Population vs Individual Healthcare
Dr. Topol: You're working 2 different ends: the individual, or the N of 1, and then your warm-up act in New York City. There is some tension there.
Dr. Mostashari: There is.
Dr. Topol: There are guidelines. There is population health.
Dr. Mostashari: Yes.
Dr. Topol: And then there is what is right for that particular patient-doctor relationship. How do we get that on track?
Dr. Mostashari: I am really glad you brought it up, because there is a tension there between personalized medicine at its best, precision medicine, which we all want to get to. We want to get to a place where there is evidence. And if there is not any evidence, we must learn from every individual healthcare encounter in a way that benefits the world's knowledge and contributes to the world's knowledge. Right? That is how I think of where we are going to be with smart health and where we are today, which is pretty blunt, evidence-based science that says things like "people with diabetes should be taking an aspirin or they should have their Pneumovax® vaccine or be on a statin." And there is tension between where we want to go and the bluntness of these guidelines. I get it, but what I think is interesting to observe sometimes is that there is a vast wilderness out here, which is untouched by any science, which is untouched by any evidence, in which variation doesn't teach us anything. That gets lumped in somehow with precision personalized medicine based on evidence and science, and it is not that.
Dr. Topol: What about this evidence-based medicine, where you get people in a room and there are no data -- they just give you their opinions. There is a lot of that too.
Dr. Mostashari: Ninety percent, probably, of what happens in healthcare today has no basis in evidence. At the very least, I think what we owe ourselves and our patients, what we really want to do is: If we have variation, if we make a decision that is not based on the general guideline, it should be studied so that we learn something from that variation.