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Eric Topol on the Medical Geographic Information System



By John Otrompke 
 
July 31, 2014 | Individualized medical geographic information systems (GIS) are poised to transform medicine, says noted futurist Dr. Eric Topol, MD, director of the Translational Science Institute at Scripps Research Institute in La Jolla, California. Topol addressed the annual meeting of the American Association of Clinical Chemistry in Chicago on Sunday 
 
The decreasing cost of next generation sequencing, and the increasing power and omnipresence of smartphones suggest that we as a society are moving from the “lab on a chip” world to the “lab in a body” world, said Topol.
 
“The iPhone 5s contains more than a billion transistors, and now there’s a creative explosion built on this smartphone infrastructure,” said Topol. Meanwhile, he noted, the cost of health care is going up—in the opposite direction of Moore’s law.
 
Topol500“Our problem is not generating data or wanting to have bigger data; our problem is that less than 5% of the data generated is ever really analyzed,” he explained. “The average car has over 400 sensors, and the average smartphone has more than 10, but our body has zero,” said Topol. 
 
Those trends will change not only medicine in general, but laboratory practice as well, said Topol. “I don’t think we are moving toward the doctorless patient paradigm, like the driverless car, but I do think most diagnoses will be done by the patient in the future,” he said.
 
As an example of future prospects, Topol explained that the current state of technology today permits the circulating endothelial cells that presage a heart attack to be genetically sequenced. “We’ve been working with Cal Tech to develop sensors to put into your body, and activate a ring tone on your smart phone that tells you you’re about to have a heart attack,” he said. 
 
Cancer is another example, Topol said. If scientists can sequence an individual’s cancer cells, it might be possible to implant sensors in the human body that would send a signal to a smart phone if those cells are detected. 
 
He envisioned, “the ability to monitor airway obstruction before there is even a wheeze, before an asthma attack.” He also proposed a breath check for cancer, an idea even he had initially discarded. “I thought that was unrealistic until I started to go back to the data about dogs being able to smell cancer, and now being able to simulate that through an electronic nose that attaches to a smart phone, is really quite remarkable,” Topol said.
 
All of these devices may well make possible an aggregation of data concerning our health which might be compared to a Google map of the individual, he noted, referencing Google’s Baseline project, a new initiative to do just that. 
 
Michael Snyder of Stanford University was one of the first humans to have such a construct made of himself. Snyder had not only gene expression analyzed, but also proteomic and metabalomic sequencing as well, as described in Topol’s recent article in Cell, “Individualized Medicine from Prewomb to Tomb” (March 27, 2014).  The procedure required one terabyte of storage for the DNA sequence, two for the epigenomic data, and 3 terabytes for the microbiome, the article said.
 
The human GIS would be composed of data describing the phenome, physiome (physiological dynamics), anatome (the body’s organs), and exposome (environmental exposure), among other ‘omes, Topol said. The phenome would include "the electronic medical record, demographics, and social media, which we don't have enough respect for traditionally in medicine, but has a lot of important information," he said. 
 
“Collectively… 10 different ‘omics’ describe the human being for all intents and purposes and are all we need to know for better medicine,” he said. 
 
While some of the potential applications are in development, the technological potential is here and now, according to Topol, who pointed to the iBGStar Blood Glucose Meter, which has FDA approval and is on the market.  
 
“A diabetic can take a tiny amount of blood from a finger stick, and analyze it with a hardware attachment that goes to your smartphone. It works with all smartphones, including Android phones, and you can get your glucose level within minutes, whereas otherwise… it would take hours, and you’d have to beg the doc to get the results,” Topol said.
 
Implementing an individualized approach using sensors is so much more precise than the way we practice health care now, Topol explained. The approach could have significant cost savings as well. 
 
“There are many different things happening with sensors, like these chip tattoos that can just peel off the skin—or even be bioabsorbable—that will also be taking hold for tracking various physiologic metrics in the future,” Topol added.
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