Eric Topol: The wireless future of medicine


Does anybody know when the stethoscope was invented? Any guesses? 1816. And what I can say is, in 2016, doctors aren’t going to be walking around with stethoscopes. There’s a whole lot better technology coming, and that’s part of the change in medicine. What has changed our society has been wireless devices. But the future are digital medical wireless devices, OK? So, let me give you some examples of this to kind of make this much more concrete. This is the first one. This is an electrocardiogram. And, as a cardiologist, to think that you could see in real time a patient, an individual, anywhere in the world on your smartphone, watching your rhythm — that’s incredible, and it’s with us today. But that’s just the beginning. You check your email while you’re sitting here. In the future you’re going to be checking all your vital signs, all your vital signs: your heart rhythm, your blood pressure, your oxygen, your temperature, etc. This is already available today. This is AirStrip Technologies. It’s now wired — or I should say, wireless — by taking the aggregate of these signals in the hospital, in the intensive care unit, and putting it on a smartphone for physicians. If you’re an expectant parent, what about the ability to monitor, continuously, fetal heart rate, or intrauterine contractions, and not having to worry so much that things are fine as the pregnancy, and moving over into the time of delivery? And then as we go further, today we have continuous glucose sensors. Right now, they are under the skin, but in the future, they won’t have to be implanted. And of course, the desired range — trying to keep glucose between 75 and less than 200, checking it every five minutes in a continuous glucose sensor — you’ll see how that can impact diabetes. And what about sleep? We’re going to zoom in on that a little bit. We’re supposed to spend a third of our life in sleep. What if, on your phone, which will be available in the next few weeks, you had every minute of your sleep displayed? And this is, of course, as you can see, the awake is the orange. The REM sleep, rapid eye movement, dream state, is in light green; and light is gray, light sleep; and deep sleep, the best restorative sleep, is that dark green. How about counting every calorie? And this is ability, in real time, to actually take measurements of caloric intake as well as expenditure, through a Band-Aid. Now, what I’ve talked about are physiologic metrics. But what I want to get to, the next frontier, very quickly, and why the stethoscope is on its way out, is because we can transcend listening to the valve sounds, and the breath sounds, because now, introduced by G.E. is a handheld ultra-sound. Why is this important? Because this is so much more sensitive. Here is an example of an abdominal ultrasound, and also a cardiac echo, which can be sent wireless, and then there’s an example of fetal monitoring on your smartphone. So, we’re not just talking about physiologic metrics — the key measurements of vital signs, and all those things in physiology — but also all the imaging that one could look at in your smartphone. Now, this is an example of another obsolete technology, soon to be buried: the Holter Monitor. Twenty-four hour recording, lots of wires. This is now a little tiny patch. You can put it on for two weeks and send it in the mail. Now, how does this work? Well, there is these smart Band-Aids or these sensors that one would put on, on a shoe or on the wrist. And this sends a signal and it creates a body area network to a gateway. Gateway could be a smartphone or it could be a dedicated gateway, as today many of these things are dedicated gateways, because they are not so well integrated. That signal goes to the web, the cloud, and then it can be processed and sent anywhere: to a caregiver, to a physician, back to the patient, etc. So, that’s basically very simplistic technology of how this works. Now, I have this device on. I didn’t want to take my shirt off to show you, but I can tell you it’s on. This is a device that not only measures cardiac rhythm, as you saw already, but it also goes well beyond that. This is me now. And you can see the ECG. Below that’s the actual heart rate and the trend; to the right of that is a bioconductant. That’s the fluid status, fluid status, that’s really important if you’re monitoring somebody with heart failure. And below that’s temperature, and respiration, and oxygen, and then the position activity. So, this is really striking, because this device measures seven things that are very much vital signs for monitoring someone with heart failure. OK? And why is this important? Well, this is the most expensive bed. What if we could reduce the need for hospital beds? Well, we can. First of all, heart failure is the number one reason for hospital admissions and readmissions in this country. The cost of heart failure is 37 billion dollars a year, which is 80 percent related to hospitalization. And in the course of 30 days after a hospital stay for a Medicare greater than 65 years or older, is — 27 percent are readmitted in 30 days, and by six months, over 56 percent are readmitted. So, can we improve that? Well the idea is we take this device that I’m wearing, and we put it on 600 patients with heart failure, randomly assigned, versus 600 patients who don’t have active monitoring, and see whether we can reduce heart failure readmissions, and that’s exciting. And we’ll start that trial, and you’ll hear more about how we’re going to do that, but that’s a type of wireless device trial that could change medicine in the years ahead. Why now? Why has this all of a sudden become a reality, an exciting direction in the future of medicine? What we have is, in a way, a perfect positive storm. This sets up consumer-driven healthcare. That’s where this is all starting. Let me just give you specifics about why this is a big movement if you’re not aware of it: 1.2 million Americans have gotten a Nike shoe, which is a body-area network that connects the shoe, the sole of the shoe to the iPhone, or an iPod. And this Wired Magazine cover article really captured a lot of this; it talked a lot about the Nike shoe and how quickly that’s been adopted to monitor exercise physiology and energy expenditure. Here are some things, the principles that are guiding principles to keep in mind: “A data-driven health revolution promises to make us all better, faster, and stronger. Living by numbers.” And this one, which is really telling, this was from July, this cover article: “The personal metrics movement goes way beyond diet and exercise. It’s about tracking every facet of life, from sleep to mood to pain, 24/7/365.” Well, I tried this device. A lot of you have gotten that Phillips Direct Life. I didn’t have one of those, but I got the Fitbit. That looks like this. It’s like a wireless accelerometer, pedometer. And I want to just give you the results of that testing, because I wanted to understand about the consumer movement. I hope the, by the way, the Phillips Direct Life works better — I hope so. But this monitors food, it monitors activity and tracks weight. However you have to put in most of this stuff. The only thing it really tracks by itself is activity, and even then, it’s not complete. So, you exercise and it picks up the exercise. You put in your height and weight, it calculates BMI, and of course it tells you how many calories you’re expending from the exercise, and how many you took in, if you go in and enter all the foods. But it really wants you to enter all your activity. And so I went to this, and of course I was gratified that it picked up the 42 minutes of exercise, elliptical exercise I did, but then it wants more information. So, it says, “You want to log sexual activity. How long did you do it for?” (Laughter) And it says, “How hard was it?” (Laughter) Furthermore it says, “Start time.” Now, this doesn’t appear — this just doesn’t work, I mean, this just doesn’t work. So, now I want to move to sleep. Who would ever have thought you could have your own EEG at your home, tagged to a very nice alarm clock, by the way? This is the headband that goes with this alarm clock. It monitors your brainwaves continuously, when you’re sleeping. So, I did this thing for seven days getting ready for TEDMed. This is an important part of our life, one-third you’re supposed to be sleeping. Of course how many here have any problems with sleeping? It’s usually 90 percent. So, you tell me you sleep better than expected. Okay, well this was a week of my life in sleeping, and you get a Z.Q. score. Instead of an I.Q. score, you get a Z.Q. score when you wake up. You say, “Oh, OK.” And a Z.Q. score is adjusted to age, and you want to get as high as you possibly can. So this is the moment-by-moment, or minute-by-minute sleep. And you see that Z.Q. there was 80-odd. And the wake time is in orange. And this can be a problem, as I learned. Because it not only helps you with quantifying your sleep, but also tells others you’re awake. So, when my wife came in and she could tell you’re awake. “Eric, I want to talk. I want to talk.” And I’m trying to play possum. This thing is very, very impressive. OK. So, that’s the first night. And this one is now 67, and that’s not a good score. And this tells you, of course, how much you had in REM sleep, in deep sleep, and all this sort of thing. This was really fascinating because this gave that quantitation about all the different phases of sleep. So, it also then tells you how you do compared to your age group. It’s like a managed competition of sleep. And really interesting stuff. Look at this thing and say, “Well, I didn’t think I was a very good sleeper, but actually I did better than average in 50 to 60 year olds.” OK? And the key thing was, what I didn’t know, was that I was a really good dreamer. OK. Now let’s move from sleep to diseases. Eighty percent of Americans have chronic disease, or 80 percent of age greater than 65 have two or more chronic disease, 140 million Americans have one or more chronic disease, and 80 percent of our 1.5, whatever, trillion expenditures are related to chronic disease. Now, diabetes is one of the big ones. Almost 24 million people have diabetes. And here is the latest map. It was published just a little more than a week ago in the New York Times, and it isn’t looking good. That is, for men, 29 percent in the country over 60 have Type II diabetes, and women, although it’s less, it’s terribly high. But of course we have a way to measure that now on a continuous basis, with a sensor that detects blood glucose, and it’s important because we could detect hyperglycemia that otherwise wouldn’t be known, and also hypoglycemia. And you can see the red dots, in this particular patient’s case, were finger sticks, which would have missed both ends. But by continuous monitoring, it captures all that vital information. The future of this though, is being able to move this to a Band-Aid type phenomenon, and that’s not so far away. So, let me just give you, very quickly, 10 top targets for wireless medicine. All these things are possible — some of them are very close, or already, as you heard, are available today, in some way or form. Alzheimer’s disease: there’s five million people affected, and you can check vital signs, activity, balance. Asthma: large number, we could detect things like pollen count, air quality, respiratory rate. Breast cancer, I’ll show you an example of that real quickly. Chronic obstructive pulmonary disease. Depression, there’s a great approach to that in mood disorders. Diabetes I’ve just mentioned. Heart failure we already talked about. Hypertension: 74 million people could have continuous blood-pressure monitoring to come up with much better management and prevention. And obesity we already talked about, the ways to get to that. And sleep disorders. This is effective around the world. The access to smartphones and cell phones today is extraordinary. And this article from The Economist summed it up beautifully about the opportunities in health across the developing world: “Mobile phones made a bigger difference to the lives of more people, more quickly, than any previous technology.” And that’s before we got going on the m-health world. Aging: The problem is enormous, 300,000 broken hips per year; but the solutions are extraordinary, and they include so many different things. One of the ones I just wanted to mention: The iShoe is another example of a sensor that improves proprioception among the elderly to prevent falling. One of many different techniques using wireless sensors. So, we can change medicine across the continuum of care, across the ages from premies or unborn children to seniors; the pharmaceutical arena changes; the full spectrum of disease — I hope I’ve given you a sense of that — across the globe. There are two things that can really accelerate this whole process. One of them — we’re very fortunate — is to develop a dedicated institute and that’s work that started with the work that Scripps with Qualcomm … and then the great fortune of meeting up with Gary and Mary West, to get behind this wireless health institute. San Diego is an extraordinary place for this. There’s over 650 wireless companies, 100 of which or more are working in wireless health. It’s the number one source of commerce, and interestingly it dovetails beautifully with over 500 life science companies. The wireless institute, the West Wireless Health Institute, is really the outgrowth of two extraordinary people who are here this evening: Gary and Mary West. And I’d like to give it up for them for getting behind this. (Applause) Their fantastic philanthropic investment made this possible, and this is really a nonprofit education center which is just about to open. It looks like this, this whole building dedicated. And what it’s trying to do is accelerate this era: to take unmet medical needs, to work and innovate — and we just appointed the chief engineer, Mehran Mehregany, it was announced on Monday — then to move up with development, clinical trial validation and then changing medical practice, the most challenging thing of all, requiring attention to reimbursement, healthcare policy, healthcare economics. The other big thing, besides having this fantastic institute to catalyze this process is guidance, and that’s of course relying on the fact that medicine goes digital. If we understand biology from genomics and omics and wireless through physiologic phenotyping, that’s big. Because what it does is allow a convergence like we’ve never had before. Over 80 major diseases have been cracked at the genomic level, but this is quite extraordinary: More has been learned about the underpinnings of disease in the last two and a half years than in the history of man. And when you put that together with, for example, now an app for the iPhone with your genotype to guide drug therapy … but, the future — we can now tell who’s going to get Type II diabetes from all the common variants, and that’s going to get filled in more with low-frequency variants in the future. We can tell who’s going to get breast cancer from the various genes. We can also know who’s likely to get atrial fibrillation. And finally, another example: sudden cardiac death. Each of these has a sensor. We can give glucose a sensor for diabetes to prevent it. We can prevent, or have the earliest detection possible, for breast cancer with an ultrasound device given to the patient. An iPatch, iRhythm, for atrial fibrillation. And vital-signs monitoring to prevent sudden cardiac death. We lose 700,000 people a year in the U.S. from sudden cardiac death. So, I hope I’ve convinced you of this, of the impact on hospital clinic resources is profound and then the impact on diseases is equally impressive across all these different diseases and more. It’s really taking individualized medicine to a new height and it’s hyper-innovative, and I think it represents the black swan of medicine. Thanks for your attention. (Applause)

58 thoughts on “Eric Topol: The wireless future of medicine

  1. eat healthy, exercise, take time to relax, hug your kids, have fun with family and friends, sleep well
    and i doubt if you need tech to track your life again

  2. As a doctor, virtually nothing can be done (or diagnosed) without personal contact, speaking with and looking at the patient
    And this IS 2010.
    Taking some data and putting it on an iphone makes it more impressive but does not change much. We are glad to be able to talk and ask patients for their own sensations via their cellphone. If you are not talking about very high effort medicine and very specific tasks and trained patients.. you get my view

  3. Diabetes has increased so much in the past 60 years. Why hasn't someone done something about this, like prove that fast food gives you diabetes? Well a glucose monitor could help people figure this out for themselves.

  4. @DaeshimShisen This is really the ideal of what I had in mind earlier this year, a device that could show a full day's worth, or real time data of vitals to help optimize health. Could be especially useful just for working out, seeing how many minutes your heart rate has been in the target range, or how many heart beats per day. The more we measure, the better correlations we can detect with regards to overall health!

  5. 1st- If you are not a doctor this info is no use to you , you send it or share it = tracking
    2nd- @xTriad – Special Interest Groups – that can loby this to be mendatory
    3rd- Would you like a shok neckless on a plane – what happens if some one spills theyr coffe on you
    4th- Tech is good and it makes our lifes better , but come on , I keep minimal money on my card, maximum fuel in my car, and i try to eat healthy and do sports , i dont need wireless gps tracking me doctroc helping kill switch

  6. Will the doctor be able to cope with such intensive data monitoring?How will doctors manage this data. Will doctor's say it is the patients responsibility, or will it be the responsibility of the doctor to interpret the data. What will also this mean for insuarnce costs. Is all this cost effective? Will this be affordable and applicable all over the world?

  7. Yeah, Im sure the alien overlords and NWO are lying awake at night, fapping with both hands at the thought of monitoring our glucose levels.

  8. A place i would like to see this is on hospital wards. it takes a lot of time each day to check BP, HR, Resp, Temp, BG four times each.

    also people filling out and reeding charts with 100% accuracy every single time is a challange.

    if we can get this to be more automated with computers giving early warnings we will save more lives and be able to give better quallity care.

  9. You obviously troll too much on the web and dont follow the news ,but let me make it simple
    -Shadow Government- Its a movie you should see,do a research and then talk about shit you dont understand
    paranoia – what the fuck are you talking about, and I'm paranoid becouse ???? Nothing I have said is paranoic , but since you understand medics equipment,lobying,the banking system you should know

  10. "banking system"??

    LOL

    Typical conspiratorial nut-job talk.

    Go fly your planes into irs buildings elsewhere. this is a talk about medical science.

  11. If you want to stay out of a hospital bed stop eating garbage and get some exercise. Prevention is better than cure every time.

  12. BTW the guys that say that some people are "conspiratorial nut jobs" is either asleep and needs to wake up or hey bury head back in the sand bird brain. What you think about us is your problem. In the USA there something called the "BILL OF RIGHTS" look it up. It might be educational for you.

  13. True. And mobility, I guess does increase quality in the sense that problems can be signaled earlier. But the doctor's practice is getting ever busier. How wil 40 simultaneous datastreams be managed if 40 anomalies are found simultaneously. Not only will the the monitoring suffice, but a close relationship with programmers will also have to be made to think of smart algorthyms to help the doctor manage false positives and false negatives in real time. That will be effective in daily practice.

  14. well, hmm, the technology seems really appealing, however, using such tech would mean you could be monitored anywhere.

    Good all Bad, those in control of this technology need to consider the privacy of those using it.

  15. You indeed need smart algorithms but a basic function could be just a simple text message to the patient (sent automatically of course) if their vital signs show dangerous anomalies. The message could depending on the case give a small piece of advice (lay down for a bit and monitor yourself or eat something, your blood sugar is dangerously low etc) or a request to call the doctor as soon as possible.

  16. I thing you need to calm down and focus on what the presentation is actually about. The technlogies displayed here are quite interesting, and you're whining about some random screenshot of some phone.

  17. well, actually I didn't see any logo during the lecture.. I think you can show anything if nothing is specially related to a certain brand…isn't it?

  18. Well this will make assassination much easier. You can confirm a kill just by hacking someone's monitors with your nexus 1. Oooh or you could send a fake signal showing liver failure or something so that the doctors do the killing.

  19. Is that TED thing in someway related with iphone? It's pissing me off that they say IThis n IThat like there is only one effin phone on the planet. So you wanna reach people in developing countries with those apps but only if they'll own fu**ing IPhone? There's more great phones out there and ppl that could use these med-app's with their handsets. I hate monopolistic attempts by apple. F**ck IRhytm, f**ck IShoe, f**ck ITunes. IFuck you.

  20. this is retarded. people don't need to see how bad their health is, they need to eat the right foods and not have to worry about their health.

    come on TED. yea, this may be impressive tech, but its a step backwards in improving our health. this "vital information" only benefits corporations investing in (and proliferating) our poor health.

    completely stupid. i hope we never get to the point where this tech becomes widely used.

  21. Money should be spent elsewhere. I hate how companies like this will receive such an abundance of money while people within the cities where these are produced are homeless. Eat healthy, be active, and age may be the only reason for heart failure in later years. I feel this constant monitoring will further increase human anxiety as the users will constantly be checking it. Things like this make life too technology driven.

  22. 05:18 Wait… "CHF $ 37 Billion/Yr"??? … Why is he telling that in Swiss Francs? Maybe I didn't see or hear something, but I'm to lazy to check again 😛

  23. Every ounce of my hypochondriac body is tingling with a desire for this technology…. I think… I hope that tingling is desire, I'm really not sure ….

    This technology couldn't come to soon

  24. ricande- The thing is, if the apps hes talking about are only available on the iphone how else is he supposed to give examples?

  25. wevenhuis- These are all very valid and important questions to ask.(Why the thumbs down?) Apart from all the questions about how the doctor manages the data. There is also the question of weather all this monitoring could lead to unnecessary treatments that could cost more and even cores harm. This is the case already with some conventional scans and tests.

  26. I am not against the application of new technologies. Even more so I like technology very much, especially if it improves care. But as WhichDcotor 1 pointed out, how do we protect the dotor from an information overload syndrome, and also prevent overtreatment and overdiagnosing? At the end of the day we are all human, not machines.

  27. "more has been learned about the underpinnings of disease in the last 2.5 years, than in the history of man."

    Yet he didn't bother to give even a single example of ANY insight into ANY disease we have gained in the last 2.5 years.

  28. surely that is not what this tedtalk was about. all disEases are the product of the degration of the air we breath, food we eat and sleep interruptrd by the constant electrical static we now live. natures subtle energies can not compete. all that taxes us will cost us our health. maybe these devicess will let us see just how much we are affected by all we do or not do

  29. then all i need to do is hack their device and I will be able to monitor their vital functions, and those of their families
    MWAHAHAHAHAHA! >:D
    or better yet, upload a live feed online an have THE ENTIRE WORLD monitoring your vital signs, every living heartbeat >:D

  30. Your boss and insurance co will live this. Monitor you at work and fire you when you are having trouble. One bad spike and the ins co will drop you like a hot potato! That super hot chick you are close to hooking up with will read you and see all your health issues. By by love !

  31. How much actually changed? Who were the winners and losers of the companies who made the product. And patient lives it improved?

    We know marketing is overpowering good technology.

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