Monday, 19 September 2016

The patient will see you now, according to Eric Topol

Eric Topol, director of Scripps Translational Science Institute, published in 2012, The Creative Destruction of Medicine, and in 2015, The patient will see you now. The future of medicine is in your hands. I had this last book on my reading list for a while and I've finally been able to read it during the holidays. It’s an important book about technology seen from the point of view of a clinical practice with extensive knowledge. I found that this literary piece goes a little too far in some chapters and I struggled to follow the thread of the main thesis, nevertheless I have to admit that the contributions of the genomics professor (and cardiologist) are very relevant and deserve to be discussed.

Gutenberg and smartphones

In 1440 in Mainz (Germany), Johannes Gutenberg, an innovative goldsmith, launched an invention based on three components: typography, based on individual metal letters that allowed combinations within themselves, a new oily ink and a press. The invention made the cost of book production 300 times cheaper as it was hitherto in the hands of scribes. It’s estimated that just sixty years later in Europe there was a thousand printers capable of producing millions of books. People could read the Bible for themselves and, more importantly, they could also interpret it. Gutenberg's invention changed the course of history.

Topol believes that, after six centuries, we are experiencing a new communication revolution comparable to that. Now each and every one of us has a small computer in our pocket and we can access, what was unthinkable until recently, encyclopaedic, scientific, administrative and many other data bases. We can interact in multimedia formats and almost without limits, with family, colleagues or strangers and remote individuals or groups. A new communication revolution is underway. The information has been democratized thanks to the power of smartphones, as the printing press had democratised the Bible a few centuries back.

Massive Open Online Medicine (MOOM)

Based on the new social and technological reality (a smartphone in every pocket), Topol elaborates the MOOM theory, playing with the educational trend MOOC (Massive Open Online Courses). MOOM is a conceptual model where each person is involved in the generation and storage of their own clinical data in distributed but safe computing environments and does so from the position of owner of the information. According to the author, a MOOM environment should improve the patient experience and should favour the practice of shared clinical decisions. This new model provides bilateralism, meaning that, as physicians have access to clinical data of patients, naturally with his consent, patients should also know the clinical results offered by every doctor and every healthcare provider.

In summary

"The patient will see you now" is rich in nuances, a complex work written from a professional perspective that is close to the patient, and dealing with aspects of genomics, epigenetic, understanding risk, sensors for smartphones, the project "open notes", the "right care", and so on, but the prevailing thought is that of MOOM.

As the author says: "We are all dressed up with nowhere to go". We have made great effort to digitize the medical records of primary care and hospitals (separately, of course), we have digitized diagnostic images and laboratory results, we have deployed the internet to impressive boundaries, we have learned to store tons of data in the cloud and, oh miracle, we have very powerful computers in every pocket of every citizen. Where do we go next? Undoubtedly, MOOM is the answer.

Jordi Varela

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