Some doctors might tell you that their electronic medical record systems have already plunged them into a horror story along the lines of a "Coma"-like Robin Cook thriller. Dr. Cook himself sounds the alarm about the possible dangers of high-tech health tools in his latest bestseller, "Cell." (As in cell phone. As in an app that functions as your dream doctor. Except when things go wrong in that sinister Robin-Cook-ish way.)
But there's not a trace of the Luddite about him; he co-wrote a piece in the Wall Street Journal recently that began:
A sweeping transformation of medicine has begun that will rival in importance the introduction of anesthesia or the discovery of the germ basis of infectious disease. It will change how patients and physicians interact. It will change medical research and therapy. "Sick care"—the current model of waiting for you to get sick and then trying to alleviate symptoms and make you well—will become true "health care," where prevention is the mantra and driving force. Welcome to the world of digital medicine.
We chatted at a lunch last week for the Friends of the Newton Free Library, where Dr. Cook taught a rapt audience the rudiments of thriller-writing. Our conversation, lightly edited:
In your latest book, "Cell," a virtual-doctor app goes horribly wrong. But in your recent op-ed piece in The Wall Street Journal, you sound very bullish about digital medicine. So are you feeling some ambivalence here about digital medicine?
The point is that it’s coming and nobody’s going to stop it. And none of the stakeholders are all that excited.
I was thinking that you've written a kind of an electronic health record nightmare — but then, some doctors say they're already living that in real life.
The problem with electronic health records is that the medical profession didn't jump on them, and what we end up with today is that it's such a ridiculous hodgepodge and it doesn't work: In the same city, one hospital cannot talk to another hospital. And I think that the medical profession has to assume a responsibility for spearheading that.
You can't blame doctors for some of their initial resistance — some of the systems were glitchy and expensive --
I think it's because the medical profession is actually perhaps the most conservative, and so doctors don't want to change. And in a lot of ways, that’s been a good thing, because it would be bad if the medical profession jumped on every fad and fashion, but instead they look at everything with a jaundiced eye.
Of the whole digital frontier in medicine, what most excites you?
The ability of the smartphone to play the role of the primary care physician, which is what "Cell" is about. In the novel, my main character says, 'Oh, the public is not going to accept this,' and the other med student, who's going into business, says, 'Access is going to trump that. People want to know now.'
The way the system works now, first of all, you can’t even get hold of your doctor, and then if you do, then you’ve got to go in and wait, and then the doctor says, 'I think you should get a test,' and then you draw the test, and then you’ve got to wait, sometimes for weeks, for the results. And then you finally get the test back and go back to see the doctor again. What a system that is not for the benefit of the patient! It’s for the benefit of the medical profession. And for the benefit of the other stakeholders involved here, like the medical lab industry. Whereas, as I talk about in "Cell," all of that can be instantaneous: the cellphone itself, with various attachments, will be able to function as a medical lab, and you'll get the information right away, and then you own the information. Now, the doctor owns the information.
It’s interesting that the FDA — which has really developed over the years into a part of the medical profession in a lot of ways — reflects the idea that they have to agree to anything to do with medicine. But the public is already doing this. The public is already getting all their information from the Internet and social media. Yet they're trying to say, 'Oh, no, you can't do that,' or 'You can't get your own DNA information because you won't be able to interpret it.' Well, most doctors can't interpret it! And if you're connected through your phone with Watson, Watson can handle it very well.
Also, the medical profession has been unwilling to solve the lack of primary care physicians, mainly because they haven't been willing to team up and figure out how to get enough primary care providers, and then when you suggest some other staffing mechanism, they say, 'No, no, you can't do that, it has to be a physician." And yet for years, we’ve had a system that works really well: When I was in the military they used corpsmen — essentially, physicians' assistants — and everybody in the military loves the system and it works fantastically. When I was in the military I only saw maybe 10 percent of the people, they saw 90 percent. And yet the medical profession has always said, 'Oh, no, no, you can’t see someone who's just been through nursing school.' Well, corpsmen had only gone for a couple of months of training."
But what about if a virtual doctor purveys bad information?
Or privacy issues. I don't think bad information is as big a challenge as privacy issues, because the existing medical industry already has a lot of bad information. You have to think about how long ago it was that your doctor graduated from medical school. Whereas in its digital form, all the information is updated on a daily basis.
So that's more on the 'pro' side for patients, that information can be more current.
It’ll be great for doctors, too. We all use the Internet all the time. 'What was that syndrome?'
And privacy may be less of a concern now that Obamacare prevents insurance denials?
There can always be discrimination in terms of employment. Before, the worry was that you wouldn't be able to get health insurance. That one element can be removed. But there are lots of opportunities for discrimination, or you could just find yourself in the hands of quacks.
For lay readers, what digital tools would you most recommend?
It’s what they're already doing — you get some symptoms, you go on the Internet, and that's it, it's like a tree: This leads to that, that leads to this. And you go on social media and say, 'Has anyone had this kind of problem?' and suddenly you're in a conversation with 4,000 people who've had this same trouble with their toe.
"Cell" is expected out in paperback in December. Given that your books so often pick up on the medical cutting edge, what are you writing about next?
The next big thing is something called proteomics. It’s a mixture of protein and genomics and it's going to revolutionize therapy and pharmaceuticals.