Inside Story

Treat the patient, not the x-ray

Individualised medicine promised the world, but can it deliver?

Gideon Meyerowitz-Katz Books 11 October 2023 1119 words

“We have been capable for years of identifying the people most likely to experience a gamut of diseases, but we have yet to be able to change their fate.” iStockphoto

What if I told you our entire medical system is intrinsically flawed? That we were all pursuing a broken form of healthcare that’s outdated, poorly implemented and generally ineffective? That a new and innovative world of medical care just around the corner will revolutionise everything?

In a nutshell, that is the case advanced in The Age of Scientific Wellness. It’s a new science book looking at the world of AI and genomics in medicine. Throughout, the authors — two highly qualified and very well-respected scientists with decades of experience behind them — weave a tale in which what we call medicine is irretrievably broken and our health will only improve once their futuristic paradigm emerges from the ruins.

As the story goes, what we currently call healthcare is, in fact, “sickcare” or “deathcare.” Right now, most treatment is provided to people when they are already suffering from disease’s symptoms, but that’s backwards. Instead, the authors propose, we should use the vast wealth of data that people now generate about their own health to better understand their long-term risks, and figure out how to identify problems with health long before they happen. We can then prevent these conditions, thus saving us all a great deal of suffering.

This brave new world will be built on emerging healthcare technologies. The authors focus particularly on genomics, microbiomics — the study of the bacteria and other micro-organisms that live in and on our bodies — and brain health. The book wends its way through a tapestry of possibilities, discussing how we can improve cognitive outcomes and capitalise on the vast promise that AI holds for improving our lives.

The Age of Scientific Wellness starts out strongly, but ultimately much of it rings a bit hollow. The authors focus relentlessly on the positives, but to those of us who remember IBM Watson, an enormous investment into medical AI that crashed and burned over the course of a decade, it’s harder to be optimistic. The authors talk about a wonderful future where we all have access to endless data about ourselves, but they also acknowledge that they already tried to form a company based on this promise, Arivale, and it fell apart in 2019.

There’s not much evidence in the book to back up its relentless optimism. From the first chapters, the focus of wellness and personalised medicine is clearly defined as common chronic diseases — diabetes, heart disease, chronic obstructive pulmonary disease — but the success stories included in the book simply don’t match the hype.

We’re introduced to Lynn, who was experiencing the early symptoms of Hashimoto’s thyroiditis and was diagnosed a bit earlier than expected because of the huge gamut of tests Arivale ran on her. Max, another patient, was experiencing health problems that were traced back to extremely low vitamin B12 levels. Another woman, Beth, was diagnosed with colon cancer because of anomalous blood cortisol results.

These are not grand stories of a novel way of medicine. They are boring, everyday stories of how medicine works already. Despite the heady rhetoric of the book about finding people long before they become unwell, virtually all the practical examples deal with illness the traditional medical system would usually pick up anyway.

The authors blame much of the inertia within healthcare on profit incentives, saying things like “trillions of dollars have already been spent for infrastructure and disease strategies that are expected to pay off in the long run… if that changes, the equation changes.” That reads oddly coming from the former owners of a company, Arivale, that charged people thousands of dollars a year for testing and treatment that the book’s descriptions suggest were not proven to have any specific benefit.

This is a well-known problem with precision medicine, and something the book silently struggles with right the way through. We have been capable for years of identifying the people most likely to experience a gamut of diseases, but we have yet to be able to change their fate. A famous saying in medicine is “treat the patient, not the x-ray”: this book seems focused on sorting out minor inconsistencies in various tests rather than on healthcare improvements that will make a difference in people’s lives.

Everyone who has prediabetes is at a pretty high risk of developing diabetes in the near future, something we’ve known since at least the 1980s, but the treatments we have to prevent that transition are still fairly slim — essentially, we recommend diet, exercise and sometimes one or two medications. The main theme of The Age of Scientific Wellness — that identifying illness risk early can completely prevent negative disease states — is missing a crucial step.

There’s also not a great deal of evidence that personalising treatments makes them more effective. Trials of personalised diets have shown, at best, minimal benefits when compared with generic advice. One of the main take-homes from the book — that you should train your brain to reduce your long-term risk of cognitive issues — has very weak evidence behind it and may not improve your outlook.

As a visionary tract, The Age of Scientific Wellness ultimately doesn’t feel convincing enough. The authors are genuine authorities and they lay out their arguments methodically, but I was left sceptical about their vision of the future. We’ve had access to most of this technology for more than a decade. It’s already long past the time when any of this could revolutionise the world overnight.

The book is also not one I’d recommend for those looking for an easy read. Phrases like “these data will allow us to identify data-informed multimodal intervention strategies for personalised care and disease reversal” are pretty common throughout. It often feels like a book written for other scientists working in non-healthcare disciplines rather than for a wider audience.

If you have an advanced degree in a scientific discipline and are looking for a well-written review of some of the more hopeful treatment paradigms that people are spending enormous sums of money on these days, The Age of Scientific Wellness is worth picking up. And the chapters on Alzheimer’s are a harrowing and worthwhile read for anyone with a family member suffering from the condition.

For me, though, the combination of extreme complexity and overwhelming — at times inappropriate — optimism ultimately felt just a little bit misleading. If it had been written in 2013, this book would be visionary, but in 2023 it feels a bit more like a sales pitch for something that has already been and gone. •

The Age of Scientific Wellness: Why the Future of Medicine Is Personalized, Predictive, Data-Rich, and in Your Hands
By Leroy Hood and Nathan Price | Harvard University Press | $55.95 | 352 pages