Cook and Topol: How Digital Medicine Will Soon Save Your Life

You wake up with chest pain. Your smartphone reads your ECG. If it’s a heart attack, it calls an ambulance and sends your data ahead to the ER.


Feb. 21, 2014 7:07 p.m. ET
A sweeping transformation of medicine has begun that will rival in importance the introduction of anesthesia or the discovery of the germ basis of infectious disease. It will change how patients and physicians interact. It will change medical research and therapy. “Sick care”—the current model of waiting for you to get sick and then trying to alleviate symptoms and make you well—will become true “health care,” where prevention is the mantra and driving force. Welcome to the world of digital medicine.First and foremost, the digitalization of medicine will personalize health care: Treatment will be tailored to each person as a unique individual suffering a unique illness according to his or her genetic makeup. Currently, therapy is based on population statistics. Patients are separated into groups defined in various ways but usually by similar symptoms or by the results of basic lab tests (like cholesterol levels). These groups are then treated with drugs that may help many people, but not all of them, and often only a fraction of them. By incorporating information from an individual’s DNA, the data made available through digitalization will enable clinicians to match individuals with treatments. Only patients who will benefit will get a particular drug.

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This is huge. Giving drugs to patients who are not helped has been enormously expensive and often perverse. Particularly with anticancer drugs, it often condemns such patients to horrendous side effects for no benefit.

Second, digitalization will democratize medicine: You will own or control the data about your own medical condition, and you will be able to analyze it instantly by your connectivity to the Web. In many ways, the profession of medicine today is where Christianity was when the Gutenberg Bible put scriptures into the hands of the laity. But the profession is going to change, subtly and not so subtly shifting power away from the medical-industrial complex: doctors, health insurers, hospitals, medical labs and Big Pharma.

The brave new world of digital medicine is coming about by the convergence of three rapidly evolving technologies: IT, or informational technology, involving wireless signaling, cloud computing and, most particularly, the spread of ever more sophisticated smartphones; medical applications of nanotechnology; and the progressively lower cost and availability of genome sequencing.

Today, all the physiological data monitored in a hospital intensive-care unit—including ECG, blood pressure, pulse, oxygenation, sugar level, breathing rate and body temperature—can be recorded and analyzed continuously in real time on a smartphone. A small piece of hardware, either the size of a cellphone, or one integrated with a cellphone, held against your body, functions as an ultrasound device. It can deliver information instantly to you or anyone you designate, and the information rivals that collected in a physician’s office or hospital setting. It can do so when you are experiencing specific symptoms—no appointment necessary—and at virtually no additional cost.

Thanks to more than 20 Silicon Valley startups and advances in microfluidic technology, smartphones will soon be able to function as a mobile, real-time resource for rapidly obtaining all the studies done currently in a medical laboratory, including chemistries, blood values and microbiological studies. A device worn on the wrist, called Visi, has been approved by the FDA for hospital use that can measure your heart’s electrical activity, respiratory rate, blood oxygen and blood pressure (without a cuff), and transmit the data wirelessly. Many other such devices are coming out that could be used by patients in their own homes.

Today an individual can feed a test strip into a device (there are a number of them) that—once connected to a smartphone equipped with an app—can carry out a complete urinalysis and instantly give the individual his or her specific gravity, pH, and levels of glucose, protein, red blood cells, white blood cells, bilirubin, nitrates—and even tell a woman if she is pregnant by measuring her HCG hormone.

And just last month llumina, a San Diego-based firm, announced a new machine that can sequence the human genome for $1,000. At this price, the genome sequence of millions of people becomes possible to collect and analyze. This vast trove of DNA data would become medically useful for understanding each individual’s specific disease profile and matching the correct drug therapy to it when necessary.

Meanwhile, progress in nanotechnology has made it possible to inject tiny sensors called nanobots into the bloodstream that can transmit information wirelessly to a smartphone. This opens up the possibility of tracking changes in blood chemistry, the activation of an individual’s immune system (for example, in response to an attack by a pathogen), the early detection of cancer from the DNA of a tumor, and the precursor signals of a heart attack. Nanobots may even be able to eliminate infectious agents and deliver drugs directly to a target tissue, such as a cancer.

In a very real sense, your smartphone, loaded with a heuristic medical algorithm, is poised to become an avatar physician. You wake up at 3 a.m. on Christmas morning with a bout of chest pain. Your smartphone reads your ECG and reassures you that you are not having a heart attack—or tells you to call an ambulance and places the call, meanwhile instantly transmitting all the data to a hospital ER. And while you are at the hospital receiving treatment or care, your avatar doctor remains at your side as a constant adviser and ombudsman.

In the very near future, your avatar doctor may be able to warn you days in advance that you are going to have a heart attack by sensing certain genomic signals circulating in your blood stream and sending you to your cardiologist or to the ER. It can tell you if that sore throat you feel coming on is strep, and if it is, automatically send a prescription by email to the local pharmacy for an appropriate antibiotic. And with so many routine exams, labs, and aches and pains and handled by the avatar, your flesh-and-blood primary care physicians will have more time to talk to you when you do need to see them.

The other large benefit from this new world of digital medicine will come in lower costs. Until now, technological breakthroughs in medicine, like MRIs, have invariably resulted in increased health-care costs. Digital medicine is going to lower health spending significantly—by emphasizing prevention, by saving huge expenditures on laboratory studies and on expensive medications that don’t work, and by appreciably lowering the need for hospitalization when monitoring vitals at home can do just as well.

The benefits of the digital revolution are large. But we’ll also have to deal with problems and unanticipated consequences, mostly related to privacy, the possibility of misuse, and the concern that patients might be overwhelmed with so much information. The government via the FDA will need to play a role to ameliorate all three of these potential issues. Regardless, digital medicine is coming over the next few years with the force of a hurricane whether we doctors—and we patients—are ready or not.

Dr. Cook has written 33 novels. His new book, “Cell,” is published by Putnam. Dr. Topol is a cardiologist at Scripps Clinic in San Diego, Calif., and the author of the nonfiction book “The Creative Destruction of Medicine” (Basic Books, 2013).

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