Health care’s not-so-brave new world

I was back in high school when I first read “Brave New World,” Aldous Huxley’s cautionary parable of a future society in which everyone is genetically programmed for their station in life, the natural world is something to be held at bay, and people are kept happy and obedient with the help of pharmaceuticals.

The underlying message: Be careful how you engineer the future, because the results might shape humanity in ways we neither intend nor want.

Biotechnology has accomplished amazingly wonderful things. If you had been among the audience at a meeting last week on future opportunities for local angel investors, you would have heard about many of the leading-edge developments in the life sciences: personalized medicine, direct-to-consumer digital health information, nanotechnology and continuing advances in medical imaging, diagnostics, electronic health records and medical devices.

It all sounds so promising, but is it really going to be the brave new health care world it’s cracked up to be?

At the very least, the future might not arrive as quickly as we thought. Take the Human Genome Project, which completed the first sequencing of the human gene 10 years ago this month. Although it revealed a trove of information, it hasn’t exactly resulted in a flood of new drugs, the New York Times reports:

A decade ago, drug companies spent billions of dollars equipping themselves to harness the newly revealed secrets of human biology. Investors bid the stocks of tiny genomic companies to stratospheric heights.

That “genome bubble” has long since popped. And not only has there been no pharmacopeia, but some experts say the Human Genome Project might have at least temporarily bogged down the drug industry with information overload.

As the head of Novartis’s pharmaceutical business lamented in 2000, “Data, data everywhere, and not a drug, I think.”

Indeed, even though research and development spending by major pharmaceutical companies has roughly doubled in the decade since the genome project was largely completed, reaching $46 billion last year, the number of new drugs approved each year has stayed about the same.

As we saw only last week, progress in targeted therapies for cancer has been achingly slow and often filled with setbacks and disappointments.

The story sounds similar on a variety of other fronts. Although the electronic health record is touted as the wave of the future, medical providers have been slow to adopt this technology and it has come at a considerable financial cost. Implementation of useful online tools for patients to store their health information and communicate with physicians has been slow to happen.

At the same time there seems to be increasing specialization and fragmentation of all the gadgetry designed to help people achieve or maintain better health. Maybe I’m behind the times or maybe I’m just a skeptic, but I have a hard time working up a ton of enthusiasm for everything that’s new and kewl, such as these iPhone health-related apps that allow you to measure the temperature of your food or collect performance data while pedaling your bicycle. There could well be a market for this, but how large is it?

Meanwhile, very real concerns have been raised about the cost vs. the benefit of all this brave new biotechnology. Should we be offering cancer treatments that cost thousands of dollars but fail to extend life by more than a couple of months? Has the promise of technology ratcheted up people’s expectations to a level that’s both unrealistic and unsustainable? Is it deepening the divide between health care’s haves and have-nots, and is this a direction in which we want to go?

This is not to say that it’s all doom and gloom. On balance, we’re clearly far better off than we were a decade ago. We can’t afford, though, to overlook the human element and the possibility of unintended consequences.

In this vein, it was intriguing to read this commentary, by a medical apps guru, about the potential pitfalls of a new iPhone app, called iTriage, that allows patients to locate a physician, check out his or her rating on HealthGrades, and obtain information about symptoms, diseases and costs of treatment. Satish Misra ponders whether consumers are truly getting objective information and whether it will help them make better decisions. There’s always the risk of self-diagnosis and delayed treatment, he writes:

In difficult economic times especially, all people (including patients) will try to minimize unnecessary costs. The difference between dodging a physician visit and a shopping trip, though, can be the difference between life and death. The last thing anyone wants is a patient looking up “abdominal pain” on this app, deciding it’s gastritis instead of appendicitis, and becoming septic two days later.

As resources like this become more common, “it will become incredibly important for patients and physicians to have strong, trusting relationships,” Misra writes. “Physicians need to talk to patients about appropriate use of these kinds of resources, risks/benefits, and emphasize regular follow-up care.”

Exactly. Even the best ideas come with a down side that needs to be weighed. New things can often be good, but the mere fact that they’re new doesn’t automatically mean they’re useful or valuable, or that they come with an immediate payoff. The sign at the entrance to the brave new world of health care always reads, “Proceed with caution.”

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