WSJ or NEJM?

It's nice to see that the business of medicine is becoming more mainstream, but there are issues and they are usually not discussed at Grand Rounds.

Every medical student grows up reading the New England Journal of Medicine (NEJM), arguably one of the 3 most prestigious medical journals in the world. Faculty strive to get their articles published there and scientists cite NEJM articles frequently to add credibility to their own publications.

Recently, healthcare innovation has gone mainstream and instead of reading about technology innovation first in the NEJM, doctors, patients, and scientists read about it in the headlines of The Wall Street Journal (WSJ). One of the cultural conflicts differentiating industry from academia is the notion of protect and patent in the former versus publish or perish in the latter. As noted in a recent JAMA article, this creates issues.

1. Stealth research and development bypasses the peer review process and appears to be driven more by short commercial, marketing, and investor interests than clinical safety and efficacy or comparative effectiveness.

2. Digital health products and services, if they are deemed to be non-medical devices, do not require FDA clearance before they are marketed. As a result, few have been clinically validated. Remote patient monitoring for heart failure, for example, might reduce hospital readmissions, but there are barriers to widespread adoption and penetration and it is unclear which technologies add value, instead of cost.

3. The conflicting incentives create a technology transfer scramble at major research universities, with the resulting last minute telephone calls to intellectual property attorneys struggling to get the first to file provisional patent delivered before the faculty member is scheduled to deliver her paper at a major medical meeting in 12 hours.

4. Media hype creates unrealistic or misleading expectations in the mind of patients before the inventions have been fully vetted by the physician community.

5. Some argue that the scientific community is so conservative that they interfere with innovation and smother disruptive technologies, like the Theranos clinical lab model. The result are some interesting marketing meetings when the conversation is about direct to patient marketing v marketing to doctors.

6. Conflicts of interest in the medical and scientific community make it hard to see through the self-dealing.

7. The pressure from the investment community to bypass expensive and time-consuming clinical trials results in failed product launches or recalls during aftermarket surveillance. Just ask the folks at Apple Watch.

8. Doctors are confused when it comes to which technologies they should use or recommend to patients or how they should incorporate them into their treatment armamentarium.

9. The lack of scientific or clinical evidence or peer review contributes to more Type 1 and Type 2 technology adoption errors.

10. The value of a given sick care or health care technology differs to different stakeholders and the lack of transparency makes it impossible to gauge whether it meets the goals of reducing per capita costs, improving patient outcomes and the patient and doctor experience.

When I go to Grand Rounds, I see as many residents and faculty with The Wall Street Journal tucked under their arms or in their now-supersized pockets of their white coats (to hold iPads) as those reading the New England Journal. It's nice to see that the business of medicine is becoming more mainstream, but, as I said, there are issues and they are usually not discussed at Grand Rounds.