Digital innovations have now made it possible for consumers to use portable devices to access their medical information, monitor their vital signs, take tests at home and carry out a wide range of tasks. In his book "The Creative Destruction of Medicine," Eric Topol, a cardiologist, geneticist and researcher, describes how medicine is entering an age of democratization as power shifts from hospitals, doctors and other caregivers to patients, potentially leading to dramatic health care improvements.
In the mid-20th century Joseph Schumpeter, the noted Austrian economist, popularized the term "creative destruction" to denote transformation that accompanies radical innovation. In recent years, our world has been "Schumpetered."
By virtue of the intensive infiltration of digital devices into our daily lives, we have radically altered how we communicate with one another and with our entire social network at once. Everywhere we go, we take pictures and videos with our cellphone, the one precious object that never leaves our side. Forget about going to a video store to rent a movie and finding out it is not in stock. Just download it at home and watch it on television, a computer monitor, a tablet or even your phone. The Web lets us sample nearly all books in print without even making a purchase and efficiently download the whole book in a flash. Our lives have been radically transformed through digital innovation. Radically transformed. Creatively destroyed.
But the most precious part of our existence – our health – has thus far been largely unaffected, insulated and almost compartmentalized from this digital revolution. How could this be? Medicine is remarkably conservative to the point of being properly characterized as sclerotic, even ossified. Beyond the reluctance and resistance of physicians to change, the life science industry (companies that develop and commercialize drugs, devices or diagnostic tests) and government regulatory agencies are in a near-paralyzed state, unable to break out of a broken model determining how their products are developed or commercially approved. But that is about to change. Medicine is about to go through its biggest shakeup in history.
For the first time we can digitize humans. We can remotely and continuously monitor each heart beat, moment-to-moment blood pressure readings, the rate and depth of breathing, body temperature, oxygen concentration in the blood, glucose, brain waves, activity, mood – all the things that make us tick. We can image any part of the body and do a three-dimensional reconstruction, eventually leading to the capability of printing an organ. Or, we can use a miniature, handheld, high-resolution imaging device that rapidly captures critical information anywhere, such as the scene of a motor vehicle accident or a person's home in response to a call of distress. We can determine all 6 billion letters ("life codes") of a person's genome sequence.
And all of this information about an individual can be assembled from wireless biosensors, genome sequencing or imaging to be readily available, integrated with all the traditional medical data and constantly updated. We now have the technology to digitize a human being in highest definition, in granular detail, and in ways that most people thought would not be possible.
This reflects an unprecedented super-convergence. It would not be possible were it not for the maturation of the digital world technologies – the ubiquity of smartphones, bandwidth, pervasive connectivity and social networking. Beyond this, the perfect digital storm includes immense, seemingly unlimited, computing power via cloud server farms, remarkable biosensors, genome sequencing, imaging capabilities and formidable health information systems.
Think of the cellphone, which is not only a hub of telecommunications convergence, but also a remarkable number of devices all rolled into one gadget: camera, video recorder, GPS, calculator, watch, alarm clock, music player, voice recorder, photo album and library of books – like a pluripotent stem cell. Armed with apps, it carries out diverse functions from flashlight to magnifying glass. Then connect it to a wireless network, and this tiny device is a web surfer, word processor, video player, translator, dictionary, encyclopedia and gateway to the world's knowledge base. And, by the way, it even texts, emails and provides phone service. But now picture this device loaded for medicine, capable of displaying all of one's vital signs in real time, conducting laboratory analyses, sequencing parts of one's genome, or even acquiring ultrasound images of one's heart, abdomen or unborn baby.
These are the collective tools that lay the groundwork for digitizing humans. This is a new era of medicine, in which each person can be near fully defined at the individual level, instead of how we practice medicine at a population level, with mass screening policies for such conditions as breast or prostate cancer and use of the same medication and dosage for a diagnosis rather than for a patient. We are each unique human beings, but up until now there was no way to establish one's biologic or physiologic individuality. There was no way to determine a relevant metric like blood pressure around the clock while a person is sleeping, or at work, or in the midst of an emotional upheaval. This represents the next frontier of the digital revolution, finally getting to the most important but heretofore insulated domain – preserving our health.
We have early indicators that this train has left the station. The first individual, a five-year-old boy who had his life saved by genome sequencing, was recently documented. But it's not just about finding the root molecular cause of why an individual is sick . We can now perform whole genome sequencing of a fetus to determine what conditions should be watched for postnatally. At the other end of the continuum of life, we can do DNA sequencing to supplant a traditional physical autopsy, to determine the cause of death. We can dissect, decode and define individual granularity at the molecular level, from womb to tomb.
That's just the start of illuminating the human black box. Recognizing that we are walking event recorders and that we just need biosensors to capture the data, and algorithms to process it, sets up the ability to track virtually any metric. Today, these sensors are wearable, like Band-Aids or wristwatches. But soon enough they will also be embedded into our circulation in the form of nanosensors, the size of a grain of sand, providing continuous surveillance of our blood for the earliest possible detection of cancer, an impending heart attack or the likelihood of a forthcoming autoimmune attack.
Yes, this does ring in the sci-fi concept of cyborgs, the fusion of artificial and biological parts in humans. We've already been there with cochlear implants for hearing loss, a trachea transplant, and we're going there in the creation of embedded sensors that talk to our cellphones via wireless body area networks in the future. With it comes the familiar "check engine" capability that we are accustomed to in our cars but never had before for our bodies. Think true, real prevention for the first time in medical history.
We live in an extraordinary data-rich universe, a world that had only accumulated 1 billion gigabytes (109 or 1,000,000,000 bytes of data) from the dawn of civilization until 2003. But now, we are generating multiple zettabytes – each representing 1 trillion gigabytes – each year and will exceed 35 zettabytes by 2020, roughly equivalent to the amount of data on 250 billion DVDs. Sensors are now the dominant source of worldwide-generated data, with 1,250 billion gigabytes in 2010, representing more bits than all of the stars in the universe.
The term "massively parallel" is an important one that, in part, accounts for this explosion of data and brings together the computer, digital and life science domains. Note the convergence: from single chips that contain massively parallel processor arrays, to supercomputers with hundreds of thousands of central processing units, to whole-genome sequencing that is performed by breaking the genomes into tiny pieces and determining the life codes in a massively parallel fashion. In 2011, the Watson IBM computer system beat champion humans on the game show, "Jeopardy!" Watson is equipped with a 15-terabyte (1012) or 15,000,000,000,000-byte databank and massively parallel 2,880-processor cores.
So, beyond its television premiere and victory, where was Watson first deployed? At Columbia University and the University of Maryland medical centers to provide a cybernetic assistant service to doctors. David Gelernter's February 2011 op-ed in The Wall Street Journal, "Coming Next: A Supercomputer Saves Your Life," introduced the concept of a WikiWatson supercomputer that could bring together the whole world's medical literature and clinical expertise. Putting a massive databank to use to improve health care is emblematic of the overlay of the digital and medical worlds.
In some health care systems, patients can now directly download their laboratory reports and medical records, which they were never allowed to do in the past. Any consumer with adequate funds can have his or her genome scanned or even wholly sequenced.
But just having these technological capabilities will not catapult medicine forward. The gridlock of the medical community, government and the life science industry will not facilitate change or a willingness to embrace and adopt innovation. The U.S. government has been preoccupied with health care "reform," but this refers to improving access and insurance coverage and has little or nothing to do with innovation. Medicine is currently set up to be maximally imprecise. Private practice physicians render "by the yard" and are rewarded for doing more procedures. Medical care is largely shaped by guidelines, indexed to a population rather than an individual. And the evidence from clinical research is derived from populations that do not translate to the real world of persons. The life science industry has no motivation to design drugs or devices that are only effective, however strikingly, for a small, well-defined population segment. At the same time, the regulatory agencies are entirely risk-averse and, as a result, are suppressing remarkably innovative, and even frugal, opportunities to change medicine. The end result is that most of our screening tests and treatments are overused and applied to the wrong individuals, promoting vast waste. And virtually nothing is being done to accelerate true prevention of disease.
In fact, consumers must provide the impetus for new medicine – a new medicine that is no longer paternalistic, since the doctor does not necessarily know best anymore. The American Medical Association has lobbied the government hard for consumers not to have direct access to their genomic data, asserting that this must be mediated through physicians.
We know that 90 percent of physicians are uncomfortable and largely unwilling to make decisions based on their patients' genomic information. But it is your DNA, your cellphone and your right to have all of your medical data and information. With a medical profession particularly incapable of making a transition to practicing individualized medicine, despite a new array of powerful tools, isn't it time for consumers to drive this capability?
A revolution in technology that is based on the primacy of individuals mandates a revolution by consumers in order for new medicine to take hold. We desperately need medicine to be Schumpetered, to be radically transformed. We need the digital world to invade the medical cocoon and to exploit the newfound and exciting technological capabilities of digitizing human beings.
Excerpted from "The Creative Destruction of Medicine" by Eric Topol (Basic Books, 2012)