This book is a futuristic vision of a ‘medicine turned upside down’, with patients playing the central role in their healthcare. This will overturn what the author sees as the deficient and paternalistic culture of medicine we have inherited from Hippocrates. This culture is characterised by a knowledge gap between physicians, who exert an authoritative control over medical information, and their patients. The author argues that this asymmetric control of knowledge disadvantages patients and undermines their safety. This tyranny of experts, as he sees it, promotes unnecessary, harmful, and wasteful medical practices such as annual physical examinations, cancer screening, robotic surgery, and proton beam irradiation (pages 141-147). Allied to this is the harm posed to patients by the current structure of hospitals, a threat which the author says ‘cannot be dismissed or substantively diminished’ (page 193). The author anticipates that the patient of the future, enlightened and engaged, will stand on an equal footing with their doctors (page 13).
The book predicts a medical future in which the power of physicians, akin to that of religious leaders and nobility, will whittle away. He also predicts that ‘hospitals, as we know them today, will eventually be extinct‘ (page 186). He demo how this transition, already underway, is inspired by the increasing access of patients to information, and driven by the proliferation of knowledge apps and big data (pages 35, 40-41). The vehicle the author credits with attaining his vision of a patient-led healthcare is the smartphone, the device he calls the hub of medicine, and ‘the substrate for a new medical communications revolution‘ (page 53). He says it will ‘democratise’ medicine, and do for healthcare what the Gutenberg press did for education (pages 14, 38-40).
The author relates several examples of patients who are already redefining the practice of medicine. Kim Goodsell for example, discovered that the two rare diseases she has, arrhythmogenic right ventricular dysplasia (ARVD) and Charcot Marie Tooth disease (CMT), are not coincidental as her doctors told her (pages 15-17). Another example the author cited is Katherine Leon who has the rare condition spontaneous coronary artery dissection (SCAD) and, finding very little research has been done on it, established a virtual SCAD patient registry (page 211-212). The author also referred to Angelina Jolie‘s decision to have double mastectomy to counter her genetic risk of breast and ovarian cancer. He says this decision is a tipping point, and ‘a landmark story about self-determination in medicine‘ (pages 55-62).
The book explored a breathtaking array of technologies which will empower patients to take their healthcare literally in their hands. The visionary technologies will include lab-on-a-chip and lab-in-the-body (pages 109-112), pocket scanners (page 118), microchip-embedded drugs (page 133), implanted biosensors (page 95, 109-112), virtual health assistants (page 165), virtual consultations (page 166-167), and massive open online medicine or MOOM (page 198). The access to big data will also change medicine into a data science, characterised by ‘unsupervised algorithms, machine learning, augmented reality, and neuromorphic computing‘ (page 238).
The author predicts that these technologies will enable patients to edit and sign their medical records (page 128), and have direct access to their full laboratory results (page 107). The future patient will be able to carry out physical examinations, perform laboratory tests, take and interpret medical images, and even carry out predictive analytics (page 51). He expects that these technologies will influence all medical specialties, from pharmacogenetics to molecular autopsy, saying ‘there’s hardly a chronic condition that isn’t amenable to sensor, lab, and smartphone’ (page 278). He urges doctors to understand the changes already underway and start by adopting the technologies already available today. He encourages doctors, for example, to use email communication with patients, and engage in online social health networks (page 178).
The author, a cardiologist and prominent medical technology advocate, paints an almost dystopian future of medicine. He covers an extensive scope of issues, and supports this with important references. The book highlights the changes smartphone and information technology portend for the patient-doctor relationship, and it paints a predominantly technology-driven healthcare. This may threaten the empathy and humanity that lie at the root of medical care, and it is not clear if people want to, and are able to, take on the responsibility of all aspects of their healthcare. The author’s vision is however compelling and the book makes for essential reading.
This book addresses the future of medicine, looking at how technology will put patients more in charge of their healthcare. The author adequately explores this very important subject which will impact on healthcare. The prospects are promising in some respects, and frightening in others. There will be challenges for patients and doctors, not least the prospect of sifting out good from bad information, and the danger of misapplying the emerging technologies. The topic is one which healthcare will have to address, and I recommend the book to all doctors.
- Publisher, Place, Date: Basic Books, New York, 2015
- Number of Chapters: 15
- Number of Pages: 364
- Price: £19.99
- Star Rating: 4 stars
- Other related book: Creative Destruction of Medicine