Why I think 2018 will (Finally) be the Tipping Point for Medicine and Technology
Each year I opine with what my best predictions for healthcare and medicine are in the near future. What my dowsing has lead me to conclude for 2018 are actually a number of things. Please do share your predictions, here are mine…
Machine Learning and Artificial Intelligence
The idea of bringing in machine learning and artificial intelligence (AI) into medical practice generally has concerns with a machine being as good as a human being. Does it pass muster with the Turing Test? Decades ago this was experimented with in my area of specialty, clinical psychology, or psychotherapy in particular.
I consider the Journal of the American Medical Associationand the New England Journal of Medicine as two of the top general medical journals. As best I can tell, it was just last year in which these two powerhouses published articles inclusive of machine learning. My prediction is this will dramatically increase in the future, and we will see a shift (as were are already seeing in radiology) that AI may not only be as good as a human, but indeed, better.
But, Clinician Beware
A caveat is articulated in a great article, Voodoo Machine Learning for Clinical Predictions, is important to keep in mind — not all algorithms are created equal: “…Cross-validation is the standard approach for evaluating the accuracy of such algorithms; however, several cross-validations methods exist and only some of them are statistically meaningful….(the researchers) found that record-wise cross-validation often massively overestimates the prediction accuracy of the algorithms… (and) …this erroneous method is used by almost half of the retrieved studies that used accelerometers, wearable sensors, or smartphones to predict clinical outcomes.”
Trying to distinguish fake-news or bad science from the flood of information available from Dr. Google is a near impossible challenge. There is a great site to sort out what’s true concerning nutrition and supplementation called Examine.com. The site is made up of medical doctors, scientific researchers, professors, and pharmacists that keep up on the peer reviewed literature. I’ve mentioned them in a whole piece I wrote on bio-hacking herein LinkedIn this past summer, but the point I want to reprise here is that of personal genomics:
If 23andMe had a baby with Examine.com then Dr. Rhonda Patrick would deliver “Found My Fitness.” Dr. Patrick is amazingly brilliant; she scours the literature for relevant and properly done studies similar to the folks at Examine, but what is really cool is that you can upload your 23andMe information and she will share what studies are relevant to YOUR specific genomic data. I did use Rhonda’s Genetic Tool, and I have also used Promethease. Both are a $5 bargain.
Promethease runs your genomic data against a whopper database called SNPedia. It is a wiki for human genetics with more than 57,000 published gene polymorphisms. Using it provides information about your propensity for and against certain diseases. It uses the data on specific Single-Nucleotide Polymorphisms (SNPs) within your genome. Its comprehensiveness is both a blessing and a curse in that the findings are overwhelming to review, and is like many genetic findings, puzzlingly contradictory. I found Rhonda’s Genetic Tool, to be much smaller, but more useful. Indeed, she notes “The report represents the genes I think are most interesting with regard to my focus is maintenance of healthspan. In some cases, some polymorphisms may have more obvious lifestyle intervention implications… in other cases, it might just be because it’s a gene variation that interests me and I want to tell you about it. In all cases, however, they are picked by me and reflect my personal exploration of this growing field. In this sense, it is a living report that might be worth re-running periodically to see my latest revisions and possible corrections!” Thank you Rhonda.
Of course, I feel obliged to make note of CRISPR (or the less cool sounding: clustered regularly interspaced short palindromic repeats). For the uninitiated, this is a Gattaca-esque approach to inexpensively edit human DNA in embryos or adults. I predict there will be a lot of unfulfilled expectations along with alarmist warnings. Remember cloning…?
Also, in tee-ing up this next area, I also predict that more individuals will begin to take better care of themselves, and family members, by seeking out cheaper and more easily available (yet nevertheless scientifically solid) tools and datasets. They’ll then combine this with sensors and apps to help optimize the health and/or performance. I suspect aging boomers may comprise a large portion of this tribe.
Three years ago next month, then President Obama announced the Precision Medicine Initiative® (PMI) in his State of the Union address. Through advances in research, technology and policies that empower patients, the goal is to enable a new era of medicine in which researchers, providers, and patients work together to develop individualized care. It’s a bit “moonshot-ish,” which I personally like. It’s also very integrative, which I also like. Results may not be as immediate as anyone would prefer, but I predict the National Institutes of Health will have the funding maintained for the Initiative in the near-term, and I think the sorting and sifting of the big data will prove a bigger challenge than initially conceived. I also precict that personalized medicine could go broad-spectrum, and impact public health. My fingers are crossed on that hopeful forecast.
I incorrectly predicted a decline in the 165,000 healthcare and wellness apps available in 2015, figuring that Darwinian market forces would have culled that herd, but nope, in fact a new report by IQVIA Institute found more than 318,000 today with a growth rate averaging about 200 a day.
A cool aspect is that medical apps are increasingly being vetted via clinical trials, and IQVIA note that there are about 860 such trials currently underway.
Most apps are in the behavioral health area, which makes sense as apps are a good fit for such issues. I have been working with Prevail Health and I have to say, their tech, which is a hybrid of supervised and trained peer support blended with Cognitive Behavioral Therapy, is impressive and as best I can tell, unparalleled. One of the key draws for me was their having published randomized control trials (RCT) demonstrating their outcomes in two top ranked peer reviewed journals. I predict we will see more widespread adoption of such integrative and empirically validated tools used by payers and healthcare systems.
My prediction about apps is that they will continue to grow for a period of time, but more importantly they will become better and more empirically-based. The IQVIA report noted, in my defense, that the number of wellness management apps (like exercise and fitness) did decline (about 18%), but the increase in health condition management more than made up for the loss. Furthermore, I predict we’ll see more hospitals, healthcare systems, and yes, even payers, adopting more activity sensors/trackers, parameter-specific biosensors (think glucometers, oximeters, etc.) in an Internet of Things style approach. The question will be, will the resultant big data be used for good or evil.
Time will tell if my crystal ball is functioning more like a snow-globe, you can wager your bitcoin on it…
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