Book Review of “The Patient Will See You Now”

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Image by NEC-Medical-137

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.

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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).

New Startups, Hacks and Conferences Focused Upon Health Data and Analytics

The intersection of digital technology, the Web and modern medicine seems to produce new innovative approaches to health care on a very steady basis. Three reports have appeared within the past ten days that I believe typify the imagination and dedication of the companies and individuals in this space. While the following articles barely scratch the surface, they nonetheless provide an informative sampling of some very interesting trends that likely would not have been possible until quite recently.

1. User Survey Data Mined to Provide Consumer Information on Prescription Drugs: A new company called Iodine has created a database based built upon 100,000+ surveys provided taken from people who have been prescribed medicines. Visitors to the site can use it to look up the consensus findings about the effectiveness, potential side effects, warnings, pricing and other practical information about a vast number of drugs. (Of course, consulting first with your doctor about them is always of primary importance.)

The full details of the Iodine’s origin, current operations*, investor support, use of Google Consumer Surveys and other data sources, and its potential benefits to patients and the pharmaceutical industry was the subject of a very engaging article published in the September 23, 2014 edition of The New York Times entitled To Gather Drug Data, a Health Start-Up Turns to Consumers by Steve Lohr. (See also another brief article entitled Iodine: A Platform to Help You Choose the Best Medicines for You by Ben Woods, posted on TheNextWeb.com on September 24, 2014.) I also highly recommend a click-through to Iodine’s site to view and test out their new approach to producing and presenting this specialized consumer information.

2. Hackers Modifying Medical Devices: A group of engineers have joined forces online to provide a useful hack to the continuous glucose monitor produced by a company called Dexcom. As reported in an article entitled Hackers Tinker With Medical Devices in the September 27, 2014 edition of The Wall Street Journal, by Kate Linebaugh (a subscription to WSJ.com is required for access), this hack is called NightScout. To briefly sum up this story, NightScout enables data from this device to be uploaded online to permit parents and other concerned individuals to remotely check the blood glucose levels of family members and friends who have Type 1 diabetes, from their smartphones. The Dexcom monitor currently on the market does not do this, although such a connection is planned for a subsequent release possibly next year.

The monitor itself consists of two parts: A small plastic pod which is worn by person with diabetes that transmits the blood glucose readings on a continuous basis to a handheld device within a 20-foot radius (which is nearly the same dimensions of a typical smartphone). This system is used to look for and alert the user to certain helpful patterns in the changes to their blood glucose levels and to record this data. In turn, the data is also quite helpful to the person’s medical providers.

This is indeed a very data-driven approach to treating Type 1 diabetes, which has always required close monitoring by the patient in an effort to maintain normal blood glucose levels. Doing so helps to avoid long-term complication and maintain good health.

Neither the manufacturer nor the FDA has approved NightScout, but they have not tried to stop it. Rather, they are closely watching its ongoing improvements by the NightScout online community and how this is affecting the quality of care for the users.

3. Industry Conference Presentation on Data-Driven Medical Technologies: An article entitled Can a Computer Replace Your Doctor? by Elizabeth Rosenthal in the September 20, 2014 edition of The New York Times, reported on other advances and growing interest by doctors driven by big data collection and analytics. These developments were the subject of a presentation called Health By Numbers at the recent 2014 Health Innovation Summit in San Francisco. This article opens with an account of a doctor asking his audience whether they would prefer an AI to an actual doctor.**

To briefly summarize this story, some of these systems and methodologies discussed, among others:

  • An iPhone app to diagnose ear infections
  • Home kits to check cholesterol levels
  • The above mentioned blood glucose monitoring devices
  • Wearable fitness trackers

Moreover, the attendees discussed many key issues about pursuing these lines of medical treatment and administration including high expectations and mixed outcomes, challenges in quantifying exactly what “health” means, that sometimes good data does not always equal a healthy patient, and how to most meaningfully process and analyze all of the available data. I highly recommend a click-through and full read of this very informative and thought-provoking piece.

My follow up questions concerning all three of these stories include:

  • Will the privacy patient and user data be adequately protected by current laws or do the rapid emergence and adaptation of these systems require new legislation and regulation to ensure patient privacy?
  • Whether and how the roles of doctors and other medical service personnel will be changed? If so, how will their academic training need to be revised?
  • What, if any, will be the impact on the costs, quality, policies and politics of medical care in the US and elsewhere?

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*   No stitches were involved as these concern business, not surgery.

** Compare and contrast to this September 1, 2014 post here entitled Possible Futures for Artificial Intelligence in Law Practice.