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Smartphone-Connected Patients Are Asking, “Can You Treat Me Now?”

Mobile. Smart. Disruptive. These words dominate discussions of technology-driven trends in e-commerce, social networking, and the sharing economy. And soon these words will apply to healthcare, which represents the next barricade to be stormed by smartphone-wielding revolutionaries. Already, the popular press is celebrating the “doctor in your pocket.”

In the vanguard of the new medicine are “think different” types such as Eric Topol, M.D. As if his duties as the director of the Scripps Translational Science Institute weren’t enough to keep him fully occupied, Dr. Topol has found the time to write a popular book about the medical impact of smart, handheld, networked devices.

The book is titled “The Patient Will See You Now: The Future of Medicine Is in Your Hands” (Basic Books, 2015). It describes the democratization and individualization of medicine.

Traditional medicine sees people from 30,000 feet and misses granular detail. It has been much more art than science. We lacked the ability to digitize a human being. Now we can develop a kind of Google medical map with multiple layers that include the phenome, anatome, physiome, and all of the different biological “omes”

He says “We now have a mosaic composite of the individual. We can capture data about a person through wearable biosensors, obtain a DNA sequence, profile the gut microbiome—and many of these examples represent real-time, streaming data.

Medicine is becoming a much more quantitative science. It is changing to accommodate a new level of data, big data, for each individual.

“When you refer to the patient-doctor relationship, I would emphasize that the individual will soon be a big driver of this relationship going forward, because a lot of the data will be individual-generated through sensors or by doing self-lab tests or self-imaging,” he adds.

Democratization of healthcare means that everything is available to all in the medical sphere. Many things that are happening today reinforce that democratization is taking hold. One of the first things is that people are generating data through their smartphones.

People are performing their own electrocardiograms or taking images of skin lesions or rashes, and they can receive diagnoses immediately via algorithms. Parents can get a child’s ear infection diagnosed using a smartphone and algorithms. Sleep apnea can be assessed in the comfort of a patient’s own bedroom, and the results would more accurate than those from a hospital sleep lab, while saving about $3,500.

For the first time, over the past year, one of the major central laboratories, LabCorp, has enabled people to order their own lab tests without needing a doctor’s order. That’s a big step forward, especially in light of the falling costs of genetic testing.

Soon, patients may no longer be totally dependent on doctors, hospitals, and health systems. Consumer surveys indicate that at least 80% of people want to be able to take much greater charge and direction of their medical care.

The digital transformation of medicine is already happening. You can use Uber to bring a doctor to your house. On-demand medicine is a big part of the democratization of medicine.

But the big shift going forward will not be the capability to have a video chat with the doctor, or summon the doctor to your house, but rather the ability to generate data and share it with the doctor. The patient-doctor exchange will go beyond chatting. It will involve the review of data, getting oversight of the data, and getting guidance and an injection of wisdom, experience, and compassion.

Smartphone labs are part of the story. For example, it is possible to make a diagnosis of infection through a smartphone. That has been demonstrated in as remote a place as Rwanda, where 99% accuracy was achieved for detecting HIV and syphilis, at a cost of 50 cents, with results available in minutes.

Additionally, we now have the ability to consider portable sequencing in the field, to provide an agnostic approach to identifying pathogens. This is still some years away, but it’s becoming technically increasingly likely.

Many companies are working on processing the breath using a smartphone, for example, to be able to measure aldehydes and other organic compounds that would increase the suspicion for cancer—not just lung cancer, but any type of cancer. He insists that we will also be able to monitor the environment in general, for radiation exposure or for air quality and pollutants.

The only thing in the technology area that is missing for this transformation to happen is being able to take the data from remote monitoring and apply it to patient care. “We need remote data-monitoring centers. The only one I know of is at Mercy Hospital in St. Louis. With sufficiently exquisite remote monitoring, we may, eventually, be able to show that the “hospital room of the future” should be the patient’s bedroom.

Another exciting technology is the liquid biopsy. Nearly 40 companies are now trying to harness the information from circulating DNA in the blood to make the earliest possible diagnosis of cancer, or to monitor people after treatment for cancer.

The use of circulating free DNA or RNA can be extended beyond cancer to study methylation and other epigenomic changes and to monitor various organs and systems. This relates to the idea of using nanosensors in the bloodstream, coupled with genomic signaling, with the results being reported to a mobile phone app.

His teams are also working on cardiac applications and are hoping to pick up genomic signals that predict heart attacks. But the regulatory path to validate this type of test is long. “You have to get the blood test approved first, then the sensor approved, before you can then get the combination of the sensor and the blood test approved. It takes multiple years and large clinical trials.”

Dr. Topol also believes that pharmacogenomics has been one of the biggest missed opportunities in medicine for many reasons. First, it is hardly used by doctors, in part because it is not available as a practical, inexpensive, rapid test. “If I am going to start somebody on a medication for which there is unequivocal data that could tell me if it is the right medicine at the right dose and if there are any potentially serious side-effects for this patient, I want to get that information in minutes and at a very low cost.

That capability just does not exist today. We do not have point-of-care pharmacogenomics. We may gain it, however, after a billion people have had their genomes sequenced.

At last count, there were 125 FDA-approved drugs with a genomic label, but the sad truth is that it is a rare day when any patient in this country has a pharmacogenomic test. It uniformly requires sending out for the test, the results will not come back for a week or more, and it would cost a minimum of $150–200 for a single genotype, which is usually not reimbursed.

Drug companies should be doing sequencing for every drug being developed so they would know well into Phase II clinical testing if there is some type of sequence that correlates with an adverse event. Instead of stopping development of the drug, they could avoid administration to individuals with a certain genomic burden. But pharmacogenomics is seldom, if ever, used in drug development and that is a big shame.

 

Vennila is one of BioTecNika's Online Editors. When she is not posting news articles and jobs on the website, she can be found gardening or running off to far flung places for the next adventure, armed with a good book and mosquito repellant. Stalk her on her social networks to see what she does next.