The Economist Analysis | 003

Data and medicine

A revolution in health care is coming

Welcome to Doctor You

Feb 1st 2018

NO WONDER they are called “patients”. When people enter thehealth-care systems of rich countries today, they know what they will get: prodding doctors, endless tests, baffling jargon, rising costs and, above all, long waits. Some stoicism will always be needed,because health care is complex anddiligence matters. But frustration is boiling over. This week three of the biggestnames in American business—Amazon, Berkshire Hathawayand JPMorgan Chase—announced a new venture toprovide better, cheaper health care for their employees. A fundamental problem with today’s system isthat patients lack knowledge and control. Access to data can bestow both.

The internet already enables patients to seek online consultations whenand where it suits them. Youcan take over-the-counter tests to analyseyour blood, sequence your genome and check on the bacteria in your gut.Yet radical change demands a shift in emphasis, from providers to patients and from doctorsto data. That shift is happening. Technologies such as the smartphone allow people to monitor their own health. Thepossibilities multiply when youadd the crucial missing ingredients—access toyour own medical records and the ability easily to share information with those you trust. That allows you to reduce inefficiencies in your owntreatment and also to provide data to help trainmedical algorithms. You can enhanceyour own care and everyone else’s, too.

Thedoctor will be you now

Medical data may not seemlike the type of kindling to spark a revolution. But the flowof information is likely to bear fruitin several ways. One is better diagnosis. Someone worried about their heart cannow buy a watch strap containing a medical-grade monitor that will detect arrhythmias. Apps are vying to see if they candiagnose everything from skin cancer and concussion to Parkinson’s disease. Researchis under way to see whether sweat can be analysed for molecularbiomarkers without the need for an invasive blood test. Some think that changesin how quickly a person swipes a phone’s touchscreen might signal the onset of cognitiveproblems.

A second benefit lies in the management of complex diseases. Diabetesapps can change the way patientscope, by monitoring blood-glucose levels and food intake, potentially reducing long-run harmsuch as blindness and gangrene. Akili Interactive, a startup, plans to seek regulatory approval for avideo game designed to stimulate an area of the brain implicated in attention-deficit hyperactivity disorder.

Patients can also improve the efficiency of theircare. Although health records are increasingly electronic, they are often stilltrapped in silos. Many contain data that machines cannotread. This can lead to delaysin treatment, or worse. Many of the 250,000 deaths in America attributable to medical erroreach year can be traced to poorlyco-ordinated care. With data at their fingertips, common standards toenable sharing and a strong incentive to get things right, patients are morelikely to spot errors. On January 24th Apple laid out its plans to askorganisations to let patients use their smartphones to download their ownmedical records. 

A final benefit of putting patients in charge stems from the generation and aggregation of their data. Artificialintelligence (AI) is already being trained by a unit of Alphabet, Google’s parent company, to identifycancerous tissues and retinal damage. As patients’data stream from smartphones and “wearables”, they will teach AIs to do ever more. Future AIs could, forinstance, provide automated medical diagnosis from a description of yoursymptoms, spot behavioural traits thatsuggest you are depressed or identify if you are at special risk of cardiac disease. The aggregation of datawill also make it easier for you to find other people with similar diseases andto see how they responded to varioustreatments.

An Applea day

As with all new technologies, pitfalls accompany the promise. Hucksters will launchapps that do not work. But with regulators demandingoversight of apps that presentrisks to patients, users will harmonly their wallets. Not everyone will want to take active control of their own health care; plenty willwant the professionals to manage everything. Fine. Data can be poredover by those who are interested, while those who are not can opt toshare data automatically with trusted providers.

The benefits of newtechnologies often flow disproportionately to the rich. Those fears aremitigated by the incentives that employers, governments and insurers haveto invest in cost-efficient preventive care for all. Alphabet has recently launched a firm called CityblockHealth, for example, which plans to trawl through patients’ data to provide better care for low-income city dwellers, manyof them covered by Medicaid, an insurance programme for poorer Americans.

Other risks are harder to deal with. Greater transparency may encouragethe hale and hearty not to take out health insurance. They may evenmake it harder for the unwell to find cover. Regulations can slow that process—by requiring insurers to ignore genetic data, for example—but not stop it. Securityis another worry. The more patient data are analysed in the cloud or shared withdifferent firms, the greater the potential threat of hacking or misuse. Almosta quarter of all data breaches inAmerica happen in health care. Health firms should face stringent penalties if they are slapdashabout security, but it is naive toexpect that breaches will never happen.

Willthe benefits of making datamore widely available outweigh suchrisks? The signs are thatthey will.Plenty of countries are now opening uptheir medical records, but few have gone as far as Sweden. It aims to give all its citizenselectronic access to their medical records by 2020; over a third ofSwedes have already set up accounts. Studies show that patients with suchaccess have a better understanding of their illnesses, and that their treatmentis more successful. Trials in America and Canada have produced not just happierpatients but lower costs, as clinicians fielded fewer inquiries. That should beno surprise. No one has a greater interest in your health than you do. Trust inDoctor You.

prodding doctors, endless tests, baffling jargon, rising costs and, above all, long waits. 

frustration is boiling over

bear fruit 

As with all new technologies, pitfalls accompany the promiseidentify cancerous tissues and retinal damage

spot behavioural traits that 

at special risk ofcardiac disease

responded to various treatments

demanding oversight of apps

present risks to patients

harm only their wallets

take active control 

WORDS:                                                            

Access to data can bestow both.

The internet already enables patients

Yet radical change demands a shift in emphasis

Technologies such as the smartphone allow people

The possibilities multiply

they can diagnose everything 

signal the onset of cognitive problems

change the way patients cope

stimulate an area of the brain implicated in 

spot errors

As patients’ data stream from over by those who are interested, while those who are not can opt disproportionately to the rich. Those fears are mitigated

SENTENCES:                                                                   

Other risks are harder to deal with. 

Securityis another worry. 

Will the benefits of making data more widely available outweigh such risks? The signs are that they will.

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