healthxl: "if you live long enough, the future changes"
TRANSCRIPT
“e-Patient Dave” deBronkartTwitter: @ePatientDave
facebook.com/ePatientDaveLinkedIn.com/in/[email protected]
If you live long enough,the future changes
If you live long enough,reality changes
“e-Patient Dave” deBronkartTwitter: @ePatientDave
facebook.com/ePatientDaveLinkedIn.com/in/[email protected]
What if you woke up every day
and the laws of nature had changed?
What would you do?
How would you planfor the future?
Source: @Asymco
1969!
Whole Earth Catalog “Millennium Edition”1994
“Health Online”– in 1996!
Classic Stage IV, Grade 4
Renal Cell Carcinoma
Illustration on the drug company’s
web site
Median Survival:24 weeks
Because of the Web, Patients Can Connect to Information and Each Other
Transformation of Knowledge Access
Slide by @ePatientDave 2015 based on Engelen & Derksen 2010 at
Closed system Open network
Slide by @ePatientDave 2015 based on Engelen & Derksen 2010 at
Transformation of Knowledge Access
Predictably,the empire starts
to strike back.
It can look ludicrous.
Meanwhile,evidence growsthat the current
paradigm is collapsing
Reported June 2015
Reported June 2015
Adoption of new practices years after discoveryThe “17 years” thingFrom A. Balas, Institute of Medicine, in Yearbook of Medical Informatics 2000
Flu vaccine, year 32: 55% doing it, 45% still not
Beta blockers, year 18: 62% doing it, 38% still not
Diabetic foot care, year 7: 20% doing it, 80% still not
Cholesterol, year 16: 65% doing it, 35% still not
Creative Commons Attribution / Share-AlikeMay be distributed with this license included
After 30 years of practicing peer review and 15 years of studying it experimentally, I’m unconvinced of its value.
Evidence on the upside of peer review is sparse, whereas evidence on the downside is abundant.
Most of what appears in peer reviewed journals is scientifically weak.
Richard Smith, 25 year editorof the British Medical Journal, 2009
Richard Smith25 year editor of the BMJ
Marcia AngellFormer NEJM editor-in-chief
Richard HortonCurrent editor-in-chief,The LancetApril 2015
The evolution ofscientific certaintyand thus authority
Let’s meet two real e-patients:
Hugo Campos andDana Lewis
Hugo Campos wants his ICD data
Patient Experience: periodic printouts
Kardia (née “AliveCor”): Smartphone ECG
#OpenAPS & @DanaMLewis(Open Source Artificial Pancreas System)
“Quantified Self” #OpenAPS
Public Health conferenceSan Diego, May 18 (n=1)*59 (n=1)*59
August 13: *103
#OpenAPS users are tweeting
When assets digitize, what’s possible changes fast.
Fundamental Principle:
My college classmate Jay
The futurewhen Jay and I were born
Today:Medicine and population health
are preventing most deaths
34 years from now:a truly unprecedented
population profile
Half of everyone who’s ever been 65 is alive today
Population today: ~7.0 billionEnd of World War II: ~2.3 billion
42
“But culture changeis HAAARRRRD.”
1871: Oliver Wendell Holmes
“Your patient has no more right to all the truth you know than he has to all the medicine in your saddle-bags. He should get only just so much as is good for him.”
Bellevue graduation speech
“A new scientific truth does not triumph by convincing its opponentsand making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”
Max Planck Nobel Prize, 1918
When new things become possible,
best practices change.
Innovators,don’t &@#$ it up
