The future of precision medicine doesn’t lie in some theoretical construct but is here now in the form of digital tools that are currently available to providers and patients alike.
That’s the contention of Eric Topol, MD, director of the Scripps Translational Science Institute and a keynote speaker at Wednesday’s opening session of the 2017 AHIP Institute & Expo in Austin, Texas.
However, before healthcare can take full advantage of a personalized approach to healthcare that treats individuals—not populations—the industry needs to come to terms with its failed ways.
“Medicine today is in a pretty sorry state—it’s sad to admit, and we have to face the problems we have,” said Topol, who contends that “imprecision” is a root cause of the inefficiency and waste in medicine. “We have this illusion that we provide such great healthcare in this country, and it’s so far from the truth.”
Despite the billions of dollars spent developing medications, he pointed to the fact that 75 percent of patients who are prescribed the 10 top-selling drugs don’t respond to these pharmaceuticals. In addition, Topol noted that the medical error problem in healthcare is profound, representing the third leading cause of death in the United States; in addition, 12 million Americans are misdiagnosed each year. Further, he said that one in four hospitalized patients are harmed while in the care of clinicians.
“We’re talking about at least $1 trillion of waste per year because of this imprecision of not seeing people as individuals, but rather (using) this population medicine approach,” according to Topol. “There is no one who is average—that person doesn’t exist.”
Leveraging the available technology to understand each human being is where medicine needs to go in the 21st Century, he said. What’s needed is to “map” the human body, providing a “Google Medical Maps” equivalent. “But, instead of the satellite street view and traffic view, you have the views of the person’s phenome, external features, their DNA, RNA proteins, their epigenome, their microbiome and their exposome,” added Topol.
According to Topol, mobile technology is the enabler for measuring human physiology. “Today, we can use smartphones to accomplish a lot of this understanding of each individual,” he said. “And, the smartphone will indeed be the hub in the imminent years of medicine because there are sensors for every physiologic metric.”
At the same time, Topol insisted that these “medicalized” smartphones will serve as technological enablers for the “democratization” of medicine, giving patients control of their own data, which has historically been the exclusive domain of physicians.
One of the mobile devices that Topol is particularly keen on is smartphone ultrasound. “You can now get high-quality, high-resolution images through your phone of any part of your body except the brain, because you can’t image through the skull,” he added.
A cardiologist, Topol said he also uses a portable echocardiogram through his smartphone to monitor a beating heart.
“Why would you ever listen to a person’s heart with an obsolete stethoscope?” he asked. “It isn’t even a scope. It’s a stethophone. This is really a big shakeup in healthcare, and the fact is that most doctors are not using this. There’s only one reason why it isn’t being used. It has something to do with the big ‘R’—reimbursement.”
Health payers are “in the driver’s seat here, and there’s no entity that has the power to change medicine as insurers, so I’m hoping they will buy into these really exciting times that we are in,” concludes Topol. “We have the tools to do it. Hopefully, we have the will to do it.”
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