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Medicine Unplugged: A Double Entendre

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Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It's already taking off at a pace that parallels the explosion of another unanticipated digital force -- social networks.

Take your electrocardiogram on your smartphone and send it to your doctor. Or to pre-empt the need for a consult, opt for the computer-read version with a rapid text response. Having trouble with your vision? Get the $2 add-on to your smartphone and get your eyes refracted with a text to get your new eyeglasses or contact lenses made. Have a suspicious skin lesion that might be cancer? Just take a picture with your smartphone and you can get a quick text back in minutes with a determination of whether you need to get a biopsy or not. Does your child have an ear infection? Just get the scope attachment to your smartphone and get a 10x magnified high-resolution view of your child's eardrums and send them for automatic detection of whether antibiotics will be needed. Worried about glaucoma? You can get the contact lens with an embedded chip that continuously measures eye pressure and transmits the data to your phone. These are just a few examples of the innovative smartphone software and hardware -- apps and "adds" technology -- that have been developed and will soon be available for broad use.

A recent mobile health report by Pricewaterhouse Coopers documented that consumers want these new apps and add-ons for their smartphones -- but doctors are not enthusiastic. Why is that? From its inception, the medical profession has been characterized by information asymmetry. Doctors had control of all the data, information and knowledge. Not unlike the high priests before the printing press, the medical profession did all the essential reading. The great inflection of medicine is about to empower consumers to be able to read -- not just a one-off measurement (like a blood pressure) but also data for all their relevant physiologic metrics, continuously, on the go. It will provide insights about each individual that we did not have before, such as how blood pressure fluctuates during a stressful event or during sleep. Such data will be graphed on one's smartphone or tablet, and can be sent to a doctor, caregiver, or even a social network. And this is the precursor to having the key parts of your genome sequence -- that which interacts with various prescription medications -- maintained on your phone. Your phone, your DNA, your data.

But clearly the reach and impact extends far beyond accessing the individual's metrics. Being able to diagnose a child's ear infection remotely will pre-empt the need in many cases to see the pediatrician or go to an emergency room. Having one's eyes refracted by a smartphone add-on leaves the need for an optometrist wanting. The benign skin lesions that so many people are living with but concerned about could get accurately diagnosed without a dermatologist. Phoning in the electrocardiogram data for someone with palpitations and lightheadedness obviates the need for a cardiology consultation or another emergency room visit. Capturing brain wave data along with oxygen level in the blood, heart and breathing rate with a home sensor would largely eradicate the need for expensive hospital-based sleep studies. If this doesn't represent the beginnings of the greatest shakeup in medicine, then what does?

Physicians should not be fearful or threatened by the emerging smartphone-centric revolution of health care. The remarkable inefficiency of how medicine is currently practiced, along with its high costs, leaves enormous room for improvement. Rather than waiting an average of one hour for an office visit that lasts about seven minutes with the doctor, who typically spends the time looking at a keyboard rather than the patient, why aren't we doing many office visits with secure video connects or even Skype and FaceTime? And having real face time. The relevant data on blood pressure, glucose, or whatever relates to the primary concern could be readily transmitted just before or during the visit. With the growing physician shortage that looms ahead, it's all the more reason to embrace a new form of unplugged medicine. Note to my fellow physicians: It's time to let go!

Eric J. Topol, MD
Scripps Clinic and The Scripps Research Institute
La Jolla, California

Dr. Topol is Director of the Scripps Translational Science Institute and author of The Creative Destruction of Medicine (Basic Books).

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