Saturday, March 14, 2015

Wishful Thinking

Medical Trials have gone through decades of improved sophistication and are also extremely expensive to conduct. I would argue that the main reason is patient compliance. Trials often spend time on recruiting and then monitoring patients.

Patients are the most difficult part. They lie. "I do not smoke", "I really did not eat that much", "I take the medications as you told me", "I am dieting every day", "I check my blood sugar", and "I don't drink that much" Son consider this article describing Apple's view of patient self reported data.

In MedCity News they report:

Apple executives envision ResearchKit serving as an aggregator of medical and health data from hundreds of millions of iPhone users worldwide, helping researchers identify and track subjects for their work. That’s a great idea, and would be an even greater idea if Apple follows the open-source model and builds or allows a third party to create an Android version. The company described ResearchKit as a framework to help medical researchers design apps for clinical studies, speeding up data collection on an exponential scale.

The problem is that we do not know whether the information is correct or not. Patients lie to their Physicians, patients lie to themselves. So what are they going to tell their iPhones? Is there some truth meter here?

The article continues:

Medicine is also going toward personalization as genomics grows in popularity and falls in price. Hopefully, someone will develop apps on the ResearchKit platform that helps make sense of the massive amounts of genomic data that sequencing is just starting to generate. According to Williams, ResearchKit will provide academicians and practitioners alike with nearly continuous data flows, not just occasional “snapshots” of information, so they will be able to track patient symptoms more accurately. “But perhaps the most significant challenge is the communication flow,” Williams said. “When you participate in a study, you often don’t hear back until the very end of the study, if at all.”

It is not at all clear how an iPhone and genomics play out, are we placing a sequencer on the iPhone? Doubt it. But as to the  continuous flow of information, if it relies on the patient then it is highly suspect. The purpose of many clinical trials is to take the patient out of the loop specifically because of this fact. Reliance is upon objective measures. Also patient compliance even in a Trial is a challenge.

Thus claims that these technologies are a panacea are at best specious.