Do you have a blender? Of course you do. Almost everyone does.
Now take a few ingredients:
1.
Patient centered.
2.
Shared Responsibility
3.
Patient determined diagnostic tests
4.
Google
5.
Expert opinions
6.
Population Medicine
7.
Genetics
8.
Epigenetics
9.
Medical Apps
10.
Digital Electronic Medical (Health) Records
Put them in the blender and press the switch. And what do
you get?
CHAOS!
Remember Mark Cuban’s self-monitoring regimen of serialdiagnostics? Now add to that the new Arizona law that allows patient to seek diagnostic tests on demand, sponsored and perhaps
lobbied, I believe by at least one private company Theranos, now defunct because of fraud, hubris and conceit. and then for good measure throw in the $1000 genome sequencer (available soon
from MinION) and what will you have? I am all for low costs and freedom to
violate the vein where truth flows, but shouldn't we also have the wherewithal to
understand the information that elixir of life holds and its true meaning?
Otherwise we have, health-ism on steroids! Think Road Rage
was a 2014 issue, think again. Wearables, forget them our sodium and potassium
levels will be on TV just like the lady that walks smiling at everyone and
finally levels with her co-conspirators in the ad that her cholesterol dropped
by a few % points because of the pill. And what does that mean exactly for her
health anyway? Now we find out…little. But that ad sold the pill to the tune of
many billions of dollars and may reach $1 Trillion by 2020 .
Information is great if one can interpret it. Information is
good if it can be assimilated and the individual can draw an understanding from
it. (And there is no political correctness here about how smart the average
person is) Even an above intelligent person, (reference to the average
intelligent person cannot be found anywhere) with a science background but
without the medical reasoning will be lost in the cold waters of the Atlantic
Ocean just like Mr. DeCaprio in the Titanic or the warm waters in a pool in Hollywood, your call.
You see, and this is not a
paternalistic statement, when fear envelops a person, reason is thrown to the wind.
Everything becomes dark as fear and caution arrive at the doorstep. So yes Mark
Cuban is a very smart business man and he has tens of interpreters of maladies
available to him that assign risks as related to his medical tests. Do we all
have that capacity? Yes you say, I have Google! Sure you do as does the rest of
the world. But is the information in Google easily assimilated? For instance
can you easily figure out what the following paragraph means? And then we circle back to is Mark Cuban correct in his interpretation?
Or for that matter, here in this article is the inverse of
the loop-hole of expression, and benefits are told through the worm-hole of inhibition…
Interpretation is filtered through the lens of one’s experience. Reasoning is based on critical evaluation that is derived from years of knowledge gathering and experience, sifting through what was evidence to what is evidence now and only through squeezing the fruits of your labor through the ethereal filter of the cognitive cloth, the nectar of reason appears. I doubt that Google searches can deliver that. Sergey might disagree.
So yes, the world is agog with patient centricity but rational decisions can be irrational in times of stress. Take for example the rate of the C-Difficile infection rate differencesbetween the Northeast,
where everyone seems to know everything, the C-Diff rate is 8/1000 hospital patients. In the South the rate is 5/1000 hospitalized patients. Here the prodigious use of antibiotics is the culprit- a problem both at the consumer demand level and the physician care-delivery level. Judicious use of therapy is equally as important as the reasoned use of diagnostics.
Speaking of Genetics, now there is where real information will flow; and lots of it. But will anyone be able to accurately decipher it. Probably not well. Even geneticists have problems merging the science of DNA (easy) with miRNA (not so easy) and that to translatable proteonomics (even more difficult). Our thinking that one gene defect equates to one disease is unfortunately archaic. Now we have come to realize that even mutations within the BRCA 1 gene segment have varying consequences on health.
So yes, the world is agog with patient centricity but rational decisions can be irrational in times of stress. Take for example the rate of the C-Difficile infection rate differencesbetween the Northeast,
where everyone seems to know everything, the C-Diff rate is 8/1000 hospital patients. In the South the rate is 5/1000 hospitalized patients. Here the prodigious use of antibiotics is the culprit- a problem both at the consumer demand level and the physician care-delivery level. Judicious use of therapy is equally as important as the reasoned use of diagnostics.
Speaking of Genetics, now there is where real information will flow; and lots of it. But will anyone be able to accurately decipher it. Probably not well. Even geneticists have problems merging the science of DNA (easy) with miRNA (not so easy) and that to translatable proteonomics (even more difficult). Our thinking that one gene defect equates to one disease is unfortunately archaic. Now we have come to realize that even mutations within the BRCA 1 gene segment have varying consequences on health.
From there we have come to the “BRCAness of breast cancer disease process.” Things do go bump during a lifetime with the jumping genes or transposons as Barbara McClintock called them; mating, fusing, halving at will, to always create the “fittest” model of human being.“The progeny of two (such) sister cells are not alike with respect to the types of gene alteration that will occur. Differential mitoses also produce the alterations that allow particular genes to be reactive. Other genes, although present, may remain inactive. This inactivity or suppression is considered to occur because the genes are ‘covered' by other non-genic chromatin materials. Gene activity may be possible only when a physical change in this covering material allows the reactive components of the gene to be ‘exposed' and thus capable of functioning." -- Barbara McClintock”
BRCA 1 & 2 Gene Segments
Such inner experiments by the DNA are not uncommon. So it is better to realize the shades of meanings before we start touting the virtues of genomic diagnostics. We could end up ruining lives and for their “forever,” live in a state of fear of a hazard that never materializes, like a benign nodule in the lung on X-Ray. Yet the fear throws them into the caves of depression and enforces consumption of fifteen different pharmaceutical agents via televised broadcasts of longevity and that, my dear friends in some cases becomes the norm.
Just before we go drinking that “milkshake of nirvana health” from the blender, let us consider the consequences of such a drink. Shall we?
Above all do no HARM!
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