October 31st, 2011 by Bryan Vartabedian, M.D. in News, Opinion
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If you want a glimpse at a company putting precision medicine into practice look no further than Prometheus Labs. They make diagnostic products for personalized care in digestive disease and oncology. I use their products to diagnose and target therapy in children with inflammatory bowel diseases (crohn’s disease and ulcerative colitis).
IBD offers a nice place to see the evolution of precision diagnostics:
Early biomarker testing. Initially we had ASCA and pANCA antibodies to discern crohn’s and ulcerative colitis.
Advanced biomarker testing. Read more »
*This blog post was originally published at 33 Charts*
September 9th, 2011 by Bryan Vartabedian, M.D. in Opinion
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In The Innovator’s Prescription Clayton Christensen details how technology is disrupting health care. He describes the provision of medical care as occurring on a spectrum ranging from intuitive medicine to precision medicine. Intuitive medicine is care for conditions loosely diagnosed by symptoms and treated with therapies of unclear efficacy. Precision medicine is the delivery of care for diseases that can be precisely diagnosed and with predictable, evidence-based treatments. Intuitive medicine is almost entirely dependent upon clinical judgment. Precision medicine not as much. 19th century medicine was intuitive; the 21st century will prove precise.
When we think about our role as doctors, we like to see ourselves as providers of intuitive medicine. It’s how we were all trained – products of 20th century mentoring. And so we see of ourselves just as indispensable as we were 100 years ago. But as medicine makes its march toward predictive care all of this will change.
There’s an endemic insecurity among the 21st century doctors: Read more »
*This blog post was originally published at 33 Charts*
June 20th, 2011 by Davis Liu, M.D. in Opinion
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Doctors are professionals. But are doctors cowboys or pit crews? Recently, physician writer, Dr. Atul Gawande, spoke about the challenges for the next generation of doctors in his commencement speech titled, Cowboys and Pit Crews, at Harvard Medical School. Gawande notes that advancement of knowledge in American medicine has resulted in an amazing ability to provide care that was impossible a century ago. Yet, something else also occurred in the process.
“[Medicine’s complexity] has exceeded our individual capabilities as doctors…
The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.”
Despite all of the advancements in medicine, the outcomes and consistency in treatment and care are not as good as they could be. Doctors are not doing basic things. The fact that Gawande, author of The Checklist Manifesto, spoke at one of the finest medical schools in the country indicates how much more the profession needs to go.
“We don’t have to look far for evidence. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
