Desktop Medicine

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Pauline Chen (NYT):

"“There has been a fundamental change in how we think about what health and disease are and how we practice medicine.”

That change revolves around the computer. While health care was once premised on the physical exam and a physician’s diagnostic skills, it has become increasingly reliant on computer-based syntheses of clinical findings and measurements, complex statistical models and risk factor calculations. “Now we look at various factors that put a patient at risk, then calculate whether it is worth treating that patient,” Dr. Karlawish said.

In other words, we have gone from bedside medicine to desktop medicine.

One example of a disease in the new desktop medicine era is dyslipemia, or abnormal blood cholesterol and blood fat levels. Cholesterol-lowering drugs were initially used to treat patients who suffered from inherited diseases that prevented them from processing cholesterol, putting them at risk of hardening of the arteries and heart attacks. Over time, though, clinical trials revealed that the same drugs could reduce heart attack risk in some otherwise healthy individuals who simply had high cholesterol.

What was once a natural variation became a full-blown disease. Or at least a chronic condition that needed to be managed.

“Contrary to the bedside medicine model, where diseases are based on discrete symptoms and clinical findings,” Dr. Karlawish said, “desktop diseases are contingent on the results of a clinical trial showing that some intervention can influence how patients will do over time.”

With these new “diseases,” physicians and scientists can design computer-based programs that tap into a vast network of data and calculate an individual’s risk of doing poorly and the need for treatment. For example, doctors can now enter information into specialized Web sites (or, in one case, an iPad app) that, with a single click, can spew out a patient’s 10-year risk of bone fractures from osteoporosis, or of a heart attack from high cholesterol and high blood pressure.

While those who advocate a return to bedside medicine may shudder at the image of a doctor turning to her iPad for clinical wisdom, refusing to acknowledge this new model of disease and care has its own perils. “There’s been a lot of progress in health care because of desktop medicine,” Dr. Karlawish said. “We can’t laugh like it’s the next generation of goldfish swallowers, because it won’t go away.”

Moreover, in the world of desktop medicine, larger social forces influence which health risks are deemed worth identifying and reducing; and the political, economic and personal repercussions can be enormous. Cholesterol-lowering drugs, for example, are now the most widely prescribed medication in the United States; and a single brand may save one patient out of several hundred from a heart attack. But that medication will also cost several dollars per pill for patients and generate billions of dollars in revenue for a pharmaceutical company." (