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?