Robot Medicine

Just when you thought you were beginning to figure out all the changes in medicine, a completely different variable comes our way.  Take a look at this lengthy article in The Atlantic and see the incredible work being done with Watson the computer.  That’s the same Watson who beat all the experts on Jeopardy a while back.  Now IBM is finishing off the real reason Watson exists, to improve diagnosis and treatment of patients.  That’s right a computer that could replace many of the activities you would associate with a physician.  Before you dismiss the idea take a look at the places that are part of this work, which include Sloan Kettering and the Cleveland Clinic.

A few years back, at a meeting focused on innovation, I saw a panel discussion that included the person who invented virtual reality gaming and the recently retired head of the FDA.  It was an odd mix to say the least.  After the commissioner talked about how the clinical testing process was done and how it had “evolved” over the last few years it was up to the virtual reality inventor to respond.  In all seriousness he asked why did they even bother putting drugs into real people when he could easily design a “game” that would do exactly the same thing and not put people at risk.  The room was silent.  The commissioner smiled, then pondered and then began taking notes.

The article should at least make you think about the future of medicine.  Before thinking this type of work is years off think about so many other things in your life where people have been replaced by machines making diagnoses.  When you take your car in for a checkup everything is hooked up to a computer that looks for any error codes and then the mechanic fixes them.  Days are over when the mechanic takes everything apart to try to figure out what is wrong.  If you go take a golf lesson today the pro will make extensive use of computers to diagnosis every body movement that happens in your swing and then tries to fix the part that is most out of whack.  Your electric lines and Internet lines are diagnosed at central offices and repair people are told precisely where the problem is and how to fix it.  So is this type of work in medicine that far off?  In some ways we know it is really happening already.

The one line in the article that I found most interesting and perhaps most relevant for the pharmaceutical industry was when the robot, after determining the most appropriate care plan, would communicate with the insurer to gain approval and assure reimbursement for the work.  The article didn’t say so but I wonder how long it will be before the computer just talks to a computer at the insurance company.  The concern is that this will become an all or nothing type situation for the pharmaceutical industry.  In other words if the program after completing all its work decides a particular drug is the most appropriate that drug will be selected 100% of the time.  There won’t be any “spreading” of the business that we often count on in crowded therapeutic areas.  Our sales representatives won’t have any influence on what is done and all our TV advertising and other marketing tactics will be irrelevant.

What will become even more important is our ability to prove that our product is better than our competition.  This proof must be evidenced based as these new protocols will become much more than guidelines or suggestions, as they will be hard wired into the system.  We must be able to differentiate our product and show where it is the most appropriate for particular patients.  And by the way, I think price might be important here.  I doubt if this system will have a dedicated portion set aside for passing out co-pay vouchers to get around third tier situations.  Robot medicine, at least as described in the article, may be a ways off but our thinking should change immediately as this robotic thinking by both payers and providers is already happening!

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