It’s easy for big data enthusiasts to embrace the dream that data analysis will be the cure for everything in healthcare. But the reality is that data, no matter how big or small, is only part of the healthcare revolution story.
New data sources and analytics are a godsend to patient care, to be sure. But it’s all for naught if action isn’t taken at the patient, provider and societal level. Here are the boundaries between the data and the action, the place where reality and dreams collide or compromise—depending on how well we handle things.
The genetic confusion in precision medicine and treatments outside providers’ purview
Dr. Abigail Zuger penned an interesting post in the NY Times wherein she said genes are only one piece of a larger puzzle. She offered, as an example, a patient of hers, Barbara, who is an alcoholic with AIDS—as well as problems with her heart, liver, lungs, and hips.
"Was it the genetic predilection for alcohol that created her lifestyle (pure chaos) and environment (streets, shelters, hotels)? Or did the story start at another point in the cycle, with alcohol selected as a comforting longtime companion, then taking over?" she asks in her post.
She then goes on to wonder aloud how precision medicine is to help patients like Barbara. Any analysis from big data, precision medicine, an ER doctor, or the patient herself is likely to come to the same prescription. "Gotta find a place to live, gotta make new friends, gotta take my meds," summarizes Zuger.
What part of finding a place to live, making new friends and actually affording and acquiring the meds can precision medicine deliver? What part can big data deliver?
It is one thing to identify needs but quite another to fulfill them.
Precision medicine and big data can collectively and independently make the prescription but they cannot fill it.
Nor can providers fill it. Doctors and social workers can tell the patient all day long, every day to move into better housing and take their meds, but healthcare providers can’t provide the housing or pay for the meds.
A dilemma at every income level
And this dilemma applies to more than the poor and downtrodden. Many people in the U.S. at every income level below the top 1% find themselves in untenable circumstances affecting their health.
Take for example, the new Hepatitis C drug, Sovaldi, which cures almost all patients of the disease. Precision medicine and big data analysis will inevitably point to Sovaldi as the best solution for almost all Hepatitis C patients. After all, it is the only known cure for a previously incurable, potentially lethal disease.
But the makers of that drug, Gilead Sciences, attached an $84,000 price tag to the drug. Few can afford that. Even insurance companies can’t afford it.
“U.S. payers [insurers] argued that the drug, which cures nearly all patients of the liver-wasting disease, could cost $200 billion to cover the entire hepatitis C population, an unsustainable sum for society,” reports David Morgan in his Reuters article.
If you want to learn more about that and a host of insurer problems throwing precision medicine off track, see my earlier post.
The upshot is that access and affordability of many treatments is a problem for the vast majority of patients no matter their income level or insurance plan.
For now, suffice it to say that despite the knowledge we pull from precision medicine and big data, many patients’ circumstances and resulting decline in health will worsen or continue uninterrupted. Now what?
Big data and precision medicine must push beyond provider walls
Obviously, society and governments must step up to resolve some of the patients’ issues if anything is to change for the better. In the U.S., fears of socialized medicine are likely to stymie such efforts, even though there are ways to address at least some of the problems without socializing medicine. In areas where socialized medicine exists, patient outcomes can be radically improved and costs reduced by taking a similar tact as outlined below.
In the U.S., the federal government could subsidize some drugs to make them more affordable and accessible as it currently does for vaccines. Another way is to enable public insurers, Medicaid and Medicare, to negotiate to reduce drug prices. Yet another way is to regulate insurer formularies to ensure access to better drugs. Some efforts in these regards are currently being attempted. Others are still largely ignored. You can read more about these situations in my earlier post.
Another way is for members of society to produce drugs via biohacking techniques to ensure far more people have access to them at minimal to no cost. To see how that can be done, watch this video featuring biohacker Cathal Garvey. Pay attention to the end of the video where Garvey specifically talks about producing antibiotics in this way.
Consider that biohacking is done at both the citizen science and professional scale. See my earlier post on storing data in DNA for an example of professionals engaging in biohacking. The point is that biohackers of all stripes can focus on producing medicines at far cheaper costs. As they do so, both the pharma and insurance industries will be disrupted.
Socialized medicine can also benefit from access to cheaper drugs via biohacking, as can populations in remote areas. Biohacking enables drug production on site as needed so that peripheral costs such as refrigeration and transportation are reduced or eliminated, too.
3D printing to the rescue
Biohacking is just one way society can heal itself. Other creative measures can also take root in professional and citizen communities bent on committing societal good.
For example, homes have been printed cheaply and rapidly already. This presents a new means to resolve the housing crisis for the homeless and those living in subpar, unhealthy homes. As an example, a Chinese company 3D-printed 10 homes in a single day for under US$5000 each. Here’s a video on that:
Homes for the disadvantaged among us are but one application of 3D printing for homes. Check out this upscale villa and an apartment building 3D printed by WinSun, the company that printed the homes in the video above.
As new technologies come onboard to make it cheaper and easier to address issues such as housing, transportation, and access to medicines, the health of patients will be easier to address on all levels. When that happens, precision medicine will better hit the mark.
Big data can help identify individuals who need this assistance to improve their health, and help communities determine the best way to provide it.
So, while big data isn’t enough to resolve all health issues on the provider end, when it is applied holistically to all related health challenges it can be used to improve public and private health well beyond the walls of medicine.
Now would be the time to focus on broadening big data’s scope in healthcare to include issues governments and society can and should address. We should begin thinking now of how to converge all these new technologies into a single goal: better health for all.
Join the big thinking and share your thoughts and experiences in the comments below please.
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