Physicians may be marginalized as mobile tech engages us in healthcare

Mobile to usher in era of patient engagement, health conference told

NEW ORLEANS - There will come a day in the not-so-distant future when physicians take a back seat in healthcare, and where patients will have the mobile tools to diagnose, and in some cases, treat themselves.

That was the summation of a keynote speech at the HIMSS13 Conference here given by Dr. Eric Topol, a professor of genomics at the Scripps Research Institute.

"Is your doctor becoming obsolete?" Topol said, quoting from a recent front-page headline in The Atlantic. "That was unthinkable until now. We have the components for a digital revolution."

The statement drew resounding applause from a packed hall at the conference, where more than 32,000 people are in attendance this week.

Topol took aim at the medical community, calling for an end to paternal medicine -- where only the physician has access to healthcare information -- and the beginning of a time when patients own their data.

"You have a doctor-patient relationship that today is based on asymmetry. A lot of information to the doctor, very little for the patient," he said. "We're about having ... information parody. That's exciting. We can get away from this superiority of physicians to patients. That has got to go."

Topol compared mobile technology to the Gutenberg press and they way it revolutionized the way information was shared throughout the world.

Topol highlighted a plethora of emerging mobile technology, such as wearable wireless monitors to smartphone attachments that will offer consumers the ability to track everything from core vital signs to impending heart attacks by discovering problems with heart tissue.

Topol demonstrated several mobile healthcare technologies, including a finger pulse oxymeter that plugged directly into an iPhone, and an iPhone case that doubled as a cardiogram when a person touched two sensors on the back of the case.

He pointed to Apple, which sells glucometer attachments for the iPhone, used by people with diabetes to test their blood sugar levels. "Who would have thought that would ever happen," he said.

Topol also noted that just 10 years ago, there was no Skype, Facebook, YouTube, Twitter, Pinterest, or iPhone, among other top social networking and mobile technologies.

"All of these things are not even a decade old and they're transforming our digital world. Except in medicine -- so far," he said. "It hasn't hit medicine yet, but it will."

"We have a problem," he continued. "We have all this engagement, but we don't know that much about patients yet. We're still in this Voltaire era about doctors prescribing medicines of which they know little for patients they know even less and of human beings of which they know nothing."

The problem, Topol explained, is lack information on patients as individuals and as a larger community. For example, gene sequencing, which at one time cost millions of dollars to perform on a single person, today costs just $4,000, he said.

Through the use of genomic information, personalized medicine will come of age, allowing customized medicines to be used to treat a myriad of illnesses, from cancer to diabetes, Topol said.

"We have a serious problem because they're treating all people the same. This is population medicine personified," he said. "Mammography done for all women over the age of 40 has net harm. Net harm of almost 200 per every 1,000 women screened. Similarly for prostrate PSA, net harm - 200 per every 1,000 screened."

With better wireless monitoring technology, disease can be detected early, eliminating the need for annual screenings -- even physicals, he said. Topol pointed to research being done at The California Institute of Technology where embeddable sensors are "half the size of a grain of sand," yet they can detect irregularities in the heart.

"We have sensors in our cars. Why don't we have them in our body?" Topol said. "Most tasks can be taken on by patients. We don't need doctors so much when we have this innovative technology."

Among several examples of how current drugs have fallen short in treating a large swath of the population, Topol pointed to three of the top arthritis medications: Humira, Remicade, and Enbrel. Of all arthritis patients taking the drugs, only 30% benefit from them, he said.

"That means 70% of $30 billion is waste," Topol said, referring to the money spent on developing and producing the three arthritis medications. Topol suggested results would be far better with "personalized medicine," where genomic information is used.

Topol is no stranger to controversy. In 2005, Cleveland Clinic's then top cardiologist, Topol challenged the safety of the pain reliever Vioxx, even acting as a key witness in lawsuits against Merck & Co., which claimed they concealed the dangers of the drug. The result was the drug being removed from the market.

After leaving the Cleveland Clinic, Topol became a genomics professor at the Scripps Research Institute, where he is now the chief academic officer and is vice-chair of the board of the West Wireless Health Institute.

"We shouldn't be suppressing direct-to-consumer access to genomic information. It's your DNA, you should be entitled to that information," he said.

While Topol's view of the future of healthcare may seen controversial, he's not alone in his opinion. HIMSS board member Scott Holbrook took a similar position, speaking just prior to Topol.

"If we are to transform healthcare information technology, that means we must engage all stakeholders. That means non-IT people," Holbrook said. "We must transform from provider to citizens-centered healthcare. We must bring these consumers into our world."

Lucas Mearian covers storage, disaster recovery and business continuity, financial services infrastructure and health care IT for Computerworld. Follow Lucas on Twitter at @lucasmearian or subscribe to Lucas's RSS feed. His e-mail address is lmearian@computerworld.com.

See more by Lucas Mearian on Computerworld.com.

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