Dr. Tuckson on NPR’s Science Friday

On June 1, 2012, Dr. Tuckson had the pleasure of participating in NPR’s Science Friday for a segment titled “Can Technology Deliver Better Health Care?”. Below is an excerpt from the interview, as well as an audio recording of the full conversation.

 

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You’re listening to Science Friday. I’m Ira Flatow. We’re talking this hour about the future of medicine with my guests, Dr. Eric Topol, author of The Creative Destruction of Medicine; Dr. Reed Tuckson, Executive Vice President, chief of medical affairs for UnitedHealth Group; Dr. Arnold Relman, former editor-in-chief of the New England Journal of Medicine.

Eric, you write about the digitized human being. What is that, and how is that going to give us better health care?

The way we practice medicine today is at the population level. We haven’t had individualized data. We have one-off blood tests or procedures, but we don’t have ways to get granular: knowing one’s genome sequence or having wearable sensors for the particular metric of interest, whether it’s blood pressure or blood glucose, imaging that’s portable, equivalent to what you would get in hospitals. We have new tools to make this big transition from a population-based medicine to an individualized basis. And I think that’s quite exciting potential.

Reed Tuckson, as the head of the UnitedHealth Group, the cost of health care, I’m sure, is important to you. Do you believe this will bring down the cost of health care?

I am very excited by the opportunities for personally relevant information to help people identify what their opportunities are to affect the prevention of disease, and the management of disease once it is manifested, more effectively.
I’m also excited by the capability of these tools to assist physicians in making more science-based and personally appropriate decisions with and on behalf of their patients. The challenge in all of this will be how effectively we can integrate these tools into the prevention system and the clinical care system.
That’s going to require a great deal of thoughtfulness on the part of all players in health care.

Arnold Relman, you became a physician in 1946. It seems like almost a whole different era. What is your view on all of this medical technology? Is it better for the patient?

I’m not sure. I think in some ways it surely is and has been demonstrated to be better. But I think however impressive this new technology is, it’s not going to revolutionize the practice of medicine the way Eric suggests.
I think that medicine is not going to go away, and I think that we will still need the person-to-person contact between well-informed, compassionate doctors and their patients.

The availability of this personally relevant information gives people data and feedback that is specific to them, and then provides them with support services to guide them along a path that they need to undertake in their own best interest.
I think that Dr. Relman is appropriate in his caution for how will this change the dynamic between a patient and their physician, which has always been the essential dyad of how health care has been delivered.
And I think that this will require certainly some changes between how physicians interact with patients. We don’t want to patients making extraordinarily complex decisions without guidance. But it is true that there are decisions that people are making today and often making poorly that compromise their health. It is a good thing for them to have available not only information and data but also empowerment tools and support.

It’s a matter of balance. I don’t see a creative destruction of medicine. Medicine’s not going to be destroyed. Medicine will continue to play an important role, and that’s because no computer, no instrument can really care for patients. That’s what the essence of medicine is. To care for patients, you need an intelligent human being, a well-informed, compassionate physician who is able to operate in a health care system that encourages him or her to act in an appropriate way.

Eric talks about the imbalance of information. In the old days, the doctor had all the information, and the patient had very little. Today the patient will be coming in with more information that is very specific and very relevant to them as an individual. And now the patient-physician relationship is going to be based on one where the patient is seeking the physician’s judgment.
Judgment becomes extremely important here, so now we really are in a partnership. Bring that information into the arena with the physician and engage in a true conversation that is based on best science but is also based on the judgment and wisdom of the physician, as well as based upon the values and needs of the patient. Together they now may be able to reach better outcomes for that individual.

Are you optimistic we’re going to see this all being integrated? Or is it going to be a learning experience as we go along, with hit and miss here and there?

When you can start to predict an asthma attack before a person even has any symptoms, or when you can similarly predict a heart attack days or weeks before it happens, that’s really transformative.
We have 70 million people in the United States with high blood pressure; half of them don’t have very good control. When they can have their blood pressures being shown on their smartphone without any effort, and getting that blood pressure under better control to avoid strokes and heart attacks, that’s where a lot of this data and information could really seed a revolution.

The great thing about innovation is it blossoms and blooms out on its own. You can’t put the genie back in the bottle. At the end of the day, though, let us not be seduced by technology.
Technology is a tool that has to be applied as a part of an overall strategy and an overall effort. Inevitably, people are going to be using these tools. Physicians will have access to patients who have them, and physicians themselves will have it. Now, it is time for us to get creative and thoughtful.