genes. But such a report ignores the important role of the epigenetic/lifestyle factors we just discussed in the manifestation of these diseases. Does information like this improve your health, or just cause you to worry unnecessarily?

The other potential risk here is that people will exclusively self-treat, and not seek out the care of a trained professional. There’s an old saying: “The doctor who treats himself has a fool for a patient.” Even an experienced clinician is better off seeking care from another clinician, rather than self-treating. The judgment and outside perspective of a skilled an experienced physician is invaluable. Of course this is even more true for someone without any medical training at all.

As someone who was completely failed by the conventional medical system, I believe in empowering patients to take charge of their own health. I see how better access to personalized data will accomplish this goal. I just think we also need to be aware of the potential harm this explosion of information could cause. Technology is a tool. It can be used wisely, or foolishly.

Now I’d like to hear from you. How will these new technologies affect our health and well-being? Will they empower us and give us more control over our own health? Or will they overwhelm us and lead us astray?

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Comments Join the Conversation

  1. says

    A “Google diagnosis” of any given set of symptoms will always tell you that you are most likely terminally ill and have mere weeks to live!

    More information can be valuable, but only given enough knowledge to be able to interpret it properly.

    But more concerningly, things which may currently be thought of as indicators of ill health may simply be common in healthy people but not yet noted as such in the literature, or just plain badly interpreted by health professionals (total cholesterol numbers anyone?).

  2. says

    Software just automates a process, it shouldn’t make the decision, in most cases, especially in multi-factorial areas like health.

    Also, regarding this comment: “I respect my doctors, but I see them only when I’m sick. ” and reducing annual visits. This doesn’t make very much sense given the majority of health costs are from less than 20% of the population and the majority of their illnesses are lifestyle related. I don’t know they need to see a doctor nor do I think the majority of tests given are necessary, but I do think that having a good relationship with a system of health practitioners is a good thing. Planning to fix something once it’s broken is, in general, a bad idea. Maybe the tests at the annual physicals are based on the paradigm of fixing thing when they are broken. Maybe there can be other tests that are based on the paradigm of staying healthy.

    • D. Smith says

      If you can afford all their tests, and if you believe those tests reveal something accurate in regard to your overall health, go for it. Personally, I only see my doctor once every year because I need a refill on a beta-blocker for a PMV. I’m working diligently to get rid of the beta-blocker so I don’t need to go at all. When something “breaks” do you actually think our broken medical system can fix it? I think ER’s and some surgeries are probably all together necessary, but otherwise our health system is beyond broken. It’s a profit-driven industry, there is no “health care” involved.

  3. says

    You bring up great points Chris. As a GAPS practitioner, I especially resonate with the self-treatment idea, and we don’t even need to go so far technologically to experience issues there. The sole access to a detailed book and online resources give people enough empowerment to tackle pretty complicated health concerns by following steps just as 1, 2, 3. GAPS, like many other approaches can be powerful, but it’s not for everyone, or every time, and even if it’s an appropriate treatment to be considered, it needs to be personalized because we are all unique. Easy access to information is great, but it can never replace experienced practitioners!

  4. Geoff says

    Thanks for posting this commentary Chris.

    I’ve recently returned a 23 & Me spitoon, I’m primarily interested in the drug adverse reaction data, which I appreciate is partial. I was a crossfitter/parkour guy until late 2010 when I was misdiagnosed and mistreated for what turned out to be a genetic condition of the bone (fibrous dysplasia), I was given an antibiotic (Cipro) which I became aware of after a serious adverse reaction. Almost 18 months later and I am unable to attempt to return to the incredible level of strength, power and vitality I had as a result of this drug. The bone condition I was advised 15 months ago required surgery – for an intermedullary rod. I have postponed this, against orthopedic advice as a result of my desire to get as well as possible prior to surgery and out of fear of possible adverse reactions from further drugs ie anesthetic/antibiotic/anti inflammatories. Its very hard to discuss these issues with orthodox medics, since adverse reactions are beyond their understanding since their education if from pharmaceutical companies in these matters. In the meantime I continue with paleo (which I was before) plus some TCM acupuncture, herbs and meditation. Keep up the great blog!

  5. vacexempt says

    Could be some great things come of it, though not through untrained individuals thinking this could replace the role of medical professionals. And I really get tired of hearing people blame serious illness and death on genetics when clearly lifestyle changes could have been a significant factor. It kind of takes the responsibility off of a person to take measures to improve their health if they’re resigned to some imagined genetic predestination. Anyway, your readers know better. But what about new technology lending a hand in epidemiological studies? Instead of paper surveys once a year asking what a participant ate or how much they exercised, real-time data could be sent to researchers that would surely be much more accurate, even though it wouldn’t absolutely prevent fudging. A lot of times people probably aren’t knowingly lying about what they ate or did, but just remembering badly. Mobile devices could improve that type and the amount of data a great deal. And as far as getting feedback about things that are pretty well accepted as markers of good health, such as blood pressure, blood sugar, and even lipid profiles, some of the moderately well-informed non-medical people among us could make good use of that data in our day to day health goals.

  6. says

    I fixed all my own problems, with advice and methods not suggested by any of my doctors.

    GERD, painful esopageal spasm leading to many ER visits, cystic acne, chronic eczema, attention deficit, athsma, weight loss, hair loss, allergies, recurring infections like UTI, constant illness, the list goes on.

    All thanks to my ability to use the internet, and careful self-experimentation. I fixed everything myself. The most mysterious problem was the esophageal spasm. No one had any idea what caused it, they simply gave me some pain meds, and sent me away. And told me to keep taking PPIs (such a bad idea.) I had already determinied that the esopagheal spasm was independent of my GERD, based on my own observations and careful tracking.

    It all came down to wheat products! Paleo = cure for everything!

    Read my full story: http://musclegeek.wordpress.com/about/

  7. says

    Another great post Chris!

    I’m a psychotherapist married to a tech geek, so ongoing conversations around here about this. He’s constantly coming up with ‘new cool’ ideas for how I can automate my practice. I point out that while he spends 1/4 of his life playing on his iPad or iPhone, he rarely uses these devices to actually communicate.

    My point is that healing and/or lifestyle change doesn’t happen in a vacuum. We humans, who can’t see our own face, need the interaction and inspiration that comes from genuine caring as much as we need improved apps & procedures.At the end of the day, perhaps it is like so many other issues: balance and the middle way serve us best.

  8. Patricia says

    I am also a bit wary of this type of technology. While it’s great that the cost of testing is going down, and an individual has easier access to their own information, we need to understand what it really tells us. I highly recommend Dr. Otis Brawley’s book “How We Do Harm: A Doctor Breaks Rank About Beng Sick in America.” Does a great job of explaining how modern medicine has evolved into a disease care system rather than a health care system. Wonderful to see more MDs talking about these issues.

  9. greg says

    This isn’t revolutionary, it’s just a continuation of the western medicine paradigm. Everything about this technology viewpoint assumes disease will ‘just happen’ and that technology will save us.

    I don’t want to revolutionize health care, I want to revolutionize HEALTH. A revolutionary idea would be for us to step back a little from technology and reconnect with nature. Get outside, get some sun, plant a garden, get some exercise turning your compost pile. Climb trees to pick apples. Staying fit and eating wholesome foods; Now that’s revolutionary!

    • D. Smith says

      @ greg: I agree. Just a continuation of the current system. What I worry about with all the technology is the fact that we are now being tracked because of the medical HIPPA requirements. If we still have family practitioners (where entire families were treated by the same doc) rather than have a pediatrician (is there a more useless thing on earth?) and a specialist who knows about your right nostril but nothing about your left nostril – I mean, really? We wouldn’t need all of this technology if we just kept it simple from the get-go.

      My Dh and I are both into the field of ethnobotany – it’s fascinating in our area. We also like to research TCM when we get the time.

    • engineering-health.org says

      There’s plenty of diseases which can’t be prevented or treated with a generic healthy lifestyle, but require diagnosis and intervention. In some cases that intervention may be a personal deviation from what would generally be healthy for most people.

      I want to revolutionize healthcare *and* health. More data and better diagnosis methods can revolutionize healthcare. Making healthier choices (which could also benefit from more data to determine what’s actually healthy) will revolutionize health.

  10. Mike says

    like all new technologies, there is a need to reinvent most of the systems and processes that we take for granted. In the past, the role of the doctor was to evaluate, diagnose and treat, and the primary mode of delivery was through personalized one-on-one sessions where the doctor played the role of the expert advisor and the typical patient played the role of passive recipient. I’m hopeful that these new technologies will empower patients to be more active in their own health care, and that doctors will find multiple modes of collaborating with patients (e.g., group sessions, education, etc.)…

    • D. Smith says

      Yeah, that would be the hope all right, but it has been my experience that most doctors in the current paradigm do NOT like it if you take a proactive role in your health. Alternative practitioners encourage it much more often. Some of the regular MD’s get downright nasty and snide if you even suggest taking an active interest in your own health care curriculum.

      I am not encouraged by the idea of adding more ways to misdiagnose – and it happens frequently. I think actually LOOKING at the patient and conversing with them rather than seeking answers from some digitalized thingamagig will tell doctors more about their patients/clients. But no one wants to do that anymore because it means taking an active role in their patient’s lives. They’d rather push buttons and watch screens and grids. When doctors still made housecalls, they knew more about their patients in five minutes just by looking around at the way they lived, than he could/would ever learn from something as impersonal as a computer screen.

      And yet, we have the most broken system of health care in the entire world. Reading Death By Medicine (even though it’s 10 years old now) was a very enlightening thing for me. I also read Dr. Marcia Angell’s books and she makes no bones about the warts in the way the system is run.

  11. Jack LaBear says

    It is true that half of all people are below average (same as median in a normal distribution) – in any parameter you can measure such as IQ, knowlege, research ability, experience, critical thinking skills etc. For the rest of us, I offer the following two comments:
    All health care practioners are biased against self care for financial reasons unless they are selling self-help books ;-)
    The patient that is a fool is one who does not defend him(her)self against iatrogenesis by questioning and researching everything their practioner says and recommends.

  12. Chris Kresser says

    Jack: I’m hardly biased against self-care, as that is how I healed myself from a chronic illness before I became a practitioner. I wouldn’t be here having this conversation if I didn’t believe in self-care. But being on the other side of the equation as a clinician, I can see some of the potential issues that arise with exclusive self-care. Many of my patients come to me because they’re overwhelmed by trying to figure everything out on their own. There’s a ton of conflicting information out there, and it can be difficult to make sense of.

    I’ve written extensively about iatrogenic illness and death (http://chriskresser.com/medical-care-is-the-3rd-leading-cause-of-death-in-the-us), so I agree that blindly following a doctor’s advice is not a good idea.

    This isn’t a black or white issue. And speaking for myself as a practitioner, it has nothing to do with financial motivation. I’m not even accepting new patients now and won’t be for some time. My goal with every patient is to get them to a place where they don’t need me anymore. I don’t doubt that there are some bad apples out there, but most practitioners I know personally truly care about their patients and are not primarily motivated by money.

    • Jack LaBear says

      Chris,
      I appreciate your work a lot and have learned good things from you.
      If I lived in SF and you were taking new patients, you would be my first choice of practitioner to work with. :-)
      My comments sprang from my experiences the last few years with the AMA/FDA medical system. I too discovered that in most cases I can do better for myself (thanks in part to sources like you) than what the system has to offer. Of course, sometimes getting a prescription and help with diagnosis can be usefull.
      Thank you for sharing your knowledge and please keep up the good work.

      Jack

  13. engineering-health.org says

    This isn’t an argument against collecting data, it’s an argument for developing better ways to analyze and make use of that data.

    I envision that non-experts will be collecting data on their phones, and their phones will analyze it with powerful bayesian statistical methods which are adjusted to only alert people of levels with low false positive rates. Everyone doesn’t need to be good at analyzing their own data, as long as the people writing the software they’re using are good at analyzing the data.

    Doctors themselves rely on hunches rather than rigorous inference logic when performing diagnosis. I suspect that well designed software and good biosensors will outperform doctors as far as false positive and false negative diagnosis rates in the near future.

    With proper and responsible analysis of the data, there’s no reason more data will turn everyone into a computer assisted hypochondriac.

    • Jack LaBear says

      There is a great book called “Over-diagnosed: Making People Sick in the Pursuit of Health”. You can Look Inside at amazon. Googling: Overdiagnosis “Harriet Hall” will get a good review.
      It is eye opening to learn of the downside to more and more detailed screening and measurement.
      Incidentalomas anyone? Help yourself!

      • engineering-health.org says

        Over-diagnosis isn’t a necessary consequence of having more information- it’s a product of applying weak reasoning and poor analysis techniques to that old information. If having more information causes you to make worse decisions, then you’re using the data wrong: the solution is to use the information correctly, not to remain in the dark.

        Old medical practices rely on looking for any symptom and then making a diagnosis. When you have lots of data, that old practice results in false overdiagnosis. This doesn’t mean we need less data, it means we need new and logically rigorous method of using the data. I am currently working on such a method ;)

        • engineering-health.org says

          The problem of making accurate diagnoses with more information that has a high noise content, is the classical problem of statistical inference. It’s simply something doctors aren’t trained to do, they haven’t the first clue about how to apply probability theory to filter noise out of large amounts of noisy data.

          Right now, the more data a doctor has the less able they are to cope with it using their traditional diagnosis methods, because they lack training in statistical inference and informatics: the tools they would need to use such data.

  14. Cassiel says

    I am so incredibly grateful to technology and the internet because they have made it possible for people to become educated themselves about what is wrong with them; to seek alternate opinions, ask questions, do their own research, and find out why their doctor’s advice is not working.

    I however have mixed feelings about too much technology putting health information at our fingertips, but not just because of what you’re concerned about, Chris. See, I admit to being the cynical type, and I fear government or corporate intervention. Once everyone is able to easily monitor their heart rate, blood sugar, cholesterol etc all the time, I can quickly imagine these giant bodies using that as an excuse to force us to do so, and to make (bad) policies or decisions based on the results. What about insurance companies tracking a diabetic’s every meal and cancelling their insurance if they eat paleo? Or bosses tracking your health and firing you for eating a donut or drinking too much coffee? Yeah, I’ve probably read way too much science fiction, but given how much the government already tries to control our health as it is, is it really too much to believe that they’d try to do things like that?

    Another thing I have been pondering lately is how the internet is changing and shaking up a lot of old systems, and fast; it is changing the way many things are done. Systems that have had essentially monopolies on the population for centuries are suddenly finding themselves obsolete, particularly if they are foolish enough to dismiss this as a “passing fad” and not try to evolve WITH it. (Think newspapers as one prime example.) I see doctors facing this exact problem. They have gotten comfortable with the idea that they are needed, that people have no choice but to come to them when they are sick. Sadly, this has made a certain percentage of them both lax and egotistical. But now people have the means to educate themselves and seek alternative options, and now they have the means to reach out and find those options. It is the doctors who recognise this and who evolve to work with this new technology that will continue to prosper in the future. But unfortunately, most of the doctors I have seen in the last several years are trying to cling to their old glory and deny the changes, and I foresee this being their ruination.

    I have solved more health problems in the last ten years thanks to the internet than I have by visiting doctors – despite that I have tried to visit doctors first. I developed dyshidrosis several years back, yet the doctor had no idea what it was, refused to believe that I wasn’t using industrial chemicals that had caused allergies, and refused to do followups. An internet search on my symptoms quickly found the condition and taught me how to manage it, and the solutions provided worked. Was it that impossible for my doctor to say “I’m not sure, let me do some further research”?

    Last year I suffered from crippling chronic fatigue for over a year that lost me my job overseas and forced me to move back to my home country. I spent almost a year essentially lying in bed being too ill to get up and even potter around the apartment. I lost count of the number of doctors who essentially told me I was lying because my blood tests showed nothing wrong. I had dozens of tests done, from MRIs to ecchocardiograms to ultrasounds to a sleep study. Nobody knew what was wrong with me and people kept dismissing me, writing me off, or just plain being confused.
    I finally figured it out myself by reading the American list of side effects of an anti-depressant I was taking and realising those side effects were all my symptoms. I stopped the medication — against my psychiatrist’s orders — and started to get better within a week. I am fully recovered, but I lost almost a year of my life to that. The listed side effects in Japan, where I was first prescribed the medication, and in Australia, where I returned to, did not include many of my symptoms. It was only through repeated searching on the internet that I figured out my own solution. The medication was “disregarded” by my doctors as causing the problem because I’d been taking it for almost a year before the problem started.

    I could never have figured that out for myself 20 years ago when I was first prescribed an anti-depressant, because I had no internet. If such a problem had occurred then, I may well have wasted years and years of my life being poked, prodded and disbelieved. I know that there are many people out there less lucky than me who have indeed wasted years of their life in that exact way.

    I am immensely grateful for the internet and technology and the freedom these things have given us to seek alternative solutions to our problems. I sincerely hope that doctors will realise where things are going and will embrace these changes and work with them, rather than against them. And, I hope that governments and corporations will not take advantage of these changes to try and cripple us all the more.

  15. Ann says

    I wish the technophile’s would focus on how to produce more healthy food more sustainably or figure out what we can do with the toxic soup we live in already from pesticide residues and endocrine disruptors in the environment. I am a big believer in self-care, but there is a limit to what you can do. Who are these technologies for in terms of who can afford them? Ultimately, we need to get more active politically to counter the corporate capture of our regulatory agencies. The market and the self-responsible citizen will not be enough to save our health, I fear. The problem is far too big for any one person. It is going to take a social movement.

  16. Brian Young says

    I think over information can be crippling to health. I for instance have been suffering major health anxiety for months due to looking up heart disease symptoms online. The anxiety and depression I have that comes along with it is terrible. Even though it seems obvious I’m fine (I’ve always had OCD which is pretty much the same as health anxiety and I’m only in my teens). The fear of my heart becomes so overpowering and a lot of it is due to being able to read symptoms online etc.

    Chris, I’d love to hear your thoughts on health anxiety/ hypochondria?

    • D. Smith says

      @ Brian Young: stop looking at heart disease and start looking up proper breathing techniques.

      I can sympathize with you somewhat, although I didn’t have anxiety from having a computer to help me get there! I am in my late 50′s now, but when I was 19 years old and in college, I started suffering from terrible panic attacks (I, too, was worried about my heart because it pounded and crashed around in my chest all the time), although oddly enough I was not depressed – but stressed to the max. Back in the early 1970′s when this happened, no one really understood panic/anxiety too much, not even doctors. Because I was so stressed and so literally uptight (my muscles were clenched all the time) one doc put me on some valium (a sort of muscle relaxant) and it did help for a while. I took it very sparingly because I didn’t want to depend on it. Long story short though, I suffered with fear of my own heart attacking me until I was well into my 40′s when I was taught some easy breathing techniques by a friend.

      There were a couple of other things involved with my getting better, but the breathing was the main issue, truly it was. Maybe you can find some help from my past experience. Be well.

  17. Bridget says

    I don’t have a smart phone…is this going to be one more way to put social pressure on me to have a smart phone? What will people who can’t afford smart phones do? I’m kind of tongue in cheek here, but also kind of not.

    The way tech things go from luxury items to expected, standard issue, stuff within minutes bothers me. And it’s not like I’m a Luddite. I’m an online teacher and I love being able to travel while I’m working. I just have a limit on how much of my life I’m willing to devote to tech items.

  18. Sheridan Jackson says

    The urologist said my PSA numbers dictated a biopsy for prostate cancer, so we did the procedure at 2pm in his office. Next morning I was in ER with projectile vomiting and projectile diarrhea from acute sepsis caused by the biopsy. I nearly perished, and was so ill I would have accepted the relief of a quick end, but after three days they finally found an antibiotic that would treat the bug that laid me low. I had IV antibiotics for weeks, followed by oral antibiotics for months. This was the only time in my life in a hospital as a patient. Ironically, the biopsy was negative. I am now considerably less inclined to follow doctor’s orders!
    Instead, I take no meds, at age 79, but have for years taken supplements and herbs, and evolving more and more toward paleo.

  19. Ken Stoltz says

    “Do patients have the training and analytical skills to translate it into better outcomes?”

    I think an equally important question is “Do most doctors (specialists and gp) have the same capabilities?” In many cases, patients are becoming more aware of scientific literature than their doctors are. Why? They have to self-advocate for their health, and are taking accountability into their own hands. I think younger generations in particular are a lot more questioning of a doctor’s diagnosis and treatment. Older generations tend to not to question (again in general terms). If there is a way that both doctors and patients can benefit from this, I’d love to hear it. Sometimes it takes an awful lot of scouring to find doctors with open minds who also try to keep abreast of new literature and studies. It’s even more difficult to reject a doctor’s advice if one feels it’s the wrong course.

    • Chris Kresser says

      I think an equally important question is “Do most doctors (specialists and gp) have the same capabilities?”

      I agree, Ken. That’s why patients are often stuck between a rock and a hard place. They don’t have the training and analytical skills themselves, but their doctors may be operating from an old paradigm and unwilling to adapt.

  20. says

    Patients are notorious for being unable to express themselves as to the quality of their symptoms. Many times pysicians have run every test and drawn every lab, getting every piece of quantitative data possible and still come up short on the diagnoses. That being said, could technology put all these pieces together better than a person? I think not necessarily. There are too many afflictions that result in qualititave changes before any data corroborates it. Something missing in many encounters with a health professional is observation and reason. Could technology aid this? Not with humans coding the algorithms. The forest will be lost in the trees!
    I found the following editorial enlightening (not available yet online but will be @ http://www.ncbi.nlm.nih.gov/pmc/issues/206413/):
    False Scents, False Sense, and False Cents: Why Physicians Should Read Sherlock Holmes
    Ira Martin Grais, MD, FACC
    (Tex Heart Inst J 2012;39(3):319-21)

  21. says

    The future for healthcare that I envision is not one in which we rely more on more on technology. We’ll have the advantage of select high tech assessments and interventions, but there will be an enhanced degree of low-tech human-to-human interaction. We can’t ignore the growing body of evidence about social and interpersonal factors in health. You can’t get that from a machine.

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