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The Disruptors

A radical
prescription

by Lucy Hooker

Could digital technology make doctors of us all?

Advances in artificial intelligence, diagnostics and electronic data gathering could prompt a revolution in how we access healthcare.

Necessity is often credited as the mother of invention. For Jonathan Rothberg it was the frustration of sitting around in hospital waiting rooms that made him the father of a new idea.

His daughter suffers from tuberous sclerosis causing cysts to grow in her kidneys, for which she needed repeated ultrasound scans, but they were time-consuming and involved travelling back and forth to hospital. He was convinced there was an easier way.

Mr Rothberg already had a track record of innovation: he was behind the first high-speed sequencing of DNA using digital technology, which allowed many more people access to their own genetic codes.

This time he was sure technology could deliver a cheaper, easier way to perform ultrasound scans.

Just a few years down the line and he has produced the Butterfly IQ. It fits in a lab-coat pocket and plugs into an ordinary iPhone. It uses thousands of tiny sensors, each smaller than a human hair, mounted on a computer chip, which, in the same way that a bat uses sound to locate objects, can build a picture of a human body from the inside out, to check the growth of a foetus in utero, the size of your liver, or assess a tumour.

Jonathan Rothberg says his aim is to “democratise” healthcare by offering the scanner at a low cost – it is priced at $2,000 – and by putting diagnosis in the hands of ordinary people.

“Our vision wasn't just to empower healthcare professionals,” says Mr Rothberg.

“We wanted anybody, anywhere, to have a window into the human body.”

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If thermometers started off as specialist medical devices, and are now in every home, argues Mr Rothberg, why not the same for ultrasound? In much the same way that giant mainframe computers have been supplanted by smartphones, innovations like this promise to transform healthcare, rolling out services that used to be the preserve of hospitals and specialists and putting them into the hands of ordinary medical staff and even patients.

We are poised to harness the power of electronically-stored data, and the benefits of devices that can monitor every individual’s health, every moment of every day, say the champions of the digital revolution. Yet at the same time the challenges facing our health services are vast.

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Virtual Reality

While there is broad-based optimism that technology will help to provide more effective care, there are also plenty who warn against becoming too starry-eyed over “sci-fi” developments that look good on magazine covers, but have yet to deliver proven results.

“There’s a lot of fly-by-night, ‘look at this whizzy gadget I developed’, but not measuring the use of it,” says Cambridge University’s Lydia Drumright, a specialist in medical data analysis.

Yet some developments, that might have initially looked like gimmicks, are reaching the medical front line, and their effectiveness is being tested in hospital-based trials.

Take virtual reality. VR technology offers the ability to create immersive alternative worlds with their primary aim to make playing on your games console a lot more exciting. But over a decade ago, researchers at the University of Washington in Seattle realised it could do more.

One of the first patients to test VR was Lt Sam Brown, who had suffered severe burns on his first tour of duty in Afghanistan. He reported that donning goggles and being shown a cartoonish, wintry landscape, where he could pelt penguins with snowballs, helped distract him from the excruciating pain of daily dressing changes.

Because VR allows you to control all visual stimuli in a three-dimensional setting, it allows patients to imagine they are somewhere else. Basic interactivity helps absorb their attention and carry out actions they might shy away from in the real world. Firms are now exploring wider applications for VR: confronting phobias, physical and cognitive therapy, and replaying combat scenarios to help servicemen and women manage post-traumatic stress disorder.

In hospitals and medical schools, VR can also be used to enhance doctors’ training, allowing them to virtually “walk through” complicated surgical procedures, such as separating conjoined twins.

According to Miki Levy, co-founder of Israeli start-up VRHealth, a firm that has five VR applications approved by the US’s Food and Drug Administration, and further products in development, the new platform could save health services money by aiding faster recovery, keeping elderly patients more mobile and potentially, in the area of pain relief, reducing reliance on opioids.

And it’s already making a difference to patients like Ety Yaakobovich.

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But wearable technologies like VR, could be set to overturn healthcare provision in much more dramatic ways too, thanks to the opportunities they offer to collect and analyse data.

As the trend grows for wristbands and watches and, in future embeddable or ingestible devices that monitor our vital signs, the data available both to us as patients and our doctors will balloon. That flood of patient-owned data will radically undermine the current structure of healthcare, according to Bertalan Mesko, editor of The Medical Futurist, a website and consultancy dedicated to predicting tech trends in healthcare.

Once wearable devices can reliably alert us “like a car warning light” if there is something wrong, he believes power will shift out of the “ivory tower” of the doctor’s surgery and into the hands of patients.

“The hierarchy becomes a partnership… the patient’s role changes from being a passive member to being an empowered, pro-active member who wants to take care of their disease management,” he says.

Combined with the proliferation of apps that offer medical consultations over the internet, such as Babylon in the UK, Berlin-based Ada and Ping An Good Doctor (PAGD) in China, there’s scope to move basic medical services, not just out of the surgery, but out of the hands of human doctors altogether, he suggests.

“The entire structure of healthcare, as well as the roles of patients and doctors, will fundamentally shift from the current status quo,” predicts
Bertalan Mesko.

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Artificial Intelligence

These “symptom-checker” services use artificial intelligence; an algorithm sifts through a huge database of previous cases to draw a machine-based conclusion from the information it has been given. In China nearly 50 million people are already using PAGD every month, with the range of its healthcare “ecosystem” extending from an online pharmacy to Chinese traditional medicine and referrals for cosmetic surgery.

The reaction of the medical profession to such apps, and other technology that places more control in the hands of patients, is mixed. Dr Ana Maria Lopez, President of the American College of Physicians, believes it offers a “fabulous” opportunity to free up doctors’ time and to focus face-to-face care on those who really need it. She welcomes patients becoming more engaged with their own healthcare, especially if it encourages them to adopt healthier lifestyles. But she admits there’s also a chance, paradoxically, that it could increase doctors’ workloads if it encourages the “worried well” to seek more medical care.

Dr Andrew Goddard, President of the Royal College of Physicians in London, agrees that new technologies and new approaches are to be welcomed, but worries that some digital innovations are in danger of serving only part of the patient population.

“On the back of my iPhone I have an ECG heart-tracking device. If I have a palpitation I can put my finger on it and measure my own heart rate and email it to the cardiologist. That’s ok for an educated person, comfortable using an iPhone and emailing.

“Imagine if you are 80, living on your own, struggling to use a phone even with big numbers. You haven’t got a computer in the house.

“The worry with this technology is that it will create a greater division in healthcare. It’s empowering to some patients, but not to others.”

But while physicians may have misgivings, the technology sector is forging ahead. As well as the flood of new start-ups, technology giants are investing in medical applications and services.

Apple hopes to exploit the potential of the iPhone and the Apple watch to integrate personal health data with new services, while Google has invested in firms using AI to diagnose disease, such as DeepMind which recently announced progress in machine-based analysis of eye scans. And China’s Tencent has joined forces with London-based start-up Medopad to use AI in the treatment of Parkinson’s disease.

Amazon has teamed up with investment firm Berkshire Hathaway and the bank JP Morgan Chase with the ultimate aim thought to be a shake-up of the healthcare system in the USA. Though they haven’t announced details, Berkshire’s chairman, Warren Buffett, famous for his financial acumen, said the aim was to challenge the “hungry tapeworm” of healthcare costs.

But progress for anyone trying to disrupt healthcare across the board will rely on advances in some underlying structural matters: shifting to electronic patient records, and establishing privacy regulation around that data. For those reasons Lydia Drumright says the development of more AI-based decision-making in medicine has been “slow going” so far. It is poorer parts of the world that would benefit most, she says, if the basic infrastructure could be put in place.

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Life-saving
data

Now, though, firms are beginning to tackle that challenge too. Medic Mobile, a non-profit enterprise operating in 20 countries in Asia and Africa, helps healthcare workers compile electronic records in the field. A simple smartphone app provides them with a way to keep track of which patients are pregnant for example, or have been vaccinated or who are at risk of disease.

The app provides AI-sourced advice for healthcare workers, giving them access to a broader spectrum of medical expertise. And it uses the most accessible of technology, the smartphone. If the internet is not available, a more rudimentary service still operates via text message.

“Sometimes it’s the simplest things that make the biggest difference,” says Regina Mutuku, Africa regional director for Medic Mobile. In rural settings, with poor communications and sparse health services, the service is invaluable, she says.

“Having a community health worker reporting there’s a woman who is 20 km away who is already bleeding and having the health facility dispatch care, or tell her what to do in real time as opposed to waiting for her to go to a health facility, which can result in death - this is the power of having this in the community.”

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We shouldn’t expect Medic Mobile, or any of the range of other new digital technologies coming on stream, to be a universal panacea. Chronic conditions such as diabetes, heart disease and musculoskeletal disorders that are related to lifestyles, and are exacerbated by longer lifespans, remain the biggest challenges on the healthcare horizon. Hard-to-control epidemics still ravage parts of the world and infectious diseases still test our capacity to respond.

But digital technology is beginning to change the way medicine is being delivered, providing new tools to manage these challenges and support patients, and helping us understand our own health in new ways. And ultimately, embracing a revolution in the way care is delivered may be the best hope we have, suggests Bertalan Mesko, because without that we are already on a trajectory where we simply won’t be able to meet demand.

“If we keep healthcare as it is today, people will lose access to medical professionals. Physically they won't be able to accommodate patients’ needs. It'll be a luxury to talk to a physician.”

A cultural transformation that hands more control to patients, automates some services, builds on the insights AI can provide, and uses digital record-keeping and communication more efficiently, is the only way to ensure doctors can still serve patients when they need it most, he says.

“That's the only sustainable scenario we have,” says Mr Mesko, “to use these technologies.”

Picture credits: Getty, Butterfly Network, Ping An Good Doctor, BBC.

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