There was great sorrow across the world on Friday, February 27, 2015 over the passing of Leonard Nimoy. (The link is to his obituary in The New York Times.) He was a renowned and prolific actor, director, photographer and poet. He will forever be best known for his remarkable portrayal of Mr. Spock on the original Star Trek series and later on in the franchise’s other shows and movies (two of which he directed). I will greatly miss him as someone who has faithfully followed Star Trek through every single adventure on the small and large screens.
I heard the sad news just shortly after I had finished reading The Patient Will See You Now: The Future of Medicine is in Your Hands by Eric Topol (Basic Books, 2015). The coincidence of these two events took on a significant meaning for me. This is because some of the tech portrayed as pure science fiction in ST has, over the 48 years of the franchise’s existence, actually came into being, while Dr. Topol’s book now proposes using smartphones to as medical testing and communication devices to revolutionize health care delivery and informatics. In part but with some major distinctions, this will be somewhat akin to the tricorder used by the crew of The Enterprise. (See also, the XPrize competition that the semiconductor company Qualcomm is running to award $10 Million for the creation of a working tricorder.)
Just as the many iterations of the Starship Enterprise undertook long voyages into new and distant parsecs of space, so too does Dr. Topol (who is a cardiologist, professor of genomics and the director of the Scripps Translational Science Institute in California as shown on the book jacket), take his readers deeply into the realms of science, technology, bioethics, economics and policy. Notwithstanding the complex inter-relationships among these topics and his well-considered proposal to use smartphones as the basis for an integrated medical platform, he manages to explain and present all of this in a highly accessible and imaginative manner. I would thus add to his lengthy list of accomplishments that he is a very effective communicator of what might otherwise have been as dry as bio-inactive dust text in the hands of another writer. His presentation in his book indeed shows an expert touch in balancing the art of his prose with the science of his profession.
So, what is all this new-fangled medical/techno-network hub(ub) about anyway? At the core of his book, Dr. Topol proposes to extend and enhance the capabilities of iPhones, Android phones and the like so that patients and doctors can use them to perform medical tests such as, among many others, checking blood pressure, cardio functions, blood and genomic factors, and even as a form of microscope. This data can then be readily uploaded for analysis and recommended treatments. This new configuration could potentially be far cheaper and faster than current methods for similar results. More importantly, this would help to democratize medicine whereby the patient owns and controls the distribution of his or her personal medical data.
In careful detail, Dr. Topol expands the notion of this alternative platform outward in assessing and proposing the benefits to everyone in the US healthcare system. This could enable the gathering and unlocking of massive troves of medical data for research and analytics to produce more accurate and meaningful test results, improve proactive preventative health programs, reach under-served communities, and perhaps reduce spiraling costs and intractable bureaucracies. He addresses the timely and critical concerns of privacy and security that generating such massive amounts of highly sensitive data would surely entail. As well, such a system might raise the incentives for the medical establishment to develop more universal standards and greater interoperability for electronic medical records systems.
Dr Topol’s other critical theme is that his proposals would redefine the balance of control between the doctor to the patient. Hence the title of his book that inverts the traditional announcement in the doctor’s waiting room of “the doctor will see you now” into a new construct where the patient has new-found precedence in their care and data. As part of his call for this transformations, he repeatedly mentions the eternal persistence of doctors’ “paternalism” as being both an anachronism and an impediment to trying to improve the healthcare system. He has a, well, healthy skepticism about this still prevalent artifact and believes it can be effectively routed around by empowering patients with the ever-increasing numbers and capabilities of their smartphones.
It would be difficult for anyone to disagree that the US healthcare system is in dire need of change for a multitude of scientific, economic and political reasons. Bravo for Dr. Topol in challenging his own profession’s conventional wisdom and proposing a truly bold plan to disrupt it and make it more responsive to the needs of patients. Rather than being an all or nothing proposition, his plan can also be viewed as an opening gambit to incrementally move these possibilities forward.
The science and technology needed to start implementing and networking some of these systems already exist in part or in full. The bits and bytes are likely the easier part of this equation. The genuinely hard part is finding the broad-based consensus, will and the resources to get it done. This book eloquently and persuasively lays out the policy and particulars for anyone in the medical industry, medical education, government and regulatory agencies, insurance industry, pharmaceutical companies, and consumers to consider and then perhaps begin doing something.
Not only does Dr. Topol have his finger on the pulse of today’s patient needs, he likewise has it on the entire medical establishment. He has used his experience and insight to write a 290-page prescription for a new alternative treatment to re-energize an ailing system that deserves the reader’s serious consideration. Who knows? It may well be the beginning of a new path for us to try in an effort to live longer and prosper.
For two additional recent reviews of this book I recommend clicking through to ‘The Patient Will See You Now,’ by Eric Topol, reviewed by Sandeep Jauhar, in the February 13, 2015 edition of The New York Times, and Doctor Android reviewed by David A. Shaywitz in the January 12, 2015 edition of The Wall Street Journal (subscription required).