"Hello," responds an
automated voice. "There is a 97% likelihood that you will have a cardiac
event within the next 12 hours. Please proceed to a hospital as soon as
possible."
According to experts like
Eric Topol, director and chief academic officer at Scripps
Translational Science Institute, technology like this -- and a slew of
other medical wonders -- isn't so far-fetched. In fact, some of it is
already here.
There are now more cell
phones in the world than there are toilets and toothbrushes, Topol said.
And these phones, which have become our constant companions and virtual
extensions of our bodies, are increasingly being used to track our
physiology from moment to moment.
The intersection of
technology, science, medicine and design has led to an explosion of apps
for monitoring blood pressure, glucose levels and heart rate and
measuring how well you sleep, whether you're stressed or relaxed and
whether you're eating healthy. We have been able to harness the existing
digital infrastructure to get personalized health data we did not have
access to before.
Combine wireless sensors
with the study of genes, or genomics, imaging and a proliferation of
health-focused social networks, and you have a convergence capable of
bringing about the "creative destruction" of medicine.
That's the term Topol
uses in his 2012 book, "The Creative Destruction of Medicine: How the
Digital Revolution Will Create Better Health Care," to refer to the
transformation that accompanies radical innovation.
This disruption, said Topol, will be characterized by the personalization of drugs, devices, screening tests and treatments.
Personalized medicine
can deliver better information to help patients make an individual
choice about the risks and rewards of a particular course of treatment:
which medicines will work for him or her, which drugs may pose a danger
and whether doses may need to be adjusted. Personalized medicine can
also help profile someone's potential risk for contracting a disease
like cancer or diabetes.
But not everyone agrees with Topol.
"Personalized medicine
is a myth. It's hyperbolic," argued Dr. Ezekiel Emanuel, vice provost
for global initiatives and chairman of the Department of Medical Ethics
and Health Policy at the University of Pennsylvania.
Emanuel spoke with Topol
and Margaret Hamburg, commissioner of the Food and Drug Administration,
on a panel about personalized medicine at the Aspen Ideas Festival this month.
According to Emanuel,
tailoring medical treatments to individual characteristics of each
patient is both overly optimistic and cost-prohibitive. He likened it to
buying a custom-made suit versus one off the rack.
But in an interview
after Aspen Ideas, Topol disputed that, saying that nowhere is the
promise of personalized medicine as hopeful or exciting as in cancer
research.
"We are at a pivot point when it comes to cancer," Topol observed. "We may not have had the tools before, but we do now."
Mapping the human
genome, which initially took more than a decade and roughly $3 billion,
can now be performed in a little more than an hour to the tune of $900.
Several cancer centers like MD Anderson in Texas and Sloan Kettering in
New York have begun identifying the genetic fingerprints of tumors and
targeting specific treatments.
The first step is to
sequence the patient's DNA in order to uncover the cancer-causing
mutation. Then, instead of administering a one-size-fits-all drug,
doctors would use one that addresses the specific mutation.
"It's a more intelligent, precise way," Topol said.
The patient's response
to treatment would also be monitored. "Instead of putting them through
radiation, PET scans and CT scans, which are very expensive and
potentially harmful, we are now looking at noninvasive tests that do the
same job," Topol said.
One example, he said, is
a promising test that uses microchip technology to sift through blood
in search of circulating tumor cells, which come from solid tumors and
roam through the blood.
"Both the initial
treatment that addresses the root cause and the follow-up can be
revamped," Topol said. "And it's not that expensive. In fact, it's far
cheaper."
In addition to what he
felt would be explosive costs, Emanuel also argued against personalized
medicine by observing that behavioral and lifestyle changes like diet,
smoking and exercise, which account for 40% to 60% of all disease, are
far likelier to have an impact on longevity and health-care
affordability than genetics and thus should be the center of focus.
Topol said that none of
what we talk about in personalized medicine is meant to supplant efforts
to improve people's diets, lifestyles and physical activity.
But, to use one lifestyle example, there are different explanations for obesity beyond "you are eating too much."
That approach doesn't
take into account an individual's biological disposition. Some people
are obese not because they eat too much but because they have a genetic
structural variation. Others may have an issue related to their
individual microbiomes: the totality of microbes, their genomes and the
collective environmental reaction in the gut.
Researchers have linked
certain microbiomes to obesity, which then opens the door to
individualized probiotic and other therapies. "That's the whole idea
behind individualized treatment and prevention," Topol said.
The bottom line is that
when it comes to technology's disruption of medicine, Topol believes the
genie is already out of the bottle. Some of the best cancer centers are
on this path. They are, however, treating a minority of the patients
out there.
There are a host of
barriers to realizing the promise of personalized medicine -- insurance
reimbursement, privacy and regulatory issues, information and
aggregation issues, among others -- but perhaps none so pernicious as
resistance.
"The problem is that it takes physicians so long to accept a radical change. And the lag is unacceptable," Topol said.
Resist as some might, the power of one's own data is the future of medicine.
"It is only a matter of when," Topol said.
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