Ezekiel Emanuel (brother of Chicago’s mayor, Rahm) has a Wall Street Journal op-ed, “The Hype of Virtual Medicine” in which he takes a not unexpectedly critical eye to all of the various computer-based technology being marketed to people in the name of making them healthier:
Will “virtual medicine” transform the American health-care system? Will the latest computer-based technologies—apps, wearables, remote monitors and other high-tech devices—make Americans healthier? That’s the promise made by tech gurus, who see a future in which doctors and patients alike track health problems in real time, monitor changing conditions and ensure both healthy habits and compliance with drug and therapy regimens.
If it all sounds too good to be true, that’s because it is. Computer-enabled technology will indeed change the practice of medicine, but it will augment traditional care, not catalyze the medical revolution prophesied by Silicon Valley. Machine learning will replace radiologists and pathologists, interpreting billions of digital X-rays, CT and MRI scans and identifying abnormalities in pathology slides more reliably than humans. Remote observation of patients will be used in tele-intensive care units. And monitoring technologies will make it easier to treat patients at home, facilitating more out-of-hospital care.
But none of this will have much of an effect on the big and unsolved challenge for American medicine: how to change the behavior of patients. According to the Centers for Disease Control and Prevention, fully 86% of all health care spending in the U.S. is for patients with chronic illness—emphysema, arthritis and the like. How are we to make real inroads against these problems? Patients must do far more to monitor their diseases, take their medications consistently and engage with their primary-care physicians and nurses. In the longer term, we need to lower the number of Americans who suffer from these diseases by getting them to change their habits and eat healthier diets, exercise more and avoid smoking.
There is no reason to think that virtual medicine will succeed in inducing most patients to cooperate more with their own care, no matter how ingenious the latest gizmos. Many studies that have tried some high-tech intervention to improve patients’ health have failed.
Whether Dr. Emanuel likes it or not, the use of technology in health care will increase and it will increase beyond the American practice of medicine’s ability to control for three reasons. First, for the developing world there is no other choice. The developed world is importing physicians from the developing world as fast as they can be trained even as there’s a dire shortage of physicians in the developing world. If many of the world’s people are to receive any sort of care at all, it will be through “virtual” medicine or telemedicine and many of those people will think that some care is better than none at all. It apparently has escaped Dr. Emanuel’s notice that 95% of the people in the world do not live in the United States.
Second, medical technology companies will insist on it. They won’t be willing to cede a market of five billion people to Chinese and Indian medical technology companies.
But third and importantly while it might be true that technology will not change patients’ behavior it makes physicians’ behavior a lot less important. We can’t afford the present high rate of misdiagnosis, estimated by some to be between 10% and 20%. Based on my own experience it’s much, much higher since that estimate probably doesn’t consider the cases in which a correct diagnosis was eventually arrived at rather than all of the misdiagnoses that preceded them. Furthermore, iatrogenic morbidity and mortality is one of the leading causes of death in the United States. Blaming the patients is only telling half of the story.
In my view the battle that American physicians should be fighting is the fight to ensure that the direction of medical technology is towards helping patients rather than just reaping profits. A delaying action against technology is a mug’s game.