How far can interactive digital medicine go?

Health 2.0

Health 2.0 | Special report | The Economist

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THE advances in digital medicine described in this special report have already started to move patients from the margins of the medical system to its centre. Some think there are bigger things to come. “The key is patient-driven research,” explains Gregory Simon, head of Faster Cures, an advocacy group in Washington, DC. Most of the push for adopting electronic health records has come from institutions anxious to cut costs and reduce medical errors, but he thinks the biggest gains will come in the shape of better treatments for difficult diseases. He sees patients increasingly getting together online and sharing medical data and treatment histories. 

On a website called PatientsLikeMe, members from around the world swap stories about their ailments and discuss subjects like adverse drug interactions, dosing strategies, new drugs and trials for more than a dozen diseases. A report by the California HealthCare Foundation, a think-tank, argues that in dealing with multiple sclerosis, a neurological disorder for which there is as yet no cure, “the collective wisdom on this website may rival the body of information that any single medical school or pharmaceutical company has assembled in the field.”

Mr Brown of Ideo argues that until recently the flow of information in medicine has tended to be one way. In future, he thinks, medical knowledge will increasingly flow in many directions. Mr Brown points to a proliferation of health blogs, online groups and peer-to-peer portals as a sign that the age of social networking in medicine has arrived. Google already has a feature that allows users of its EHRs to share their health information with others.

It is easy to be sceptical about such online communities. A fatal illness will not be cured by Twittering about it. And for many people nothing will replace the personal relationship between a patient and his doctor. But it seems clear that patients are going online to get more information on their illness, to see what other consumers think of new medications and to get emotional support from fellow sufferers. 

Even doctors, who may seem to have the most to lose from patient-centred digital medicine, increasingly support the move online. Many of them are themselves keen users of secure medical chat rooms. Thomas Lee of Partners Community Healthcare thinks such social networking helps make up for the “water-cooler chats” of yesteryear that allowed doctors to exchange knowledge across specialisations. 

How far could all this go? Neil Seeman, who runs a health-strategy innovation group at the University of Toronto's Massey College, thinks that “Health 2.0” is important “because it reinvents how we identify opinion leaders and exploit disruptive innovation.” His research has shown that the most active communities on social networks such as MySpace concentrate not on celebrity gossip or sport but on chronic illness—especially stigmatised conditions like depression. 

The most influential health blogs on the web, he finds, are those that offer people with chronic illnesses medically relevant and accurate information. One post from a trusted surgeon blogger, he says, now has a far more immediate impact on improving surgical care globally than a peer-reviewed trial published in a prestigious journal. WebMD and America's Centres for Disease Control (CDC), standard-bearers of the old model of one-way information flow online, are now offering social networking tools like blogs and wikis. CDC even has a presence on Second Life, an online virtual-reality game.

One man who has seen all this before is Steven Case. He founded America Online, a pioneering internet firm, and made a fortune selling it to Time Warner just before the technology-stock bubble burst. A few years ago he became convinced that the next big thing on the internet was health, so he launched Revolution Health, which after recent acquisitions has become the biggest online health firm. The firm's early efforts were slow to develop, he concedes, in part because health care is a conservative business and the financial-reimbursement models in health care are extremely convoluted. 

But Mr Case remains convinced that digital medicine will take off. As people live longer and spend an ever larger proportion of their income on health, he says, “the consumer will demand to know and will want to be empowered.” He likens the current state of digital medicine to the heady days of the late 1970s when Apple ushered in the age of personal computing. 

Doctors are quick to point out that transistors are not the same as transplants. Medicine is more complex than electronics or even the internet. And there are a number of things about established medical practice that are to be cherished and not recklessly cast aside in the name of change. 

That is why it may make more sense to see the move to digital medicine as a reformation rather than a revolution. In an issue of the British Medical Journal which was devoted largely to this topic last month, Joanne Shaw, a prominent figure in the British medical establishment, argues that “traditional paternalistic relationships between patients and doctors are being undermined in much the same way as the religious Reformation of the 16th century empowered the laity and threatened the 1,000-year-old hierarchy of the Catholic church in Europe. The Reformation had irreversible consequences for Western society; the implications of the health-care reformation could also be profound.” Fiona Godlee, the journal's editor, agrees with her that the shift towards patient empowerment is “unstoppable”.

That is why it may make more sense to see the move to digital medicine as a reformation rather than a revolution. In an issue of the British Medical Journal which was devoted largely to this topic last month, Joanne Shaw, a prominent figure in the British medical establishment, argues that “traditional paternalistic relationships between patients and doctors are being undermined in much the same way as the religious Reformation of the 16th century empowered the laity and threatened the 1,000-year-old hierarchy of the Catholic church in Europe. The Reformation had irreversible consequences for Western society; the implications of the health-care reformation could also be profound.” Fiona Godlee, the journal's editor, agrees with her that the shift towards patient empowerment is “unstoppable”.

As bottom-up digital medicine arrives in full force, it will at last provide reformers with the tools they need to tackle the great health-care challenges of this century: dealing with the cost of chronic care for the ageing populations of the rich world and helping the weak health systems in poor countries tackle deadly diseases. 

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Health 2.0

How far can interactive digital medicine go?

From the April 18th 2009 edition