maximizing the use of your smart phone: medical apps & digital medicine

Maximizing The Use of Your Smart Phone: Medical Apps &

Digital MedicineKent Bottles, MD

[email protected]

www.kentbottlesmd.com

610 639 4956

37th Semi-Annual Spring Temple University Family Practice Review Course

March 22, 2013

mailto:[email protected]

http://www.kentbottlesmd.com/

The Talk

• Smartphones as a window onto Digital Medicine and Big Data

Harvard Health Letter on Smartphone Apps

• Harness phone’s computing power, cameras, audio, video, motion sensors, and GPS to create new ways to manage your health and wellness

• Uncharted

• Unstable

• Unregulatedhttp://ow.ly/3gVzg

Smartphones

• “The paradigm of healthcare has changed. You used to bring the patient to the doctor. Now you take the doctor, hospital, and entire healthcare ecosystem to the patient”

• “You cannot call your gastroenterologist every time you buy a new product.”

• “The technology of telehealth is well ahead of the socialization of the telehealth idea and we are at tipping point for utilization to take off.”

Traditional Medicine

• Biomedical model reduces every illness to a biological mechanism of cause and effect

• Attention on acute episodic illness• Generalists replaced by specialists• Focus on individuals• Cure as uncompromised goal• Focus on disease• Antibiotics & infectious disease

Traditional Medicine

• Diagnose and treat• Health is defined as absence of disease• Patient story is subjective and untrustworthy• Lab results are objective and true• Pathologists are the most important doctors• Clinicians are paralyzed until lab provides dx

Digital Medicine

• Digitizing a human being– Genome– Remotely, continuously monitor vital signs,

mood, activity– Image any part of body, 3d reconstruction, print

an organ– Readily available on your smartphone, integrated

with traditional medical record, constantly updated

Digital Medicine Convergence

• Genomics

• Wireless sensors

• Imaging

• Information Systems

• Social networks

• Ubiquity of smartphones

• Unlimited computing power via cloud server farms

Eric Topol on MI prevention

• “Monitoring would ideally use an implanted nanosensor, smaller than a grain of sand and capable of finding its targets in even one-millionth of a liter of blood, communicating with a patient’s smartphone. Individuals who would get the nanosensors would be those whose genome sequence or other biomarkers had already put them at risk for a heart attack.

Eric Topol on MI prevention

• Well before the horse was out of the barn, the nanosensor could alert the individual to seek attention; therapy then would consist of both ant-clotting and anti-inflammatory medications. At some point in the future, nanosensors will likely have the capacity to release medications on their own in response to high levels of circulating cells or nucleic acids”

Digital Medicine of Present & Future

• Human body and disease is complex emergent system that may never be fully understood

• Attention on chronic diseases

• Managing chronic diseases rather than cure

• Focus on person and the disease

Digital Medicine of Present & Future

• Predict and Prevent

• Health is a state of complete physical, mental, and social well-being and not merely absence of disease

• Patient story is essential for development of personal metrics which will be unique to each individual

• Pathologist sadly becomes less important

Big DataViktor Mayer-Schonberger & Kenneth Cukier, 2013

• Google Nature article predicts flu spread in USA• Compared 50 million search terms with CDC data

on spread of flu from 2003 to 2008• 450 million different mathematical models• 45 search terms had strong correlation with spread

of flu• H1N1 crisis in 2009 Google approach worked


• Big data refers to things one can do at a large scale that cannot be done at a smaller one, to extract new insights or create new forms of value, in ways that change markets, organizations, the relationship between citizens and governments.

• Causality is replaced by correlation

• Not knowing why but only what


• Statistics allows richest findings using the smallest amount of data

• Randomness trumped sample size

• 2007 300 exabytes of stored data

• 2013 1,200 exabytes of stored data

• 2013 only 2% is non-digital

Big DataWSJ March 11, 2013

• 1950s 600 megabytes (John Hancock)

• 1960s 807 megabytes (AA Sabre)

• 1970s 80 gigabytes (Fed Express Cosmos)

• 1980s 450 gigabytes (CitiCorp NAIB)

• 1990s 180 terabytes (WalMart)

• 2000s 25 petabytes (Google)

• 2010s 100 petabytes (Facebook)

Big DataWSJ March 11, 2013

• 1 Bit = Binary Digit

• 8 Bits = 1 Byte

• 1000 Bytes = 1 Kilobyte

• 1000 Kilobytes = 1 Megabyte

• 1000 Megabytes = 1 Gigabyte

• 1000 Gigabytes = 1 Terabyte

• 1000 Terabytes = 1 Petabyte

• 1000 Petabytes = 1 Exabyte

• 1000 Exabytes = 1 Zettabyte


• Increasing volume of data leads to inexactitude• Big data is probabilistic rather than precise• Microsoft’s Banko & Brill tested 4 algorithms

with 10 million, 100 million, 1 billion words• Accuracy rate of one went from 75% to 95%• Only 5% of digital data is structured• Without accepting messiness 95% of unstructured

data is useless


• To analyze & understand the world we used to test hypotheses driven by theories

• Big data discards theories & causality for correlations

• Univ of Ontario premature baby studies• 1,260 data points per second• Diagnose infections 24 hours before apparent• Very constant vital signs indicate impending

infection


• Datafication: unearthing data from material nobody thought held any value

• Digitization: process of converting analog information into zeroes and ones of binary code so computers can handle it.

• Data is something that allows it to be recorded, analyzed, and reorganized


• GPS allows us to establish location quickly, cheaply, and without requiring specialized knowledge

• UPS uses geo-loc data from sensors, wireless modules, and GPS on vehicles

• 2011 UPS shaved 30 million miles off routes, saved 3 million gallons of fuel, and 30,000 metric tons of carbon dioxide emissions


• Datafication of acts of living

• Zeo large database of sleep patterns

• Asthmapolis sensor to inhaler that tracks location via GPS identifies environmental triggers

• Fitbit and Jawbone

• iTrem monitors Parkinson’s tremors almost as well as the tri-axial accelerometer used in specialized office medical equipment


• Search data can be reused

• Hitwise is web traffic measurement company that lets clients mine search traffic to detect consumer preferences

• Telefonica mobile phone created Telefonica Digital Insights to sell subscriber location data to retailer


• Recombinant data

• Danish Cancer Society study on cell phone/cancer

• Cellphone users from 1987 to 1995 (358,403)

• Brain cancer patients (10,729)

• Registry of education and disposable income

• Combining the three databases found no increase in risk of cancer for those who used cell phones

• Not based on sample size; based on N=all


• Multiple uses of same database

• Data exhaust: digital trail people leave in their wake

• Google spell checking system uses bad data to improve search, autocomplete feature in Gmail, Google Docs, and translation system


• Paralyzing privacy– Notice and consent– Cannot give informed consent for secondary uses– Anonymization does not work

• AOL 2006 20 million search queries from 657,000 users: NY Times identified user number 4417749 as Thelma Arnold (“My goodness, it’s my whole personal life. I had no idea somebody was looking over my shoulder”)

• Netflix Prize 100 million rental records from 500,000 users. Mother and closeted lesbian in Midwest was reidentified


• Probability and punishment– Minority Report: People are imprisoned not for what

they did, but for what they are foreseen to do, even though they never actually commit the crime

– Blue CRUSH (Crime Reduction, Utilizing Statistical History in Memphis, Tennessee

– Homeland Security FAST (Future Attribute Screening Technology)

– Big data based on correlation unsuitable tool to judge causality and thus assign individual culpability


• Dictatorship of Data– Relying on numbers when they are far more fallible

than we think

– Robert McNamara’s body count numbers in Viet Nam

– Michael Eisen tried to buy The Making of a Fly on Amazon in April 2011. Two established sellers offering the book for $1,730,045 and $2,198,177. Two week escalation to a peak of $23,698,655.93 on April 18

– Unsupervised algorithms priced the books for the two sellers.


• Regulatory shift from “privacy by consent” to “privacy through accountability”

• “Differential privacy” through deliberately blurring the data so hard to reidentify people

• Openness, Certification, Disprovability

• Algorithmists to perform “audits”

What Big Data Can’t DoDavid Brooks, NY Times, February 26, 2013

• Data struggles with the social

• Data struggles with context

• Data creates bigger haystacks (spurious correlations that are statistically significant)

• Data has trouble with big problems

• Data favors memes over masterpieces

• Data obscures values

maximizing the use of your smart phone: medical apps & digital medicine

Health & Medicine

disease patient

digital medicine

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schonberger

kenneth cukier

eric topol

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