It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.
Here are four trends that are changing health care but on the surface are too unsexy for us to care about.
Trend 1: The doctor-patient trust is at an all-time low
The relationship between doctors and patients has transformed from the one where the doctor intimately grasped our history by treating everyone in the family to a transaction-based activity.
Patients have changed from care receivers needing sympathetic treatment to care buyers with high demands. Most would rather have doctors unclog their arteries with a pill than listen to advice on lifestyle changes.
Doctors on their part are stuck between two ends.
On one hand, doctors inherit a Hippocratic oath that calls for warmth, sympathy and preferring prevention of disease over cure. On the other hand, they are pressured by new needs of ROI in the medical business, which calls for monetization of expensive resources (often required to meet new demands from patients).
The end result is a system that’s low on trust. Hundred years ago all that patients were often given were placebos (and sometimes morphine) and it worked because they trusted the doctor giving them. Today, the situation is quite different with an altered patient-doctor equation. The high cost of low trust results in a very expensive model, which is what we have brought about in every health care system world over.
Trend 2: More testing is leading to disease management not resolution
Amidst a background of low trust, both doctors and patients have increased their reliance on testing from pathology to imaging to radiology. At an earlier time, doctors relied more on an intuitive sense based on examining presenting symptoms and conducting thorough physical exams. However, such an approach today could invite lawsuits from patients when a gut-call without data goes wrong.
Therefore, we not only have greater number of tests for every disease condition but also an overall increase in the total number of lab tests performed. In the U.S. alone, we perform close to 20 million tests per day. While the premise of lab tests is prevention of disease, the reality is an associated over-treatment that results in ongoing disease discovery and management.
This trend of becoming lifelong patients is likely to continue as we find more ways to capture data from the body.
Trend 3: New findings are putting past guidelines into question
After recent findings, the US Preventative Task Force, considered a gold standard for screening, recommends that women go through annual screening for breast cancer after age 50 instead of an earlier guideline of age 40. This puts into question the decision by millions of patients who went through annual mammograms based on earlier recommendations.
Not just for breast cancer but guidelines for high blood pressure have also changed. In 2014, JNC 8 guidelines recommended drug intervention if blood pressure is 140/90 mm Hg or higher (not 120/80 mm Hg as was widely regarded). Then in 2017, American Heart Association, the American College of Cardiology, and other health organizations lowered the threshold to 130/80.
New cholesterol guidelines call for prescribing statin drugs based on a specific risk-factor calculator and not on LDL cholesterol numbers. Guidelines for hormone replacement therapy for women who reached menopause, pap smear tests for cervical cancer, and prostate cancer screening for men have also changed. Adding to the confusion, not all doctors or medical societies agree with these changes.
As a former hypertensive patient, I feel obtuse for having popped a pill for two decades. Doctors on their part must feel disoriented too — having implemented earlier guidelines so surely and now having to implement new guidelines not so surely. It’s another shift that alters the doctor-patient relationship.
Trend 4: Our environment is changing the rate at which we get disease
The more modern our environment, the greater seems to be our long-term disease-risk. From refined oil to sugar that pours, we’ve managed to create food that looks great on the outside but has in turn messed with our insides.
We’ve managed to make our cows give more milk, sometimes without calves. We can create plump chickens in just a few weeks, albeit without normal bone-structures. We’ve created disease-monsters on our dining table by consuming fat-rich, fiber-less, salty diets, often precipitated by fast food.
What we believed to be advances hitherto seem to have now altered the natural course of our bodies.
From 2001 to 2009, Type 1 and Type 2 diabetes significantly increased among children and teenagers. Puberty age has steadily dropped. A study conducted between 1989 and 2005 indicated a one-third drop in average sperm count. Among the 56 million people who died worldwide in 2012, the World Health Organization says that 68% died because of non-communicable diseases (NCDs pertain to heart disease, cancers, diabetes, and chronic lung diseases) — an increase of 8% from year 2000. Rich countries fare worse: 87% of people die because of NCDs.
We can always argue whether we have enough conclusive data to link these changes to our environment but it’s not difficult to observe that there’s a shift at play around us.
Changing the questions we ask
As unexciting as they may seem, these trends are disrupting our industry for good. We can choose to ignore them and reserve our enthusiasm for the next medical toy. Or we can accept the obvious reality that something’s a little off here and play more evolved roles as patients, doctors, clinicians, technologists and business people by changing the questions we want answers for.
In an emerging world of self-driving cars that may routinely monitor our health, we seem to have the resources to find answers to any question we choose to ask. All we have to do then is ask different questions.
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