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.