Is our failure to document medicine and pay attention fuelling the exponential growth of bad medicine?

Isaac Kohane MD PhD talking at Exponential Medicine 2014

…a Malaysian Airline disappeared and the whole world was activated to figure out where it had gone and what had happened. At two of our top hospitals in Boston the following peak of heart attacks happened, so this was over the base line an 18% increase in heart attacks, and so what we were flying into this mountain of morbidity was not ‘a’ plane load but a thousand plane loads, then thousand plane loads of Patients with heart attacks. And guess what: no one ever noticed. It’s only when we did the analysis through the Electronic Health Record of the data that we became aware of it. So it’s like a thousand Malaysian 747’s just disappearing without a trace but in this case we caused it. We actually shot them down. We gave Vioxx (Rofecoxib) and we are the cause of that mortality and morbidity. We caused it. You’d give me a standing ovation maybe if we told you that we caused a 5% decrease in Heart Attacks, (well) we caused an 18% increase in Heart Attacks and we didn’t even know it and it was knowable, why? how do we know this?, because Kaiser Permanente took it off their formulary early on when they saw early papers suggesting that there was cardiotoxicity. That’s our healthcare system and guess what? I have many other papers that cite, some of which we’ve done, that tell you this is happening now. Today. We’re not paying attention. You know all these measures we’re hearing about: readmissions, this and that, there are huge signals that we’re missing if we could only be bother to be creative and look…

Isaac Kohane, MD, PhD, coDirector of the Centre for Biomedical Informatics at Harvard Medical School gave this fantastic talk about the Exponential Growth of Bad Medicine at last years’ stunning Exponential Medicine Conference. Click here to apply to join us for the 2015 event (9-12 November again in San Diego).

mHealth Insights

This is why I think new entrants from the mobile industry like Apple (who have got business models that benefit from being creative and looking for signals) are going to radically change how we practice medicine.

When you appreciate the imprecision of medicine and the loss of symptom information that takes place every time we try and get the busy/tired/expensive Doctor entering it via their computer (instead of letting Patients help) it’s hard to see how we’re going to continue to be allowed to refer to the undocumented practice of medicine as ‘caring’.

Related: This talk is also a very good reminder of why we need much greater transparency when we let managers/payers modify the decision support tools that Doctors rely on to prescribe medications to Patients.

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