10 Innovations Of 2018 That Allow Patients To Take Back Control
Over the past decade, smartphones have radically changed many aspects of our everyday lives, from banking to shopping to entertainment. Medicine is next. With innovative digital technologies, cloud computing and machine learning, the medicalized smartphone is going to upend every aspect of health care. And the end result will be that you, the patient, are about to take center stage for the first time.
With the smartphone revolution, an increasingly powerful new set of tools—from attachments that can diagnose an ear infection or track heart rhythms to an app that can monitor mental health—can reduce our use of doctors, cut costs, speed up the pace of care and give more power to patients. Digital avatars won’t replace physicians: You will still be seeing doctors, but the relationship will ultimately be radically altered. (I consult for several companies on many of the issues discussed here.)
All of this raises serious issues about hacking and personal privacy that haven’t yet been addressed—and the accuracy of all of these tools needs to be tested. People are also right to worry that the patient-doctor relationship could be eroded, diminishing the human touch in medicine. But the transformation is already under way.
Let’s say you have a rash that you need examined. Today, you can snap a picture of it with your smartphone and download an app to process the image. Within minutes, a dedicated computer algorithm can text you your diagnosis. That message could include next steps, such as recommending a topical ointment or a visit to a dermatologist for further assessment.
Smartphones already can be used to take blood-pressure readings or even do an electrocardiogram. ECG apps have been approved by the U.S. Food and Drug Administration for consumers and validated in many clinical studies. The apps’ data are immediately analyzed, graphed, displayed on-screen updated with new measurements, stored and (at an individual’s discretion) shared. I thought I’d seen it all in my decadeslong practice as a cardiologist, but recently, for the first time, I had an ECG emailed to me by a patient, with the subject line, “I’m in atrial fib, now what do I do?” I immediately knew that the world had changed. The patient’s phone hadn’t just recorded the data; it had interpreted it.
Now, at any time of day or night, you can demand and get a secure video consultation with a doctor via smartphone at the same cost (about $30-$40) as the typical copay charge through employer health plans. This may seem exotic now, but several large consulting firms—including Deloitte and PricewaterhouseCoopers—have forecast that virtual physician visits (replacing physical office visits) will soon become the norm. Deloitte says that as many as one in six doctor visits were already virtual in 2014. In many U.S. cities, you can even use a mobile app to request a doctor’s house call during which a physician would not only provide a consultation but could even perform procedures, such as suturing a wound, which would have usually required an expensive emergency room visit.
Many surveys show that most consumers want to get information about the actual costs of their care from their doctors but can’t get it. Going forward, what things cost will no longer be the great unmentionable hanging over medicine: Cost-transparency apps for your smartphone already exist and are quickly being expanded to cover lab tests, scans, procedures, hospitals and doctor visits.
Even bigger changes are in the works. Using wearable wireless sensors, you can use your smartphone to generate your own medical data, including measuring your blood-oxygen and glucose levels, blood pressure and heart rhythm. And if you’re worried that your child may have an ear infection, a smartphone attachment will let you perform an easy eardrum exam that can rapidly diagnose the problem without a trip to the pediatrician.
These innovations are just the start. In the next year or two (depending on approval by the FDA), many Americans will probably start sporting wristwatches that continuously and passively capture their blood pressure and vital signs with every heartbeat, without even having to press a start button.
Such wristwatch sensors could do enormous good. By having the equivalent of intensive care unit monitoring on your wrist, hospital rooms—those $4,500-a-night risk zones for serious infections and other complications—can be replaced by our bedrooms. As a result, except for ICUs, operating rooms and emergency rooms, hospitals of the future are likely to be roomless data surveillance centers for remote patient monitoring.
Other wearable sensor tools now being developed include necklaces that can monitor your heart function and check the amount of fluid in your lungs, contact lenses that can track your glucose levels or your eye pressure (to help manage glaucoma), and head bands that can capture your brain waves. Someday, socks and shoes might analyze the human gait to, for instance, tell a Parkinson’s patient whether his or her medications are working or tell a caregiver whether an elderly family member is unsteady and at risk of falling.
We know that our health is highly influenced by our environment, which has been difficult to quantify. But smartphone sensors under development will be able to monitor your exposure to radiation, air pollution or pesticides in foods. And your medications could soon be digitized to provide you with reminders to ensure that you’ve taken them as prescribed.
It isn’t just hospitals’ rooms that are on their way out; so are their labs. Smartphone attachments will soon enable you to perform an array of routine lab tests via your phone. Blood electrolytes; liver, kidney and thyroid function; analysis of breath, sweat and urine—all can be checked with small fluid samples in little labs that plug directly into smartphones. And you can do your own routine labs at a fraction of the current cost.
Smartphone selfies are all the rage, but smartphone physical exams are just taking off. The ability to make a definitive DIY diagnosis of an ear infection with a phone is just the first step. Apps are now being developed to handle all aspects of the eye, the throat and oral cavity, and the lungs and heart. Meanwhile, nearly all sophisticated medical imaging devices are being miniaturized: Hand-held ultrasound devices are already available, and some medical schools have begun issuing them in the place of the old-school stethoscope. Hand-held MRI (magnetic resonance imaging) machines aren’t far behind, and engineers at UCLA have come up with a smartphone-sized device that can generate X-rays. It won’t be long before you can take a smartphone X-ray selfie if you’re worried that you might have broken a bone.
In the next decade, you—under select circumstances, involving high risk or major medical need—will be able to monitor almost every organ system, no matter how difficult to access, as firms start to produce nanosensors to be embedded in your bloodstream. These microscopic sensors within your body can float in blood or be fixed to a microstent in a tiny blood vessel. You’ll then be able to keep your blood under constant surveillance for the first appearance of cancer, autoimmune attacks on vital tissues or the tiny cracks in artery walls that can lead to heart attacks or strokes.
With all these new tools, it is no surprise that we’re talking about the possibility of “doctorless” medicine. Let’s not get too carried away. You’ll still be seeing doctors—but you’ll have a lot more control.
That change is badly overdue. Medicine has long been dominated by a priestly class, beginning with Imhotep, the first physician (and a priest), in Egypt some 4,600 years ago. Things had hardly changed two millennia later when Hippocrates, widely considered the father of medicine, held that most medical information should be concealed from patients.
Hippocrates’s paternalistic sentiments survive today in our culture’s pervasive sense that “doctor knows best.” Physicians obviously tend to think so, but that sentiment is also powerfully reinforced by the top-down way medical information flows (or clogs). The vast majority of doctors are unwilling to email patients or share their office notes. Getting a copy of a report after lab tests or medical scans seems impossible—and don’t even think about getting the results or images themselves. That is all about to change.
We’re often told that the U.S. faces a big looming shortage of physicians. The expansion of DIY medical capabilities certainly challenges that notion: We may end up not having a physician shortage at all.
But one discipline already has an unequivocal dearth of health-care professionals: mental health, which is also the leading cause of disability in the U.S. and many other developed countries. Smartphones can be particularly helpful here. New apps aim to quantify your state of mind by a composite of real-time data: tone and inflection of voice, facial expression, breathing pattern, heart rate, galvanic skin response, blood pressure, even the frequency and content of your emails and texts.
We may soon take an even bigger step forward, thanks to the unexpected advantages of virtual psychiatrists. Recent studies, including a paper by Gale Lucas and others published last year in the Journal of Computers in Human Behavior, have demonstrated that people are more willing to disclose their inner thoughts to a computer avatar or “virtual human” than a real one. With machines working to quantify moods and even offering virtual counseling to help make up for our current profound shortage of mental health professionals, we can glimpse a new approach to improving mental health.
This is heady stuff—but this vision of medicine also raises some serious and reasonable concerns. Before these tools enter widespread use, they must all be validated through clinical trials and shown to not only preserve health but to do so while lowering costs. Without such validation, the whole promise of digital medicine will be for naught.
Moreover, while we may find cases in which it is easier to tell things to a digital avatar, we can’t rely on avatars as doctors, powered by DIY physical exams and lab tests alone. These new high-tech tools can provide useful medical information directly, quickly and inexpensively to consumers. But physical visits with doctors will never be replaced for important, serious matters that require face-to-face conversations—and no keyboards.
Even as we’re making great strides in capturing personal medical information, we’re way behind in dealing with the data deluge. We’ve done far too little to protect our precious personal health data’s privacy, stop it from being sold to third parties or secure it from hacking. We’re also pathetic at data analytics: We tend to hoard big data and have done relatively little to extract meaningful information from it. To make matters even more complicated, none of the new patient-generated data—from sensors, lab tests, self-exams, DNA sequencing or auto-imaging—is flowing into the traditional hospital- or doctor-owned electronic health records.
I think all these problems can be managed, but it will take work. And these obstacles shouldn’t dissuade us from seizing the progress that is at hand.
The real revolution doesn’t come from having your own secure, in-depth medical data warehouse on your smartphone. It comes from the cloud, where we can combine all our individual data.
When that flood of data is properly assembled, integrated and analyzed, it will offer huge new potential at two levels—the individual and the population as a whole. Once all our relevant data are tracked and machine-processed to spot the complex trends and interactions that no one could detect alone, we’ll be able to pre-empt many illnesses.
Take asthma attacks. A teenager who’s prone to wheezing in gym class could get comprehensive data on environmental exposures such as air quality and pollen count, along with data on physical activity, oxygen concentration in the blood, vital signs and chest motion; their lung function can be assessed through their smartphone microphone, and their nitric-oxide levels can be sampled via their breath. Then that information could be combined with the data from every other tracked asthma patient—and trigger a warning, delivered by text or voice message on the teenager’s phone, that an attack is imminent and tell the teenager which inhaler would prevent it.
The same type of procedure could prevent heart failure, seizures, severe depression and autoimmune disease attacks. It could save countless lives.
Finally, we simply cannot imagine what we’ll learn from the brave new world of open medicine: massive online information resources that pull together data from millions and eventually billions of individuals. Think of Facebook’s ability to obtain social data from more than a billion people—but now imagine pulling together medical information never previously aggregated or even acquired. A person who develops a new illness could use an open-medicine resource to find their nearest “neighbor”—the individual who most closely resembles their condition—to help determine the best treatment.
Putting hundreds of sensors into cars and providing exquisite computer navigational support didn’t just produce autonomous cars; it also made them safer than old-school, lower-tech cars driven by humans. The same combination of sensors and computing power is about to do something similar to medicine—transforming it from a weakly evidence-based practice to a data science, with empowered individuals at center stage.
As more medical data is generated by patients and processed by computers, much of medicine’s diagnostic and monitoring aspects will shift away from physicians like me. The “doctorless” patient will remain in charge, turning to doctors chiefly for treatment, guidance, wisdom, experience, empathy and the human touch. These doctors won’t write orders; they’ll offer advice.
Just as the printing press democratized information, the medicalized smartphone will democratize health care. Anywhere you can get a mobile signal, you’ll have new ways to practice data-driven medicine. Patients won’t just be empowered; they’ll be emancipated.
Even healthy people worry about the quality of care they can expect to receive when they become ill. Will a cancerous tumor be spotted early enough? Will hospital staff move fast enough to save my life? What is the worried-looking doctor scribbling in my chart?
Post-Traumatic Stress Disorder
Health-care innovations aren’t limited to drugs and devices. Experts
increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients’ quality of life and lowering costs. Here are 10 innovations that took root in 2014 and are changing the care patients will get in 2017.
Doctors Are Adopting a Better Bedside Manner
Hospitals increasingly have a new focus: keeping patients happy. Surveys sent home after a hospital stay are asking patients to rate everything from whether nurses and doctors seemed attentive to their concerns to how clean their room was. The institutions are putting doctors, nurses and other employees through customer-service training, hiring “patient experience” consultants and designating staff ombudsmen to handle complaints. The moves follow prodding from Medicare, which now ties payments in part to how patients feel they were treated. The changes, though, benefit all patients.
Heart Attacks Are Being Treated Faster
Speed is of the essence in surviving a heart attack, and in many cities now treatment starts before the patient reaches the hospital. Emergency medical technicians perform electrocardiograms and transmit results wirelessly to the emergency room. New guidelines from the American Heart Association and the American College of Cardiology aim to quickly restore blood flow when an artery is blocked, the most severe type of attack known by the acronym STEMIGuidelines call for balloon
angioplasty and stents as preferred treatments for STEMI , and clot-busting drugs as a stopgap measure. Also recommended: Chilling the patient in cases of cardiac arrest, a practice that reduces subsequent brain injury. In new research, survival rates were higher among cardiac-arrest patients who received CPR longer–a median of 25 minutes versus 16 minutes. For patients, the message is: Don’t delay calling 911 when you have symptoms, and avoid going to the hospital in a private car.
ERs Are Getting Better at Handling Medical Mysteries
Wireless Information System for Emergency Responders (WISER): Identifies Hazardous Substances During An Emergency.
A growing number of hospital emergency rooms are opening observation units to keep an eye on patients who show up with complaints that can’t be quickly or conclusively diagnosed. This reduces crowding in harried ERs. It also allows emergency staff to closely monitor at-risk patients and conduct tests more quickly and cheaply than by admitting them as an inpatient to a hospital room.
You Can Finally See What Your Doctor is Writing About You
Patients who have access to the notes their doctor makes about them are more likely to understand their health issues, recall what the doctor told them, and take medications as prescribed,
according to a trial program called Open Notes initiated by several big hospitals and now spreading across the country. Although patients have the right to view doctors’ notes, these often aren’t included in patient requests for medical records and doctors don’t make it easy to see them. In the Open Notes trial, some patients picked up errors. Other patients became more diligent about follow-up actions that eliminated the need for additional office visits, says Thomas Delbanco , a physician at Beth Israel Deaconess in Boston and lead investigator of the study.
Health Apps Are More Sophisticated
Rather than just count calories and monitor exercise, new apps take on more serious concerns. “Is it Contagious?” from the Nemours Foundation has information on some 85 childhood infections and conditions, including info on when to seek immediate medical care. An app from the Centers for Disease Control and Prevention enables searches of health information. Carolinas Medical Center has an app to calculate the risk of pain and discomfort after hernia surgery. MyIBD , from Toronto’s Hospital for Sick Children helps those with irritable bowel disease track symptoms and food intake. The nonprofit Pew Research Center says some 19% of smartphone users have at least one health app on their device.
Tests for Colon Cancer Are Less Arduous
Colonoscopy is the gold standard for detecting colon cancer. Yet millions of people who should have one don’t, whether out of distaste for the laxative prep regimen or fear of the procedure. Alternatives include a “virtual” colonoscopy, using CT scanning to examine the colon. A new version of the fecal occult blood test analyzes stool samples gathered at home to find polyps, abnormal growths that can become cancerous. Randomized controlled trials have shown the technique reduces colon cancer death rates. Kaiser Permanente mails test kits to its Northern California patients and gets 3,000 samples a day. If test results are positive, colonoscopy is advised.
Talk of Dying Gets a Little Less Daunting
Families and patients are getting help with one of the most difficult care decisions: When to stop invasive and costly treatments and focus on a dignified and comfortable pathway to the end of life. A program known as POLST–Physician Orders for Life-Sustaining Treatment –has been adopted in a growing number of states. It offers a template doctors and patients can use to discuss and record which types of care patients want and which they would rather forgo. Another program, the Conversation Project , created by writer Ellen Goodman , is a way to help people talk about these issues with loved ones around the kitchen table. A starter kit, available free online, helps map out how to think about what matters most, such as being able to recognize family members, and how to talk to family about tough care decisions.
The Hospital Is Less Likely To Make You Sick
The problem of hospital patients who contract potentially fatal infections has dogged providers for years. Medicare has stopped paying to treat some infections acquired in the hospital. A breakthrough came in September with news that a program in 1,100 intensive care units in 44 states reduced the rate of a deadly hospital bloodstream infection by 40% over four years.
The remedy seems simple: Doctors and staffers follow a checklist of routine precautions, including washing hands and removing catheters from patients as soon as possible. Peter Pronovost , the Johns Hopkins patient safety expert who oversaw the program, estimated it has saved more than 500 lives and $34 million and will lead to more programs to reduce harm.
Robots Are Helping Your Surgeon
In a growing number of medical schools and hospitals, trainees and staff are learning procedures on lifelike electronic robots that bleed, have seizures, and give birth–all while simulating emergency complications that require c are providers practice critical thinking and decision-making under pressure, “without risking the well-being of actual patients,” says George Halvorson , outgoing chief executive of Kaiser Permanente.
A robot named Noelle
can simulate a birth emergency while the multitalented SimMan
has the ability to present realistic human responses to heart attack, stroke or respiratory distress. Studies show that simulation leads to enhanced teamwork and crisis-management skills of health-care providers.
Vetting a Hospital Gets Easier
Data on hospital quality and safety has been available online for some time, but not in a very user-friendly way. This year, the Leapfrog Group , a coalition of public and private purchasers of employee health coverage, graded hospitals, from A to F, based on measures of patient safety. Some hospitals got poor grades and took issue with the methodology, which was subsequently altered slightly. Leapfrog CEO Leah Binder says it is “the toughest standard-bearer and provides the most complete picture of a hospital’s quality and safety.”
Breathe2Relax Helps With Mood Stabilization, Anger Control, And Anxiety Management.
The list of 1,200 hospitals, released Dec. 4, ranks only 89 of them as top facilities. Patients can use a free website or a mobile app to compare hospitals based on overall safety or based on selected procedures such as heart bypass surgery. A research team at Johns Hopkins’ Armstrong Institute for Patient Safety and Quality will provide scientific guidance in future.
The Future of Medicine Is Now
In our era of instant gratification, the world of medicine seems like an outlier. The path from a promising discovery to an effective treatment often takes a decade or more.
But from that process–of fits and starts, progress and setbacks and finally more progress–grow the insights and advances that change the course of medicine.
A decade ago, the completion of the Human Genome Project sparked optimism that cures for debilitating diseases were just around the corner. Cures still generally elude us, but now the ability to map human DNA cheaply and quickly is yielding a torrent of data about the genetic drivers of disease–and a steady stream of patients who are benefiting from the knowledge. On other fronts, technology is putting more power in the hands of patients, and researchers are learning to combat disorders by harnessing the body’s own ability to heal and grow.
A test developed by Foundation Medicine Inc. analyzes tumor DNA to help find targeted treatment options for patients with cancer.
Advances bring other challenges, including how to pay for them. Meanwhile, the complex biology that stymies gains for some patients sets goals for new advances.
Here Are Six of Today’s Potentially Transformative Trends:
Growing a Heart
Surgeons at Boston Children’s Hospital have developed a way to help children born with half a heart to essentially grow a whole one–by marshaling the body’s natural capacity to heal and develop.
About 1,000 babies are born in the U.S. each year with a condition called hypoplastic left-heart syndrome, the result of a genetic anomaly that leaves them without a functioning left ventricle, the heart’s main pumping chamber. Without a surgical repair, the defect is almost always fatal.
A new surgical strategy helped 9-year-old Alexa Rand’s body to essentially grow half a heart into a whole one.
The standard treatment is a series of three open-heart operations to reroute circulation so that the right ventricle can take over pumping blood to the body’s organs and extremities. But the right ventricle “is meant to handle low-pressure blood flow to the lungs,” says Sitaram Emani, the surgeon heading the effort on the new approach. “Now you’re asking it to do the work of a high-pressure system and to do that work for many years. Eventually it fails.” That’s one reason why 30% of patients or more don’t survive to adulthood.
Dr. Emani and his colleagues devised a complex strategy to open obstructed valves and repair other malformations to direct blood flow to the left ventricle instead of away from it. That triggers biological processes that promote the heart’s growth.
Last month, after using the approach on 34 carefully selected patients over the past decade, the doctors reported in the Journal of the American College of Cardiology that 12 now have two working ventricles. One of them, 9-year-old Alexa Rand of Kings Park , N.Y. , whose treatments began in utero, is thriving. She sings, dances and surprises doctors with how long she can walk on a treadmill, says her mother, Rosamaria Rand.
The main drawback: The strategy requires one more surgical procedure, on average, and significantly more days in the hospital than the conventional surgery. The hope is, Dr. Emani says, that the long-term benefits will outweigh the extra hospital time.
DNA Sequencing for Routine Checkups
At a genetics conference in November, Oxford Nanopore Technologies unveiled the first of a generation of tiny DNA sequencing devices that many predict will eventually be as ubiquitous as cellphones–it’s already the size of one.
Since the first sequencing of the human genome was completed in 2003 at a price tag of over $2 billion, the speed, price and accuracy of the technology have all improved. Illumina Inc. has dropped its price for individual readouts to $5,000; earlier this year, Life Technologies introduced a sequencer it says can map the human genome for $1,000. The smallest machine is now desktop-size.
But nanopore sequencing devices, which are designed to be even smaller and more affordable, could speed efforts to make gene sequencing a routine part of a visit to the doctor’s office. DNA molecules are exceedingly long and complicated; that makes them hard to read. Nanopore technology measures changes in the molecules’ electrical current as the DNA is threaded in a single strand through tiny holes called “nanopores” created in a membrane.
So far, U.K.-based Oxford has released the results of sequencing a virus genome with this technique. The company hasn’t provided data, however, showing that the sequencers can analyze the much larger human genome. A spokeswoman for Oxford says the company is working hard toward being able to sell devices, including one that is expected to cost under $1,000, though it doesn’t yet have a launch date.
Amit Meller–an associate professor at Boston University, a scientific adviser at Oxford and the co-founder of Noblegen Biosciences–is at work on another nanopore device that he says would use fluorescent signals to read the DNA information. His company is still a number of years away from a prototype, but Dr. Meller says the goal is to speed up sequencing even more–with results in a few hours, not the current weeks or days, at a cost of less than $100.
Matching a Tumor to a Drug
Our growing understanding of the workings of the human genome is posing a new challenge: How to use that data to change the course of disease. Consider cancer. As seen through a gene-sequencing machine, some cancers can appear as at least a dozen different genetic diseases, some of which have been shown to respond uniquely to a specific drug. But how do cancer doctors quickly match a patient’s tumor with a drug that targets it?
One answer is a test developed by Foundation Medicine Inc., a Cambridge , Mass. , startup whose scientific founders include one of the leaders of the Human Genome Project. The test, officially launched last June, enables doctors to test a tumor sample for 280 different genetic mutations suspected of driving tumor growth.
This changes “everything in terms of how we approach patients with cancer,” says David Spigel, director of lung-cancer research at the Sarah Cannon Research Institute in Nashville , Tenn. He used the test in one patient with advanced disease and few apparent options. She turned out positive for an alteration in a gene targeted by several drugs currently in development. She was signed up for one of the studies. A short time later, “she’s like a new person,” he says. “She’s off pain medicines. She gained her weight back.”
Michael Pellini, Foundation’s chief executive officer, says that more than 600 oncologists have requested the test, which lists for $5,800. So far, he says, about 70% of cases have turned up a mutation that is potentially targeted by a drug on the market or in a clinical trial.
In one recent case, Dr. Pellini says, a sample from a woman with advanced pancreatic cancer yielded a response for “her2,” an alteration associated with a certain form of breast cancer. She was treated and her cancer responded to the breast-cancer drug Herceptin. Few oncologists would think to look for her2 in a patient with pancreatic cancer, he says.
Letting Your Body Fight Cancer
Few advances in cancer care are generating more enthusiasm than harnessing the power of the immune system to fight the disease.
Tom Stutz is one reason why. Last April, the 72-year-old retired lawyer was confined to a wheelchair, struggling for every breath, and required help with simple tasks such as eating, all because of a previously diagnosed skin cancer that had spread to his lungs and liver. “I was ready to check out, to be honest,” he says.
That month, he began taking an experimental drug known as MK3475. Six weeks later, he started feeling better. Today, Mr. Stutz has jettisoned the wheelchair and regularly walks a 3.5-mile loop near his home in Los Angeles . “I feel terrific,” says Mr. Stutz, who learned after a checkup in the fall that his tumors had shrunk by about 65% so far.
For decades, cancer researchers have wondered why the immune system typically doesn’t treat tumor cells as invaders and target them. Part of the mystery was recently solved: Tumors protect themselves by hijacking the body’s natural brake for the immune system.
MK3475, being developed by Merck and Co., is among a new category of drugs that release the brake, unleashing an army of immune cells to hunt down the cancer. A recent report from a trial in which Mr. Stutz participated said that of 85 patients who took the drug, 51% saw their tumors significantly shrink; in eight cases, the tumors couldn’t be detected on imaging tests.
Still, not everyone was helped. And unleashing the immune system can put normal cells in harm’s way: In studies of MK3745 and similar drugs, some patients developed serious side effects related to immune-system response, including a small number who died.
But interest in the approach is strong. Bristol-Myers Squibb Corp.’s drug Yervoy, approved by the Food and Drug Administration in 2011, is the first of its kind to reach the market. The company has others in development. GlaxoSmithKline PLC and AstraZeneca‘ s MedImmune are among others exploring ways to activate the immune system against cancer.
One reason for the excitement is that most “solid” tumors–colon, lung, breast, prostate–use the same or a similar mechanism to hide from the immune system. Obstructing that mechanism may have a broad impact across a variety of malignancies.
Health in the Palm of Your Hand
There’s a good chance that you already own one of the most ubiquitous health-care innovations: a smartphone. Last month, the FDA cleared a new iPhone add-on that lets doctors take an electrocardiogram just about anywhere. Other smartphone apps help radiologists read medical images and allow patients to track moles for signs of skin cancer.
“I see the smartphone as one piece of how we’re going to try to get health costs under control,” says David Albert, the Oklahoma City-based inventor of the just-approved AliveCor electrocardiogram application.
At $199, AliveCor consists of a case that snaps onto the iPhone, with electrodes on the back. It reads heart rhythms and relays the recording to an iPhone app, allowing physicians to read the data. Dr. Albert says a $99 version should be available soon that will let patients capture their own heart data, documenting sometimes-fleeting arrhythmias when they feel symptoms or tracking the success of lifestyle changes at curbing heart troubles.
Doctors say that mainstream EKG machines provide more information but the iPhone version is sufficient for many diagnostic needs. “When I go to [the] clinic, I use it in place of an EKG all the time,” says Leslie Saxon, chief of the University of Southern California ‘s heart-rhythm department, which has conducted research using AliveCor’s device.
The FDA has cleared a handful of apps, beginning with an iPad- and iPhone-based medical imaging reader in 2011. The smartphone lets us “bring health care into the home,” says Erik Douglas, CEO of CellScope. His company is developing an iPhone-based otoscope that would allow parents to upload images of the inside of children’s ears when they show signs of infections, with the aim of avoiding unnecessary doctors visits.
Rejigging Your Genes
After years of controversy, gene therapy is poised to become a viable option for a variety of often life-threatening medical conditions, especially those resulting from a single defective gene. Last month, the European Union approved Glybera for treatment of a rare genetic disease, making it the first gene-therapy medicine approved in the Western world. The approval comes amid a flurry of research showing broader promise for the approach in a range of disorders, from a rare form of blindness to hemophilia to heart failure.
Though outright cures are still elusive, gene therapy “is beginning to emerge as a meaningful clinical” strategy, says Stephen J. Russell, director of molecular medicine at the Mayo Clinic in Rochester , Minn.
Gene therapy’s tantalizing attraction is that a single treatment has the potential to cure lethal diseases by enabling normal genes to take over for defective ones. The treatment involves loading a functional gene onto a fragment of a deactivated virus that transports the gene to a cell’s nucleus, where it is intended to take over.
The idea suffered major setbacks in 1999 when a U.S. teenager died in a gene-therapy trial and again soon after when several children in Europe developed leukemia after receiving gene therapy.
The episodes prompted criticism that researchers had moved too quickly. Scientists returned to the laboratory, hoping to develop better delivery vehicles and to improve both the safety and efficacy of the treatments.
Bluebird Bio, a Cambridge, Mass., gene-therapy startup, expects to launch studies next year for two rare genetic diseases: childhood adrenoleukodystrophy, or ALD, an inherited and lethal neurological disorder; and beta thallasemia, which causes the destruction of red blood cells and leads to life-threatening anemia. Its technique involves extracting a patient’s own bone-marrow cells, isolating certain stem cells, and delivering the gene therapy before returning the cells to the body.
Four boys in Paris with ALD have been successfully treated, says Nick Leschly, Bluebird’s president and chief executive officer, including two treated nearly six years ago. They are now in their teens and would otherwise likely have died before age 10, he says.
Other gene-therapy efforts include Novartis SA’s partnership with the University of Pennsylvania on a treatment for cancer, GlaxoSmithKline’s alliance with Italian scientists for a range of disorders, and Celedon Corp.’s clinical trial of a gene therapy in patients with advanced heart failure.
Mobile Health Apps Worth A Closer Look: