Week 9: Why the Stethoscope is on its way out...

Distribution Source: TED.com
Content Source: Eric Topol
Format: Video
Length: 16 minutes and 59 seconds
Link: The Wireless Future of Medicine

As many of my friends know, I am a huge fan of the iPhone. From my iPhone I can access my bank account, get directions, send a customized post card (from a photo I took on my phone), read the news, play games.. the list goes on. Hell, my iPhone can also turn into a flute, recognize unknown songs playing on the radio or at a bar, and even repel bugs. Yes, you read that correctly - the phone emits a high frequency noise that keeps bugs away. It is simply unbelievable.

I've always tried to convince people who don't yet "get it" that the iPhone and other smartphones are revolutionary not because they have the internet, or because they have great graphics. They are revolutionary because they represent a very new platform that spans all spheres of life and literally expands the realm of what is possible. I'm not joking when I say that the iPhone has saved me more time than any other single device, person - whatever - in my entire life. By far. And what's exciting to me is that the realization of this potential has barely begun in the two areas in which it may have the most lasting impact on humanity: education and medicine. Indeed, one of the points of this blog is to show how iTunesU - which I access through my phone - provides good, free information to anyone with the internet. But today I will focus on medicine, something my mom and girlfriend know a lot about, but about which I know basically nothing.

Dr. Eric Topol gave a fascinating talk last fall that starts with a bold prediction: the stethoscope, invented in 1816 and still widely used today, will be obsolete by 2016. Why? Because not only will a patient's heartbeat be available to a doctor in real time - anywhere in the world - but so too will all vital signals. Already the technology exists to see a patient's electrocardiogram on an iPhone. In some hospitals, doctors can see from their phones the heart rhythm, blood pressure, oxygen and temperature of their ICU patients - without having to be anywhere near the patients! Here is an example of how this would look on a phone.

Other technologies are equally fascinating - imagine, as an expectant parent, being able to monitor in real-time intrauterine contractions or the fetal heart rate. While we have continuous glucose sensors for diabetes patients, they have to be placed under the skin and then brought to doctors. The technology is almost there to have a non-implantable sensor, link it to a phone, and then send the results electronically to a doctor. Soon every smartphone user will be able to map literally every minute of his or her sleep, with breakdowns by different sleep stages (REM, light sleep, etc). There are already many calorie measurement programs - intake and outtake - on smartphones. Perhaps the most popular exercise-management program is the Apple-Nike partnership where a chip in Nike shoes automatically uploads workout statistics to the iPhone. Over 1.2 million Americans use this technology. The Holter Monitor, according to Dr. Topol, will also soon be obsolete. Now we have peripheral sensors or "smart band-aids" that can be uploaded through a "body area network" to your smartphone. Once it is on your smartphone it can be distributed wherever or however you like - to the hospital, the doctor, etc.

It is important to note that the wireless medical innovations are not limited to just physiologic metrics. They also extend to areas like imaging. For example, GE has introduced a hand-held ultrasound. This device has the capacity to do a Cardiac Echo or fetal monitoring, and is more sensitive than a stethoscope.

While some of this may seem like it is not practically applicable yet, Dr. Topol surprised the audience by revealing he was wearing a wireless device during his talk. He then showed in real time his ECG, heart rate, fluid status, respiration, posture, oxygen level and temperature. All of these are vital for monitoring someone with heart failure, the number one reason for hospital admissions and readmissions. The cost per year is estimated to be $37B, with 80% of costs related to hospitalization. The readmission numbers are staggering: over 50% will be readmitted after six months. This monitoring software is now being used in a trial that will attempt to prevent such high readmission rates among heart failure patients.

The armchair politician in me scratches his head and asks - instead of trying to guess at future health care costs based on models of the number of sick Americans, why not immediately seek bipartisan support for trials like this? In the same way that cheap energy ignited an industrial revolution, shouldn't we be focusing on extremely cheap and scalable preventative monitoring practices? If successful, this would both cut costs and improve the health of Americans in a way that seems to represent the ultimate in consumer-driven health care.

The problem, of course, is huge: 140MM Americans have one or more chronic diseases, and 80% of the $1.5 Trillion in medical expenditures are related to chronic disease. How can wireless medicine help? Dr. Topol outlined the ten targets for wireless medicine, listing the innovations that will improve each:

Alzheimer's (5MM Affected) - Vital signs, location, activity, balance
Asthma (23MM Affected) - Respiratory rate, FEV1, air quality, oximetry, pollen count
Breast Cancer (3MM Affected) - Ultrasound and self-exam
COPD (10MM) - Respiratory rate, REV1, air quality, oximetry
Depression (21MM) - Med compliance, activity, communicatio
Diabetes (24MM) - Glucose, hemoglobin A1C
Heart failure (5MM) - Cardiac pressures, weight, BP, fluid status
Hypertension (74MM) - Continuous BP, med compliance
Obesity (80MM) - Smart scales, glucose, calorie in/out, activity
Sleep disorders (40MM) - Sleep phases, quality, apnea, vital signs

The potential impact of these technologies on Hospital/Clinical Resources are huge, with major implications for hospital beds, outpatient visits, assisted living facilities, sleep labs, Holter Monitoring, mammography, and ultrasound/echocardiography (to name a few). Also fascinating is the potential for overlap in advancements in genetics with wireless advances. We have learned more about the genetics of diseases in the last three years than in human history. Using technology for both monitoring and cross-referencing, we can begin to predict who is likely to get Type 2 Diabetes, who is at risk for breast cancer, who may get atrial fibrillation, sudden cardiac death, etc. To some degree this capability exists, but not on a widespread, scalable, cheap platform like that which smartphones will allow.

In short, the potential changes and implications of wireless medicine span the globe, span age, sex and race, and span the many types of diseases. Put simply: we need to accelerate the era of wireless medicine. An article on this topic said the following: "The personal metrics movement goes way beyond diet and exercise. It's about tracking every facet of life, from sleep to mood to pain, 24/7/365." This may sound very scary, and in some ways it is. But it's not inconsistent with the underlying theme that to some degree has and will continue to define my generation: uber-transparency and significantly less individual privacy. This is yet another piece of the puzzle that is the exponentially increasing volume of information. To me the two key underlying questions are: how do we use this information, and how do we protect both the integrity and security of sensitive information? These questions, while extremely important, are somewhat irrelevant to the bigger picture. The train has left the station: the unbelievable power and scale of these new platforms has been unleashed. Now we must learn to maximize their benefits and minimize their potential costs. Supporting wireless medicine is a good place to start.