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Shaky prognosis for precision medicine
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NEVER before have China’s oft-maligned public hospitals been seen as potential agents of a revolution in healthcare. All this changed recently though thanks to the emergence of a new concept: precision medicine.
This term first came to wide public attention when US president Barack Obama stressed the need to fund a precision medicine initiative during his 2015 State of the Union address.
Simply put, precision medicine is a medical model that emphasizes the customization of healthcare with decisions, practices and products tailored to individual patients.
To the delight of industry observers, China launched its own national precision medicine scheme last year. Investors smelled blood and acted quickly. Healthcare stocks rallied on speculation that favorable policies would be forthcoming, and media abounded with headlines touting precision medicine as the next big industry niche.
Amid all the fanfare though, few stopped to seriously question this new concept and what it will mean for medical practitioners and patients. In fact, at the current stage, all the talk of precision medicine’s bright future seems like so much hot air.
During a recent lecture given to EMBA students at Fudan University’s School of Management, Xiang Yaojun, deputy director of Shanghai’s Changhai Hospital, an AAA institution under China’s three-level rating system for public hospitals, pointed out that precision medicine has a long way to go before it can generate its intended benefits in China.
Unlike e-commerce and other hi-tech industries where instantaneous communication is not essential, face-to-face content is vital to practicing medicine, according to Xiang. In outlining his vision of an ideal medical-treatment environment, Xiang slammed the widely-held belief that machines are more effective than human beings when it comes to diagnosing illness.
One can have a device strapped to one’s arm to monitor minute changes in blood pressure, and then have these readings transmitted in real-time to a family doctor. Yet, as Xiang argued, this will never take the place of a face-to-face consultation.
He also noted that this approach contradicts the traditional Chinese medical tenet of wang wen wen qie, meaning that doctors need to treat patients in person, study their faces and feel their pulse.
“The idea that machines can be trusted with all of a doctor’s work is patently wrong,” he asserted.
In his opinion, over-reliance on machines is both misguided and dangerous, since machines tend to overlook the diversity of human responses to illness.
In the case of flu, people with different immune systems are impacted to varying degrees, and this isn’t always reflected in machine-aided readings.
Standardized processes
Moreover, Xiang’s ideal includes consistent standards for testing and treatment. This can sometimes be a problem even now at established outfits like the one he heads. Xiang mentioned one patient at his hospital who suffered complications after receiving a liver transplant. Complicating doctors’ first-aid efforts were the conflicting results of two lab test reports, one issued by the emergency department, the other by the in-patient department.
Although these inconsistencies are rare at top hospitals, this story highlights the significance of standardized medical processes. And standardization, in theory, is the lifeblood of both precision and conventional medicine, Xiang noted. He also argued for the sharing of information among hospitals, as this would provide an important step toward laying the groundwork for precision medicine. If multiple doctors are to treat the same individual, it is vital for doctors to share a patient’s medial records, CT scans and nuclear magnetic resonance reports.
As a crucial component of precision medicine, telemedicine, which refers to the provision of healthcare via telecommunications equipment, could theoretically be a boon to people without access to quality medical resources. Yet rarely has this boon materialized. Many like to think that the Internet has empowered patients by linking up the farthest corners of the country and putting quality medical services just a click away. But in fact, the Internet is a mere novelty in far-flung areas, which is another reason why Xiang dismissed the frenzy over precision medicine as “premature.” Telemedicine remains out of reach for the have-nots. Xiang explained that local doctors he knows lack interest in attending televised consultations for a fee of up to 1,000 yuan (US$155). On the one hand, this amount simply isn’t enticing for many already overworked doctors; while on the other, it is far too much for the most needy.
“Precision medicine must reach a broad base of patients if it is to be taken seriously,” he added.
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