Bright Idea for a Bad Disease, But Will Knowing Early Help?

Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

As a physician, watching Max Little's TEDTalk, "A Test for Parkinson's with a Phone Call," brings up two divergent thoughts.

First, the pompoms.

Who is this guy, this non-MD, thinking he can revolutionize the practice of medicine, without being a doctor? I'd say he's the future. For most of history, the physician has been the prime mover of medical advances. That was particularly true when the practice of medicine involved mostly art (the physician's subjective experience: "One leech, or three?") and very little science (objective research: "What do randomized controlled trials show?"). But now medicine is mostly science and a small fraction art, and the simpler disease processes have already been mapped out. As we delve deeper into the biochemical and genetic complexities of the human body, it seems to me that future innovations in health care will increasingly come from non-physicians like Little, whose scientific expertise and broad imagination will help them become the new leaders in health care.

Besides that, to really innovate one has to be willing to potentially put oneself out of business; in this case, a cheap 30-second phone call may replace an expensive 20-minute test. Like many long-standing institutions, modern medicine, with physician at the helm, is so thoroughly entrenched that it may be incapable of fixing itself. The cure might have to come from the outside.

Screening for disease -- finding it early, before obvious symptoms develop -- works best when there is a treatment available that can capitalize on early detection.-- Craig Bowron

Second, a Nerf dagger.

Little's voice analysis system holds some exciting possibilities for Parkinson's disease, including the ability to monitor disease progression and response to therapy. But his repeated injunction that the technology be used to find the disease early, "before it's too late," may be a little misleading.

Screening for disease -- finding it early, before obvious symptoms develop -- works best when there is a treatment available that can capitalize on early detection. For example, say I plunk you down at home plate in your local baseball stadium. After arming you with a Red Ryder BB gun, I release a ravenously hungry lion from the center field bullpen. As the beast crosses the warning track, I offer you a pair of opera glasses, so that you can better visualize the lion as it begins to pick up your scent. Forget the opera glasses, how about some binoculars? As the lion enters the infield, I offer you a camera with a powerful telescopic lens. Now you can see every hair on his snout, but as long as the only heat you're packing is a BB gun, a better view just prolongs the terror. Early detection of the lion will not affect the outcome.

Currently there are no medications that can stop or even slow the progressive neurodegeneration that manifests itself as Parkinson's disease. All of our medications treat symptoms only. So for now, finding Parkinson's disease early, when the symptoms are so minor that treatment is not indicated anyway, runs the risk of saddling a lot of people with the psychological angst of knowing what they're in for, without any way to change it. Maybe knowing early would help some patients live their lives better or differently, and maybe symptomatic therapy applied very early in the disease could somehow alter the long-term course. No one knows for certain, but with contributions from the likes of Max Little, we press on. Like ballet, progress is a delicate dance.

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