“Smart Medicine” to the Rescue?

Humans are inclined to be optimistic; to believe that things will get better, that every problem has a good solution.  We have to fight that tendency with every fiber of our being if we are to approach the world realistically and rationally.  A Wall Street Journal article reflects this undue optimism by preaching the looming benefits of the “smart medicine” revolution.   (WSJ Article)   The article is written by Dr. Eric Topol, who is a well-regarded, and appropriately so, cardiologist from the Scripps Institute.  Unfortunately, like many others, he falls prey to the notion that technology, data, analytics, etc., etc., will radically transform health care, saving hundreds of billions of dollars, while at the same time improving health outcomes.  There is nothing in history or research to suggest that this is the case, in fact, the technology revolution, whether related to processes in the health system, or to actual health services and products, generally increases costs, often dramatically (see specialty drugs), while creating incremental, at best, improvement in health outcomes.

He starts with the myth (it really is) that the US health system is uniquely inefficient and wasteful.  According to this myth, the average US patient is getting all kinds of inappropriate and unnecessary care.  This simply isn’t supported even by cross-nation research.  The US does a pretty good job of utilization control.  Maybe too good at times.  I continue to suspect that if every patient got the idealized version of exactly the best care that ensures optimum health, we would be spending about what we are now.  Undelivered necessary care is roughly equal to unnecessary care that is rendered.  Our problems are largely unit price ones, accompanied by patient demographics–our population is just unhealthier than that of many countries.  We eat poorly, don’t exercise enough and live longer while engaging in these bad habits–they don’t kill us fast enough to prevent a lot of health spending before we finally succumb.

Dr. Topol then focusses on how all these whiz-bang wearables and monitors creating all this great data scrutinized by Watson and other AI programs will just make sure we get “precise and economical care for individual patients.”  What on earth would make you think that would be true?  Last time I checked, these vendors expect to get paid a lot of money for their products and their output generates lots of clinical work, for which people also expect to get reimbursed.  Here is our real health-spending problem, crystalized in two diseases.  One is Alzheimer’s, the incidence of which is growing dramatically.  It is becoming the number one costly disease.  There is no effective treatment.  Want to reduce spending?  Find a cure for Alzheimer’s.  How expensive will that be?  Well, look at the hepatitis C example.  We got a cure, really a tremendous innovation with fantastic outcome improvement.  It was priced pretty much at exactly the savings expected to be generated by a cure as opposed to ongoing treatment, so there are limited net savings.  Want to save money?  Figure out not only how to generate these cures but to price them at a reasonable return, not an excessive one.  Second disease–cancer.  Thanks to better treatment, it is becoming a chronic disease, treated with very expensive drugs and radiation, that extend life but don’t rid the patient of the disease.  Sometimes the outcomes are better but often just incremental.  And the cost keeps going up and up.  Want to reduce spending?  Find real cancer cures, again, priced at a reasonable return.

Forget the technology and data, focus on curing a few expensive diseases and make the cures affordable.  Then we will see real reductions in spending.