Magical Thinking

Margaret Anderson, COO, FasterCures
I appreciated the message of Carol Diamond and Clay Shirky’s recent piece in the August 2008 Health Affairs titled “Health Information Technology: A Few Years of Magical Thinking?” In it they say that “proponents of health IT must resist “magical thinking,” such as the notion that isolated work on technology will transform our broken system.” It’s interesting to think about systems change at the front end, and how easy it is to get stars in our eyes about how things like health IT or personalized medicine will transform the world as we know it, and how all of our problems will then magically go away.

I was speaking recently to a colleague here Kristin Schneeman about her life working in Vice President Gore’s office in the early days of the Clinton Administration and how new and novel email was at that time. I recall getting my first work email account and not having anyone to really email anything to, except my colleagues on the same floor. Greg Simon, President of FasterCures has talked about how he had a cell phone in the early days and was embarrassed to be talking on the street with it so he’d take it into a pay phone booth to look more “normal.”

Cell phones, email, and the Internet have certainly transformed things in ways we couldn’t have imagined, but they’ve introduced problems we couldn’t have imagined. Technologies such as FAX machines have been leapfrogged over. Problems such as the overabundance of information, and the speed of information flow are here to stay it seems. In the case of health IT, FasterCures sees it as a vital bridge to the future of more rapid information collection, characterization, and analysis which could speed our time to cures.

We are working on a white paper for the U.S. Department of Health and Human Services about educating and building awareness among consumers about personalized healthcare. This is another area where we must resist “magical thinking” and get down to brass tacks. Too often, the discussion about personalized medicine has been at a 30,000 foot level. For this paper, we’ve talked to many patient advocacy and disease research groups and everyone holds their breath about the potential power that these technologies may hold for their disease areas. They all want more targeted therapies with fewer side effects, which is ultimately the promise of personalized medicine. But they also recognize its complexities. It needs to take into account the world of co-morbidities we all live in; even if baby boomers are out running marathons and eating their greens and blueberries, the reality is that many of us are living with many conditions and diseases, not just one. It will probably raise costs before it can lower them. It's unlikely many diseases will yield to the relatively easy HER2-Herceptin gene-to-drug relationship. Patients are likely to get much more information about their genetic makeup than they can act on in the near-term. So, with all these complexities, is it magical thinking to ponder how scientific advancements in genomics and proteomics may change things for the better? Is it magical thinking to imagine a health IT system that can propel these advancements forward even faster? Or can we make it real? You tell me.