Precision medicine, hope or hype?

Cristina Roure

Fifteen years after the human genome has been deciphered, after 3 billion dollars and after 13 years of intense network research, the cost of sequencing the entire genome has been reduced a thousand times and more than 20 million people already get concrete results. In a few weeks, from a simple saliva sample, these people will receive comprehensive information about their genetic material for less than $100 thanks to companies such as 23andMe or Ancestry. In the United States, through an alliance between Genomind and the Albertsons pharmacy office chain, patients treated with psychoactive drugs can receive advice from their pharmacist so that their doctor prescribes a pharmaceutical-genetic test and perform it in the same pharmacy office. It’s spectacular that a series of emerging diagnostic technologies target healthy people to predict or detect diseases early: immune footprint to predict various types of cancer and infectious diseases, biomarkers for Alzheimer's disease, or exhaled breath tests for early detection of lung cancer.

Primary Health Care Centres management notes

It is not the same to sail with no wind as it is to sail with a swell, it is not the same to manage a health unit in calm weather as in a pandemic. But it is useful to learn from storms because, as the sailor knows, they never come alone. 

Europe's public health systems are huge structures that could be likened to a fleet with hospitals as huge ships and Primary health centres as smaller, more agile ships. In these days of disruption with a shower of protocols from the general command but without a clear vision of what we were up against, each unit did what it could. Some maneuvered quickly, others less so; some did so skillfully, others were overtaken by circumstances.

The epidemic of job disaffection compromises the results

Gallup, in State of the Global Workplace Report, considers that a worker is involved in his work when he is enthusiastic about what he does, feels (psychologically) the owner, and produces and innovates to move the organization forward. According to this definition, the job portrait of today's world published by Gallup is very disappointing: only 15% of employees are motivated, while 67% are unmotivated and worse, 18% are actively unmotivated... In Spain, these figures are even worse, as can be seen in the following chart prepared by Corporate Rebels in "The way we work is broken". In fact, the Spanish results, with half the number of motivated workers than the world average, are the worst in the series of the ten selected countries.

Medicine based on customs

@varelalaf

The universe of my childhood was full of incontestable rules; most of them had to do with the precepts of religion, although the matter affected all aspects of daily life. I remember that you could not bathe in the sea or in the pool if you had eaten or drank within a minimum period of two hours, a period that the strictest families extended to three. When you were a teenager and you protested, the parents told you all kinds of calamities that could happen to you if you failed to comply with the rule, according to a lot of legends that were passed down from generation to generation.

For a more conservative medicine

@varelalaf

Last week I discussed the influence of machine learning on clinical practice, a dynamic loaded with chiaroscuro and, for this reason, I think it is worth echoing today the manifesto "The case for being a medical conservative" written by four doctors: John Mandrola (cardiologist), Adam Cifu (internist), Vinay Prasad (oncologist -haematologist) and Andrew Foy (cardiologist). The authors clarify that their manifesto has nothing to do with politics, but that, given the dazzle of technology and the pressure of consumerism; they are forced to embrace conservatism, a way of saying enough when nobody is willing to do it.

"Machine learning" and clinical practice

@varelalaf

Machine learning is a branch of artificial intelligence based on the idea that systems can learn, identify patterns and make decisions with minimal human intervention, as is the case, for example, with weather forecasting. When I was little, the men of the time (then there were no women in these jobs) drew isobar lines on a blackboard where they had made their predictions based only on their experience and the four sources of data that came to them from the meteorological observatories. Now, as the forecasts are made by the models, meteorologists have enough time to comment on photos sent by viewers, in addition to raising awareness of the effects of pollution and climate change.

Primary Health Care: Working in the Darkness

Working as a family doctor these days is not easy because we're walking blind. First of all we are trying to do as much work as possible over the phone to prevent patients from travelling and coming to a health facility if it can be avoided. On the other hand we do not have reliable data. Every day we receive various protocols, instructions, directives, official emails and so on in what has been a fluctuating data overload in addition to what everyone receives through their personal social networks, Whastapp groups and so on.