Future of Medicine
Reflection on the “Creative Destruction of Medicine” book written by Eric Topol in conjunction with my own professional experiences.
By Anastasia Stanislawa Malicka, MPH Program at Saint Joseph University
Original Paper: August 2015.
I was very intrigued by this book, considering it was written from physician’s perspective on the future of our healthcare. It touched on many drivers of change, especially on mobile technology transforming our communication, and future convergence of technology and medicine. In many respects, it sounded very futuristic, yet very real and current at the same time. I was fascinated by his review of life sciences industries, and its future challenges. Since I have been working for several companies he collaborated with on clinical trials, it sparked my interest even further. I have done many interviews with Global Thought Leaders over time, and I wanted to better understand his specific recommendations how we can improve our developmental process in the future. At the end, I was looking forward to learn how we can all work together more efficiently to transform our health care system to be more effective.
Mobile technology transformed how we communicate and interact with one another. It is not just communication; it is now both entertaining and interactive. We can connect with anyone around the world within seconds. Through crowd sourcing, we have the ability of “pooling minds” over the mobile technology anywhere in the world. Now, we are starting to “outsource our brains” to the cloud. We are also accessible to anyone in the world through facebook or twitter or some other social media applications. It is the way we are democratizing our data, and it is driven by us, consumers. Furthermore, this state of constant connectivity impacts how we think. We are becoming more linear in our thinking and less likely networked in the way we process information. As I am contemplating on the above advancements, I am starting to realize that we are at risk of being influenced by almost anyone around the world.
New companies are emerging in providing health solutions and empowering patients. Patientslikeme and Sermo promise to provide more innovative solutions, reporting more useful data on patients and physicians. I had a privilege to work with both of them in the past, and I am very familiar with their capabilities. As Dr. Eric Topol indicated, internet does not always provide well validated sources of information, and it can sometimes create more harm. Therefore, there is a great need for increased vigilance and oversight of the type and quality of information that is being provided, especially when informing people on treatments or potential outcomes. It can quickly result in further comprising our quality of care and putting millions of people at risk.
This is why DTC and any educational programs are heavily regulated, and also why they continue to create many debates and controversy. When it comes to health information, each statement needs to be validated and based on clinical evidence. FDA works unceasingly to make sure that our patients are safe and that no one is misrepresenting clinical data. With internet opening doors to anyone around the world trying to sell their products or share their ideas, we are at higher risk of having patients being influenced by unreliable sources. It is the risk that at the end, physicians have to manage, putting greater demand and pressure on them.
Despite the above challenge, the author argues that we are on the verge of the biggest convergence of technological advancement, most arguably the biggest advancement in human history. With introduction iPhone, now we can convert them into diagnostic tools. He argues that by 2020, there will be 6 billion of mobile phones around the world. The cost of computing will be further reduced, and now DNA sequencing can be available to just anyone. We will have tsunami of data, which does not even include data from nano-sensors. There are now close to 645 million+ of sensors available around the world. As he points out, anyone anywhere can be transmitting information in the future. He projects that they will be placed in humans to provide ongoing monitor of our vital signs, provide early diagnosis, and even release treatments. The can even transform the way we think and act. All of it can be possible through application of mobile technology. However, we need to learn to apply this type of technology in practice of medicine and physicians are very reluctant to embrace anything that is new. It is not surprising, considering the number of recent technological setbacks, especially as it relates to data privacy. He continues to argue that even our academic leaders also suffers from “Bankruptcy of Vision”, not willing to change the way they teach medical students. We need to embrace more interactive tools in the future to better engage students.
There is also an opportunity to reboot life sciences industries, now facing “innovation crisis”. He suggests that the industry may be even more compromised by the technological advancements in the future. He claims that this is a panic time for the industry. The discovery of New Chemical Entities declined from 56 in 1996 to only 20 in 2010. The industry faced massive patent cliffs, losing $50 billion in revenue stream. There was ongoing consolidation and acquisitions over the past two decades. At the same time, the way the industry approached discovery and development of new products was seriously flawed. They still approach discovery based on outdated population-based approach, rather than individualized medicine based on human genomics.
In order to revamp their discovery, the industry needs to embrace Wiki Medicine and Networking. Use internet to post all of their data to help scientists tap into their latest knowledge and findings, he argues. Also, they need to consider digital tracking of their post marketing data. They need to re-vamp their developmental processes to identify higher responders to their medicine through discovery of new biomarkers rather than wasting resources by treating everyone. Moreover, they need to abandon their “pathetic moral reasoning” and accept the science of individuality. This argument brought back to me some very recent memory of the statement I heard that: “only people, who deserve HIV treatment, will receive it”. It made me wonder, who is it that decides who deserves and who does not, in the category where only 39% of HIV patient receive treatment? It is also a category where it is highest among minorities, especially young African Americans. Therefore, when you have population that is untreated, you cannot afford to debate over who is going to respond to your treatment. We have moral obligation to treat all, without any constrains. Also, we have duty to our patients and our stakeholders to protect our data, which is our biggest source of competitive advantage. Why would we purposely compromise our position, and potentially expose ourselves to greater risks? This was an innovative approach I would highly discourage any industry from adopting, especially during the race that can easily put the entire population at risk.
Working with number of biomarkers in the past, what we learned is that they are not 100% predictive. Instead, they are anywhere from 30-70% predictive. There is a long way before we can be anywhere close to achieving 100% confidences as to response of an individual to any specific treatment. In a meantime, we have moral responsibility to provide treatment to anyone who needs it, especially in category such as HIV or oncology.
In the last chapter, Dr. Eric Topol predicts that digital capability will transform our reality into “Homo Digitus” approach and based on individuality, rather than public approach to care. Now we are entering new era where we can use bio-sensors to control diagnosis and treatments. Furthermore, we can soon control our mind, and even digitalize our brain. There are on-going experiments where they can stimulate parts of our brain to trigger very specific behavioral and emotional responses. In fact, we can make people think and behave in a certain way. Furthermore, the real prevention, he points out, will start prior to conception, and will enable us to detect early if there are any genetic abnormalities. It concerned me tremendously. What we are proposing is to alter our human existence, manipulate our thoughts, change our behaviors, and control population based on genomics. In my opinion, this approach is not endorsing and protecting democratization concept; this could lead to dictatorship and oppression at its worse-case scenrario.
As we are considering all of our options to overcome our existing challenges and introduce innovative solutions, we must never confuse transforming our health care with transforming our humanity. In all of our decisions, we need to always retain autonomy and dignity of human existence. No one has the right to deprive another person of that right. We are all born with innate dignity, given to us by God, and that cannot be compromised by any political or organizational system.
We also have an obligation to protect our public from harm. The advancements in technology, despite their benefits, they can easily be used to exterminate masses of population on a scale never possible to achieve before, even with the use of nuclear energy. We not only need to stay abreast of the latest developments, we need to be ahead of everyone. Our security of our citizens needs to be protected more than ever. This is not anymore a nice to have, this is critical to our survival.
Furthermore, we need to have much stronger educational focus on establishing strong medical ethics, and moral conduct. We cannot afford to take one step in the wrong direction– because we may have another opportunity.
References:
E. Topol. (2012) The Creative Destruction of medicine. Tantor Media, Inc.