Who Will Solve Healthcare For Our Parents And Grandparents? Probably Not Google.

I assume by now that you’ve heard the news: Google wants to tackle aging. Specifically, they announced this week the launch of Calico, “a new company that will focus on health and well-being, in particular the challenge of aging and associated diseases.”

Because, says Larry Page, with some “moonshot thinking around healthcare and biotechnology, I believe we can improve millions of lives.”

“Can Google Solve DEATH?” shrieks a TIME cover.

Google’s goal, it seems is to find ways to extend human lifespan and essentially stave off aging.

Coincidentally, on the same day Physician’s First Watch directed me towards this NEJM editorial, announcing that NEJM and the Harvard Business Review are teaming up on a project on Leading Health Care Innovation.

Here is the paragraph that particularly caught my eye:

“The health care community and the business community today share a fundamental interest in finding ways to achieve higher value in health care. The ultimate objective for both communities is to keep people healthy, prevent the chronic illnesses that consume a large fraction of our health care dollars, use medical interventions appropriately and only when needed, and create an economically sustainable approach to the delivery of health care. While we want to foster innovation and novel therapies against disease, we also recognize that, whenever possible, prevention of disease before it is established is the better solution.” [Emphasis mine.]

And therein lies the rub. Whether it’s Google or a high-powered partnership between NEJM & HBR, everyone is enamored of prevention and innovative cures.

Let’s prevent those pesky chronic diseases! Let’s cure aging!

Ah, spare me.

The problem of prevention

Now, it’s not that I’m against prevention. I would love nothing better than to see most Americans living healthier lives, with more exercise, better eating habits, less obesity, and less stress.

And of course it will be a wonderful day when we become actually able to cure or stop terrible diseases such as Alzheimer’s, or Parkinson’s, or cancer.

But when we perpetually focus on cures and prevention, where does that leave those of us – patients and clinicians — who are struggling to manage multiple chronic diseases and age-related difficulties?

Consider this: the most urgent health policy problem of the next 10-20 years is how to provide compassionate and effective healthcare to the Medicare population, at a cost we can sustain. For most of them, it’s too late for prevention and cures are not an option; either their bodies have already suffered damage from age and chronic diseases, or a cure is still being researched.

In other words, for millions of Americans (including those who are driving the bulk of healthcare expenditures), the thorny problem is how to provide better management of ongoing health problems, and of age-related difficulties.

How to care, rather than cure

Prevention does, of course, play a role in this. We want to prevent chronic illnesses from getting worse, or at least slow the progression. We want to minimize functional impairments, so that people can have as much independence and quality of life as possible. We want to prevent related illnesses and complications, so we work to prevent falls in older adults with poor balance, and we work to prevent renal failure in diabetics.

Most importantly, we should strive to prevent needless suffering of patients and caregivers. Illness and age-related declines are inevitably difficult for people, but we make things even harder due to our chaotic and uncoordinated healthcare system that remains unable to offer high-quality primary care and person-centered care to most patients.

Think of Katy Butler’s story, recently published in her book, Knocking on Heaven’s Door. Her vigorous 79 year old father is felled by a devastating stroke. He and his family go on to endure six years of disability and decline, in large part because a cardiologist persuades the family to place a pacemaker.

What kind of moonshot thinking will help future families avoid this ordeal? Now, perhaps some will argue that we need to focus on preventing such strokes. Or they’ll say we need innovative therapies so that more patients can recover from such strokes.

Well yes, but here’s the thing. If it’s not that stroke that leaves an older person disabled and a family overwhelmed, it’ll probably be something else. Advancing heart failure. Progressively crippling arthritis. Maybe we’ll find a cure for Alzheimer’s but we’ll still have vascular dementia. (Plus any cure for Alzheimer’s is at least 20 years away from widespread clinical use, if not more.)

I’m not against prevention, innovation, and moonshots. I’m just against the fact that they are constantly hogging the limelight.

For those of us interested in an aging America, there are some innovative healthcare models being developed, some of which might get older people off the medical merry-go-round. They need more attention, funding, brainpower. (Suggest NEJMand HBR set up a section on “Leading Health Care Innovation” focused on helping today’s Medicare population. Then maybe we’d get somewhere faster.)

But as far as I can tell, Google is not going to help me help my patients and their families. Those people who advocate healthier eating habits as a cure for our healthcare ills are not going to be much use to me either.

Should we be treating age as something to be cured, or staved off? Or should we roll up our sleeves and figure out how to better help elders and families through the challenges that most of them will live with for years?

Really, we need both. Especially more of the latter.

Now who is willing to direct a ton of money and brainpower to innovations in age-related medical caring rather than curing?

Leslie Kernisan, MD MPH, is a practicing geriatrician, cautious techno-optimist, and enthusiastic caregiver educator. She hopes to someday be surrounded by cool tools and innovations that will make great geriatric care totally doable for all, especially primary care providers and family caregivers. She is a regular THCB contributor, and blogs at Geritech.org and at drkernisan.net.

13 replies »

  1. Thank you a bunch for sharing this with all of us you actually realize what
    you are talking approximately! Bookmarked. Please also consult with my site =).
    We could have a link trade arrangement among us

  2. Agree that often the issues related to aging and health become very micro-medicalized, which is tiresome for patients and families, and also often impedes true person-centered care.

    That said, people often reach a point at which their health issues — and encounters with the healthcare system — are big dominant factors in their life. As I mentioned above, Knocking on Heaven’s Door is a good book for illustrating this stage.

    I do think many elders will need clinicians to help them with their diseases and health issues in order for them to have the best independence, function, and quality of life. The tricky part is figuring how to make it doable, how to not let it take over families’ lives, and how to not lose sight of the person-patient at the center of it all.

  3. thanks for bringing this initiative to my attention. I personally focus mainly on better management of the medical/health issues affecting the elderly, and that their caregivers have to help handle.

    But always good to see more innovators interested in the aging space and needs of older adults!

  4. Thxs for this comment Lauren.

    Well, Google has strengths in areas that are really important to the health & healthcare of an aging population. For instance, Google is often great at making useful information easily accessible and available. I am constantly stymied in practice by trouble accessing information, or difficulty organizing it for myself and for the families. Even something that helped families and clinicians find the right tech app with less hassle would be helpful.

    But this is probably not the route that Calico will go.

    Re aging and end-of-life, I’m reading Knocking on Heaven’s Door now. Good for illustrating how much messy overlap there is between the two…which is why I find addressing end-of-life issues much harder in the context of primary care clinic than when I used to staff Palliative Care consult service in the hospital.

  5. these are great examples of low-tech interventions that really improve the quality of life of aging adults and/or those with dementia.

    Google needs to be given the right problems to solve.

    How to fund and improve access to the kind of sensible and humane services many older people need is another story altogether…very important, thanks for bring up!

  6. This is the SINGLE issue around which the US medical profession and the US can possibly mature?

    We really need a strong dose of humility – Not the arrogance and hubris and financial costs to actually believe that we can “cure” aging

    Dr. Rick Lippin

  7. I should have said “15+” years on google–more time if we add other search engines.

  8. What I am finding difficult is the “heaviness” surrounding these topics, whether it’s prevention or management. I went through the decline and eventual demise of both parents, and it was a torturous process. At this point, I have friends with/without chronic illnesses who are moving to Florida or focusing on their illnesses. I am staving all this off by doing what I’ve always done–working, weight training, hip hop dancing, socializing–focusing on a “here and now” that is similar to what I’ve always enjoyed. Diana Nyad did the same thing, in my view–persevered at a life-long goal–not something that started/ended at a certain age. Yes, we must continue to care for our parents, friends and ourselves. But the emphasis on “aging” and “boomer markets” and the like are obscuring the joy we could all be experiencing simply by functioning as best we can and striving to do what we’ve always done (assuming we’ve enjoyed that). I’ve been saying for 30 years that if you google “health” or “mental health,” you get very little about health and a whole lot about disease. How can we shift our mindset not into some New Age spiritual-type stuff (though that might be fine for some), but to counter all the messages that say: oh, at this age, you have to take statins, and at this age, you have to have a colonoscopy…etc. Physiological, emotional, mental and social “ages”–they vary in everyone and we need to take all of it into consideration when defining ourselves and others.

  9. Really great post and important points.

    I am a big fan of Joseph’s House, which offers compassionate end-of-life care for homeless men and women in Washington, D.C.., because they are not trying to cure death but rather help individuals die with dignity and acceptance. Moreover, as you astutely pointed out to me on linkedin (thank you!), caring for the aging population and end-of-life care are very different concepts, both in need of innovation and attention. Like you, I hope Google will do more than just play the cool Silicon Valley company and really tackle how care is delivered to the aging population.

  10. “Most importantly, we should strive to prevent needless suffering of patients and caregivers. Illness and age-related declines are inevitably difficult for people, but we make things even harder due to our chaotic and uncoordinated healthcare system that remains unable to offer high-quality primary care and person-centered care to most patients.”

    Thank you for writing this, Leslie.

    Spent a little time reading about musical therapy for dementia–ala Oliver Sacks–yesterday. Such a wonderful way to provide patients a sense of identity and opportunity to feel and focus, to provide loved ones immersed in caretaking a little sense of relief, and to remind nursing staff and care providers that their patients were once people with the ability to live well and independently.

    Wonder if Google would be down to invest in drum circles or a capella in skilled nursing facilities…

  11. “Should we be treating age as something to be cured, or staved off? Or should we roll up our sleeves and figure out how to better help elders and families through the challenges that most of them will live with for years?

    Really, we need both. Especially more of the latter.”

    Yes. I just finished up 15 years of next-of-kin/caregiver duties not too long ago. My Ma spent 4 years in LTCin increasing enfeeblement. I cut $300k in checks for that. My Dad spent 7 years in LTC with dementia (on the VA’s dime). Both of them had had cardiac interventions that extended their lives.

    Difficult stuff, all of it.

    Now I’m 67 and getting up with stiff hands and back pain. My turn, I guess.

    ps- see you at Health 2.0 in Santa Clara?