Our Medical Future

Health and healthcare were a prominent theme of this year’s World Economic Forum in Davos, and one of the first sessions took a look into our medical future.

Notably, the leaders of the session did not include a doctor/physician. The moderator Lionel Tarassenko is a professor of electrical engineering at Oxford, and speakers were genomics researcher Professor Steve Cole (UCLA) and Andrew Thompson, CEO of Proteus Digital Health. Between them, they conveyed a powerful vision of digital health monitoring in our everyday lives that will empower preventative and personalized medicine.

Lionel Tarassenko explained how his previous work for Rolls Royce has fueled his ideas for developing digital health care. Their jet engines are continuously monitored as they fly aircraft such as the A380 around our skies, and each day, 25,000 hours of engine data are collected from multiple sensors, relayed back to the company and analysed using algorithms, which he helped develop, and which are capable of detecting subtle departures from normality.  This means that any problems are identified early and can be fixed pre-emptively, allowing the company to sell their engines with a total care package, charging for power by the hour, rather than handing the risk of engine failure over to the customer.  Now his focus has returned to human health, and he is applying his Rolls Royce experience at the Institute of Biomedical Engineering in Oxford he helped set up 6 years ago.

Steve Cole is exploring whether gene expression data can provide meaningful information on whether we are interacting with our environment in healthy or unhealthy ways.  As an example of his work, he showed a microarray heat map that color codes, for each individual tested, the relative expression levels of different genes in their white blood cells. Two broad patterns are discernible, and there is a significant association of the one showing a higher expression level of genes known to be involved in proinflammatory immune response or tissue repair pathways with individuals who are lonely or socially isolated. The trend of an increased or more readily triggered inflammatory response to stress in individuals with adverse early life events or socially isolated versus well integrated individuals is supported by a number of studies he and others have published, and this pro-inflammatory bias is also seen at the level of bone marrow cell differentiation, such that the “normal” response of upregulating myeloid cell and downregulation of lymphocytes in response to perceived threats is accentuated in socially vulnerable individuals.   Steve’s view of his results from an evolutionary perspective (explained at greater length in a recent review), is that our genome evolved to respond to threats of acute physical damage, for example from predators, as well as from pathogens, and provides the ingredients for responses that promote survival in the face of such threats. However in our modern world, these same pathways may be stimulated by stressful situations for which they are no longer an appropriate response, and this in turn leads to a greater susceptibility to cancer, cardiovascular disease and mental health disorders.  The good news is that behavioral interventions to reduce stress and manipulation of sympathetic nervous system activity have been shown to modify the adverse transcriptional profile, and Steve advanced the idea that monitoring this type of genomic feedback in vivo will usher in a new era of molecular self-awareness in which people can optimize their own individual health and well-being.  

As yet the technology to monitor transcriptional responses as people live out their daily lives is not yet developed, but sensors that monitor better understood health indicators are already in existence. Andrew Thompson’s company have developed tiny sensors that they place inside pills, which when ingested relay back a signal (specific to that pill) to a wearable patch, which also monitors respiratory rate, heart rate, sleep, activity and posture. The data from these sensors is transmitted to the patients mobile phone, and can be shared with their relatives, carers and doctors. This digital feedback system is already in commercial use, proving its worth in elderly individuals who wish to continue living alone, and making digital healthcare in the home a reality for many.  At present the ingestible sensors are approved for use in inert “marker pills” taken alongside the patients prescribed medication, but it is anticipated that they will be on the market inside pharmacologically active pills by next year. This more direct monitoring avoids placing an additional burden of compliance on the patient, and should help tackle the problem of lack of adherence to prescribed medication regimes, currently estimated to occur among 50% of patients, and to be a significant health cost.

Lionel Tarassenko wrapped up the session by predicting that sensor technology will dramatically change the way healthcare is delivered, and emphasizing that digital health approaches are readily scalable and can improve healthcare for all. Even without waiting for sophisticated new sensors, his institute is working to bring the doctor into the home, with patients keeping health diaries they have been involved in designing themselves, and receiving digital feedback – for example those with depression are guided to cognitive behavioral videos. In India, ASHAs (accredited social health assistants) are already taking Android tablets into the villages to collect data on blood sugar level and blood pressure in a campaign to monitor cardiovascular risk and detect problems that can be treated before a major heart attack occurs.  

As the conference continued, sensors continued to feature. In one of ideas labs, Axel Scherer (Caltech) described the development of glucose and ion sensors, around 100um in size, that can be implanted in the skin to give continuous blood monitoring for 6 weeks of more, allowing instant diagnosis and the tailoring of appropriate drug regimes. In an interactive session on transforming healthcare, with NIH Director Francis Collins leading the discussion on genomics, the development of wearable health sensors was discussed by David Icke, CEO of mc10. Issues of who owns the data collected and who should have access to it were discussed for both sensors and genomic data, as was the challenge of anonymizing, curating and integrating these data in standardized form, so that they can be used for research. 
As WEF participants trod carefully along the icy pavements of Davos, and retired to their beds at night, the wristbands given to them on registration counted their footsteps and hours of sleep, relaying the information to their smart phones. Digital health is on its way. 

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