Perils & Prospects of Practicing Medicine in a Digital Era g - PDF document

Perils & Prospects of Practicing Medicine in a Digital Era g Kent Bottles, MD Chief Medical Officer, PYA Analytics Thomas Jefferson University School of Population Health kent@kentbottlesmd.com; 610 639 4956 NAMS 2013 Annual Meeting Plenary Symposium 1 Traditional Medicine • Biomedical model reduces every illness to a The Digital Revolution in biological mechanism of cause and effect Medicine • Attention on acute episodic illness • Generalists replaced by specialists • Focus on individuals • Cure as uncompromised goal • Focus on disease • Antibiotics & infectious disease Traditional Medicine Jeff Goldsmith on Digital Future • Diagnose and treat • “David never spent a day in the hospital, and had one home and two office visits with • Health is defined as absence of disease his physicians during the course of p y g • Patient story is subjective and untrustworthy • Patient story is subjective and untrustworthy treatment, which consisted in its entirety of • Lab results are objective and true six weeks’ worth of home infusion therapy. • Pathologists are the most important doctors • Clinicians are paralyzed until lab provides dx 1

The End of Illness Jeff Goldsmith on Digital Future David Agus, New York: Free Press, 2011 • “Take a moment to imagine what it would be • The bill for all these services was created, like to live robustly to a ripe old age of one evaluated, and paid electronically, with hundred or more. Then, as if your master David’s nominal portion of the cost billed to p switch clicked off, your body just goes kaput. , y y j g p You die peacefully in your sleep after your last his Visa card, per agreement with his health dance that evening. You don’t die of any plan. He never saw a paper bill, though he particular illness, and you haven’t gradually could view the billing process in real time been wasting away under the spell of some awful, enfeebling disease that began years or on his health plan’s web site.” decades earlier.” Eric Topol on MI prevention Eric Topol on MI prevention • “Monitoring would ideally use an implanted • Well before the horse was out of the barn, nanosensor, smaller than a grain of sand and the nanosensor could alert the individual to capable of finding its targets in even one- p g g seek attention; therapy then would consist ; py millionth of a liter of blood, communicating of both ant-clotting and anti-inflammatory with a patient’s smartphone. Individuals medications. At some point in the future, who would get the nanosensors would be nanosensors will likely have the capacity to those whose genome sequence or other release medications on their own in biomarkers had already put them at risk for response to high levels of circulating cells a heart attack. or nucleic acids” Digital Medicine Convergence Digital Medicine • Genomics • Digitizing a human being • Wireless sensors – Genome • Imaging g g – Remotely, continuously monitor vital signs, Remotely, continuously monitor vital signs, mood, activity • Information Systems – Image any part of body, 3d reconstruction, print • Social networks an organ • Ubiquity of smartphones – Readily available on your smartphone, • Unlimited computing power via cloud server integrated with traditional medical record, farms makes Big Data Analytics possible constantly updated 2

Digital Medicine of Present & Digital Medicine of Present & Future Future • Human body and disease is complex • Agus consulted on treatment or Steve Jobs emergent system that may never be fully • Jobs had both his cancer and normal cells understood sequenced for molecular targeted therapy sequenced for molecular targeted therapy • Attention on chronic diseases • Oncologists customized his chemotherapy • Managing chronic diseases rather than cure to target specific defective molecular pathways in his tumor • Focus on person and the disease • Treatment changed when tumor mutated during therapy Digital Medicine of Present & Systems Biology Yields New Future Therapies • One of Steve Jobs’ doctors said there was hope • Zoledronic acid affects bone metabolism that his cancer would soon be considered a and is used to reduce fractures but does manageable chronic disease, which could be nothing to cancer cells. g kept at bay until he died of something else kept at bay until he died of something else • Zoledronic acid decreases breast cancer • “I’m either going to be one of the first to be recurrence by 36% presumably because it able to outrun a cancer like this, or I’m going to be one of the last to die from it. Either changes the environment of bones so cancer among the first to make it to shore, or the last cells cannot spread to get dumped” Systems Biology Yields New Systems Biology Yields New Therapies Therapies http://www.nytimes.com/2012/07/08/health/in-gene-sequencing- http://www.nytimes.com/2012/06/03/business/geneticists-research-finds-his-own- diabetes.html?_r=1&pagewanted=print treatment-for-leukemia-glimpses-of-the-future.html?pagewanted=all • Dr. Lukas Wartman of Washington • Michael Snyder sequenced his genome that University developed Adult Acute showed he was at high risk for Type 2 Lymboblastic Leukemia Diabetes • Sequenced cancer cells & healthy cells • Blood tests every 2 months of 40,000 • Discovered normal gene in overdrive molecules producing huge amounts of protein • After 7 months showed he had developed DM • Drug for kidney cancer shut down the • Early detection, early treatment malfunctioning gene • “This study is a landmark for personalized • Whole genome sequencing medicine.” Eric Topol 3

Sizing Up Big Data Sizing Up Big Data Steve Lohr, NY Times, June 20, 2013 Steve Lohr, NY Times, June 20, 2013 • Philosophy about how decisions should be • Bundle of technologies made – Web pages, browsing habits, sensor signals, social media, GPS location data, genomic , , g – Decisions based on data and analysis Decisions based on data and analysis information, surveillance videos – Less based on experience and gut intuition – Advances in data storage and processing – Eliminates anchoring bias and confirmation – Machine learning/AI software to find bias actionable correlations from the big data • Revolution in measurement – Digital equivalent of the telescope – Digital equivalent of the microscope Jeffrey Hammerbacher Jeffrey Hammerbacher http://www.youtube.com/watch?v=OVBZTDREg7c http://www.youtube.com/watch?v=OVBZTDREg7c • Oracle: From Overload to Impact • All industries are being disrupted – Healthcare executives say collecting & managing more – Moneyball, 538, Large Hadron Collider business information today than 2 years ago • McKinsley: Big Data: The Next Frontier • McKinsley: Big Data: The Next Frontier – Average increase 85% per year A erage increase 85% per ear for Competition • Frost & Sullivan: US Hospital Health Data Analytics Market – $338 billion potential annual value to US – 2011 10% of US hospitals use data analytic tools healthcare – 2016 50% of US hospitals will use data analytic tools – $165 billion in clinical operations – $105 billion in research and development Big Data Algorithms Mine Public Data Viktor Mayer-Schonberger & Kenneth Cukier, 2013 • To analyze & understand the world we used to test • Atul Butte combined data from 130 studies of hypotheses driven by theories gene activity levels in diabetic & healthy tissue • Big data discards theories & causality for • Butte identified new gene associate with Type 2 g yp correlations DM because stood out in 78/130 studies • Univ of Ontario premature baby studies • Algorithm looking for drugs & diseases that had opposing effects on gene expression • 1,260 data points per second • Diagnose infections 24 hours before apparent – Cimetidine for lung adenocarcinomas – Topiramate for Chrohn’s Disease • Very constant vital signs indicate impending infection 4