Eric Topol’s new book explains how digital technology enables individualized health care. While the book has some flaws, it’s a reasonably good introduction to a fascinating and important topic.
The book is divided into three parts: Setting The Foundation, Capturing The Data, and The Impact of Homo Digitus. Part One begins with a familiar message: the Internet and digital technology are changing everything. The next chapter reveals that many accepted medical practices are based on questionable research findings. Part One ends by discussing how consumers are sometimes misled by modern medicine—and may be misleading themselves about alternative medicine. The overall message is that the current system often causes as much harm as good, but not to worry, help is on the way.
Part Two describes new ways of harvesting health data. It’s unfortunate that Topol doesn’t cover some of the technologies in more depth. It’s even more unfortunate that he doesn’t display the same skepticism as in Part One. For example, he talks about putting sensors in automobiles to monitor the driver’s health, with the possibility of asking the driver to pull over or even automatically shutting down the car’s ignition system. If the lesson of Part One is that the current system can be hazardous to your health, the message of Part Two seems to be that the new technology merits blind trust.
Part Three argues that the U.S. health care system is too conservative and unaccountable, and how that’s about to change. As the author of a book about the history of medical technology, I can’t agree with Dr. Topol’s diagnosis. There is overwhelming evidence that new technology has repeatedly and dramatically changed our health care system. But it’s good to know that the medical profession resists change just for the sake of change. And if we want doctors and hospitals to be more accountable, then we need to start comparison shopping. Make them compete for our business, and do our own research on the Internet.
I have two major problems with Topol’s book. How could a proponent of individualized health care be so oblivious to the elephant in the room? The Patient Protection and Affordable Care Act will make our health care system more centralized, more top-down, and more bureaucratic. That doesn’t lead to individualized health care—it leads to one-size-fits-all health care.
The other problem is that the book is brimming with clichés. In fairness, Topol warns in the title that this is a book about “creative destruction” (if not “the democratization of medicine”). This is more than just annoying, however. For example, Topol pays obligatory homage to “crowdsourcing.” In my opinion, the “wisdom of crowds” is an oxymoron. According to a popular anecdote, when a large number of fair-goers were asked to guess the weight of an ox, their individual guesses were wrong but the average guess was remarkably accurate. Sorry, but this does not show that crowds possess wisdom. It merely illustrates how people’s false judgments are sometimes evenly distributed around the truth.
Topol boasts that in 2011 he tweeted: “Tunisia… Egypt… American medicine?” Last I heard, Egypt was on the verge of handing power over to the bigoted and anti-democratic Muslim Brotherhood. And a year after the Tunisian revolution, there are reports of journalists being arrested.
Topol’s book contains many interesting ideas and facts. And I’m sure it’s an accurate reflection of what many digital health care entrepreneurs are thinking. But the “Arab spring” is not a good model for health care reform. Not by a longshot.
Tuesday, February 21. 2012
The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care
Sunday, January 15. 2012
The End Of Illness?
There was a highly misleading article by David B. Agus, a professor at the University of Southern California, in this weekend's edition of the Wall Street Journal. A Doctor in Your Pocket suggests that "tiny health monitors" and "tailored therapies" will lead to a future in which people will live disease-free lives up to age 100 or older. Agus exaggerates personal health technology's near-term potential to promote a greater role for government in health care.
Agus claims that with enough information we can either prevent diseases or catch them early enough to nip them in the bud. I agree that the more we know about diseases the better equipped we will be to prevent them or at least catch them during the earliest, most treatable stages. I also believe that new technologies will enable us to gather and analyze much more health data than was previously practical. But we are a very long way from being able to prevent most diseases and cure those that can't be prevented. Agus admits as much when he acknowledges that his strategy will only work up to about age 100. What he doesn't acknowledge is that people begin aging much earlier.
The point of the article seems to be that we must let government gather and use all available health data. Agus complains that privacy concerns are getting in the way: "...we can't expect the health care industry to continue to innovate and grow if we continue to hoard health information." Since Medicare pays over half of our country's medical bills, Agus reasons, then letting Medicare harvest and analyze its patients' data would enable Medicare to improve public health.
Agus argues that if we knew more about the body then we could put more emphasis on preventive medicine as opposed to diagnostic medicine. That's a popular view among people who want to see more government involvement in health care, but it assumes that most if not all diseases can be prevented. Agus also says he is a "big proponent" of genetic profiling for consumers, but as I discussed here these services offer most people little more than entertainment.
It's what Agus doesn't say that really worries me. Surely he knows that people don't always choose the healthiest alternative even when presented with ample information. In a free society, individuals have the right to eat and drink what they want, exercise or not exercise as they prefer, and make other tradeoffs that involve health risks. And there are, contrary to Agus, legitimate reasons for keeping private health data private.
Worse, Agus seems unaware that most health care innovation comes from private individuals and companies--not government. His vision of bringing all health databases together in a "centralized network" could actually discourage innovation.
Agus claims that with enough information we can either prevent diseases or catch them early enough to nip them in the bud. I agree that the more we know about diseases the better equipped we will be to prevent them or at least catch them during the earliest, most treatable stages. I also believe that new technologies will enable us to gather and analyze much more health data than was previously practical. But we are a very long way from being able to prevent most diseases and cure those that can't be prevented. Agus admits as much when he acknowledges that his strategy will only work up to about age 100. What he doesn't acknowledge is that people begin aging much earlier.
The point of the article seems to be that we must let government gather and use all available health data. Agus complains that privacy concerns are getting in the way: "...we can't expect the health care industry to continue to innovate and grow if we continue to hoard health information." Since Medicare pays over half of our country's medical bills, Agus reasons, then letting Medicare harvest and analyze its patients' data would enable Medicare to improve public health.
Agus argues that if we knew more about the body then we could put more emphasis on preventive medicine as opposed to diagnostic medicine. That's a popular view among people who want to see more government involvement in health care, but it assumes that most if not all diseases can be prevented. Agus also says he is a "big proponent" of genetic profiling for consumers, but as I discussed here these services offer most people little more than entertainment.
It's what Agus doesn't say that really worries me. Surely he knows that people don't always choose the healthiest alternative even when presented with ample information. In a free society, individuals have the right to eat and drink what they want, exercise or not exercise as they prefer, and make other tradeoffs that involve health risks. And there are, contrary to Agus, legitimate reasons for keeping private health data private.
Worse, Agus seems unaware that most health care innovation comes from private individuals and companies--not government. His vision of bringing all health databases together in a "centralized network" could actually discourage innovation.
Sunday, May 15. 2011
How Not to Take Control of Your Health
I couldn’t wait to read Thomas Goetz’s book, The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine. It’s clearly written and contains a good deal of interesting and useful information. But as I began reading it I quickly found myself feeling restless and bored. I had expected a book about individual empowerment. What I got was a book about personal responsibility as told from the perspective of a public health policy wonk.
The book’s ten decision trees—decision-making flow charts—are symptomatic of the problem. I can only conclude Mr. Goetz thinks the average reader is a simpleton. For example, on page 200 he presents “Ben Franklin’s Decision Tree Model,” the gist of which is that you should consider the pros and cons of every choice. On Page 87 he presents the obligatory “How to Quit Smoking” decision tree. It shows that your first decision—for which there is only one allowable answer—is deciding whether you want to quit.
Mr. Goetz finds plenty wrong with modern medical technology. Too often (p. 130), CT scans uncover “pseudodisease.” On page 133 he informs us that “The Pap test isn’t perfect.” And an entire chapter is devoted to “Why Most Drugs Don’t Work.”
This book isn't about taking control of your health. It is, more accurately, about how you can be a better citizen health-wise. For example, there are plenty of expensive screening tests you could have but a good citizen will sometimes forego tests in deference to the societal cost-benefit analysis. The punch line is that sometimes “we expect too much” from modern medicine (p. 196).
I’m not saying that Goetz is completely wrong. In order to take control of your health, you need to be aware of modern medicine’s flaws and limitations. Yes, sometimes screening tests produce false results. Yes, the risk posed by a specific treatment may be greater than the risk posed by the disease. However, the larger problem isn’t that “we expect too much.” It's that there are too many experts deciding what is best for us.
Mr. Goetz could have written a book that helps individuals take greater control of their health and health care. Instead, he chose to write a book that says that we should be more involved in our health decisions—provided that we start making better decisions.
The book’s ten decision trees—decision-making flow charts—are symptomatic of the problem. I can only conclude Mr. Goetz thinks the average reader is a simpleton. For example, on page 200 he presents “Ben Franklin’s Decision Tree Model,” the gist of which is that you should consider the pros and cons of every choice. On Page 87 he presents the obligatory “How to Quit Smoking” decision tree. It shows that your first decision—for which there is only one allowable answer—is deciding whether you want to quit.
Mr. Goetz finds plenty wrong with modern medical technology. Too often (p. 130), CT scans uncover “pseudodisease.” On page 133 he informs us that “The Pap test isn’t perfect.” And an entire chapter is devoted to “Why Most Drugs Don’t Work.”
This book isn't about taking control of your health. It is, more accurately, about how you can be a better citizen health-wise. For example, there are plenty of expensive screening tests you could have but a good citizen will sometimes forego tests in deference to the societal cost-benefit analysis. The punch line is that sometimes “we expect too much” from modern medicine (p. 196).
I’m not saying that Goetz is completely wrong. In order to take control of your health, you need to be aware of modern medicine’s flaws and limitations. Yes, sometimes screening tests produce false results. Yes, the risk posed by a specific treatment may be greater than the risk posed by the disease. However, the larger problem isn’t that “we expect too much.” It's that there are too many experts deciding what is best for us.
Mr. Goetz could have written a book that helps individuals take greater control of their health and health care. Instead, he chose to write a book that says that we should be more involved in our health decisions—provided that we start making better decisions.
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