Monday, 8 January 2018

“The patient will see you now” on the subject of 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." For a long time I had this last book on the waiting list and finally I could read it taking advantage of the holidays. It’s an important work, which talks about technology based on in-depth knowledge of clinical practice. It’s a literary piece, for my taste, a bit too overloaded, to the extent that, in some chapters, it’s difficult to follow the thread of the main thesis, but despite this, I have to admit that the contributions of the professor of genomics (and cardiologist) are relevant and I think they deserve to be discussed.

Gutenberg and Smart phones

In the year 1440 in Mainz (Germany), Johannes Gutenberg, an innovative goldsmith, launched an invention based on three components: a print based on individual metal letters that allowed various combinations, a new oily ink and a press. The invention allowed a 300 fold reduction in the production costs of books that until then was the monopoly of the monks. It’s estimated that, sixty years later, in Europe there were a thousand printers with the capacity to produce millions of books. People could read the Bible on their own and more importantly, could interpret it. Gutenberg's invention changed the course of history.

Topol defends that, after six centuries, we are living in a new communicative revolution comparable to that one. Now, each of us has a small computer in our pocket, an access, unthinkable until recently, to encyclopaedic, scientific, administrative databases, etc. One can interact in multimedia formats and almost without limits, with the family, with colleagues or with unknown and remote people or groups. A new communicative revolution is underway. The information has been democratized thanks to the power of smart phones, as in the past the Bible was democratised by the printing press.

Massive Open Online Medicine (MOOM)

Starting from the new social and technological reality (a smart phone in each pocket), Topol develops the MOOM theory, playing with the educational trend MOOC (Massive Open Online Courses). MOOM is a conceptual model in which every person is involved in the generation and storage of his own clinical data, in distributed but secure computing environments and does so from a position of proprietary information. According to the author, a MOOM environment should improve the patient's experience and should favour the practice of shared clinical decision. This new model considers a bilateral approach, that is, just as physicians would have access to patients' clinical data, logically with their consent, patients should know the clinical results offered by each doctor and each healthcare provider.

In summary

"The patient will see you now" is a complex work, rich in nuances, written from a professional vision very close to the patient, where we talk about genomics, epigenetic, understanding risk, sensors for smart phones, the project "open notes", of right care and of a long etcetera, but the prevailing idea is that of the MOOM.

As the author says: "We are all dressed up with nowhere to go": we’ve made an immense effort to digitize the clinical histories of primary care and hospitals (separately, of course), we have digitized diagnostic images and laboratory results, we have deployed the internet to impressive limits, we have learned to store tons of data in the clouds and, oh miracle, we have very powerful computers in every pocket of every citizen. Where are we going now? MOOM is the answer without a doubt.

Jordi Varela

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