When it comes to medical breakthroughs, my mind has always taken a techno-futuristic turn, as you would expect from the name of this column.
We need swallowable robot pills! 3D-printed human tissue! Manipulated DNA! Then everything will be better.
This approach is fine and dandy, for sure, but there’s a “shark tank” business incubator at Dartmouth College that thinks an alternate approach is just as valuable.
And despite my geeky preferences I’ve come to share that opinion. Oddly enough, it’s because of alternative medicine.
The Levy Incubator is a joint venture between The Dartmouth Institute for Health Policy & Clinical Practice and Dartmouth Health. It’s been going on for five years, funding around three proposals at a time for a year each.
“The history of the incubator is to focus on care delivery. That’s very different from devices and novel ways to perform complex specialized procedures,” said Evan Cavanaugh, administrative director for the Levy Incubator. “Those are important, don’t get me wrong, but it’s very different from the way the incubator works.”
The Levy Incubator works like any business incubator, giving money to start-up plans with a hope that they’ll be able to keep going on their own, although unlike business incubators it doesn’t require investment returns, just a requirement that winners share what they learn. Richard Levy, a retired business executive and Dartmouth alum, and his wife, Susan, gave $5 million to launch the program.
It also uses a public pitch session to choose winners, like that TV show and various knock-offs. Recently 10 teams of physicians and medical school faculty used three minutes each to pitch their innovations to compete for a year’s worth of funding. Six were chosen to give full applications and three will get the money and time.
The solution can’t require hiring more medical staff, since it’s impossible to fill all the positions that currently exist, and it has to show that it can provide data reflecting its success because you can’t actually help patients unless you can convince hospital administrators to support the program.
But the key point is that programs have to develop and test “health care delivery interventions” with a patient-focused approach. The incubator likes to say that its focus is on the actual delivery of health care — the “how” rather than the “what.”
A gizmo such as telemedicine shows up occasionally but many of the winning systems involve various nudges and prompts, methods of interaction with patients to do things like motivate hypertension patients to monitor their own blood pressure, ways to improve group therapy sessions for things like smoking cessation, or improving the delivery of obesity care, osteoporosis care and palliative care for patients with advanced heart failure.
To a geek, these are very unsatisfying results. We like binary answers preferably involving technology: Give them a shot! Put them in a big machine! Touchy-feely approaches are too analog, too dependent on unpredictable humans.
But that’s the whole point, said Cavanaugh: “One of the key differentiators between these ideas and the traditional shark tank would be our stance on variation. … A product or complex procedure would work to minimize variation. That gets to higher safety standards, higher quality. Our program has to embrace variation, understand that every patient is different, and patients have drastically different feelings about the same medical diagnosis.”
My younger, hard-scifi-loving self would have rolled his eyes at this idea, scoffing at therapies and nudges. But my older self thinks it’s great.
What changed? Decades of seeing alternative medicine.
Most alternative medicine doesn’t “work” in that its claims are flawed or just plain nonsense (I’m looking at you, reiki). Yet a surprising amount does “work” in the sense of often helping patients, sometimes even reiki. Why?
Geeks brush this off by saying “that’s just the placebo effect” which fools the patient’s mind into doing the doctor’s work. Maybe so but the placebo effect is real and quantifiable; it’s foolish to ignore it.
Although it doesn’t express the idea directly I think many of the solutions offered at the Levy Institute really are trying to channel the placebo effect within the structures of scientific medicine.
If you can give medicine that actually works instead of crystals or chakras and also prompt our internal systems to maximize their benefit, you’ve got the best of both worlds.
The easiest way to do this is to increase the time that doctors, nurses or therapists can spend with patients, since scheduling is the biggest advantage of alternative medicine. Your herbalist probably knows you a lot better than your general practitioner does, and your body appreciates it.
But increasing time with patients is the same as increasing staff, which isn’t going to happen. Instead the incubator is often looking for clever ways to get more patient satisfaction and understanding, and thus more self-healing, without spending more time. Hence the emphasis on communication, which Cavanaugh describes as “less check-lists and more affirmative listening.”
Touchy-feely? Yeah, maybe, and definitely not as exciting as growing human organs in vats. But it’s what modern medicine needs.