In 2005, Walter De Brouwer’s five-year-old son was rushed to the hospital with a severe head injury after falling more than 30 feet out of a window. In the three months that his son spent in the intensive care unit, De Brouwer, a Belgian tech entrepreneur transplanted to Silicon Valley, took to learning the myriad hospital machinery that tracked his son’s vital signs. He began bringing his laptop to the hospital, copying the reams of data into an Excel spreadsheet to study the relationship between his son’s blood pressure and heart rate, or the way his condition seemed to decline around the same time each night.
When his son was well enough to be discharged to a regular hospital room, De Brouwer panicked. “I knew this environment and these numbers and then I had to go to a room with no numbers, not even a computer,” he says. “I thought, ‘Why do I only have a thermometer at home?’ Perhaps we should know more about our health before it gets bad.”
The experience gave him the idea for the Scanadu Scout, a futuristic palm-sized device that can monitor five different vital signs, including temperature, heart rate and blood oxygenation level, by just holding it to your temple for 10 seconds. It then transmits the results wirelessly to your smartphone so you can track your health information over time, seeing, for instance, if a certain medication makes your heart rate climb, or what’s going on inside your body on those nights when you can’t fall asleep.
Pending approval by U.S. regulators, De Brouwer hopes to have the Scout on the market at the end of the year for $150. Getting regulatory approval to sell the device in Canada is the next logical extension, he says.
The company offers the promise of “sending your smartphone to med school” in recognition of the fact that today’s smartphones, with their powerful processors and high-speed Internet connections, have the potential to become pocket-sized, wireless diagnostic machines. That idea, says De Brouwer, is already having a profound effect on medicine. “In the next three to four years a big part of preventative medicine will be taken up by the Internet of things around us, which will communicate with our phone,” he says. “When we have an accident and people rush to us they won’t be coming to feel our bodies, but to look at our phone.”
Scanadu is developing disposable test strips that can be scanned at home by your phone to analyze saliva for different strains of the flu or strep throat, or to check urine samples for urinary tract infections, renal failure or complications from pregnancy.
De Brouwer is hardly the only Silicon Valley entrepreneur working to revolutionize the doctor-patient relationship. There are now as many as 18,000 medical apps aimed at consumers that promise to diagnose illness, suggest appropriate treatment or monitor a patient’s health status. While they range from free programs based on pseudo-science, to apps designed by some of the continent’s top medical research universities, all are part of a broader movement to fundamentally shift power away from doctors and into the hands of patients themselves.
Even as technology is opening new opportunities for medicine, it is also creating new dangers. As is the case with flesh and blood doctors, the diagnosis is only as good as the app or device you’re using. With regulators struggling to keep up with the hundreds of new health-related apps uploaded to the Internet daily, it means personal health care is becoming something of a Wild West frontier. But it also means the days of relying on your family doctor to figure out what’s wrong with you—a diagnostic process virtually unchanged for generations—are quickly coming to an end.
Consumer devices that track your vital signs have long been popular among amateur and professional athletes who use heart-rate monitors and GPS-enabled wristbands that measure speed and distance travelled during training. But as the technology has evolved, it has also attracted those with chronic health conditions. These “e-patients” are part of a more wide-ranging shift in the health care system driven by consumers themselves.
“If you were to pick one thing to correlate with how good a doctor is going to be, a pretty good pick is how many cases of a particular condition and a particular treatment they have seen,” says Sean Ahrens, a San Francisco-based software engineer. “What if there was a doctor who could see a million patients, or every single case in the world? It’s impossible for a human to do that, but maybe software can pull off that feat.”
After suffering a painful flare-up of Crohn’s disease, an incurable chronic inflammation of the digestive tract, Ahrens did what millions of people do every day: he went online in search of help.
Ahrens has suffered from Crohn’s since he was 12, when he was hospitalized after suddenly losing 30 lb. Now 26, he had exhausted every available treatment and was left with the option of having doctors surgically remove sections of his intestines.
The alternative he discovered was helminthic therapy, an experimental treatment not approved by regulators that involves ingesting parasitic worms. He found a company in Germany willing to mail him the parasites (he actually did ingest the worms for a while), but he abandoned the experiment after his symptoms got worse—and then suddenly got better.
The experience convinced him that buried in his small act of self-experimentation was vital information about a potential new therapy. Multiply Ahrens’s story by the hundreds or thousands of other patients who are popping vitamins, changing up their diets or experimenting with the multitude of other alternative therapies, often without telling their doctors and, he says, the world was losing a treasure trove of first-hand medical data that wasn’t being captured by any official clinical study of Crohn’s disease. “No one was listening to them,” he says. “Just because it’s not being done in a lab with a doctor and a researcher present, doesn’t mean this data isn’t valuable.”
In 2011, he created Crohnology.com, a social networking site for people suffering from Crohn’s and colitis. Patients can go online to track their daily health, report flare-ups and rate their treatments. They can send a text message to update how they’re feeling, which the site will also log and track over time. But more important, says Ahrens, is Crohnology’s ability to take the immense data it collects from its 2,500 members on every treatment, both prescribed and self-administered, and analyze it for trends. So far, the site’s users have reported that giving up beer offers the best results, followed by doses of vitamin B12 and use of the prescription drug prednisone.
It’s what Ahrens calls an open-source clinical trial with the ultimate goal of building a Crohn’s “superdoctor” designed by patients themselves. He’s now planning similar sites for two other autoimmune disorders, multiple sclerosis and rheumatoid arthritis. Doctors and other non-patients get limited guest privileges on the site and Ahrens hopes to eventually conduct more structured experiments and potentially share some of Crohnology’s data with non-profits that are researching treatments and cures.
Already, Patientslikeme.com, a website started by MIT grads, has conducted what’s widely considered to be the first clinical drug trial over social media when, in 2008, more than 300 of its members with ALS, or Lou Gehrig’s disease, tracked their experiments with the prescription drug lithium as a possible treatment. They found no evidence it helped with their condition. Two years later, a clinical study funded by the U.S. National Institutes of Health came to the same conclusion.
“It’s the most radical change in the history of medicine that we’re looking at here,” says Dr. Eric Topol, a prominent U.S. cardiologist and director of the Scripps Translational Science Institute. “It used to be all the information, all the control, was harboured with the doctor and the health care professional. That’s shifted to where the consumer, the patient, is getting their own data and through various means, and deciding whether they want to share it and with whom and when. They’re in control.”
Topol has become one of North America’s most vocal proponents of consumer health technology with his book, The Creative Destruction of Medicine. He says he now prescribes more apps to his patients than pharmaceuticals. Virtually all of his patients with hypertension use smartphone apps that help them monitor their blood pressure and send him screenshots of their readings in advance of their visits. “I get so much enriched information and the patient is diagnosing himself or herself,” he says. “I haven’t had anyone who hasn’t embraced it.”
Personal health care technology is attracting significant attention from investors. Silicon Valley start-up incubator Rock Health reported last year that venture capital funding for digital health grew from $968 million to $1.4 billion, even as funding for traditional medical devices and biotech firms dropped. The biggest increase was in consumer health devices, with $150 million invested into start-ups for personal health-tracking tools and $237 million into online health resources.
While most consumer apps amount to software versions of classic fitness technologies like calorie counters, heart-rate monitors and pedometers, there is an increasing array of sophisticated medical software and tools being developed, some for consumers with specific medical issues and others exclusively for health care professionals. There are now dozens of smartphone apps to help diabetics track their glucose levels and even more that promise to analyze your sleep patterns and suggest ways to get a better night’s rest.
In Canada, hospitals are increasingly using smartphone technology to interact with patients. University Health Network’s Centre for Global eHealth Innovation in Toronto developed apps that warn asthmatics of local weather that could affect their condition and alert patients with hypertension if they’ve missed a blood pressure reading. In a pilot project the centre ran with the Hospital for Sick Children, teenagers with Type 1 diabetes installed apps on their phones that prompted them to regularly check their blood sugar and then rewarded them with iTunes gift cards. Women’s College Hospital in Toronto had patients recovering from breast reconstruction surgery take photos with their phones of their surgical wounds so doctors could remotely monitor their healing.
Meanwhile, researchers elsewhere have shown that it’s possible to accurately measure someone’s pulse using the camera on a phone. At MIT, researchers have developed a prototype of a smartphone attachment that costs just $2 and can conduct an eye exam to determine the prescription for glasses—a potential boon for people in remote parts of the world. In 2011, the U.S. Food and Drug Administration, which regulates medical devices, approved a portable ultrasound device that plugs into a smartphone.
One of Topol’s favourites is an app from the Oklahoma tech company AliveCor that uses a credit-card sized sensor that fits over the back of an iPhone, turning it into a portable electrocardiogram machine to monitor the electrical impulses from the heart. So far the device is available only for health care professionals, but the company says it is working on a consumer version. Topol says he often uses the device with patients instead of a traditional ECG machine. Last year, he was on his way home to San Diego from demonstrating the device at a National Institutes of Health conference in Washington when flight attendants began calling for a doctor to help a with a passenger in distress. Topol pressed the phone’s sensors to the passenger’s chest and determined he was having a heart attack. The plane made an emergency landing outside of Cincinnati.
Perhaps the holy Grail of futuristic medical devices is the tricorder, the mythical handheld device used by every Star Trek doctor since the 1960s to remotely scan patients and come up with an instantaneous diagnosis. It’s no surprise that researchers in Silicon Valley are furiously trying to build one of their own.
Last year, Peter Diamandis, the Harvard MD whose multi-million-dollar X Prize foundation pioneered commercial space travel, launched his newest competition: a $20-million contest to build the world’s first working tricorder. The winning device must be designed for consumers and able to diagnose 15 different conditions, from pneumonia, to diabetes, to sleep apnea, as reliably as a panel of doctors. It has attracted more than 250 teams—including De Brouwer’s Scanadu—and expects to award the prize in September 2015.
The potential for a working tricorder to help consumers diagnose their own conditions is endless, says X Prize senior director Mark Winter. It could, for instance, mean being able to diagnose whether the pain in your side is appendicitis—an emergency condition—or whether you’ve just pulled a muscle in your back. Mothers could use the device to analyze the bacteria in a child’s breath to find out if they have pneumonia or a routine cold. It could also transmit that data to your local hospital so doctors already have an idea of what’s wrong before you even walk in the door.
“If you think of the mom as being the medical manager of the household and the tools she’s had over the years are a telephone and a mercury thermometer, think about arming mom with more tools to decide what to do next,” says Don Jones at Qualcomm, the wireless technology manufacturer sponsoring the tricorder competition. “That’s really what we’re talking about. It’s just leapfrogging down that toolset.”
A tricorder-like device could be routinely handed out to patients by doctors or insurance companies as a way to cut down on both the costs and the demands on the health care system, Jones says. “Frankly, many consumers are going to say this is more convenient than booking an appointment and not getting one for a week,” he says. “The entities that are financially responsible for people’s health—insurers, governments, large employers, unions and, increasingly, health care providers themselves—if they can get people to take on the responsibility of managing some of their own care, it’s a logical solution because we’re headed to a situation where we’re not going to have enough primary care providers to deal with the demands on the system over the next 30 years.”
Jones says much of the sensor technology to collect the reams of physiological data required to make such diagnoses already exists and is relatively cheap. The challenge is to integrate it into a single small device with software that can analyze the constant stream of data coming from the human body and make reliable predictions.
Such breakthroughs are already happening. Sano Intelligence, a San Francisco start-up, is developing a sensor the size of a nicotine patch that can wirelessly transmit blood chemistry data and hopes to eventually measure kidney function and electrolytes. U.K.-based DNA Electronics is building a handheld device that plugs into a tablet or laptop and uses DNA testing to see whether you might have a bad reaction to a specific prescription drug. The test is aimed at the average consumer and takes around 30 minutes.
Even more sci-fi like, researchers at Scripps Translational Science Institute in California are working on a sensor about the size of a grain of sand, called a “nanosensor,” that can be inserted into arteries. It uses laser light to detect the presence of specific proteins that warn of diseases and can then transmit that information to your phone. Researchers say it could be used to predict an impending heart attack several weeks in advance, or to detect that an organ is failing long before more obvious symptoms emerge.
The future of consumer medical technology seems limitless. But the field has also attracted its share of questionable claims. In the U.S., the FDA has already banned two smartphone apps that promised to cure acne just by holding the phone to your skin. A study last month from the University of Pittsburgh tested four apps that claimed to be able to detect to melanoma, a potentially deadly skin cancer, by having people take pictures of their moles with their phone’s camera. On average, it found the three apps that used computer algorithms to examine moles got it wrong 30 per cent of the time. A fourth app, which allowed users to send a photo of their mole to a real dermatologist, had a 98 per cent success rate. It cost just $5 per picture and guaranteed results within 24 hours. That compares to a wait of up to six months for an appointment to see a dermatologist to make a similar visual assessment.
Health regulators have been slow to acknowledge the rapidly advancing medical technology aimed at consumers. In Canada, legislation limits Health Canada to regulating medical devices that are for sale. That covers a host of devices and software, but not, for instance, apps that are offered free to consumers from health care providers, or are hosted in other countries but which Canadians can access remotely over the web.
Software running over the cloud that can instantly turn your phone into a diagnostic device is “a huge loophole,” Sarah Chandler of the medical devices bureau of Health Canada, told a mobile health conference in Toronto earlier this month.
Will Falk, managing partner of health care at PricewaterhouseCoopers and a professor at the Rotman School of Management, suspects that eventually regulators and doctors will begin filtering the thousands of medical smartphone apps just as they do pharmaceuticals, with doctors prescribing the most reliable apps to their patients. “Your family doctor is going to have to have an opinion on this, the same way they have an opinion on the drugs you take, because devices are replacing drugs,” he says. “But we’ve got to have some control over these apps. It’s going to be an app pharmacy. Not an app store.”
Until the distant day that smartphones can reliably perform complex surgery without any human intervention, there will always be a place for medical specialists. We will also still need family doctors to prescribe medications and issue referrals. But technology is making it possible to weed out the people who don’t need to go to the doctor at all, saving the health care system for the sickest patients. Those who still need a doctor will come armed with better information about their bodies.
Scanadu’s De Brouwer believes the family doctor of the future will be a comforting voice to provide support and a second opinion to patients who are diagnosing themselves on their smartphones. Sean Ahrens, the Crohnology founder, predicts that technological advances will one day make going to the doctor’s office as obsolete as going to the video store to rent a VHS. “In 50 years time will a doctor no longer really play much of the role they currently play in health care?” he asks. “I think that’s a real possibility.”