Thursday, November 10, 2011

Technology and Health Care: Quo Vadis?

I am at my core an engineer. Engineers take technological advances and turn them into worthwhile things. Engineers are not at the core a researcher, seeking knowledge for knowledge's sake; but the engineer has a goal, and part of the goal is to have something that is reproducible, cost effective and satisfies the needs of people. Engineers succeed, if and only if, people appreciate and value what they create as a new process or thing. Engineering is an honorable profession.

Now where is this going? In the NY Times the former head of the MIT Media Lab has a piece where there is a discussion of technology and health care. Now a little history, back in the 70s I  shared a student with the early entity called Arch MAC, the predecessor of the Media Lab. In the 80s I as head of R&D at NYNEX, now Verizon, gave the Media lab several millions of equipment focusing on high resolution imaging and multimedia communications. In 89 I taught the first Multimedia Communications course at MIT, the book from that available for at this point historical reference. Now one thing I found out was the Media Lab is neither science or engineering, it is demo demo demo. It is an idea factory where the ideas are but a patina of a possible reality.

Thus in reading this article I was amazed to see that not much has changed. It states:

It would begin with a “digital nervous system”: inconspicuous wireless sensors worn on your body and placed in your home would continuously monitor your vital signs and track the daily activities that affect your health, counting the number of steps you take and the quantity and quality of food you eat. 

Wristbands would measure your levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. Your bathroom mirror would calculate your heart rate, blood pressure and oxygen level.
Then you’d get automated advice. Software that could analyze and visually represent this data would enable you to truly understand the impact of your behavior on your health and suggest changes to help prevent illness — by far the most effective way to cut health care costs. 

Many situations would still call for professional medical attention, of course, but in most cases you wouldn’t need to make a costly trip to the doctor’s office. If you were not feeling well, a lifelike avatar on your smart phone would use natural-language processing to listen as you described your symptoms and then would translate them into medical jargon. After consulting a diagnostic supercomputer, the avatar would ask you to run a few quick medical tests at home. 

Now does any of this make sense? Frankly, in my opinion, little if any. Why? Well take measuring levels of arousal and anxiety. What do we measure and how often and what values are meaningful and at what costs? Just to begin asking.

I am a true believer that monitoring blood sugar is a good thing if it ca  be used to motivate weight loss and Type 2 Diabetes control. Does it work? We really do not know. At what cost? We do not know. Heart rates and the like may be useful for collection purposes but it is not clear that they will improve the life of the patient nor would they be cost effective. It requires engineering not demos.

What do physicians do. To paraphrase Osler, "if all else fails listen to the patient". That worked well at Hopkins a century ago and it is useful today as well. It is not a natural language processor that Osler had in mind. It is sitting there across from that seventy year old woman who has back problems and knee pain and find out that she has been gardening for the past month in her rock filled garden. Should we use an MRI for $2,000 a clip, and have the risk of finding things which we then must follow up on at exploding costs, or tell her in a comforting manner that some naproxen and come back in two weeks will be just fine.

All too often we do not need demos, we need competent family or general practice physicians who can handle the general day to day practice. Where can we get them, one source may be the very many foreign born and foreign educated physicians who could fill the gap. I have met many well educated physicians who could pass boards but would find it difficult to get into residency programs required for final licensing. Can we create another class, say between a Physician Assistant and a Board Certified Specialist. I believe the numbers are there and we just have to consider that option. Having more "demos" is not, in my opinion, productive in any manner.