Friday, December 6, 2013


What did meaningful use mean? Wrestling with this concept as an inducement to get paid for a spent cause is hardly the realm of a wonderful idea. And then to wrap it up in the cloak of universal utilitarianism of benefits is another blow to the human intelligence, as if there was any left in this drone milked society of ours today.

They haven’t yet proved it, that the use of EMRs has any beneficial effect on a patient’s health. But what they have proven without prejudice or bias that the imposition of this multi-billion dollar enterprise borne of an inquisitive mind to gather a fully populated big database of who does what to whom at what cost, was a boon to technology, to the middle-service-providing-people through pocket-lined contracts and a bane to the patient and the doctors, for whom it was the next coming since “pet rock.”.

Why the harsh sentiments? Why indeed?

If all you see in the pupil of your physician’s eye is the pixilated glare and flicker when you ask a question, a need has been met. But whose need, you might ask?

Yet salvaging from this experiment the emerging theme of observational science become evident too. EMRs have filled some classic gaps in the field of “this therefore that” philosophical construct through data mining. But then one would ask, is that not a good thing? Surely that question sends pings of synaptic pleasures through every epidemiologist’s veins in the form of an endorphin glow. But does a win for the individual, the patient that sits patiently on the opposing side of the flickering screen?
Thus far and this from variously sponsored studies from the pros and cons tilting windmill landscapes of contingent data, the answer remains elusive, for the propagandists  to outright, no for the pragmatists!

But lest we forget that there is a larger purpose in the linkage between the patient’s personal data and the unified correlates of big data, and the minions that spend countless hours mining it, one heap of digits at a time, we might miss that hot breath of the fire breathing dragon. And Lo, just as we question, here comes a fleeting wave of “Eureka” heralding the new dawn of discovery. Ah we have arrived at the threshold of a new paradigm. The net to bag the big fish has been cast. The rewards is well nigh at hand. “This might be a paradigm that will change the very essence of humanity,” they claim. We will know what drives what. We will know what genes are the presentiments of a given somatic discontinuity. We will know! We will know! We know! We know!

This new door into the cross-linked informational landscape between phenotype and genotype is the brainchild of big institutions, by cross-referencing a “Phenotype-wide Assay” with the “Genotype-wide Assays” and finding the needles that rule the haystack of diseases, we will, they claim harness the power. Well that is good you would think, right? And in many ways it might be. We might for instance know the multi-tasking genes that commit adultery in the soma and create a conundrum of metabolic disorders, of cancers, of heartaches and depressed human thoughts and even what makes us laugh at a bad joke or cry at a good one. All laudable concepts, all worth the congratulatory accolades! But, and this might be a mini-but, what about the gene drivers and the soma (Lamarckian) drivers within the individual. The interacting forces of these two cross-referenced Morlocks and Eloia might have differing opinions to that viewpoint. No? Might we not be surging in our minds towards a paradigm flawed in reality but gorgeous in concept?

Let us presuppose that a typical phenotype is associated with a specific genotype, that would be great, now modify the genotype and the scourge visited upon the phenotype would vanish. Voila! QED. But not so fast, lest we forget that there are incoming volleys that serve different masters within the cell and thus are automated upon invariant schedules and rise up to demands from different sources, via a supply chain of differing mechanistic pathways and cross-talks, the only rational thought we might be able o entertain is yeah, there is a “probability” that this might be associated with that, since it seems to occur in 60 or 70 or 80% of the populace.

Oh but there goes that probability thing again. This probability thing that garners almost a 100% of medical literature comes face to face with the “Ioannidis’ nightmare,” which shows more than 50% of the studies cannot be replicated due to the false gods of bias.  After all the trust lies at the feet of the curator of that big data... But I digress. Oh hey, why not! Educating the mind is a reasonable rational rewarding thing to do. Sometime as someone clever said, I would rather be an octopus and slap eight people at the same time to jog their thinking in one fell swoop, rather than a shark going after chum.

So have we resolved this matter? For now, maybe not but we might have started thinking about unintentional pathways and byways and alleyways that might pose a burden to those that do not represent the rich majority of specified shared genotype-to-phenotype-magical-shoots-and-ladders-type-approach. Just so you feel inclined to shoot the messenger here, read this one about changing landscape of the statins.

Come on give in a little and explore this concept…

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