HealthXL: "If you live long enough, the future changes"

“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