Every once in a while, a book hits upon a convergence of science, technology and society in ways the existing incumbents are not at all ready to hear. To them, it might sound like someone describing a dream. Marshall McLuhan’s work in the 60s on media and culture come to mind and technology, as do business, and innovation authors such as Kevin Kelly and Clay Shirky. These are the writers who seem to be more than 80% right if you allow a few years for the trends to play out. Their forward-thinking ideas eventually play a large part in changing the mindset of the incumbents. I see Eric Topol’s latest book, “The Patient Will See You Now: The Future of Medicine is in Your Hands” as firmly planted in this group of trend-spotters. It can’t be fully appreciated in the present.
Our “health care future is here, but it’s not evenly distributed,” as author William Gibson may have said.
From the perspective of current health care practitioners, the future that’s happening now looks like a distant planet, light years away. As evidence from some of the predictable early reviews of the book, perhaps nowhere is the future less evenly distributed than health care. Physicians (and likely a lot of health technology vendors) don’t see or recognize many of the changes taking place. In health care, after all, there’s an often-cited 17-year adoption rate of new innovation.
If this were under normal circumstances it still may take a while to get dramatic industry-wide change, but this is not internal change. Change is coming from outside, from patients and digital innovators. At a time when big tech innovators like Google are investing in outer space, this kind of innovation seems overdue for health care.
The connectivity and democratization of health information – the prerequisites for Topol’s health care future – has already started. With this new information, patients and caregivers are, at the same time, driving significant improvements in care and care delivery as the medical establishment. Consumers don’t need 17 years to adopt new tools and to develop new solutions when they are both the developers and adopters. Topol cites several examples of people taking their data and their technology into their own hands, from the 3D-printing tumors of to help their physicians gain a better view, to Angelina Jolie’s very public BRCA saga and taking preventative actions in consultation with her physician.
The disruption Topol sees for health care is not unlike the disruption MacLuhan saw for media, and Topol leans appropriately on McLuhan’s work early on to set the tone for the remainder of the book. Tech innovation will change the fabric of medicine and society’s relationship to their health care in the same way it changed our relationship to media.
Topol’s latest is a must-read for anyone interested in the future of health care and what risks and opportunities are on the horizon. There are fundamental trends that will make this happen, although it’s admittedly hard to predict when it will occur. This is perhaps the first and best book to date about the dramatic social changes technology is driving in health care. The technologies are changing traditional relationship dynamics between various stakeholders in health care. We are entering the age of “Do It Yourself” health care, smart phone care, retail care and cloud-based care. These changes are as disruptive to medicine as eCommerce and MegaStores have been to retail.
If you have an interest in the technological, social, science and business futures of health care, go read #TPWSYN with an open mind and think about how value will be generated in this new world and our privacy and our ability to live freely can be protected while managing more and more of our own health. Putting these tools to use could save your life or the life of someone you love.
8 Key Takeaways
1. Medical costs are largely about location, time and people. Intelligent networks will allow place, time and people to become more distributed.
Tech will change how and where medical intelligence will live. It will become distributed in the cloud, within connected communities, and at our fingertips in evolving ecosystems of smart phones and sensors (IoMT or Internet of Medical Things, as Topol calls them). These networks will able to access and apply the knowledge in the world and at the bedside. Kevin Kelly is calling the act of putting intelligence into things “to cognify.” We’ll see much of our world become distributed and “medically cognified” in the years to come.
2. Democratization of medicine means the end to paternalism.
Democratization of health data, health information, and sensors means the democratization of care and an end to much medical paternalism, which has largely existed because of knowledge asymmetries. With the end of these asymmetries, the relationship will undergo a change from patient as kind of object to patient as COO. As Topol notes, just as the Gutenberg’s printing press upended many institutions of the time, so too will the spread of medical knowledge upend many current institutions.
3. Democratization will lead to more Peer-to-Peer (P2P) medicine.
Networks can connect people and devices in ways that make the whole smarter than the sum of it’s parts. Patients can connect to patients who have shared problems and can share solutions, such as with the FLHCC community Topol describes that worked with researchers to find the cause of this rare cancer. People can connect images to 3D printers and monitor their ECG from across the globe. These networks of P2Ps of many varieties will continue to shake up the medical community and find solutions to difficult problems, solutions that would otherwise be expensive, rare or underfunded.
4. Because of the democratization of medical knowledge, innovation will come from all sorts of new places.
People with medical problems have the time, the resources and the incentives that the medical establishment doesn’t have. Jack Andraka is now famous as a 16 year-old high school student that came up with a novel approach to detecting pancreatic cancer. Kim Goodsell and others are were able to diagnose complex medical conditions that their physicians could never have time to figure out. The surplus of open knowledge and information (including big data and open access) will soon combine to allow innovation to spring from new places. In fact, it already has.
5. The open health movement, patient-centered care, and value-based payments are inextricably linked.
Topol devotes an entire chapter in the book to the open movement. At the core of the issue is a whole new group of people, patients and caregivers, need to have access to information – code, data, research and more – to make the best decisions. Better decisions by all players will make value-based payments successful. As I write this, Bill Clinton just committed to “open source health care” and the White House has issued new goals and guidelines around value-based payments in Medicare. Want to accelerate better decisions and success under these new paradigms? Open more access to more information resources.
6. Medical education is near-turmoil.
Medical education and knowledge will also be democratized and upended. Massively Open Online Medical Education, MOOM, as Topol calls it, may be the answer, but medical education is in turmoil. There are few digital health courses or care delivery courses in medical schools in the United States. If physicians are to continue to stay relevant, they’ll need to become as adept with these tools, and in delivering care through them, as their patients soon will be.
7. Patients may ultimately be better at understanding risks than many physicians.
In a world where, as Topol notes, nearly everyone with elevated cholesterol gets Lipitor, and mammograms find 100x more false positives than tumors, we may need a reboot of our understanding of costs and risks. The ones bearing the risks and the costs may want to have a larger voice. It’s all too easy, even with good intentions, for physicians to say, “do more,” because the risks for physicians is almost always doing too little. For the patients, doing less may be a much lower risk option, and with more data and more democratization, we may get a better handle on those risks.
8. There are risks, of course.
Just as we have networks like Google and Facebook that are virtual monopoly on our online selves, we face the same risks in our health future where identity and computing power could be controlled by a small few. We’ll have to be vigilant to keep the whole system open and balanced with privacy and security for all.
All the right notes, but…
Overall, Topol hits on all the right notes. Just when I thought, “we need to bring social media into this conversation” or “we need to bring the open movement, or costs or security into this conversation,” I would inevitably find a passage or even a chapter on the topic and a great discussion on the next subject. “‘The Patient Will See You Now: The Future of Medicine is in Your Hands” is an extremely satisfying read, offering a phenomenal tour of possibilities.
If there a few things to add to the conversation, I’ll add two.
First, more on how user-experience-driven technology design (not just the design of facilities) will play a role in providing solutions people can actually use to their greatest benefit. These new tools won’t work for everyone. We’ll need technology designers to find solutions to displace bricks and mortar health care, including some stepping stones. Who can help those that can’t help themselves with new tools? Care coordinators, social networks, nurses? I am as convinced as Topol, but we need to recognize that self-care or P2P care won’t work for everyone right away. For others, due to price and geography, these new tools may be the only options.
Second, How policy might accelerate some of these changes? Topol touches on how existing players can adapt in the last chapter, but not much on how we can help deliver this better world. I suspect Dr. Topol sees the changes he describes as inevitable because of basic economics (we’ll get more, better outcomes for less). Still, security and privacy (which Topol discusses, but there are no easy solutions here) may be roadblocks. Also, there are many perverse incentives and difficult design challenges along the way that will keep us from getting to high-quality tech-enabled care at a reasonable price. In fact, the “Obamacare 2.0” as Vox recently put it, is a proposal to accelerate pay-for-quality reimbursements may be part of the solutions.
Still, this is not that kind of book. It’s not a design or policy book. It’s about potential, a catalytic substrate for what will happen very soon as patients become central to health care and the democratization of health data comes to fruition. As Topol points out at the end, each of us could have a role toward tipping medicine toward a much brighter future. Let’s each do our part to make it a better health care world. The doors have opened.