Doctors, Pharmacogenomics, Robotics, and AI
Here are my thoughts after talking to Dr. Greg Gatchell FACLM AGSF. He is a board-certified Medical Doctor who has specialized training in geriatrics and is also a fellow of the American College of Lifestyle Medicine. We discussed topics related to physician burnout, moral injury, massive transformative purpose and longevity, lifestyle medicine, the CHIP Program, and the future of medicine.
DOCTORS: BURNOUT VS MORAL INJURY
Regarding Doctor burnout, he shares his struggles integrating other interests into his life and found that this was very hard to do as a doctor. I can relate to this issue as medicine is such a demanding career that adding another job, or interest on top, can be quite challenging, but worth it.
Dr. Gatchell tells us that he wanted to incorporate entrepreneurship into his skillset of medicine, and he states that doing both was quite a lot to take in. He discusses the difficulties with practicing within the current Healthcare System and how the current healthcare system focuses on dealing with caring for the chronically sick instead of getting to the root of disease and helping people create meaningful, healthy lives. In essence, he stated that our healthcare system is “sick-care” rather than “healthcare.”
We also touched on the term moral injury, a new term to differentiate from burn out. It is a new term that describes different aspects of physician burnout as sometimes the term physician burnout can be perceived by many practitioners as victim-blaming. Therefore, moral injury describes the fatigue caused by not being able to do what you think the patient needs. For example, someone with Diabetes and obesity has two issues; one they have to deal with the possibility that their disease could result in immediate harm, and lowering these risks can require medications or surgery. On the other hand, the person with Diabetes has to get to the real root of the disease and try to reverse it. Otherwise, the condition will continue to come back in a never-ending downward spiral. We must ask better questions; not only which medication to use? But how can we help this person heal so that they can take better care of their bodies and create their own healthy, meaningful life? Take, for instance, Type 2 Diabetes, commonly treated as a death sentence and a progressive, irreversible disease with multiple medications. However, multiples studies like the DiRECT (Diabetes Remission Clinical Trial) show that Type Two Diabetes is reversible in approximately 85% of the Type two diabetics. Thus, we have a moral conflict, and we know the patient needs certain lifestyle modifications and healing. Still, we have been trained as doctors to mainly think of the disease in terms of treatment and management with medications, and not disease reversal. Furthermore, if you look at the guidelines from the American Diabetic Association is not mentioned that Diabetes Type Two is reversible or how to do it.
Another aspect of moral injury is the gap created by the latest scientific studies and what gets into the scientific papers and thus into Medical education. There are evergrowing discoveries in the health sciences. The newest information can often trickle downstream through influencers and is only years after it makes it into the medical education system. Therefore, the latest news does not get to the bedside, and it creates confusion and suffering that is often not recognized, leading practitioners to have fatigue from seemingly unidentified sources. So the practitioner will notice that something is not right but is unable to put their finger on it. It is this that pushes many practitioners to discover and advocate for new ways of practicing medicine. The practitioners often have a suspicion that the treatment might not be the best for the patient or the one that is going to help that patient create long-lasting health or that the treatment or procedure is not getting to the root of the issue. The practitioner finds new treatments and management that are evidenced-based. And they are validated when the practitioner starts making decisions with the patients focused on getting to the root of the issue. When the practitioner sees the results, both the patient and the practitioner feel better about the management — thus designing a collaborative plan to resolve the issue or mitigate its effects leading to true lasting health.
We discussed the latest science and diagnostics, which help physicians progressively get to the root of the disease. And despite this information being readily available, it is not widely used, because, we have been taught and are used to prescribing various medications that have just been bandaid treatments for many conditions. Considering this, we discussed the difficult task of incorporating new technologies and diagnostics and practicing in a way that is true to practitioners and the latest science.
LONGEVITY
In terms of longevity, we discussed the impact of having a massive transformative purpose. Having a massive transformative purpose has been shown in scientific studies to add approximately five years of quality life. In essence, increasing how long we live. The studies done on the areas of the world called the Blue zones have discussed the subject of massive transformative purpose. The blue zones are areas around the world where people live longer lives than the average human being.
LIFESTYLE MEDICINE
The next topic we touched upon was Lifestyle medicine. I came across Lifestyle medicine after learning about the work of Dr. Ornish. Dr. Ornish has dedicated his life to figuring out how different habits can reverse chronic conditions. He showed with over 20 years of research that coronary artery disease, like most chronic conditions, could be reversed.
Dr. Gatchell also shared with us that he has become a certified educator on the “CHIP program.” The program allows participants to test initial biomarkers and then have your patients undergo specific evidence-based lifestyle changes and then measure the biomarkers again and see the results. It turns out that the CHIP program is the most well-published community-based lifestyle intervention in the literature. The CHIP program focuses on: think, move, and eat. More importantly, the program focuses on implementing these habits into one’s life.
THE FUTURE OF MEDICINE; TELOMERES, PHARMACOGENOMICS, AI, AND ROBOTICS
The future of medicine is changing rapidly. In the interview with Dr. Gatchell, we talked about what the perfect healthcare system would be. Dr. Gatchell states that an improved version of our healthcare system would be a system that is focused on helping people get to the root of disease and helps them live longer, empowered, healthier lives.
We discussed some of these technologies. Pharmacogenomics uses one’s genome to target specific drugs and increase their effectiveness with the lowest side effects specifically for that person. One of the ways that our body turns genes on or off is through single nucleotide polymorphisms. Our genes are like the ingredients that make up our skin, and our fingerprints are single nucleotide polymorphisms. And these fingerprints determine how our bodies individually react to medications and the environment and how these adaptations result in gene expression. Pharmacogenomics consolidates widely used pharmaceutical sciences such as biochemistry with knowledge of genes proteins and single nucleotide polymorphisms to use them in a clinical setting to improve outcomes. Some of the benefits of pharmacogenomics include more powerful drugs, better safer drugs the first time, more accurate methods of determining appropriate drug dosages, advanced screening for diseases, better vaccines, and a decrease in healthcare costs. If you want to learn more about Single nucleotide polymorphisms, here is a great resource.
Furthermore, we discussed telomeres, which are the ends of our DNA, like the ends of a shoestring, and they are determinants of our longevity. The cool thing is we can change the length of our telomeres through lifestyle modifications. Thus, we now have a way of determining if new habits prolong the estimate of how long we live. Some research shows that in a matter of 4 days, we can impact the length of our telomeres.
AI and robotics will also play a role in medicine. A study by Oxford University looked at using artificial intelligence to read radiology studies. The study compared 101 radiologists to an AI radiology reading system and revealed that the artificial intelligence system was comparable at detecting breast cancer as the average radiologist. It is interesting to note that the best radiologists outperformed the system, which is a testament to the value of the experienced expert. AI, coupled with machine learning, is expected to improve these radiology reading systems exponentially. It will be interesting to see how that will play out in healthcare workflow and how there will be a relationship between these systems and doctors.
Healthcare is using Robotics in many different ways. Some of the current examples are companies like VerbSurgical whose goal is to democratize surgery. Robots that will draw blood, preventing needlestick injuries to healthcare workers, and making it safer for patients. Another use of robotics is to improve the quality of life for the elder with social companion robots like Jibo, Pepper, Paro, Zora, and Buddy. Companies like luvozo are creating robots that will help sterilize rooms decreasing the amount of hospital-acquired infections. Robots in the form of Exoskeletons in the setting of spinal cord injury have been useful. Another new way healthcare is using robots is in the Pharmaceutical distribution chains, and companies like Innovation are doing just that. Robots will also go into our blood, and devices such as the origami robot are paving the way. Furthermore, companies such as Telemed, Doctor on demand, HealthTap, American well, Teladoc, Aviza, and Babylon health are using robotics to improve telemedicine.
Thank you for reading, as these are my gathered thoughts on my conversation with Dr. Gatchell, and thanks to Dr. Gatchell for an excellent discussion. Please feel free to share, leave any comments, questions, or additional information.
Full Interview