Books To Get You Thinking

Over the last decade, there have been profound changes in the information technology framework with the advent of Big Data, the Internet of Things, and over 3 billion smartphones connected through broadband and wireless networks. Along with social media portals, internet search engines and massive database systems, this has enabled instantaneous communication and transfer of data, dramatically changing many aspects of life and entire industry segments. Powerful new sensor technology and software applications have enabled the use of cell phones to record and transmit medical data while new imaging methods and devices are leading the way to the digitization of medicine, introducing new ways that patients are diagnosed and treated. The question is whether this intersection of technology and medical science would enable us to overcome the many challenges facing the delivery of healthcare services and the discovery of new treatments and cures. This month we offer a selection of books from the Mercer County Library that address different facets of digital medicine.Included is the impact of efficiencies achieved through the collection and integration of healthcare data at various service delivery points as well as transformational changes in medicine delivered through advances in genomic data analysis that would help realize the promise of personalized medicine.

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter
Robert Wachter, professor of medicine at the University of California, San Francisco, is an eminent physician with a keen interest in technology. This book, based on research that includes interviews with hundreds of top clinicians, nurse practitioners, data scientists and information technology professionals, elucidates the author’s vision of how the adoption of digital technology would impact the health care system of tomorrow. Information lies at the heart of the practice of medicine from making a correct diagnosis and prescribing the right treatment, to presenting an accurate prognosis. It follows logically that an effective information management system would be of critical importancein helping run an efficient health care system. However, computerizing all patient records and running interoperable systems between hospitals and healthcare systems present enormous and unique challenges. The introduction of Electronic Health Records (EHR) has been a big step forward from the earlier days of handwritten charts, yet in its present state it is is riddled with problems that include confusing interfaces and the absence of uniform standards in medical software.  Despite the extensive system of checks built into the system to prevent errors, Wachter cites the disturbing incident of how a teenage boy received an antibiotic dose thirty-eight and a half times the recommended dosage. The system also burdens doctors with the task of inputting excessive amounts of patient information in the computer that takes away valuable time that would be better spent with patients. Ultimately, Wachter is hopeful that the digital technology applications in medicine would evolve, develop and provide refined tools to enable physicians to “return to the fundamental work of medicine: diagnosing, treating, comforting, teaching, and discovering.”

The Patient Will See You Now: the Future of Medicine in Your Hands by Eric Topol
Director and Professor of Innovative Medicine at the Scripps Translational Science Institute, Dr. Topol, a much respected cardiologist, lays out his vision for the future of medicine and the healthcare system.  Big data, along with the proliferation of smartphones and a variety of tools and sensors capable of conducting ECGs, ultrasounds as well as scanning  blood pressure, glucose levels, eye pressure, lung function and blood oxygen concentration, have the potential of completely changing the dynamics of diagnosing and treating patients. It puts individual patients, some of the most underutilized resources in medicine, in a new commanding position where technology tools empower them to collect their own data, run the results through algorithms delivering analysis, and transmit results directly to the doctor. Topol’s vision of the future of medicine is where patients and physicians play a collaborative role in healthcare and medicine becomes a true data science. The near limitless access to medical information, personal devices and computer applications provides unprecedented opportunities to patients to both understand and take an active role in the treatment of their condition. While technological and computational advances, and artificial learning hold immense promise of making the practice of medicine more accessible and efficient and improving both diagnostics and patient outcomes, they cannot hope to replace the role of a health care professional. The knowledge-based judgment and differentiating capabilities that physicians acquire allows them to contextualize the patient’s information, while at the same time providing empathy, inspiration and support for the individual to stay or get healthy. This is something that would indeed be difficult to emulate through cognitive machine learning.

The Language of Life: DNA and the Revolution in Personalized Medicine by Francis Collins
Francis Collins, Director of the National Institute of Health, headed the Human Genome Project in 1993. The international collaboration to sequence the entire 3.1 billion-letter code of human DNA took fifteen years to come to a successful completion and lies at the heart of the emerging Precision Medicine initiative. The initiative also provides valuable insights into 20,000 genes in the human genome which control biological processes at the molecular level.  Each individual has a unique genetic structure that is embedded in their DNA. The mutation of a gene can lead to diseases like cancer, heart failure, liver disease, and diabetes. The advent of massively parallel sequencing technologies and genomic data analysis algorithms have made it possible to capture human genome structures at a dramatically lower cost and measure genetic variations and mutation. This opens up the door for tailoring treatments for the specific genetic abnormality that has been identified. Through mapping out an individual’s unique genome profile, precision medicine is now rooted in the molecular basis of a disease, rather than on mere empirical explanations. This then allows personalized preventive regimens and treatments far more effective in attacking the disease than a general one-size-fits-all treatment regimen. One important finding is cancer immunotherapy where the immune system is stimulated to recognize and kill cancer cells. The coming years will likely see an increase in both predictive genetic tests as well as stem cell and novel gene therapies. Personalized medicine in diagnostics, prevention and therapeutics will dramatically transform the practice of healthcare and medicine’s approach to treating some of the most aggressive diseases that exist today.

—Nita Mathur