Penn profs weigh in on 'desktop medicine'

These days, treatments for conditions like osteoporosis and hypertension may start sooner than a patient thinks.

School of Medicine professor Jason Karlawish called this new trend “desktop medicine,” a medical model based on risk analysis.

According to Karlawish, desktop medicine features “clinical actuarial correlations” — a statistical model in which doctors can collect information from patients based on their history and clinical tests and compare that data to studies in order to predict a patient’s risk of developing a certain condition.

Once the patient’s risk has been determined, the physician can intervene to prevent the onset of disease, rather than treat the disease once it has already developed.

Karlawish used osteoporosis as an example of a condition to which desktop medicine is continuously applied. He explained that doctors gather information from a patient like age, height, weight, family history and gender to estimate the risk of developing osteoporosis. If the risk is high enough, some doctors will advise patients to take calcium supplements as a preventative measure.

Advantages of a desktop medicine model can also be applied to patients who might not adhere to long, arduous medical treatment. Karlawish said one intervention that can address non-adherence is giving patients small up-front awards for taking steps toward risk reduction.

“We know from psychology that people tend to be present-focused rather than future-focused,” he said. “If we think that there is a reasonable probability that interventions won’t be continued, then we can build in incentives that would increase the likelihood that patients will stick to treatment.”

Penn anthropology professor Fran Barg approached the model of desktop medicine with caution, as it created the concept of what she called the “pre-patient.”

“Most people don’t spend their lives walking around thinking about what they’re going to get,” Barg said. “When you think about an [individual] identity, you’re asking people to think about themselves as potentially ill when they are not,” she added.

Bioethics professor Jonathan Moreno explained that the idea of desktop medicine had substantial financial implications for the health insurance industry, especially through adverse selection. Insurance companies could charge higher premiums to individuals at risk of developing a certain disease.

Karlawish anticipated the financial implications of the desktop medicine model. “Excluding people on the basis of pre-existing conditions unfolds in a healthcare system organized around a for-profit motive — it could be potentially unfair,” he said, emphasizing the importance of a healthcare system that distributes care equitably to all.

Despite financial implications and its effect on patient identity, the concept of desktop medicine is recognized for its potential benefits. “It is important to be aware of risk for disease, especially for certain things that need to be taken into account,” Barg said. For diseases like breast and ovarian cancer where the risk of onset increases with age, “it is important to know that you need to get a mammography when 50 and a pap smear at 21,” she added.

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