Perspective: Personalizing Medicine in the Age of Health 2.0

[NOTE: This is a life-science perspective piece by Vance Vanier, a Stanford physician and a partner at Mohr Davidow Ventures. For previous perspective pieces, click here. –D.P.H.]

vvanier-bio1.jpgBy VANCE VANIER

Katherine is a 35 year old experiencing fatigue, tingling in her hands, and visual problems. She made an appointment with her doctor, arrived with a stack of online health site print-outs, and announced that she had diagnosed her problem as a relatively rare pituitary tumor. She was right.

Such encounters are becoming more commonplace among physicians, and they are met with mixed feelings. When patients educate themselves with materials from trusted and reputable sources, these encounters lead to good discussions. In other cases, physicians get frustrated because patients may delay treatment due to misinformation online. Most importantly, however, these encounters are a harbinger of profound change in the way patients relate to their doctors and the healthcare system as a whole. A set of new technologies is empowering patients to understand and manage their care in a manner that changes the healthcare paradigm. Call it Health 2.0.

Health 2.0 in many ways follows the Internet paradigm shift from Web 1.0 to Web 2.0. In the Web 1.0 model, content, tools, and communication online often came from one centralized authoritative source with little user feedback. Web 2.0 sites, however, renounce these top-down models. Online users actively participate in generating their own content for sites and then sharing it in communities of other users.

The practice of medicine has been entrenched in the 1.0 model. Medical knowledge and the delivery of medical expertise to treat the sick has been the province of a chosen and authoritative few. Until recently, patients have largely depended on individual doctors to provide information and monitor their illness. However, there are early signs of change that suggest a shift from the 1.0 to 2.0 paradigm in healthcare. For example, there has been a rise of decentralized user-generated content in the form of wikis, blogs, and patient community social networks. According to a survey by Manhattan Research, 9.9 million consumers regularly post health information online and learn from each other.

In addition to learning from their peers, patients like Katherine are increasingly seeking information online before they visit their doctor. In a recent Harris Poll of 1010 adults surveyed in July of this year, more than 70% had looked for health information. In the near future consumers will have an even greater understanding of their health as search engines advance to take into account patients’ personal health histories–currently the exclusive domain of human physicians. Enabling this change are dozens of companies offering consumers the ability to store and manage their own personal health records as opposed to depending on their health providers for their records.

Further change is coming in the management and monitoring of patients’ chronic health conditions. In recent years, managing chronic diseases such as diabetes and depression has gradually moved from the doctor’s office to disease management companies where nurses in call centers issue frequent phone calls to patients to remind them to perform specific actions. However, some chronically ill patients can now find websites with communities of similar people exchanging information, reassurances, and practical advice. Through these new sites patients are getting more tools to monitor their conditions from home and get real time feedback that can lead to positive behavior change or earlier intervention.

For example, a preliminary study using remote monitoring devices and the Internet for patients with diabetes in underserved Medicare populations in New York State showed health outcome improvements. Remote monitoring devices tracked blood pressure and blood levels, allowing providers to easily monitor patients. Results from this study have shown patients improvement in hemoglobin, blood pressure and cholesterol levels. In addition, tools as simple as Internet enabled electronic scales that detect early weight gain can empower congestive heart failure patients to collaborate with their doctor and seek changes in medication to avoid hospitalization.

While the concepts of Health 2.0 are promising, it is still early days and there are clearly challenges to be met. For instance, user generated content while appealing to some patients has drawbacks such as the potential to generate misinformation and confusion rather than answers grounded in scientific fact. Putting health records in patients’ hands puts the onus on individuals to keep them up to date, not to mention secure and private. Not all patients want reassurance from peer networks and may prefer physician guidance instead. Though these challenges are real and complex, there are compelling aspects to the Health 2.0 shift that may have the potential to improve the lives and medical care of patients like Katherine.

Some of the nation’s leading thinkers, entrepreneurs, executives, and healthcare providers are discussing these issues at the Health 2.0 Conference today. Visit www.health2con.com for details.

Vance Vanier, M.D,. is an attending physician at Stanford Hospital and a Partner at MDV- Mohr Davidow Ventures.