For 2,000 years, from Hippocrates’s time through the Age of Enlightenment, the working hypothesis of medicine was that disease originated from an imbalance in the humors. Bloodletting, emetics, purges, warmth, and cold were prescribed in various combinations to offset a perturbation and restore the norm. By the mid-1800s, however, the scientific method was applied to study the best medical knowledge of that time, and conventional wisdom was proven wrong. Even with two millennia of experience, countless well-intentioned physicians treating untold numbers of patients had been using, at best, placebos, and at worst, harmful treatments. Medical practice did a hard reset, ushering in the age of science — redesigning itself wholly for the first time.
The first half of the 1900s was a golden age of understanding physiology, biology, chemistry, and pathology — how the body works and what could go wrong. The latter half of the century brought the second major redesign in medicine, with major breakthroughs in developing effective care — insulin therapy to treat diabetes, antibiotics to treat infection, chemotherapy to treat cancer, medications for anxiety, arthritis, and heart failure — making medical miracles almost routine and laying the groundwork for many of our most common and effective treatments.
The age of belief and the age of science have brought us to today, and we are living through the next huge shift in health care. In spite of the medical advances of the recent past, the global population is on average getting older and heavier, and as a consequence accumulating health conditions. Our health care costs are eating up ever larger percentages of our national (and personal) expenses. We have come to recognize that there is an imperfect (often inverse) correlation between spending more on health care and delivering on better health.
While health care professionals and researchers can, and will, continue to advance scientific knowledge to make medicine better, we also must understand the synergies between innovation, data, basic science, and social science, as well as help each individual understand how his or her health care decisions will impact quality of life. Policymakers, regulators, health IT vendors, and consultants alike must understand the complex interplay between patients’ desires, medical knowledge, payer policies, and measurement capacity to drive change. And it is now, during this next crucial phase, when we must redesign the system coherently, laying the new groundwork for the path that will deliver what we need: outcomes that patients want, at a price we can all afford. This third era of redesign is the age of value.
The need for ongoing health care redesign was the topic of the NEJM Catalyst event, The Future of Care Delivery: Relentless Redesign, streamed live on January 19, 2017, at 9 a.m. to 1 p.m. PT, from Providence St. Joseph Health.
This blog post originally appeared in NEJM Catalyst on January 18, 2017.