HIMSS: Smartphones, genomic sequencing will revolutionize care
NEW ORLEANS—The proliferation of mobile devices and the dawn of genomic sequencing will allow digital medicine to migrate into democratized medicine, or what Eric J. Topol, MD, called a Medical Gutenberg era, during his March 5 keynote lecture at the Healthcare Information and Management Systems Society (HIMSS) annual conference.
The importance of patient engagement will lead these efforts, as it is deemed “the blockbuster drug of the century,” and can lead to better healthcare outcomes and possibly lower costs, according to Topol, director of the Scripps Translational Science Institute and chief academic officer for Scripps Health in La Jolla, Calif.
He added that too much of healthcare still represents how the French philosopher Voltaire described healthcare in the 18th century: “Doctors prescribe medicine of which they know little, to cure diseases of which they know less, in human beings of which they know nothing.”
However, that is all changing around healthcare professionals, whether they are aware or not. To demonstrate the rapid change in the digital revolution, Topol pointed out that YouTube, Facebook, Twitter, Skype, Pinterest and LinkedIn all have emerged since 2004.
“The digital revolution is irreversibly transforming our worlds through its acceleration of innovation and drive toward productivity, but it hasn’t really impacted medicine—so far,” said Topol. However, smartphones are spreading faster than any technology in history, and that technology emerged in only 2001 with the iPhone. “Smartphones have collectively changed our lives,” leading to a condition that Topol coined "Homo distratus" because the average attention span went from 12 minutes in 1998 to five minutes in 2008.
However, healthcare will not be immune from the digital revolution for long. For instance, online social health communities, such as PatientsLikeMe, MyBCTeam and FacetoFace, are starting to emerge and have prominence. “People are willing to share their healthcare experiences with virtual peers on these sites, whom they’ve never met, perhaps more than their doctors,” he said.
Also, being able to pick out the signal from the noise, which he said is “ever more challenging, is being assisted by super computers and article intelligence, such as IBM’s Watson.”
He tracked the acceleration of healthcare through these technological steps: internet, digital devices, sequencing, social networking and social/cloud computing.
“We currently practice medicine on a population level,” said Topol. “We do everything the same for every patient, whether it’s screening or pharmacological treatments. We do not individualize care, which is where we really can make a difference, with the technological advancements that previously weren’t available.”
Looking at mass screening as a bad example population medicine, he showed a meta-analysis of mammography screenings in 40 million women above the age of 40 years that demonstrated a net harm in up to 200,000. In the U.S., 40 million women have been screened via mammography. “There is a real problem with false-positives with these tests,” he said. In a recent Consumer Reports article on cancer screening, the authors wrote that “cancer screening remains stuck in a 1960s.”
In another example of population health, atorvastatin (Lipitor, Pfizer) was a $13 billion-per year drug before it went generic last year. Yet, the large ASCOT-LLA trial assessed its use in the primary prevention setting, and found the use of Lipitor was associated with a reduction in death or heart attack from 3 percent to 2 percent.
To counteract population medicine, new technologies will allow for the patients to be better informed about what their health status is. For instance, smartphones can serve as glucometers or cardiograms. “Why would you want to do finger sticks and intermittent glucose readings, when you buy the app in the Apple Store and get continuous checks on your diabetes?” Topol asked. Also, wearable sensors can track activity, but tracking is only the beginning.
Other examples include a Parkinson's voice initiative that uses a voice-based test for potential detection of the disease. The Wheezometer analyzes 30 seconds of breath sounds using advanced signal processing algorithms to detect, quantify and document the presence of wheezing and its extent for asthma patients. The EyeNETRA (Near Eye Tool for Refractive Assessment), an add-on for mobile phones, enables users to test their eyesight.
As medicine becomes more about information, many tasks will transfer to the patients, Topol predicted.
Finally, the true way to individual care is through genomics, said Topol, which he called “a revolution in itself.” Hand-held sequencing can be done now, and the cost of whole-genome sequencing has been drastically reduced to less than $4,000.
“Oncology may benefit most from genomics, as the war on cancer is really a war on mutation,” he said.
However, the barrier to better genomics research and treatment will require a rebooting of cancer tissue/specimen handling in the sequencing era. After collection, cancer specimens are currently placed in formaldehyde, which prevents whole genome sequencing on that specimen.
Borrowing a phrase from former U.S. President Ronald Regan, Topol said that healthcare needs to “tear down the wall,” prohibiting better cancer research.
“We shouldn’t be suppressing direct-to-consumer care experiences,” Topol said. “The philosophy should be ‘Nothing about me without me.’ Mobile devices and genomic sequencing have transcended the Gutenberg era of the printing press in how individual care will be revolutionized.”