Thursday, November 10, 2011


A friend forwarded a NY Times op-ed piece this morning ( that scared my socks off. Its author, Frank Moss, an entrepreneur and hi-tech whiz, is obviously well-meaning, but he’s poorly informed about what actually occurs in healthcare.

Moss recommends juicing our anemic economy with a massive dose of medical technology, on a scale similar to our 1960s man-on-the-moon project. Here are a couple of his suggestions:
It would begin with a “digital nervous system”: inconspicuous wireless sensors worn on your body and placed in your home would continuously monitor your vital signs and track the daily activities that affect your health, counting the number of steps you take and the quantity and quality of food you eat. Wristbands would measure your levels of arousal, attention and anxiety. Bandages would monitor cuts for infection. Your bathroom mirror would calculate your heart rate, blood pressure and oxygen level.
Then you’d get automated advice. Software that could analyze and visually represent this data would enable you to truly understand the impact of your behavior on your health and suggest changes to help prevent illness — by far the most effective way to cut health care costs…
…You might slip a low-cost plastic attachment over your phone display, look into its eyepiece and conduct a cataract exam. The avatar would transmit the results to your human doctor, who would send you a video message explaining the diagnosis and prescribing treatment…
I tend to wax interminably on the threat of healthcare devolving down to a vending machine. Plans like this one come close. They assume illness to be a biomechanical problem fully amenable to technologic intervention. That might be valid if cure were available, but it usually isn’t. The bulk of visits to doctors—especially seniors’ visits—are for chronic (that is, incurable) conditions. Seniors don’t need relentless stabs at cure, then, as much as they need guidance and support in living with their conditions.
Wholly technologic strategies like this don’t recognize the sad fact that a gross proportion of American illness derives from pathogenic behaviors so tenacious (including smoking, alcohol and drug abuse, sedentary lifestyle, poor stress management, toxic exposure, and dysfunctional relationships) that the advice we docs currently know how to offer amounts to water off a duck’s back.
These strategies fail to comprehend the emotional, subjective experience of suffering because it can’t be measured by even the most clever device, so they certainly can't develop any way to address it.
Worst of all, they encourage the abdication of personal responsibility. “Just leave the quality of your life up to us and our machinery,” they say. “Trust us, we’ll treat your suffering; matter of fact, we’re developing a therapeutic texting app even as we speak.”
In the real world, Frank Moss’ suggestion, fascinating though it is, is only more of what doesn’t work now. He’s correct in predicting that expensive technologic bandaids will keep the wheels of commerce spinning, but they won’t materially affect our health or well-being. To quote Dr. John Knowles, the late president of the Rockefeller Foundation and medical director of Massachusetts General Hospital,

The people have been led to believe that national health insurance, more doctors, and greater use of high-cost hospital-based technologies will improve their health.  Unfortunately, none of them will.  The next major advances in the health of the American people will come from the assumption of individual responsibility for one's own health and a necessary change in the life style of a majority of Americans.

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