BOSTON—The rapid rise of ipods, iphones and similar devices over the past eight years shows that “things can change drastically and radically in a very short period of time,” said Eric Topol, MD, director of the Scripps Translational Science Institute and chief academic officer for Scripps Health in La Jolla, Calif., speaking at the Digital Healthcare Innovation Summit.
Healthcare clearly is ripe for change. For example, studies are showing that mass screenings for such conditions as prostate and breast cancer actually lead to net harm because of the “remarkable amount of false positives.” And, Lipitor—the No. 1 selling drug of all time—only reduces the rate of heart attack from 3 percent to 2 percent. “We’re not able to discriminate who should be screened and who should get a medication,” Topol said.
He said he thinks population health medicine will eventually be just a footnote because we already can zoom in on the individual. “Social networking has led to extraordinary power of people.” He recited a powerful quote: “the power of the people is greater than the people in power.” Topol also said a consumer revolution is “just starting to percolate right now.”
Biosensors is an area “exploding” and not just wearable sensors, he said. Topol predicts that all the Fitbits and other personal fitness trackers will be replaced with devices that do the work passively without any input by the individual.
Such devices have the potential to save a lot of money. Topol cited the average in-hospital sleep study that costs $3,000. But, newer sensor-type devices can track oxygen saturation through the night for a fraction of the cost. “A lot of these devices can cut costs pretty dramatically and they can be used for every physiologic metric you can imagine.”
Mobile health technologies have the potential to change every aspect of healthcare, Topol said. He is one of the authors of a study published in the Journal of the American Medical Association. “The problem is that we are not amalgamating enough real-world clinical trial evidence. Our biggest push is to get that evidence.”
The smartphone also has the ability to convert to a lab on a chip, he said. He cited Elizabeth Holmes, a college dropout who developed a way to make tests more accurate and less painful at a fraction of the current cost. With a tiny amount of blood, hundreds of tests can be done for a fraction of the cost of traditional lab tests. Holmes has a contract with 8,000 Walgreens stores and will train their personnel. “This is a big, creative disruption,” Topol said. “This is a whole different model that is really taking the individual into account.”
Along these same lines, he said the next exciting phase is a lab in the body. It makes sense, Topol said, because the average car has more than 400 embedded sensors and even smartphones have 10 embedded sensors. Sensors in the body could predict and prevent unpredictable conditions such as heart attack. “Almost all of us have some minor plaque in our coronary arteries but we can’t predict when a heart attack will happen,” Topol said. Recent heart attack victims Tim Russert and James Gandolfini had both been monitored--Russert’s stress test even came back perfectly normal just a few weeks before he died. Scientists have learned, however, that heart attack patients develop unusual blood cells. Tests have been conducted to characterize these cells in depth. Pairing up with the Caltech Nonfabrication Group has led to the development of a sensor one-third the size of a grain of sand that can be injected into the bloodstream. That sensor can detect genomic signals and trigger a ringtone to warn of an impending heart attack a couple days up to a couple weeks before.
Topol also said a smartphone attachment makes the stethoscope obsolete. He said he hasn’t used a stethoscope since 2009 because the high resolution ultrasound device gives images of the heart in seconds that are at least as good as the images you can get with a $350,000 echo machine.
Telemedicine through smartphones also have the ability to improve patient satisfaction and cut costs, Topol said. The average clinic visit is seven minutes long and the average wait for that visit is 60 minutes. Virtual visits saved an average of $88 per visit and patients loved it, he said.
“The way we use it today, the smartphone is going to be the hub of the future of medicine,” Topol said. From a conduit of sensors to a gateway to remarkable computing power, a lab on a chip and environmental