At SplashX Precision Health: should patients self-diagnose?

Two different views over whether or not consumers should be diagnosing themselves

During Vator's salon, SplashX Invent Health - Precision Health, co-hosted and co-produced by our awesome partner, HP, there was a discussion about how data is changing a doctor's role. This was related to the fact that there's a proliferation of at home services like 23andMe, which give people more information than ever about their own health, allowing them to self-diagnose. 

(NOTE: Save the date, our next salon is on Vitality - Healthy lifestyle as a drug, a look at wellness and prevention and behavioral change as the prescription to better health. JOIN us on December 13 at HP's headquarter in Palo Alto. Get Early Bird tickets or become a member).

This theme lasted throughout the night, leading to a mini debate between two of the members of the panel with tech pioneers and established healthcare companies. The discussion was about whether individuals were equipped to take on the role of diagnostician and administrator of their health. 

Coming down on the side of there being too much information in consumer hands was Atul Butte, Priscilla Chan and Mark Zuckerberg Distinguished Professor at UCSF.

While noting that he loves consumerism, and the fact that he can get his father's Stanford cardiology reports in the Apple Health app, he also made sure to say that, "At the same time, consumerism only goes so far."

To illustrate his point, Butte asked the audience how many of them had done their own taxes this year, and then how many of them paid a human to do it. A much larger number raised their hand for the latter. 

"You know this is computerized; it’s an engineered problem - the problem of paying taxes - and yet you go find a human to do this and you think software is going to help you on the medical side? Ok, fine," he said.

He then asked the audience a second question: if they are able to diagnose their own car. 

"In the United States, since the 1980s, there’s an OBD2 port, it’s a federal standard, underneath your dashboard there’s a little cable. If you really bend your neck you can see that little cable, and if the check engine light comes on you can buy a $200 gadget to diagnose your own car," he said, and then asked how many people in the audience owns one of them. Only a couple of hands went up.

"The rest of you are thinking we we’re going to want to self-diagnose ourselves, yet you don’t even diagnose your own car, which is a much simpler problem, because, in the end, you don’t want to just know it needs an oil change, you want someone to change the oil. So, in the end, it’s not like you can write off medicine anytime soon, for the same two reasons I just gave you: most of you don’t do your taxes by software, most of you don’t diagnose your own car. We have a long way to go in medicine," he said.

Jeffrey Brewer, Founder & CEO of Bigfoot Biomedical, a provider of an optimized insulin delivery solution, challenged what Butte had to say, noting that "there’s a difference between acute crises and chronic disease," and that, "In chronic disease you actually have the person who lives with the disease, and are very responsible for the outcomes."

"So I would posit there isn’t any choice about consumerization. For instance, you might ask why nobody has done what we’re doing, which is basically to take data that already exists from diagnostic devices and use the feedback loop to draw insulin records. The reason is that medical device companies don’t understand consumerism; they understand complicated devices that are built mostly for medical professionals that have quality control and continuing education and only do it for part of the day. But when you get tools to a consumer that has to live with a debilitating disease that they’re going to have for the rest of their lives, the gracefulness in which it fits into the cadence of daily life is much different," he said.

Take the adherence challenge away

Brewer then moved to talk about adherence, or the degree to which a patient correctly follows medical advice, and how consumerism makes that much easier.

"When it comes to chronic disease we need to get away from the concept of adherence. Apple, when they put out a new feature on the iPhone, they don’t say, ‘Why aren’t people using that? Maybe we need to give them a manual to help them to understand how they can better use it.’ They make it attractive and make it usable. With what we’re doing, we actually put the burden on ourselves to say, ‘If people aren’t adhering, if they’re not doing what we’re asking them to do, how do we make it easier? How do we actually design it so that it’s easier to comply and to adhere?’ Again, this not to compare to an acute health crisis, but with chronic disease I think consumerism is the only way," he said.