“Where today people surf the web and check their email on their cell phones, tomorrow they will be checking their vital signs.” – Eric Topol, MD
Contributors: Mark Dittman, Tyler Morton, Conor Good, Ben Sheehey, and Jacob Beran
There are many market forces changing the face of medicine. Skyrocketing rates of chronic disease, rising healthcare costs, an aging population combined with dwindling medicare funds; you name it, it is happening. Medicine is being practiced the same way despite a changing medical landscape. Being an apprenticeship, bad habits are passed down with the good. The patient, despite having access to more resources than at any point in history, is not empowered and is often overrun by inefficient medical organizations5.
Perhaps, the winds are beginning to shift. The patient for once might be empowered. As Dr. Eric Topol constantly reiterates in his book The Patient Will See You Now, the most underutilized asset in healthcare is the patient. From a time when doctors wouldn’t even mention to patients that they were undergoing cancer treatment, to the future where patients are CEOs of their health, things are changing. Nowhere is this more evident than medical diagnostics.
The ability to effectively and efficiently test biomarkers is growing. MRIs, microbiomics, metabolomics, genetics, exome sequencing, you name it5. We are nearing a future where our bodies have the amount of sensors that an average car has (400 sensors), should we choose to do it. After all, our bodies are the vehicle that we drive through life.
Several companies rise above the rest when it comes to cornering the bio-data market. Theranos, a company which has minimized the volume of blood as well as cost required to get testing, stands above many others. A decade of quiet lab-work is turning into billions in profit for the CEO Elizabeth Holmes.
Theranos has a goal of being in every Walgreens. Walk in, order your test (the prices are shown up-front—you can buy blood tests just as you would buy Tylenol), and then get the results sent to your iPhone. The big deal about Theranos is that they are leading the charge for consumers to have access to their own tests. Currently nobody really knows the price of lab tests. In Arizona, Theranos recently helped pass legislation allowing residents to go to Walgreens and then order their own tests—no doctor involved4. Good for business and presumably good for the consumer.
One area where many professionals tend to disagree is whether consumers should have access to their own data. As stated earlier, medical consumers have access to more tools thanks to the internet. Elizabeth Holmes has her opinion: “My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.” While some may disagree, the most often cited arguments for open-access to lab tests are a shift towards preventative medicine and patient engagement.
Once the legal barriers preventing direct testing are removed, Theranos can dominate an expanded market with their cutting-edge technology. The difference between Theranos and traditional blood testing is a few drops of blood versus a full vial, a painless finger-prick versus a more painful venous blood-draw, a cheaper test versus a significantly more expensive test, consumer ordered versus solely doctor ordered, and a much more rapid turnaround time with results sent to an app.
Theranos has a rocky road ahead before it becomes a ubiquitous technology. While Theranos has submitted and received FDA approval for some tests, others are still awaiting approval and the accuracy is unknown. Theranos has also frustrated regulators by not publishing their testing methods in peer-reviewed journals. The probable rationale behind not publishing their testing methods is to protect trade secrets, which could unfortunately come at the cost of patient safety.
Qualcomm Tricorder X-Prize:
The X-Prize is an organization that uses incentive challenges to foster innovation. Qualcomm, a leader in mobile technology, put up $10 million for the winner of the Tricorder medical device prize7. For reference the Tricorder is a (yet) fictional device seen in the TV show Star Trek. The requirements for the device include:
- Ability to diagnose 13 required conditions (anemia, sleep apnea, and COPD, to name a few)
- Ability to diagnose 3 elective conditions (HIV, hypothyroidism, and osteoporosis are among the choices)
- Ability to measure 5 health vital signs (blood pressure, heart rate, oxygen saturation, respiratory rate, and temperature)
- Must not weigh more than five pounds
- Must include a way for users to store and share their data
This instrument will harness the power of artificial intelligence and will allow for the diagnosis of a disease independent of a medical professional. The seven participating teams have researchers from top schools and companies across the U.S., China, Taiwan, and India. While you might think that a device of this sort is far off in the future, it isn’t. The judging of the device is taking place in November of 2015 and the final award ceremony is slated for New Year’s Day of 20167.
Genetic testing has taken off in the past decade and continues to improve. The first complete sequenced human genome cost $100 million2. What is the price for the same procedure today? About a thousand dollars. Genetic technology really is developing faster than regulatory bodies can adapt to them.
Widely available genetic testing is the biggest change in clinical medicine in the past five years. But it has also given rise to the development and understanding of another huge aspect of the human experience: the microbiome. DNA sequencing applies to bacteria just as it does to a human cell. Any good medical entrepreneur will see an opportunity here. Advance science, change lives, and make money. Ubiome is doing exactly that.
Ubiome is an early example of an evolving aspect of clinical medicine. The tests they do today will be a staple of tests you do in the future, which by then will be better understood and treated. How does it work? You get a kit, swab the chosen microbiome (gut—you swab your stool, nose, skin, mouth, and/or genitals), send the kit to the lab to be sequenced, and finally receive the results in a month.
Fortune magazine called 2015 “the Year of the Microbiome” in its yearly report1. Looks like it isn’t so. That being said microbiomics will be a staple long before 2025.
Ever been to the blood bank? A similar organization has opened that involves storing stool instead of blood. OpenBiome is an MIT-based organization that is working to simplify fecal transplantation and further research in the field3. Is your microbiome off? Replace it. One man’s trash is another man’s treasure.
HLI Health Nucleus:
Craig Venter spearheaded the sequence of the first human genome. I had a genetics professor who called him the “Donald Trump” of genetics. I suppose that means he isn’t a fan. Regardless, Venter has pushed medicine to new heights. Nowhere is that more evident than his company Human Longevity Inc. Human Longevity Inc exists at the crossroads of medical data and machine learning.
Earlier this year HLI unveiled the Health Nucleus. A so-called “executive physical on steroids”, for the price of $25,000 you can get a full genome analysis, a microbiome sequence, an analysis of 2,000 body chemicals, and a full-body MRI8. To some degree it is a gift that keeps on giving. Your data is entered into a database and you will be updated as learning evolves and applies to your data.
The reason why HLI deviates from other companies in this arena is data collection8. What we know in 2015 doesn’t compare to what we will know in 2025. And companies like HLI are bringing this future more quickly. The reality is that we can currently test many biomarkers but the struggle lies in their interpretation. HLI’s large database scanned by machine learning will make the Health Nucleus a game changer in 2015 and the norm in 2025. Perhaps they should be paying you for your data, which seems to be where the money lies.
Alphabet (formerly Google):
No dialogue on the future would be complete without mentioning Google. After Google’s reorganization under the umbrella company Alphabet, they are better geared and more focused toward tackling healthcare. Alphabet is taking a shotgun approach towards reengineering healthcare: they have subsidiaries such as the Life Sciences division, Google X, Calico (the anti-aging arm), and Google Ventures, which often invests in companies working in healthcare (23andme, Doctor on Demand, Flatiron, etc.).
So, how will this change healthcare in the near term? An exciting development is the smart contact lens from Google X, which measures blood glucose on a second-by-second basis. This will make diabetes management far simpler and more accurate. It will allow for smarter insulin dosages and a non-invasive approach to measuring blood sugar. Perhaps the blood test of 2025 will not require drawing any blood at all!
If that isn’t enough, the Google Life Science department has also developed a cardiac wrist monitor that senses EKG (Electrocardiography–a way to measure the electrical activity of the heart) as well as environmental stressors such as light and noise6. Per usual, this sort of device will be connected to the cloud and will allow for large scale research and data mining.
A third project that Google Life Sciences is working on is the Baseline Study. While currently a small study, it is designed to track thousands of participant biomarkers in order to gauge when the transition from healthy to diseased occurs–and what it looks like from a biochemical viewpoint. This is all done under the hypothesis that studying health may allow for a better understanding of disease.
The blood test of 2025 won’t look like the blood test of today. It will often be preventative rather than reactive, it will be cheap, and it may not involve drawing blood at all. Your new doctor might be powered by artificial intelligence, getting data and giving insight at a moment’s notice. Some of the changes to healthcare sound outrageous and trivial, but they are real and are flowing rapidly through the pipeline. And don’t forget that for those with serious illness, these changes may mean the difference between a life that is heaven or hell.
1) Cendrowski, S., Fry, E., Gallagher, L., Gandel, S., Griffith, E., Hackett, R., . . . Zillman, C. (2014, December 4). 29 predictions for 2015: Fortune’s Crystal Ball. Retrieved October 25, 2015, from http://fortune.com/2014/12/04/predictions-2015-future-business/
2) Hayden, E. (2014, January 15). Is the $1,000 genome for real? Retrieved October 25, 2015, from http://www.nature.com/news/is-the-1-000-genome-for-real-1.14530
3) Home. (n.d.). Retrieved October 25, 2015, from http://www.openbiome.org/
4) Hull, Gordon. “Theranos and the Biopolitics of Blood-Testing.” ‘New APPS: Art, Politics, Philosophy, Science’ N.p., n.d. Web. 26 Oct. 2015.
5) Kim, Jung A. “Book Review: Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.” Healthcare Informatics Research. Korean Society of Medical Informatics, 30 Sept. 2013. Web. 25 Oct. 2015.
6) King, H. (2015, June 23). Google testing a cardiac sensor wristband. Retrieved October 25, 2015, from http://money.cnn.com/2015/06/23/technology/google-ecg-wearable/
7) Overview. (2015, September 11). Retrieved October 25, 2015, from http://tricorder.xprize.org/about/overview
8) Regalado, A. (2015, September 22). J. Craig Venter’s Human Longevity to Offer Health Services | MIT Technology Review. Retrieved October 25, 2015, from http://www.technologyreview.com/news/541516/j-craig-venter-to-sell-dna-data-to-consumers/