On this blog and elsewhere there is much speculation about the “future of medicine”. At the TED 2011 Conference, a session on that topic emphasized technology: its eight segments were on printing a human kidney, a test for Parkinson’s with a phone call, color-coded surgery, a virtual dissection table, a tool that finds three times as many breast cancers, a warm embrace that saves lives, ultrasound surgery, and cell phone apps. The videos are truly awesome, and the importance of medical technology cannot be denied. But is medicine about things or about people?
Likewise, the Wall Street Journal reports that the future of medicine is innovation. Its six examples are growing a heart, DNA sequencing for routine treatments, matching a tumor to a drug, letting the body fight cancer, smartphone apps, and gene therapy. The stories are impressive and who could be against innovation? But is innovation only for technologists and investors?
A report on WGBH radio on “The Future of Medicine” gave three instances: awakening dormant heart cells, “looking at the whole person” to evaluate treatments and drugs, and “entrepreneurs trying to bring game-changing innovation to doctors’ offices and hospital rooms”. It is interesting material and one can surmise that the commercial interests involved in each case are inevitable. But is medicine going to be driven by business?
In a previous post, I noted an article in Inc. magazine on this topic. Each of its seven “big ideas” was linked to technology, with smartphones often involved, and being developed by entrepreneurs.
But none of the “big ideas” touted by that gospel of entrepreneurialism really seems really worthy of that description. They are actually small ideas, based primarily on incremental innovation and what might make money. A really big idea would be “No one will die of cancer”. Or “no one will get cancer”. Or “everyone will be in good health” or “everyone will get basic healthcare when they need it”.
Truly big ideas like that, however, can’t be translated into pitches for venture capitalists. The profit motive may be fine for many things, but for big ideas in healthcare it is not the right source of inspiration.
As Beth noted in her post on “A New Vision of Healthcare,” the idea that competition is the key to improving healthcare is very questionable. Whether the need is health, housing, or education, solutions are not to be found simply by enabling people to make money on the process.
In that connection, the November/December 12 issue of Technology Review, which has the theme of “big solutions”, is very relevant. On the cover is Buzz Aldrin with the caption “You Promised Me Mars Colonies. Instead, I Got Facebook”. The feature article is by editor Jason Pontin on “Why We Can’t Solve Big Problems”.
He cites the Apollo Program the realization of a big idea, noting that it could not happen today (though NASA is considering humans on Mars around 2030) because of changed attitudes toward government. Pontin agrees that “venture-backed entrepreneurialism is essential to the development and commercialization of technological innovations. But it is not sufficient by itself to solve big problems, nor could its relative sickliness by itself undo our capacity for collective action through technology.”
As an example of a big idea, Pontin gives a medical one: eradication of malaria. “The most efficient solutions to the problem of malaria turn out to be simple: eliminating standing water, draining swamps, providing mosquito nets, and, most of all, increasing prosperity.” But simple ideas are hard to execute; there are numerous social, economic and political factors involved in those objectives.
By contrast, he notes, Bill Gates has announced an anti-malaria campaign that is technology driven, with “recombinant vaccines, genetically modified mosquitoes, and even mosquito-zapping lasers” all part of the solution. “Such ideas can be ingenious, but they all suffer from the vanity of trying to impose a technological solution on what is a problem of poverty.”
Another problem with big ideas (and a kind of update/corrective notice to my earlier post): Many ideas are wrong or don’t work out. Despite the promise held out in the Inc. article regarding on-line and smartphone medical technological, it is not clear that these methods are better than visiting a medical office. For example, a recent study of four phone apps for testing for melanoma found that “on average three of them incorrectly classified 30 percent or more melanomas”. Relying on these methods therefore “can postpone diagnosis and cause harm”.
That technology enriches our lives is unquestionable. Yet its increasing effect on healthcare also raises questions. If medical advances are based on whether they make money, will we lose as much as we gain? And what happens if medicine becomes just a commodity?