Exponential Medicine

The future is here, it's just not evenly distributed
-William Gibson

Three weeks ago I had the opportunity to attend this year’s Exponential Medicine conference.  It has taken me this long to process some of my initial thoughts, as the event was quite simply a mind-blowing four days that has altered my thinking and radically expanded my perspective.
 
Technological change in healthcare is happening quicker than anything that we (meaning those of us who work daily in healthcare) might think.
 
The reason for this acceleration, is what the noted futurist Ray Kurzweil (speaker Day 4) has called the Law of Accelerating Returns (LOAR).  Kurzweil extended Moore’s Law, first observed in 1965 by Intel’s Gordon Moore, who observed that the number of transistors on an integrated circuit doubled every every two years and would do so for the foreseeable future.  Kurzweil realized that Moore’s law actually preceded semiconductor technology and could be extended back through multiple technologies, transistors, vacuum tubes, electromechanical devices all the way to Charles Babbage’s Difference Engine first proposed in 1822!  Kurzweil went further to postulate that it is information that powers this phenomenon and that any technology that is information enabled will double in performance every 1-2 years, and that once this starts it will not stop as underlying improvements in computation will continue to improve.  This effect become even more dramatic as multiple fields become information enabled and begin to synergize and converge.
 
In healthcare today, we are seeing a convergence of multiple exponential technologies that are being combined to create possibilities that only years ago would be considered science fiction.  The combinations of cheap and ubiquitous sensors, computational power, data aggregation platforms, big data engines, machine learning and deep learning along with ubiquitous mobile computing foretells a coming time when access to healthcare will be personal, precise, predictive, preventative and amazingly universal.
 
Dr. Aenor Sawyer from UCSF Digital Health Innovation Centre talked about the potential for digital health to reinvent health by connecting doctors and patients at the point of choice (rather than point of care) leveraging what she calls the panome: all the potential data now available at a patient level: genome, transcriptome, metabolome, proteome, microbiome, physiome (think sensors tracking every aspect of physiology, lifestyle and activity, antome (digital medical imaging) along with electronic medical records.  Bringing this data together in the cloud opens possibilities for machine intelligence and deep learning.  Dr. Jeremy Howard from Enlitic, described the capabilities of current generation deep learning systems outperforming radiologists and pathologists after relatively limited periods of training.  Excitingly, this ability to use deep neural networks to detects patterns and correlations across a multitude of  variables, well beyond human capability, coupled with expert clinicians opens the door to the computer augmented physician and improvements in diagnosis today.  The insights derived from the aggregation and analysis of data will power advances in healthcare as well as in wellness.  In fact the ability for consumers to understand their own health and the use of applied behavioral science and gamification to create compelling user experiences, based on data driven insights is likely the holy grail for chronic disease management.
 
Keeping all of the data secure may involve the use of the blockchain as Chelsea Barabas of MIT Media Lab proposed.  Most of us, if we know anything about the blockchain, understand it in conjunction with bitcoin, or as The Economist points out: the technology that allows people who do not know or trust each other, to create a dependable ledger. What if patient data was held in a secure, dependable ‘ledger’ where patients control who has access, revealing only the data required to make a clinical decision.  This intriguing potential may solve one of the biggest challenges to the era of personalized medicine: privacy.  This concept has also been explored by Dr. Eric Topol and Leonard Kish who argue that patients need to own and control their own data.
 
Prior to ExMed, I had read many articles and books that would breathlessly describe how a smartphone app could replace your family doctor.  As a GP myself, I felt that this was nonsense.  I honestly could not see it.  Now, I am humbled to say that the capabilities required to do this are almost here:

• Ability to understand written and verbal language
• Ability to process meaning from conversation
• Ability to understand emotion
• Ability to compare symptoms and history to a database of differential diagnosis
• Ability to learn from interactions and outcomes
• Ability to create compelling mobile app experiences (think games)

In medical school, I learned that 80% of a diagnosis came from a good history, imagine the capabilities of a deep learning system combined with increasing precise data powering a Bayesian probability engine. (I will leave that to another blog post…)
 
As you can tell by reading this far, I am very excited about the potential of exponential technologies to transform healthcare, but I could not post this without pausing to reflect some of the challenges that will occur along the way.  How healthcare systems embrace the new technology without exploding costs will depend on how well leaders view and understand the full determinants and drivers of health. Dave Chase has recently written on the “Copernican” realignment required to organize health around the individual and not around providers and medical technology.  Dave has written eloquently about a multitude of next-generation healthcare delivery organizations that are appearing in the US that understand this shift and are making it real.  In Canada, primary care reform and medical home models are emerging but in a frustratingly slow and uneven way.
 
This ability for healthcare systems to resist the changes necessary to put patients first is what concerns me most deeply at this most exciting of times.  It does give me pause to wonder if the new technology is  most likely to flourish and develop first in areas that are not deeply rooted with entrenched self-interests, regulation and change-avoidant cultures.  Two areas to watch are consumer health and wellness and emerging healthcare systems in the developing world, where in a manner similar to their adoption of cellular technology without landlines, patient centred healthcare around digital technology may be their first modern healthcare systems.
 
It will take me months to process what I learned and saw at Exponential Medicine, and I am sure that many blog posts will come from ideas that were planted in the many lectures by leading thinkers across genomics, genetic engineering, stem cells, AI,3D printing, robotics, big data, nanotechnology, virtual/augmented reality, wearables, sensors and many more!  As important as these lectures were, the hallway, dinner and late-night conversations were even more impressive.  Kudos to  Dr. Daniel Kraft and his team at Singularity University, I have to say that this was the most impressive conference I have ever attended and I look forward to next year’s.