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Book Review: “Bad Blood”

June 6, 2018 Book Review 13 Comments

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I’ll save you the $13.99 Kindle price right now. Theranos was a fraud in every possible way. Elizabeth Holmes was its paranoid, money-fixated mastermind who was enabled by media that were enchanted with the crowd-pleasing and unfortunately rare story of a young, female Silicon Valley founder. Holmes didn’t care a bit that patients were endangered by the company’s entirely inaccurate blood testing system. She was a paper multi-billionaire until a series of exposes in the Wall Street Journal took the company down and put her on “healthcare’s most reviled” leaderboard ahead of Martin Shkreli. Thanks for coming out, I’m here all week, try the veal.

Or, maybe the $13.99 is worth it just to see how the company used its heavyweight legal team and connections to keep the scam alive. Or for the guilty pleasure of reading how Holmes sweated as the noose tightened, eventually going all Hitler in the bunker as she realized that at 34, she would never be trusted or taken seriously again.

You’ll like John Carreyrou’s book if you’re a fan of “All the President’s Men” or “Spotlight” and would enjoy the dramatic (and overly dramatic at times) account of how the reporter bagged the story of a lifetime and then got to double-dip his WSJ salary by repurposing his work into a bestseller. He’s probably worth a lot more than Holmes at this point.

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Everything about the company was an elaborate hoax and so was Holmes, coached to ditch her thick glasses, speak in a creepily low register, wear black turtlenecks, and make lofty pronouncements about changing the world. She was like a lipsticked Steve Jobs except her fake voice was deeper, she was even better at milking the reality distortion field except to commit fraud instead of inspire achievement, and instead of kicking a dent in the universe, she was sent kicking and screaming into shame and ridicule (with a vacation behind bars a distinct future possibility).

Like Jobs, she was petulantly demanding, leaving a trail of fired employees and board members who dared question whether the empress was indeed wearing any clothes other than that ever-present turtleneck. Her 20-member armed security detail marched out employees who questioned the company’s patient-endangering technology that never worked. She oversaw her empire from an office she had designed as a replica of the White House’s Oval Office, which is about as weird as you can get.

The book opens with the company’s CFO playing his dutiful Silicon Valley role in inflating his already-inflated financial projection at Holmes’ insistence that she needed one of those hockey-stick growth charts like everybody else in Silicon Valley trots out while trying to keep a straight face. The CFO wasn’t too inquisitive about why Holmes refused to show him the drug company contracts on which his fantasy financials were based. His downfall came when he questioned Holmes about a demonstration of her blood testing machine that he knew didn’t actually work, charging Holmes (accurately) with simply faking the whole thing. She fired the CFO on the spot and the board didn’t press her for a reason (hello, clueless board). He was the company’s first and only CFO – despite heavy investment and a $9 billion paper company value, Theranos never had one again (hello, clueless investors).

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Holmes dropped out of Stanford’s chemical engineering program after two semesters and wrote a patent application for an arm patch that would both diagnose and treat medical conditions. Her only fear in life was needles, which she vowed to eliminate for blood draws in favor of a finger stick, which sounds great to a 22-year-old college dropout who didn’t know or didn’t care that entire companies are filled with experts who have tried and failed to make that idea work. The sample size is too small, the dilution is too error-fraught, the repeated microfluidic flow through the testing machine is too complicated, and the skin material that is sucked up along with the blood always throws the results off.

Asked to describe how its product works, Holmes provided The New Yorker with a “comically vague” explanation:

A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.

Despite having no product, the business plan Holmes cooked up was brilliant. She envisioned drug companies paying her fortunes to perform home blood testing of clinical trials subjects, claiming that real-time reporting could save them 30 percent of their research costs and alert them to stop the therapy if patients experienced problems. Holmes was healthcare illiterate, but at least she knew that in search of health riches, you go where the money is (drug companies).

Holmes whipped employees into working crazy hours, spied on their email and telephone calls, hired private investigators to follow them, and didn’t allow company groups to interact with each other for fear of compromising her intellectual property. Her second-in-command was Sunny Balwani, her secret lover who was 18 years older than she. She marginalized the company’s board as “just a placeholder” that she charmed into giving her 99.7 percent of the voting rights, rendering the aged former heads of state and billionaires irrelevant as they joined the company’s investors in breaching their fiduciary duty. They treated her like a darling granddaughter who could do no wrong, smacking their lips approvingly at the inedible Easy-Bake Oven cake she proudly served them.

The blood testing technology didn’t work, so engineers jury-rigged a glue-dispensing robot to move pipettes around. Holmes immodestly named it the Edison. It was fraught with the same problems that plagued everything that Theranos ever designed – it could perform only a few tests, it wasn’t suitable for home use, and it ran only one sample at a time. Most importantly, it delivered inaccurate results. She had a very slick, Apple-looking case designed for it, though (it was not known to wear black turtlenecks).

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Theranos ran an admirable “fear of missing out” scam on Walgreens, playing on that company’s fears that CVS would sign a deal first. Walgreens invested heavily even though Holmes refused to show them her lab and wouldn’t allow them to run side-by-side samples with commercial labs to verify the Edison’s accuracy (hello, clueless due diligencers).

Theranos avoided CMS and FDA oversight by claiming that its technology was “laboratory-developed tests” that fall between their respective jurisdictions, with the government predictably paying no attention. All Theranos had was a CLIA certificate and lab that was being run by a dermatologist with no lab experience. Holmes tried to work her connections to have the military use her product, only to become infuriated when a military expert said she would need an IRB-approved study and FDA approval. Holmes tried to get him fired. It didn’t matter anyway since she simply lied in claiming to anyone who would listen that the military was using Theranos in Afghanistan battlefields. She said it, so it must be true, and at some point she probably repeated it enough times to believe it herself.

Also scammed was the grocery chain Safeway, which envisioned a sexy future in wellness. It spent $350 million to add swanky Theranos testing stations to its stores somewhere back between the meat department and the rotisseried chickens.

Theranos started developing the MiniLab in 2010. Its only innovation over commercial machines was a smaller footprint for home and retail use. Holmes kept a straight face in calling it “the most important thing humanity has ever built.” She hired Apple’s former marketing company for $6 million to orchestrate a splashy product rollout and her own photo shoots.

Theranos couldn’t make its technology work in time to meet a Walgreens deadline, so Holmes simply bought a bunch of commercial blood testing machines and hacked them to try to make them work with the fingerstick samples. The friendly, fawning press asked no awkward questions. Her orchestrated fame emboldened her to fudge the numbers even more – she assured one investor that the company would make a $1 billion profit in 2015, while nearly simultaneously telling another investor that it would be $100 million. Her patient result numbers were equally all over the place, as the company performed untested processing on the modified commercial machines in its Phoenix-area rollout at Walgreens. They were just Fedexing samples back to California, which introduced another problem Theranos hadn’t thought of – the sweltering Phoenix summer sun was ruining the samples as they sat on hot Fedex planes. Doh!

The hoax started to unravel when a pathology blogger noticed that a paper Holmes co-authored had been published by a pay-for-play online journal in Italy and it involved a study of only six patients. The blogger contacted Wall Street Journal reporter John Carreyrou, who conducted his own test by having blood drawn at an Arizona Walgreens. He thought it was odd that it was a traditional needle draw rather than a finger stick, becoming even more puzzled when his same tests performed by LabCorp gave wildly different results.

While Carreyrou was investigating, the Theranos deception continued. The machines kept screwing up during demonstrations, so engineers rigged a “waiting” icon on display so the company could  blame connectivity problems and then run the samples later on commercial machines that actually worked. Holmes would encourage investors and reporters to have blood samples drawn in her offices and would show them the sample being inserted into the MiniLab, but as soon as they left, employees would pull out the sample and run it on a commercial lab machine.

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In honor of a visit by Vice-President Joe Biden, Theranos built a fake lab in a conference room, stacking up non-functional MiniLabs and ordering employees to stay home in case anyone asked embarrassing questions.

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Carryrou’s first article created a firestorm, although Business Insider’s Kevin Loria scooped him by a full six months in running a skeptical article quoting scientists in April 2015 – he really should get the credit. Many people defended Holmes, while others questioned how a medical company’s board and investors could have only healthcare-inexperienced people.

Holmes took to the airwaves to defend her company, proclaiming, “When you work to change things, first they think you’re crazy, then they fight you. And then all of a sudden you change the world.”

You know the rest. FDA declared the nanotainer to be an unapproved medical device. A surprise CMS inspection said Theranos was posing immediate jeopardy to patient health and safety. Holmes made Balwani her sacrificial lamb, firing him and breaking up with him. All Edison test results were voided, Walgreens and Safeway ended their Theranos partnership, Holmes was banned from the industry, and everybody involved sued Theranos, which had burned through $900 million of investor money and was rapidly going broke defending itself. As icing on the cake, the SEC began an investigation, declaring Theranos to have been a “massive fraud” from the beginning.

I’d like to think that most of us in healthcare eventually saw through the Theranos scam, or at least would have been skeptical enough to ask the questions that its investors and Holmes fanboys didn’t. The company made big claims without publishing peer-reviewed data. Its value proposition wandered – was the story the finger stick, the consumer access to blood tests, or the cost-lowering threat to LabCorp and Quest? Dropouts in their early 20s might well start technology companies like Facebook, but the Theranos board and leadership team were remarkably inexperienced and naive about healthcare and the huge players entrenched in it that had already already tried and failed to commercialize fingerstick testing. They also had the advantage that in terms of lab services, it’s all about draw-station locations and the economy of scale of running thousands of tests per minute through a highly automated factory, and Theranos would have needed to scale to thousands of times its volume to take even 1 percent of their market.

Theranos is a good reminder to healthcare dabblers. Your customer is the patient, not your investors or partners. You can’t just throw product at the wall and see what sticks when your technology is used to diagnose, treat, or manage disease. Your inevitable mistakes could kill someone. Your startup hubris isn’t welcome here and it will be recalled with great glee when you slink away with tail between legs. Have your self-proclaimed innovation and disruption reviewed by someone who knows what they’re talking about before trotting out your hockey-stick growth chart. And investors, company board members, and government officials, you might be the only thing standing between a patient in need and glitzy, profitable technology that might kill them even as a high-powered founder and an army of lawyers try to make you look the other way.

Book Review: “America’s Bitter Pill”

January 26, 2015 Book Review 1 Comment

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“America’s Bitter Pill” is not a feel-good book (pun intended). It’s not a fun read except for those folks who enjoy a maddening, blow-by-blow description of how legislative sausage is made. It tries to add drama and personal vignettes to events whose outcome is already known. Steven Brill tells us the obvious – the US healthcare system is a mess, the Affordable Care Act is a Band-Aid rather than major surgery, (and in fact made things worse in some ways), and there’s no resolution in sight.

The main message is that the Obama administration realized it had no chance of pushing through comprehensive healthcare reform given the presence of a strong healthcare lobby and rabid Republican opposition, so the ACA ended up being a Frankenstein law that was watered down with so many compromises that it did little except to expand the sales of medical insurance.

Political reality forced the administration to limit ACA to addressing coverage, not cost. Hospitals, drug companies, and device manufacturers stand to make even more money under ACA, which is why their powerful lobbyists – who practically sat at the table while the ACA was being negotiated – gave their required blessing.

Creating drama from politics requires characterizing people and organizations. President Obama is portrayed as well intentioned, but a bit detached and lazy in leaving the ACA details to others. White House staffers are seen as power-hungry and anxious to get Obama’s ear. CMS is a plodding, incompetent bureaucracy that vastly overestimated its ability to launch Healthcare.gov. Former US CTO Todd Park and HHS CTO Bryan Spivak are nice, geeky guys who weren’t invited to the Healthcare.gov table until it melted down. Insurance companies are low-margin businesses that are held hostage by greedy and ever-expanding hospitals that use their consumer brand identity to force high prices; insurance companies are also an easy but undeserving political target because that’s where the healthcare rubber meets the road for most consumers.

It’s interesting to read about how much influence data geeks have. An army of government number-crunchers has to to turn vaguely worded legalese into budget impact numbers that can make or break campaign promises, i.e. are new government ACA costs taxes or is the program budget neutral? Insurance companies have their own quant people whose insurance pool models determine their financial risk over many years. The stars of the book might just be the analysts whose numbers drove big political and business decisions.

The basis of Obamacare is the Romneycare three-legged stool: (a) a competitive insurance marketplace disentangled from employers; (b) a mandate that everyone buy medical insurance to avoid the self-selection in which healthy and young people opt out of subsidizing sicker and older ones by buying insurance; and (c) massive government welfare programs to help pay the medical insurance premiums for those who can’t afford them.

You can imagine the ugly details involved in rolling out this three-legged stool as a huge, complex law that even those legislators who passed it didn’t read in its entirety.

The book makes medical device makers as bad guys who escaped significant impact other than being charged a small medical device tax that they simply passed along to their customers. Their profit margins are extraordinary, their customers are hospitals who not only buy their products at high prices but then mark them up in selling them to patients, and they have positioned their products as a beacon of American medicine.

Drug manufacturers are bad guys, too, using their political influence to prevent importation of drugs from Canada (which like every other country, has much lower prices than here), to gain extended patent protection for biosimilar products, and to kill a provision that would have allowed Medicare to negotiate drug prices rather than paying made-up market prices.

Lobbyists had their fingers in the pie at every step, including those representing odd industries such as soft drink manufacturers, tanning bed groups, and ambulance services. Every member of Congress made sure to protect any back-home businesses that would have been negatively affected, including those that should have been targeted.

The author is sympathetic to physicians. He says Congress targeted them inappropriately in 1997 in its panic over rapidly increasing Medicare spending, implementing the Sustainable Growth Rate (SGR) payment cuts that have been overridden by Congress every year since. A fix was supposed to be in the ACA, but that, too didn’t make the final bill, and neither did tort reform.

CMS is characterized as just about as inept and bureaucratic as you would expect.They were afraid that Congress would de-fund some of their “offices” in their hatred of Obamacare, so they renamed them “centers” to make them an internal expense rather than a separately budgeted “office.” That bit of political sleight of hand came back to bite them, as the newly demoted “office” that was supposed to be overseeing Healthcare.gov was outranked by CMS’s procurement groups.

The result was a plodding bid process in which the same old government contractors made promises they couldn’t keep, with CMS deciding it would run the project internally. Literally nobody knew who was in charge – the author asked a bunch of people where the buck stopped and rarely got the same answer twice. Brill says the Beltway contractors “never met a botched product, cost overrun, or missed deadline they can’t pin on someone else.”

Still, the blow-by-blow on Healthcare.gov seems to be a distracting attempt at injecting drama and maybe selling a few more copies of the book. Government software failures, cozy contractor deals, and cost overruns are the rule more than the exception. The site was quickly implemented and horrendously complex, a massive integration effort involving other government systems run by the IRS, Homeland Security, and others. It failed, but it was fixed fairly quickly. Healthcare.gov is only a tiny part of the ACA. There were no particular lessons learned except perhaps that rushed, complex legislation that requires a rushed, complex technology solution is probably a bad idea all around.

Non-profit health systems are portrayed as somewhat well-intentioned monopolists unwilling to give up huge profits and executive salaries, using their hometown pride as big employers and their vague public threats of reduced quality from reduced payments to protect their huge incomes. The author mentions the complaints of the CEO of Montefiore Medical Center, who wailed about potential ACA-caused patient harm through lower margins just as the hospital turned a $197 million profit and that same CEO took home $4 million for the year. Brill talks about the cutthroat Pittsburgh market in which UPMC and Highmark hardballed each other and got into each other’s businesses trying to dominate the market.

Brill concludes that President Obama should be admired for pushing through broad healthcare reform even though he hadn’t expressed much interest as a candidate, but says that his failure to get involved with the details of ACA’s implementation will be be his unfortunate legacy. The backroom deals with profit-making entities ensured that the ACA fell far short of true reform and in fact will probably increase corporate profits as newly insured people consume their products and services as patients.

Brill says Obamacare won’t stand as a popular Democratic program such as Medicare and Social Security since it only helped the 20 percent of Americans without an insurance and another 10 percent or so who had been fooled into buying low-quality insurance whose benefits would run out after even a short hospitalization.

The end result is that most middle-class Americans continue to struggle to pay insurance premiums and inflated medical bills, the country still can’t afford the out-of-control medical spending that makes the US globally noncompetitive, and employers and hospitals got an easy out in blaming their ensuing self-serving actions on Obamacare.

Brill makes it clear that he would have preferred a single-payer health system, but he doesn’t notice the irony that in calling out CMS as inept bureaucrats, they run the closest thing we have to a single-payer system in the form of Medicare. He should have spent more time writing about that (and the VA’s government healthcare delivery system) than in trying to create TV moments in the form of Healthcare.gov war room arguments.

For all the problems recited, the book is short on solutions. Brill proposes:

  • Let the big health systems get bigger and cut out the middleman by starting their own insurance companies, as long as each major metro area has as least two big players, but cap their profits.
  • Limit hospital executive salaries to 60 times the salary paid to a first-year medical resident, or about $3 million in UPMC’s case (the CEO is making $5 million now). That’s not only a generous CEO salary cap, it also ensures an unintended consequence of raising resident salaries. Why not cap CEO salaries as a percentage of operating revenue instead?
  • Pay doctors for quality. Sounds good, but the devil is (as was the case with ACA) in the details, which are missing.
  • Encourage health systems to run urgent care centers and other less-expensive care venues. I think ACA is already doing that.
  • Create an ombudsman appeals process for patients or doctors who think care is being compromised.
  • Require health system CEOs to be licensed physicians with practice experience. He doesn’t provide reasoning for this argument, but he does express disdain for corporate types that move into running health systems. He also doesn’t say much of anything about for-profit chains, including publicly traded ones.
  • Require health systems to insure a given percentage of Medicaid patients at a specific discount.
  • Eliminate the chargemaster and require hospitals to charge uninsured patients no more than they charge insurance companies.

Steven Brill knew little about healthcare when he wrote his Time article and this book. In that regard, he comes across as a curious layperson outraged by what he learns, but perhaps too easily swayed by people and policies that he has filed away as “good” or “bad” in his populist outrage. 

The Affordable Care Act is a political lightning road and isn’t likely to be fine tuned by intelligent Congressional deliberation, so good or bad, it’s here to stay. Most of the people involved in creating it have already left government work and the Obama administration is counting down its remaining months. Meanwhile, the healthcare cash register keeps ringing for the same companies, organizations, politicians, and people who know how to make the system work for them. That’s what makes “America’s Bitter Pill’ unsatisfying as a reader – it’s unlikely that anything will really change as a result as healthcare costs continue to bankrupt individuals, companies, and the country itself.

Book Review: “The Patient Will See You Now”

January 14, 2015 Book Review No Comments

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I enjoy reading articles and tweets by technology fanboy Eric Topol, MD. He’s focused and intense. He’s always whipping out a smartphone-equipped EKG gadget on a plane or sticking a smartphone otoscope in Steven Colbert’s ear on TV. A lot of the tools he digs up seems to be of the “hammer looking for a nail” category and he’s created a nice gig for himself as a geeky critic of the medical establishment (even taking the AMA to task), but sometimes he comes up with ideas that might make a difference someday.

Topol is an undisputed thought leader. I like what he has to say even if I’m often skeptical.

Topol’s new book, “The Patient Will See You Now,” is an impressive (some might say “undisciplined”) romp through the healthcare technology garden. However, it fails to live up to its title, which suggests that savvy, responsible patients armed with cool smartphone EKG devices and fitness trackers have quietly wrested control of healthcare from the government, corporations, and providers of “eminence-based medicine” that make up the plodding and oppressive medical establishment. It’s a cute and gimmicky title, but it contains more hype than the book can deliver.

In fact, it sounds a lot like his earlier book (which I didn’t read) called “The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” That one is three years old, so maybe everything in it came true and he moved on.

The book wanders around so much that the only overall sense I could make of it required me to summarize each chapter, as follows:

  1. Technology is widely adopted. Patients know their own bodies better than anyone.
  2. Doctors are trained to feel superior and to control the flow of medical information.
  3. The smart phone is like the Gutenberg press in democratizing and disseminating knowledge.
  4. Angelina Jolie’s decision to undergo a double mastectomy because of genetic testing was earth-shattering, but the FDA tried to shut down 23andMe because that testing completely ignored FDA’s inquiries about its marketing and its offer to help the company comply with US laws.
  5. I glazed over on Chapter 5 because it was a complex and questionably relevant primer on how genes work and how they can be used to personalize medicine. The bottom line: we should be doing more genetic testing for research and individualizing treatments.
  6. Silicon Valley darling Theranos is revolutionizing lab testing. People have the right to see their own information. They should also be informed about the radiation dosage in diagnostic imaging.
  7. Patients should be able to see their medical records. OpenNotes and Blue Button give that capability, but only 36 percent of patients can access their records and EHRs are primitive.
  8. Prices for hospital services and drugs are irrational and vary widely, especially when comparing high US prices to those the rest of the world pays. We have a lot of waste and spend a lot on treating complications.
  9. Telemedicine is cost effective and convenient, but doctors resist new technology just as they did the stethoscope when it was invented.
  10. Hospital stays, which are expensive and error-prone, are declining as surgeries move to outpatient. Technology allows care and monitoring to be moved to the home.
  11. People are willing to share their medical data for research, which will allow collecting and collating information to discover new research and best practices.
  12. People are selling and stealing medical data.
  13. Sensors can predict and track medical conditions.
  14. Cheap smartphone-connected technology will democratize medicine to less-developed countries.
  15. People own their medical data. Big employers should be using it to squeeze big insurance companies, but none have actually done that. Consumers haven’t mobilized. CMS and other administrative waste takes a lot of resources out of the system. Other countries will do better because of our archaic payment and regulatory model.

My frustration is that while the exhausting scattershot of technology nuggets is interesting (although hardly original since I’d heard of nearly all of them), it doesn’t prove the title’s hypothesis. It may well be that a few tech-savvy and demanding patients can convince their individual providers to let them get more involved in their care, but nothing suggests the presence of an unstoppable movement. In fact, while healthcare takes heat for being episode-based, a significant portion of consumers are even more episodic – they pay attention to their health mostly when something is bleeding, hurting, or swelling and then show up expecting a TV-like quick fix. The majority (especially the medically expensive ones) aren’t quantified-selfers or fully engaged participants.

A lot of people have smartphones, health apps, and fitness trackers, but those gadgets haven’t proven to make them healthier. Capturing and tracking information is just a tiny and easy part, as evidenced by the significant penetration of bathroom scales in the homes of overweight people. Patients (or consumers or whatever you want to call the 100 percent of us who will seek medical care at one time or another) can make consumer-like demands on their doctors, hospitals, and insurance companies, but I’ve heard few examples of where that actually accomplished anything other than possibly getting themselves labeled as a troublemaker.

People who receive medical services aren’t really pure consumers, so it’s not realistic to assume that the healthcare cheese can be massively moved by technology as happened in banking and entertainment. Patients don’t usually pay all their own bills. They go to whatever doctor and hospital the party that does pay (the insurance company) dictates, so threats to take their business elsewhere are usually hollow no matter how unpleasant or Luddite their doctors may be. Strap 10 smartphones with cool apps on your belt, pass out OpenNotes articles in the waiting room, and warn hospitals that they had better not make a medical mistake during your admission – your influence is still minimal despite being informed.

Topol’s broad observations and complaints aren’t really actionable. Patients have little control over the items listed above. The book title suggests that patients are in charge, and yet it’s still insurance companies authorizing payments, doctors entering orders and performing procedures, and the much-maligned medical establishment standing between patients and their maker. The healthcare system (or more correctly, the healthcare industry) was built around everybody except the patient. That establishment isn’t just going to step aside because patients carry iPhones. Any plan that requires people to voluntarily stop doing what they’re well paid to do will fail.

A few tech-powered concierge practices, retail clinics, and drug chains are threatening the status quo. They aren’t really scaring anyone. They may cherry pick a tiny bit of profitable business, but they aren’t much of a threat to health systems that keep buying up more providers and using their political influence as big employers to make sure they aren’t pushed away from the table. That’s the best hope for quick innovation that will reverberate through the hallowed walls, such as the real threat that Theranos will force high-margin hospital labs to either increase their efficiency or survive on a fraction of their current business.

Healthcare is like your car (at least if your car was built in this century). Your car is loaded with sensors (some of which, like the speedometer, you may conveniently ignore) and requires a computer to analyze its internal computer data stream. You can’t diagnose and fix it yourself when the idiot light comes on. You can study up all you want, but your only real decisions involve (a) whether you want to get it fixed, and (b) who you choose to fix it given your available options. You sit impatiently until the mechanic hands over a grease-stained list of procedures he or she performed along with a bill (as in hospitals, the computer that creates the bill is the most powerful one). All of that technology and data didn’t benefit you very much – it just generated more business for the mechanic, allowed him or her to work more effectively, and maybe avoided even more expensive repairs down the line. That’s pretty cool, but it’s hardly a revolution in empowering car owners.

That’s my takeaway from the book. Most of the technologies listed help doctors provide better care, assuming they are willing and able to use it. The role of their patients is, at best, to push for them to actually think about using genomics, following evidence-based medicine practices, reviewing their own outcomes information, and staying current on new medical developments. Patients, however, won’t usually voluntarily leave a doctor just because they don’t use an EMR or other gadgetry – that’s the art rather than the science of medicine – so it’s not really much of a threat.

Consumer choice in healthcare involves choosing the “best” provider to interpret, order, and perform procedures (or at least the “best” one willing to see you that your insurance covers). A doctor might be willing in the seven minutes you’re allotted for a return visit to look at your fitness tracker information, sit beside you as you Google your condition, or describe their charges to the price list from the MinuteClinic down the street. Don’t count on it. You’re only as empowered as is convenient for them.

Cardiologists make a great living and Eric Topol is no doubt excited to see his Scripps patients embracing technology and participating in their care, but it just doesn’t work that way for most doctor-patient encounters. People don’t get as broadly excited about health-related technologies as they might with social networking or music since the personal payoff is slower and less certain. Fitness trackers motivate and inform people who are already motivated and informed. Those aren’t the folks running up most of the country’s medical expenses.

Topol’s confidence that abundant technology will upend the US health system in favor of patients seems wildly simplistic. We can all – as patients and industry insiders – make a long list of what’s wrong with healthcare. That doesn’t mean we can change it through our individual actions. Healthcare is like the government in that it’s easy to identify what’s wrong, but hard to even agree on a solution, much less impose it against the will of far more influential people and corporations who are pretty happy with the present arrangement.

That doesn’t mean the book isn’t worth reading as a concise overview of what technologies are on the horizon. It’s good for that, at least for the next six months until it becomes outdated. It also doesn’t mean that Topol isn’t a passionate visionary because clearly he is. However, he could raise an army of fist- and smartphone-waving readers of his book who are upset with how most of us are treated as patients and health-seekers, but that alone won’t get our broken healthcare system fixed.

That’s my disappointment with “The Patient Will See You Now.” Reading it makes it easy to see what the future could be while knowing it probably won’t really happen, at least not in this country. I give it 3.5 stars out of five, docking it a half-star for an unrealistic title. Each chapter would have made a great blog post or magazine article, but I’m not finding them as compelling or entertaining in aggregate.

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  • ratherbefishing: I went to HIMSS a lot of years. Other than the social aspect of it I don't miss it. I find it immensely more enjoyable t...

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