The Patient—and Her Data—Will See You Now

Jan 7, 2015, 1:48 PM, Posted by Susan Dentzer

Photo by Viktor Hanacek, Picjumbo.com

It’s 2015, the year that Marty McFly, the fictional character in the 1989 hit movie "Back to the Future II," visits by time traveling into the future in a souped-up DeLorean automobile. Predictably, most of the technologies the film foreshadowed haven’t been invented as of the real 2015—not the “hover board” that Marty glides along on, nor the self-lacing sneakers, nor (of course) the time travel.

But plenty else has been invented or discovered in the last 30 years, revolutionizing much of our lives, including our health and health care. If you want to feel as exhilarated, and maybe even as disoriented, as Marty did after fast-forwarding to 2015, read Dr. Eric Topol’s new book, The Patient Will See You Now: The Future of Medicine Is In Your Hands.

Building on themes he introduced in his last book, The Creative Destruction of Medicine, Topol, director of the Scripps Translational Science Institute, describes a health care world upended by digital technology—mostly to the benefit of patients. We wield dominion over this new world through our smart phones.

Today, we can use our phones to view our CT scans or MRIs; Topol, a cardiologist, has even used his on planes to view passengers’ electrocardiograms, to determine if they are having heart attacks. In the not-very-far-off tomorrow, our smartphones may be equipped with special sensors that can “sniff” our breath to detect whether we have breast, prostate, or some other type of cancer—or analyze our voices to determine whether we have Parkinson’s, schizophrenia, or other diseases.

In short, the smartphone will be our entry point into a vast and growing infrastructure, consisting of broadband Internet, wireless connectivity, and an explosion of medical knowledge. “We are embarking on a time when [individuals] will have all their own medical data and the computing power to process it in the context of their own world,” Topol writes.

The result, as the book’s title implies, will be a “’tech-tonic’ power shift” away from today’s medical establishment and toward patients, as we gain the ability to monitor, diagnose, and at least partially treat ourselves. Meanwhile, medical professionals and other innovators will tailor preventive strategies and treatments to our specific data-driven needs, giving us access to more effective, safer, and potentially lower-cost care. A case in point:  A “molecular” stethoscope could periodically analyze DNA in our blood, in effect conducting a brain or liver biopsy as part of a normal checkup, rather than waiting until a cancerous tumor shows up on a CT scan.

A vast store of data could one day be collected about us from the ten or more “omes” that constitute our humanness—ranging from the “exposome” (what we are exposed to in environment) through our phenome (height, weight, etc.) and anatome (anatomy) all the way to our “physiome” (our biologic metrics, like blood pressure); our genome (sequences of our roughly 19,000 genes that code for proteins), our proteome (all of those proteins) and transcriptome (our RNA). Add in our epigenome (changes that can take place in cells); our metabalome (the chemical components involved in metabolism) and microbiome (the one hundred trillion viral, bacterial and related cells in our bodies)  and the result could easily amount to a trillion bits of data per person per year.

Topol argues that we will each need to “own” these data, and store them in our personal “clouds”—a concept so far beyond today’s electronic health records that it’s difficult to wrap our brains around it. And even though it isn’t clear how useful or actionable all these data will ultimately be, we will probably use some portion of it to manage our health, or lend it to researchers so they can devise new treatments or predict what we may suffer from in the future.

Lots of thorny issues—and I do mean lots—will arise along the way, many having to do with keeping these data private and secure. I’ll discuss some of these challenges, and Topol’s proposed remedies, in my next post.

Meanwhile—start up the DeLorean—and be sure to take your smartphone with you.

Susan Dentzer, Senior Policy Adviser at the Robert Wood Johnson Foundation, former Health Affairs Editor-in-Chief and Health Policy Analyst, The NewsHour with Jim Lehrer, is one of the nation's most respected health and health policy thought leaders and journalists. Read more of Susan’s posts.