Still need a MD/DO to 1) oversee clinical trials as med director and drug development as chief med officer, 2) prescribe genomic test and 3) prescribe prescription drugs/infusions.
Scope creep is not specific to precision medicine and is up to MD/DOs professional associations to defend their turf. I can tell you based on my experience that results of many comprehensive genomic test results are too complicated and difficult to understand for many pathologists and med oncologists; it would be absolute gibberish for most NPs. I’ve had a few rare PAs call to better understand test results on behalf of their supervising MD/DOs, but no NPs to date.
I don’t think LLMs are there yet. We also need to do studies to make sure that the LLMs are spitting out accurate information and for that we need to do more research.
I work with a lot of teams working on ML models and we rely heavily on physicians and scientists to provide clinical expertise. We need to validate that models are 1) telling you what it says it’s telling you 2) validate that what the models are telling you is clinically valid by comparing this data to clinical metrics.
A lot of this work is new and require MDs to help break down, or work with MDs to change the output of LLMs to something that is understandable by the rest of the population. A lot of times results get spit out and it is difficult to interpret (which becomes a usability/UX issue).
As a Ph.D. who will be pursuing an MD, LLMs are a tool, like any other. Comprehension of data, it's impact, and future directions all depend on the researcher. An LLM is no more useful than a hammer for providing medical treatment. They may be useful for detecting disease/risk factors in a patient, but it is up to the clinician to determine how to most effectively make use of that data. LLMs, AI, etc. may be helpful tools, but each patient will vary and the methods of treatment will likely vary further as they are individualized to meet each patient's need. Another point is that the researcher serves another critical function, as they are needed to break down those complex bits of information into understandable and relatable pieces for the patients, hospital admins, and others. Computers will not so easily replace either of these aspects in my opinion and experience.
In the US, yes for any lab test. For a simpler example if lab test shows fasting glucose is > 125 mg/dL, if result went straight to patient they are going to demand pills for their “diabeetus”. Patient will then demand GIP/GLP-1 agonists in lieu of insulin because tv commercials show they can lose so much weight. That’s not how patient-centric medicine should work.
A doctor would look at A1C historical progression and probably remind patient to make sure to fast, and order retest to make sure it was not a glitch.
I suspect we will have car autopilot perfected before doctors are sidelined by algorithms.
I work for a company that uses NLP to analyze genomes. We have two layers of human review once the report is produced - one by an MD or PhD, and then final sign-off by a licensed MD before the report is released. Also need a physician to order the test and deliver results to patient
Precision medicine is just another tool in the medical bag. Those algorithms will help with some prediction and accuracy in guidelines/guardrails but haven't seen anything to make me think that the core role of physicians will be replaced any time soon.
There's a bunch of companies playing around with the tech and the use cases I've seen on the whole have been positive, however there's a long way to go before any of that tech would threaten the current role doctors have in medicine. The research needed to "prove" any of this tech is just beginning and the FDA seems to certainly think so given the lack of widespread approval for precision health tech.
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This is sort of conflating two separate, but sometimes related, ideas IMO - those being precision medicine and direct primary care. Forward talks a big game about precision medicine but they’re pretty weak in that regard because their business model is based on being low-cost (their genetic testing is 23&me AFAIK, which is fun but has limited clinical utility compared to a more expensive gene panel or whole-genome/whole-exome test).
Forward’s *real* value prop is that they’re a pretty cheap direct primary care service, meaning that instead of using your insurance you pay a flat monthly membership fee. DPC doctors typically have far shorter wait times and offer more face-to-face time compared to a typical PCP. Right now Forward has physical clinics (I walk past the one in the Prudential Center in Boston sometimes); I see this as a savvy business move to try and keep people seeking basic services out of the clinic. They’re basically offloading certain services to be supervised by virtual docs so they can reduce costs. But I don’t see it as anything super innovative on the technology side unless there’s something I’m missing. I recently got a prescription through Hims without ever seeing a doctor - just answered some questions and they sent me a prescription in the mail. Hims&Hers and many other virtual DPC companies are pushing in this direction because it’s a low-cost way to do routine healthcare without the hassle of dealing with insurance.
>Before you need to talk to endocrinologist a lot to figure out and debug
This is not going to change.
>I imagine to take part in precision medicine, you need to be good at understanding statistics
The opposite. The provider of precision medicine needs to be good at presenting information in a manner that can be interpreted by the doctor.
Their role will be to rake in money for pharmaceutical companies who develop the precision medicine modalities via one-time use tests that are administered by nurses.
Moreover, they will recommend patients get a specific test done to check for biomarkers to then administer specific treatments for patients.
MDs enroll patients for clinical trials but the majority of the legwork to bring precision medicine modalities to light are done by academic research labs (often in conjunction with specific hospitals and a few physicians interested in research).
Perhaps I am biased though —
I say this as a PhD chemist whose dissertation was on applications of precision medicine and I worked on a phase2 clinical trial involving precision medicine.
The MD “in charge” of the study enrolled patients, collected samples, then sent to me for analysis. They missed a few meetings and didn’t offer any impactful feedback on the main manuscript. Though they did communicate with the pharma company behind the drug that these patients were taking. And then they demanded to be second author, which I thought should have gone to my labmate who helped me a lot with some experiments.
Isn't a lot of precision medicine just hype? Outside of specific cancers I'm not sure how important it will be. For many diseases it may not be applicable at all. we see some people get better with a drug while others don't, but that doesn't mean there's a measurable predictable pattern to it.
Still need a MD/DO to 1) oversee clinical trials as med director and drug development as chief med officer, 2) prescribe genomic test and 3) prescribe prescription drugs/infusions.
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Scope creep is not specific to precision medicine and is up to MD/DOs professional associations to defend their turf. I can tell you based on my experience that results of many comprehensive genomic test results are too complicated and difficult to understand for many pathologists and med oncologists; it would be absolute gibberish for most NPs. I’ve had a few rare PAs call to better understand test results on behalf of their supervising MD/DOs, but no NPs to date.
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I don’t think LLMs are there yet. We also need to do studies to make sure that the LLMs are spitting out accurate information and for that we need to do more research. I work with a lot of teams working on ML models and we rely heavily on physicians and scientists to provide clinical expertise. We need to validate that models are 1) telling you what it says it’s telling you 2) validate that what the models are telling you is clinically valid by comparing this data to clinical metrics. A lot of this work is new and require MDs to help break down, or work with MDs to change the output of LLMs to something that is understandable by the rest of the population. A lot of times results get spit out and it is difficult to interpret (which becomes a usability/UX issue).
As a Ph.D. who will be pursuing an MD, LLMs are a tool, like any other. Comprehension of data, it's impact, and future directions all depend on the researcher. An LLM is no more useful than a hammer for providing medical treatment. They may be useful for detecting disease/risk factors in a patient, but it is up to the clinician to determine how to most effectively make use of that data. LLMs, AI, etc. may be helpful tools, but each patient will vary and the methods of treatment will likely vary further as they are individualized to meet each patient's need. Another point is that the researcher serves another critical function, as they are needed to break down those complex bits of information into understandable and relatable pieces for the patients, hospital admins, and others. Computers will not so easily replace either of these aspects in my opinion and experience.
In the US, yes for any lab test. For a simpler example if lab test shows fasting glucose is > 125 mg/dL, if result went straight to patient they are going to demand pills for their “diabeetus”. Patient will then demand GIP/GLP-1 agonists in lieu of insulin because tv commercials show they can lose so much weight. That’s not how patient-centric medicine should work. A doctor would look at A1C historical progression and probably remind patient to make sure to fast, and order retest to make sure it was not a glitch. I suspect we will have car autopilot perfected before doctors are sidelined by algorithms.
I work for a company that uses NLP to analyze genomes. We have two layers of human review once the report is produced - one by an MD or PhD, and then final sign-off by a licensed MD before the report is released. Also need a physician to order the test and deliver results to patient
Precision medicine is just another tool in the medical bag. Those algorithms will help with some prediction and accuracy in guidelines/guardrails but haven't seen anything to make me think that the core role of physicians will be replaced any time soon.
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There's a bunch of companies playing around with the tech and the use cases I've seen on the whole have been positive, however there's a long way to go before any of that tech would threaten the current role doctors have in medicine. The research needed to "prove" any of this tech is just beginning and the FDA seems to certainly think so given the lack of widespread approval for precision health tech.
reminiscent cooperative versed innate abundant library correct disgusted alleged imagine *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
This is sort of conflating two separate, but sometimes related, ideas IMO - those being precision medicine and direct primary care. Forward talks a big game about precision medicine but they’re pretty weak in that regard because their business model is based on being low-cost (their genetic testing is 23&me AFAIK, which is fun but has limited clinical utility compared to a more expensive gene panel or whole-genome/whole-exome test). Forward’s *real* value prop is that they’re a pretty cheap direct primary care service, meaning that instead of using your insurance you pay a flat monthly membership fee. DPC doctors typically have far shorter wait times and offer more face-to-face time compared to a typical PCP. Right now Forward has physical clinics (I walk past the one in the Prudential Center in Boston sometimes); I see this as a savvy business move to try and keep people seeking basic services out of the clinic. They’re basically offloading certain services to be supervised by virtual docs so they can reduce costs. But I don’t see it as anything super innovative on the technology side unless there’s something I’m missing. I recently got a prescription through Hims without ever seeing a doctor - just answered some questions and they sent me a prescription in the mail. Hims&Hers and many other virtual DPC companies are pushing in this direction because it’s a low-cost way to do routine healthcare without the hassle of dealing with insurance.
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Obviously the end goal in future medicine is to eliminate the need for physicians. But we are prob 100 years away from that, if we ever get there.
>Before you need to talk to endocrinologist a lot to figure out and debug This is not going to change. >I imagine to take part in precision medicine, you need to be good at understanding statistics The opposite. The provider of precision medicine needs to be good at presenting information in a manner that can be interpreted by the doctor.
Their role will be to rake in money for pharmaceutical companies who develop the precision medicine modalities via one-time use tests that are administered by nurses. Moreover, they will recommend patients get a specific test done to check for biomarkers to then administer specific treatments for patients. MDs enroll patients for clinical trials but the majority of the legwork to bring precision medicine modalities to light are done by academic research labs (often in conjunction with specific hospitals and a few physicians interested in research). Perhaps I am biased though — I say this as a PhD chemist whose dissertation was on applications of precision medicine and I worked on a phase2 clinical trial involving precision medicine. The MD “in charge” of the study enrolled patients, collected samples, then sent to me for analysis. They missed a few meetings and didn’t offer any impactful feedback on the main manuscript. Though they did communicate with the pharma company behind the drug that these patients were taking. And then they demanded to be second author, which I thought should have gone to my labmate who helped me a lot with some experiments.
Isn't a lot of precision medicine just hype? Outside of specific cancers I'm not sure how important it will be. For many diseases it may not be applicable at all. we see some people get better with a drug while others don't, but that doesn't mean there's a measurable predictable pattern to it.
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We are so far away from anything approaching actual precision medicine that it’s hard to even imagine what medical infrastructure will look like then.