Doctors adhere to the Hippocratic Oath, or the idea of “do no harm,” when it comes to treating patients, but over the years, the industrialization of the medical profession, bottom-line pressures from health insurers, and the increasingly high cost of medical care have all made it more difficult for doctors to truly adhere to that adage. That’s largely because of five crucial factors resulting from the pressures that modern physicians face, according to a 2021 report published in the Journal of General Internal Medicine. T
hese include everything from the amount of time a doctor can spend with a patient to the increasing complexity and demands of the modern health care system and new and novel viruses like Covid-19. It also includes the fact that a majority of our medicine is based on a population-based model, a model that relies on what is good or works for the average number of people.Evidence for population-based medicine comes from studies of large populations or datasets, the results of which are reliant on the average response. While in practice that sounds like a sound approach, it can still mean that a large number of people will fall outside that average range and not get the treatment they need or have adverse outcomes.
For example, patients with similar symptoms are given the same prescription for treatment, though the underlying conditions of their illness might be completely different. In general, population-based models don’t take things like genetics, environment, lifestyle, and other factors into account. Population-based medicine has generally focused on the treatments for populations, and less so on the prevention of health problems.
Precision medicine stands on the shoulders of population medicine. Physicians center on the individual in front of them and take things like individual genetics, background, environment, lifestyle, and other factors into consideration and then prescribe specific medicines or suggest lifestyle changes to help prevent or manage disease and illness and support more holistic wellness.
While there are plenty of reasons why our health care system is broken (and in many ways it is, according to folks like Robert H. Shmerling, MD, the senior faculty editor of Harvard Health Publishing), there is a small and growing collection of doctors and academics working within the system, using cutting-edge techniques and technology to find ways to put the patient and the human first.
I sat down with three pioneering doctors who are working to change the way that patients are treated in modern-day medicine and leveraging precision medicine to do it.
Integrating Plastic Surgery & Dermatology Techniques for Gender-Affirming Care
Dr. Elie Levine is a plastic surgeon based in New York, and alongside his wife, Dr. Jody Levine, who is a dermatologist, he and his office provide gender-affirming care as well as plastic and cosmetic surgery for all kinds of people, including those who identify as transgender.“My goal is really to help people’s quality of life,” Dr. Elie says. “Life is short for everyone, and the more you can enjoy it and the more satisfaction you get from life, the better it is. I see it in so many patients coming in where they just have an added level of comfort, an extra, almost a hop in their step, and they’re just … happier with who they are and what’s going on with their life.”Using his training in multiple aspects of plastic surgery, including hand surgery, body contouring, facial surgery, and other plastic expertise, along with his wife’s knowledge of high-tech dermatological techniques, Dr. Elie helps transgender patients. He incorporates techniques from his wife’s dermatology work into the work he does for his patients to provide things like faster healing or improved collagen production, as well as reconstructive and gender-affirming care. “I have a keener appreciation of what minimally invasive and small, little nuanced procedures can do, if done in combination with cosmetic surgery,” he says.Elie says that in the last year or so, he’s seen an uptick in gender-affirming cosmetic procedures and inquiries in two groups: those aged 18 to 30 and those in their 60s. He believes this is because of a couple of different factors.“I think there’s a little more acceptance of gender-affirming care,” Elie says. “When I talk about acceptance, I’m not just talking about the world at large, but I’m saying even acceptance [from] patients. Most inquiries from patients want to know what opportunities they have and what potential they have, and what can be done to help them in their journey. And now, I feel like a lot of patients coming in want to kind of move along with their process, and they almost carry confidence about it as opposed to almost hesitancy. … There’s almost this sense of ‘I know what I’m seeking out. I know what I need for myself. I think these are the right things for me; can you help me in this process?’ Some of that is the world kind of improving, and some of that, I think, is just more information out there for people to understand what’s doable.”
Using Artificial Intelligence (AI) & Machine Learning to Improve Your Individual Health
Dr. Florence Comite is pictured in a headshot.DR. FLORENCE COMITEDr. Florence Comite began her health care journey as a clinical researcher with a focus on internal medicine, pediatrics, and endocrinology at Yale, where she founded Women’s Health. There, she says she started to question why, with all the data that she had, the health care system was still focused on treating illnesses like diabetes rather than preventing them.“I would look at numbers and people — regular, old numbers that you’d get in an annual report — and say, ‘Oh, my God, this person is on a path to become a diabetic or have a heart attack or Alzheimer’s.’ And I realized that I thought every doctor did that,” she says. “What’s really happening is that we’re aging, and if we could stop aging by reversing it physiologically, working with the body, we can actually stop disease, and that’s what I set out to prove.”Her work led her to found the Comite Center for Precision Medicine & Health, which takes a number of individual factors into account and leverages machine learning and artificial intelligence to help people make more informed decisions about their health over a longer period of time. She is also working on a start-up called Groq Health, which leverages data about sleep, favorite foods, metabolism markers, and activity levels, as well as genetics, to give highly personalized recommendations to maximize your health. The Groq Health app is currently still in beta testing, but Dr. Comite says that she and her team are working hard to get it to the public.“I have a million apps on my phone, and I’m always studying things,” Dr. Comite says, pointing out that she wears a glucose monitor and regularly checks her app to find out what her levels are. “There’s so much you can learn [through wearables], but the data is all siloed,” she continues, pointing out that one of the major frustrations patients have is not being able to understand or act on the data that is presented.Comite says that while she truly thought that precision medicine that would incorporate details of genetics, as well as lifestyle, would have been here by now, she’s hopeful that her approach of leveraging both advancing technology like artificial intelligence and machine learning will provide more people with more targeted care and increased longevity.
Making Brain Health a Standard of Care
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Dr. Alvaro Pascual-Leone is a professor of neurology at Harvard Medical School and the chief medical officer and co-founder of Linus Health, a digital health company that’s developed a number of simple, in-office tests that can predict, detect, and address cognitive and brain disorders like dementia and Alzheimer’s. Dr. Pascual-Leone also happens to be a believer in the idea that the brain is central to who we are.“What has really always made me passionate is to try to understand what makes us who we are, who we become, what makes you tick, what makes me tick, what is my purpose. Who are the people I love? And why? And all that turns out to be manifestations of my brain or your brain — of the human brain. And when that brain doesn’t work properly, then it threatens to take away our very essence. The No. 1 cause of disability, more than cancer and cardiovascular disease together, is currently brain diseases,” Pascual-Leone says.Linus Health is developing tests that clinicians can use in their offices to provide regular checks on patients’ brain health. These tests can show if you’re developing the markers of brain degenerative diseases like Alzheimer’s and dementia, which affects around 5.8 million people, and disproportionately affects women. Dr. Pascual-Leone points out that most brain tests today don’t take place until someone starts to show symptoms, which is frequently too late.“I believe that we need to empower individuals to make their life choices. But in order to do that, we need to visualize where we are with the state of our brain health and what are the risks we face. We need brain checks. Brain checks that properly capture things in sort of what I call the pit-stop model,” Pascual-Leone says.His pit-stop model is based on the idea behind pit stops in a Formula One race: Drivers strategically come into the pit to change tires, for example, to prevent catastrophic failure on the racetrack. He and his team are working to create and implement brain tests that are like pit stops that can help prevent degenerative brain disease before it’s too late.“Just like in Formula One, patients should be able to do a very quick, very targeted pit stop, and the doctors can then monitor the person the same way we monitor the car during the race. We can develop very sensitive, very quick assessments that almost feel like a game but that you can do as a physician, and that empowers your clinician to make recommendations for you that you can own and you can follow,” he continues.While most of these techniques and approaches are still in the early stages, doctors like Dr. Levine, Dr. Comite, and Dr. Pascual-Leone are working to empower patients to take ownership of their long-term health and leveraging advanced technology to do so. It will take time for these kinds of cutting-edge tests and treatments to filter down to the wider population, but it’s heartening to see how these doctors are changing the health care and wellness conversation for patients.