The Future of Medicine is Digital

we start out

in 2400 bc in ancient mesopotamia

it was here where the first medical text

was transcribed

a simple clay tablet with 15

prescriptions

for common ailments was listed

at this point in history virtually no

information

about individual persons was collected

fast forward 1500 years or so

nearly every society china india

egypt greece were starting to record

medical texts to share knowledge

the edwin smith papyrus in egypt

describes 48 cases

of military injuries and the cahoon

gynecological papyrus discusses all

manner of women’s health

traditional indian medical texts provide

descriptions of what is thought to be

parkinson’s disease and the wandi negin

in ancient china is still thought to be

the fundamental source for chinese

medicine

even two millennia later still

much of the medical knowledge at the

time is reserved for the elites

pharaohs in egypt emperors in china

information on the common man is still

non-existent

let’s jump ahead to the 1300s the

renaissance

a time of enlightenment there is more

information being generated at this

point in history

than any time before more and more is

being understood about the human body

about medicine and about disease but we

are starting to see this pattern

emerge where information collected

and recorded is gathered only on a very

small percentage of the population

and usually reserved for those with

money and influence

the 1500s usher an era of darkness

in disarray commonly known as the dark

ages

much of the information gained

previously is destroyed

less emphasis is placed on the

individual and medical knowledge

stagnates

let’s jump ahead now to the eighteen

hundreds the world

is bigger than ever there is more

emphasis placed on the individual

and medical technology is rapidly

increasing

sir augustus frederick diaste gives us

our first look

at a complete symptom diary where he

tracks his multiple sclerosis diagnosis

for nearly 20 years including such

details as urinary incontinence

episodes of sexual dysfunction and each

of the treatments he attempts

the data in his diary is so detailed

that modern-day physicians

have been able to chart the progression

of his disease

but augustus was not the average person

in the 1800s his grandfather

was king george iii and he lived a life

of relative ease and luxury

affording him the opportunity to record

his life events

in great detail most people’s lives at

the time

were reduced to a few characters a

record of birth

and a record of death

in the early 1900s technology is driving

progress in medicine the x-ray machine

is placed in a hospital for the first

time

and electrocardiogram or ekg is starting

to be used to diagnose cardiac

abnormalities

for the very first time paper medical

records start being kept

these records along with records of

birth marriage and death

are the data collected on individual

people over their lifetime

these records are more inclusive than

any time in history

but are still reserved for those with

access to the modern medical system of

the day

fast forward to the 1960s it was here

where paper medical records were traded

for the electronic health record

in fact one of the very first electronic

health records

the medical record or tmr was created

right here at duke

by one of my mentors dr ed hammond

transforming these paper records that

could be lost or destroyed

into an electronic format enabled

drastic growth in the field of medicine

and in the care of individuals health

the year is 1984 the year the very first

ted talk occurred

there has been an explosion of

technological advancement in the field

of medicine

the pulse oximeter was introduced the

mri was approved for use in hospitals

and the personal blood glucose meter

made its debut

with these technologies came more data

data about patient health

and wellness and disease progression

let’s jump ahead to 2009 the year that i

watched my very first ted talk

and made giving a ted talk one of my

life goals

we have entered the digital age and the

age of the internet

i watched that first ted talk on a brand

new platform

called youtube that was started only a

few years before

along with the social media giants

facebook and twitter

in 2009 fitbit released their very first

tracker which recorded personal

step count data this came a few years

after the release of the first garmin

smartwatch

in 2003 and a few years before the

release of the first

apple watch in 2015. electronic health

records are becoming commonplace

thanks to the high tech act signed in

2009

and we are generating enormous amounts

of data

approximately three terabytes of data

per person per year

that’s enough data to fill a small

library

and we project massive increases in data

by the year 2020

back in 2009 we couldn’t comprehend just

how much growth we would see in data

and accessibility to data over the next

decade

in 2009 less than a quarter of the

world’s population was accessing the

internet

in 2020 that number was well over 60

and the amount of data generated by each

person has grown exponentially

since 2009. between tracking

environmental sensor data personal

health and wellness information

statistics social media profile records

we amass nearly unimaginable amounts of

data

in the healthcare field imaging

modalities have gotten better

providing us with higher resolution

images with more data

genomics and sequencing are giving us

greater insights

into human health we have made

incredible leaps forward in brain

machine interfaces and recording of

brain activity

and personal monitoring devices like

smartphones and smart watches

are giving us unprecedented amounts of

data about our health

and wellness and if we take a look back

not only are we collecting more data

than at any time in history

but this data is being collected on you

and me

average people something that would not

have been possible

at any other time in history

and this data is collected

longitudinally meaning over time

over time you may track your

expenditures or your habits using data

but we can also track your health and

wellness over time

this gives us a way to personalize

medicine like never before

using computational methods like time

series analysis and machine learning

we can begin to make predictions about

your health and wellness

based upon this historical data over

time

this digital data is giving way to a new

era of medicine

digital medicine as a digital health

data scientist

i work on using this data to diagnose

monitor and manage disease for example

in my phd i have examined the

feasibility of using smart watches for

pre-diabetes screening

pre-diabetes is a disease that is

severely under-diagnosed

in the u.s one in three people have

pre-diabetes

but only one in 10 with pre-diabetes

even know that they have it

and pre-diabetes is a precursor to type

2 diabetes

one of the 10 leading causes of death

it is very important to catch

pre-diabetes early before it progresses

to type 2 diabetes

but pre-diabetes screening is not

happening regularly enough

in a nationally representative sample

fewer than half

of those who met the screening criteria

set by the american diabetes association

were actually screened and this is not

extensible for those living

in remote rural locations or for those

without consistent

access to health care we have shown that

we can use measurements from a smart

watch

like heart rate or activity data in

order to determine

a person’s risk for pre-diabetes

the main goal is to be able to deploy

this technology

in the 117 million wearables that

currently exist

in order to screen for pre-diabetes and

alert at-risk patients

so that they can get a clinical test and

start managing their condition

i’ve had the opportunity to work in many

incredible projects in digital medicine

from using mobile apps and smart watches

for child and adolescent asthma

monitoring

to developing better methods for human

activity recognition

which can be used in those with movement

disorders or in diseases that affect

movement like stroke

or parkinson’s disease recently i’ve

been a part of teams using smart watches

for early detection of the flu

and even coven 19.

using these personal monitoring devices

gives us a way to personalize medicine

and engage people with their own health

and wellness

i personally use this technology to

track my own physiology while training

for ultra marathons

when looking at my data i found myself

annotating it

much like fredrik diaste did in his

diary 200 years ago

as you can see i usually start out way

too fast and you can see this large

peak in heart rate and then i clearly

need to work

on my hills and perhaps my fear of bees

this monitoring became even more

important this past year when i was

diagnosed with an autoimmune condition

making training for ultramarathons a bit

more challenging

i and many others are using these

personal monitoring devices

to track our own health and wellness and

provide greater insights into our own

well-being and this is the tip of the

iceberg

while my work has focused on using

personal monitoring devices for digital

medicine

there is incredible potential in

combining data from personal devices

with electronic health records

imaging data genomics data and even

behavioral profiles from social media

in order to provide us with a

comprehensive picture of our health

and wellness over time

and the best part about digital medicine

is that it is accessible

a majority of the world’s population is

now on the internet

electronic health records are being

implemented globally

and personal monitoring devices like

smartphones and smart watches

are increasingly prevalent now don’t get

me wrong

we have a long way to go if we look at

projections for the next decade

we will see that the enormous amounts of

data we are generating today

will be dwarfed it is essential

that all of us ensure that this data and

the incredible advances in digital

medicine

are accessible to everyone we need to

ensure that our models are unbiased and

that our methods

are ethical to this end i have led

development of the digital biomarker

discovery pipeline

or dvdp an open source platform

aimed at making digital medicine more

accessible and establishing best

practices that are fair

equitable and ethical

gone are the days where you had to be an

emperor

or a pharaoh or the grandson of a king

to have

your medical data recorded and to take

charge of your own health

and wellness thank you

you