February 2019

In 2017, the UK Health Secretary tasked cardiologist, geneticist, and digital medicine visionary Eric Topol with carrying out a review on how digital technologies will impact the training, roles, and functioning of clinical staff within the National Health Service (NHS). The outcome of this independent review, published earlier this month, was, overall, very well received. Despite the relative brevity of the document (about half of 104 pages are filled with infographs and images), it contains a lot of nuance; and it is a far cry from the blind techno-enthusiasm that some of us had feared to see. Topol and his co-authors do not treat technology as a fix for everything, and they do not – like some other digital medicine visionaries – envisage the typical patient as a person who orders organic meals via their digital home assistant, track their activity levels on a Fitbit, and would really love to store all their health information in their personal cloud if only their doctors let them. Instead of treating the digitisation of healthcare as a value in itself, the Topol Review puts digital technologies in the service of other values: More time for clinicians to look at, and talk to, patients, instead of looking at their computer screens; improving and measuring health outcomes, instead of seeing the progress of digitisation as a proxy for effectivity gains, and retaining meaningful human control over the use of machines. In this sense, and notwithstanding the valid criticism of some commentators that the Report leaves some of the hardest questions unanswered – the Topol Review has done a very decent job in retaining High Touch amidst the focus on High Tech in recent health policy discourse.

In terms of what the UK Government will do with the findings of the Topol Review I am less sanguine. Government is very likely to read the findings of the review in a way that suits their own vision of the future of medicine. It may have been forgotten by now, but in the same year as he commissioned Eric Topol with carrying out the review, (then) UK Health Secretary Jeremy Hunt, described his hope for the future of medicine in unambiguous terms: By 2028, he predicted, “we may well not be going to doctors for a diagnosis, we might be going to computers instead.” At that time, the UK government had just come out of a lengthy conflict with trainee doctors who had taken to industrial action trying to prevent the adverse changes to their working contracts that the government was imposing. Observers criticised the government’s harsh treatment of junior doctors, who would, after all, be the ones looking after us in the future. (Moreover, the United Kingdom already has one of the lowest doctor-to-patient ratios among OECD countries). But against the backdrop of a vision of medicine with even fewer doctors, but much more data, the government’s uncompromising approach made sense.

And it is to be seen against the same backdrop that the UK Health Secretary hired Eric Topol to review how technological innovation will impact on “the roles and functions of clinical staff”. At that time, Topol had just published a book titled The Patient will See You Now, and he predicted that the majority of health problems will be diagnosed by patients themselves, using digital aids. Hunt may well have hoped that Topol would provide the justification for what he and the Conservative Government has been planning to do: continue with their austerity politics that has led to understaffed, underequipped, and ailing NHS facilities. Many commentators point out that it is mostly due to the unwavering commitment of its staff that the NHS is still functioning as it is.

Fortunately, Eric Topol did not do Hunt this favour. Topol has moved on to become somebody who calls for clinical staff getting better support, to be given more time to learn and to teach others, and to speak to and touch patients. Jeremy Hunt has moved on, too: As the country’s Foreign Secretary he is now helping to advance Brexit, which in turn has catalysed the departure of thousands of NHS staff from the United Kingdom. Thankfully, Hunt does not need to worry about staff shortages in the UK, or about the pending crisis of overdiagnosis that the data enthusiasm that he promotes is helping to create. Dr Watson has his back.

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Barbara Prainsack is a Professor at the Department of Political Science at the University of Vienna, and at the Department of Global Health & Social Medicine at King’s College London. Her work explores the social, regulatory and ethical dimensions of biomedicine and bioscience, with a focus on personalised and “precision” medicine, citizen participation, and the role of solidarity in medicine and healthcare (most recent books: Personalized Medicine: Empowered Patients in the 21st Century?, NYU Press, 2017, and Solidarity in Biomedicine and Beyond, with A. Buyx, Cambridge University Press, 2016). Barbara is a member of the Austrian National Bioethics Committee and of the European Group on Ethics in Science and New Technologies advising the European Commission. She is a proud affiliate of CRE.