‘We practice medicine today at a population level. This will not continue. It promotes waste,’ he told participants attending the Annual Meeting & Clinical Lab Expo for the American Association for Clinical Chemistry. ‘For example, in a study on 90,000 women we learned that mammography screening doesn’t help anyone, that it had no significant benefit. In fact, it hurt tens of thousands of women who received false positives. Similarly false positives for PSA screenings hurt men by triggering serial biopsies or radiation therapy. This is what happens when we treat all people the same.’
Today Moore’s Law is moving technology in one direction, reducing cost, while the cost of healthcare is going in the other direction, continually increasing because, ‘we haven’t begun to use the information yet that’s available in digital form,’ Topol pointed out.
We have not been able to do better up to this point, but that is changing, and clinical labs need to adapt to the technological and societal trends. ‘Today we can digitise the individual, and this is extraordinary,’ he added.
In a recently published article in Cell, entitled, ‘Individualized Medicine: From pre-womb to tomb,’ Topol suggests that through an individual’s digital data we can understand their medical essence, take a pan-omic view of each individual and learn what makes him or her tick.’
Medical metrics have moved beyond the established genomic or proteomic information about the individual, growing to a family of up to 10 -omics, as well as a study of an individual’s environment, or exo-omics.
Progressively, he said, this data will enable the delivery of preventive care and far better medical outcomes in the future. It will take medicine to a much higher, more precise level. Google, Apple, and Samsung are all companies positioning to aggregate this data, though it is not yet medical-grade data.
Blood pressure and glucose measures are today well established with mobile devices. Recently cardiograms have come into the digital picture. ‘Cardiograms have been read by algorithms for decades. Now they can be read at the consumer level,’ stated Topol. ‘Smart watches pre-empt the need to get to a smartphone, sending all kinds of stored information to other devices that monitor vital signs continuously. All of this needs to be validated through rigorous study; but, it has been called a Trillion Dollar Cure for the healthcare system, to have individualised healthcare, rather than the increasing cost of Population-Based Healthcare.’
Lab testing is pivotal to medicine, he noted, but at a cost that is among the top drivers of increasing medical costs.
Today, innovation is starting to rethink the role of laboratory medicine, he said. Increasingly almost any biological test can be performed on miniaturised lab-on-chip assays. At the AACC exhibitors show more and more point-of-care and hand-held instruments. These devices, according to a recent publication, put ‘a pathologist-in-your-pocket’.
‘We are still asking whether patients should have access to their lab results. Why shouldn’t they have access? Why do we even ask this question anymore?’ Topol asked the audience of lab clinicians. ‘We have a new model that is going forward, with diagnostics done by patients in the years ahead. This will be a big shake up enabled by all this technology.’
Medical imaging is being revisited, the cardiologist believes, thanks to pocket tools made possible with new technologies. Patients will soon be able to do ‘selfies’ of a joint, or a bone. Ophthalmologic exams today can already be done with the Eye-Phone at a fraction of the cost of the usual visit. ‘The stethoscope is out,’ he confirmed. ‘Harvard is asking doctors, why would you listen to the heart, when you can see it in seconds? Taking on this icon of traditional medicine shows how these new tools will bring about a creative destruction of medicine.’
Eric J Topol MD, is an American cardiologist, geneticist, and researcher. Much of his career was spent at the Cleveland Clinic, where he served as chairman of cardiovascular medicine and founded the Cleveland Clinic Lerner College of Medicine. He is currently Director of the Scripps Translational Science Institute in La Jolla, California. In January 2012 he published the popular book The Creative Destruction of Medicine, which examined the impact of the genomic and wireless revolutions on the healthcare system.