Monday, November 19, 2012

Medicine by the numbers

This is the age of data. Everyone is hopeful that based on number crunching and data analytics, we will be able to improve the quality of health we provide to patients. Thus , Mr Khosla believes that Big Data ( will allow us to create algorithms to treat patients, making the doctor a commodity; and sites like 23 and me (
are promising to take personalized digital medicine to the next level by providing genomic data to individuals . The hope is that people can use the information in their DNA to not only be able to predict which diseases they are at risk of; but also to be able to receive personalized therapeutics. Personalised genomics and personalized proteomics have been promoted as having the potential to revolutionise medicine.

On an intuitive level, this makes a lot of sense. After all , isn’t every patient different ? Doesn’t it make sense to customize treatment for each individual ? Won’t having more data make it easier for the doctor to be able to find the right personalized treatment for you ?

I think there are 2 things wrong with this approach.

 One is that a lot of the data is just noise , and we are not very good at extracting the signal from all this noise , because so much of it is just random . This means we will end up overtreating and mistreating a large number of patients . Medicine has accumulated a lot of knowledge , based on empirical evidence painstakingly collected by wise doctors over many years of experience , and it’s still not possible to convert all this digital data into clinically meaningful interventions .

Even worse is the possibility that this data may just drive a further wedge between the doctor and the patient . Even today, most patients are extremely unhappy about the fact that doctors are more interested in treating their lab test results or looking at their CT scans, rather listening to them; or their heart or lungs.  The new tsunami of digital data may end up overwhelming the doctor’s neuronal circuits , so that he may have no time to talk to the patient at all – or , even worse , may not even feel the need to do so, because he believes he has all the data he needs to make the right diagnosis and provide the right treatment !.

This kind of depersonalization of the doctor-patient relationship bodes ill for the future. When you are
sick , you don't just want treatment - you need someone who will hold your hand ; provide you with a shoulder to cry on ; and treat you with tender loving care and compassion.  The danger is that too much data and digital analysis will end up depersonalizing medicine,  rather than personalizing it !

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