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