By Janet Fang
Posting in Cancer
Many of us assume that more data -- from iPhone apps and telemonitoring, for example -- means better health care. But do all these technologies benefit patients? The evidence is mixed.
Cellphones display your vital signs and take ultrasound images of your heart. Genetic scans of malignant cells match your cancer to the most effective treatment. Virtual house calls and remote monitoring could replace doctor visits and even hospitalizations… medicine is on the verge of an overhaul.
Digital technology might make caring for your health more effective one day soon, but is it beneficial to have that much data? Sharon Begley asks in a Scientific American review.
So, here're some things digital tech might bring us:
- True prevention, like nanosensors that patrol your bloodstream for the first sign of an imminent stroke or heart attack, releasing anticlotting or anti-inflammatory drugs to stop it
- Individualized care, like DNA analyses that match patients to effective drugs
- Cost savings, by giving patients only those drugs that help them
- Reduction in medical errors, because of electronic health records. In fact, e-health is so widely favored that the 2010 US healthcare reform act allocates billions of dollars to electronic health records in the belief that they will improve care.
Much of the enthusiasm for bringing the information revolution to medicine reflects the assumption that more info means better health care. But do all these technologies and their deluge of data lead to better results on a large scale? The evidence is mixed.
1. Take m-health and telemonitoring, in which today's mobile apps and tomorrow's nanosensors would measure blood pressure, respiration, blood glucose, cholesterol, and other physiological indicators.
- In a 2010 study of 480 patients, telemonitoring of hypertension led to larger reductions in blood pressure than standard care.
- And a 2008 study found that using messaging devices and occasional teleconferencing to monitor patients with chronic conditions like diabetes reduced hospital admissions by 19%.
- But a 2010 study of 1,653 patients hospitalized for heart failure concluded that "telemonitoring did not improve outcomes."
- A recent review of studies of mobile apps for smoking cessation found that they helped in the short term, but there's insufficient research to determine the long-term benefits.
2. Perhaps the most promising path to personal medicine is pharmacogenomics, or using genetics to identify patients who will or will not benefit from a drug. Only half the patients receiving a $50,000 hepatitis C drug, and half of those taking rheumatoid arthritis drugs that ring up some $14 billion in annual sales, see their health improve on these medications. By preemptively identifying who's in which half, genomics might keep patients, private insurers, and Medicare from wasting tens of billions of dollars a year.
- Despite some progress, pharmacogenomics "has had limited impact on clinical practice," according to a 2011 study.
- And insurers still doubt the value of most such tests. It's not clear that testing everyone who's about to be prescribed a drug would save money compared with giving it to all those patients and letting the chips fall where they may.
3. Electronic health records (EHRs) seem like a can't-miss advance: corral a patient's history into something easily searchable - rather than leaving it scattered in piles of paper with illegible scribbles - and you'll reduce medical errors, minimize redundant tests, avoid dangerous drug interactions, and ensure that necessary exams are done.
- In a 2007 study, EHRs weren't associated with better care in doctor's offices on 14 of 17 quality indicators.
- These included managing common diseases, providing preventive counseling and screening tests, and avoiding potentially inappropriate prescriptions to elderly patients. (Practices that used EHRs did do better at avoiding unnecessary urinalysis tests.)
Still, the ability to digitize any individual's biology, physiology, and anatomy will undoubtedly reshape medicine, thanks to the "super-convergence of DNA sequencing, mobile smart phones and digital devices, wearable nanosensors, the Internet, [and] cloud computing," says cardiologist Eric Topol, author of the upcoming book The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Only a fool wouldn't root for such changes.
From Scientific American.
Jan 12, 2012