Commentary article by: Eric J. Topol, MD
Published on December 16, 2016 at www.medscape.com
Last year, I put out my first top 10 tech list, and it seemed to get a lot of interest. So here is this year’s list, not in any rank order. There are many more important advances than I list here, but I have focused on the ones that can make a real difference for patients and patient care. I have no conflict of interest with any of the companies listed here.
Artificial intelligence Comes to Medicine
Artificial intelligence (AI) has hit its stride in many other areas of our daily lives, and it is starting to demonstrate the kind of impact it can have in medicine. The extraordinary ability of AI to accurately interpret pathology slides, x-rays, skin lesions, and retinas has recently been shown. There are over 90 start-up companies working on AI applications in healthcare, no less the engagement of tech titans that include IBM (Watson), Apple, Google, and Microsoft, all of which have made major investments. A recent 60 Minutes segment filmed at the University of North Carolina suggested that AI could find an evidence-based therapy for 30% of patients with cancer that was not identified by their oncologists.
Advanced Wearable Sensors
2016 was characterized by remarkable progress in wearable sensor technology with flexible, stretchable, printable, and even battery-less characteristics and ever more tracking of physiologic metrics, chemistries (including glucose, ethanol, and lactate levels), and the environment (such as ultraviolet light exposure).
Liquid Biopsy for Cancer
Major validation studies of circulating cell-free, plasma tumor DNA (tDNA) versus solid tissue biopsy were published, and the number of companies pursuing this goal, with targeted sequencing of the tDNA, has now expanded to more than 50. The extent of cancer-related genes sequenced from the blood sample has grown substantially. New entrants into the field this year include Grail and Cirina, both of which are doing studies to detect cancer in large cohorts of healthy people, using either tDNA or tDNA methylation.
It remains to be seen whether a liquid biopsy will provide accurate detection in asymptomatic individuals, but the benefits over solid tissue biopsy for patients with a presumptive diagnosis or undergoing surveillance are especially alluring (less expense, risk, and discomfort, and possibly more representative of the cancer biology process, overriding solid tissue heterogeneity).
Virtual Medical Center for Remote Monitoring (‘Bedless Hospital’) and the Rapid Rise of Telemedicine
In St Louis, Mercy Virtual has 330 healthcare professionals overseeing real-time monitoring of thousands of patients remotely. In parallel, the rise of telemedicine for outpatient visits is growing very rapidly.
First CRISPR Genome Editing and Initiation of Clinical Trials
In China, on October 28, the first patient treatment with CRISPR genome editing for lung cancer was performed by removing immune cells, editing them to engender heightened immune function (disabling PD-1), culturing the cells, and injecting them back into the patient. More trials have been approved to start in the United States for cancer and there has been remarkable progress for a variety of monogenic diseases, such as sickle cell, with clinical trials to start soon ( ).
Last year, I highlighted the Philips Lumify smartphone ultrasound as a top tech advance. In 2016, a dedicated cardiac probe was introduced that generates exquisite images through an Android app (see video). A second entry of smartphone ultrasound—Clarius—is also being introduced, and it has a wireless connection to the smartphone. Recently, I’ve been made aware of a third smartphone ultrasound device developed by Healcerion. 2016 was the 200th anniversary of the stethoscope. I think we have far better technology to offer now that supersedes sounds.
Lab in Your Pocket
The point-of-care ability to rapidly and inexpensively diagnose a significant number of infectious diseases is remarkable. The list now includes HIV, human papillomavirus, influenza, and group A streptococcus, with many more in progress.
The mobile device platform that is increasingly being used makes this highly attractive for remote areas. Recently, Imperial College announced a disposable USB memory stick that can accurately determine HIV viral levels from a drop of blood. And “ubiquitous sequencing”—the ability to sequence a pathogen rapidly from a body fluid specimen —holds the promise of revolutionizing our approach to infectious disease diagnosis in the years ahead.
New Genomics for Cancer Predisposition, Whole-Genome Sequencing
In March 2016, Veritas Genetics announced at our Future of Genomic Medicine conference that they will perform whole-genome sequencing for $999. Although there had been much banter about the $1000 genome for years, this was the first real fulfillment of reaching that threshold, given that the path via Illumina HiSeq X Ten required $10M of machine purchases.
We now know a substantial number of the common variants in genes that predispose one to cancer—both in oncogenes and tumor suppressor genes. For individuals with a family history of cancer, 30 of these genes can now be sequenced by Color Genomics for $249. Several other companies are offering mutation panels or other targeted sequencing to help define increased risk. This could sharpen the use of screening and get us toward the promise of prevention by identifying increased risk long before cancer manifests.
Microfluidic Chips for Labs via a Droplet of Blood
I wrote about the Theranos debacle in the updated paperback edition of The Patient Will See You Now (excerpt here). Theranos had promised low-cost, accurate blood tests from a droplet of blood, and although that clearly did not materialize from Theranos, the technology to do this with microfluidics and colorimetrics is moving forward. As an example, here are the immunoassays I had done by Genalyte with a droplet of blood, run before me in 9 minutes. This would normally require a send-out to specialized labs, take a week or two, and cost over $1000.
Microfluidic technology can make a substantial proportion of assays cheap, fast, and accurate. In contrast to Theranos, this company is fully transparent, and has published a number of peer-reviewed validation papers.
Virtual Reality for Pain, Phobias, and Prevention of Falls
The tech titans have placed big bets on the future of virtual reality (VR), such as Facebook’s acquisition of Oculus Rift. At the time, not many people realized how effective VR could be in medicine. A randomized trial in the Lancet showed how VR can reduce the propensity for falls, which adds to highly promising data published or presented for relief of pain, phobias, and posttraumatic stress disorder. On top of treatment, the use of VR for surgery and simulation for medical education is taking off.
Related to VR is augmented reality, which had some buzz with Google Glass and more recently showed up in the CBS TV series Pure Genius (which I reviewed in an article that will be forthcoming in JAMA).
I’m sure I have left out some advances that you consider worthy or have included ones you may not agree with. But I hope you find this list useful. I try to put out progress on a daily basis via Twitter, so follow me there @erictopol if you want a constant infusion.
Wishing you a happy holiday season and all the best for 2017, Eric J. Topol, MD
Topol on Physician and Patient Attitudes Toward New Technology
Three Grand Books: Genetics, Life and Death, and Humankind
1. Jha S, Topol EJ. Adapting to artificial intelligence radiologists and pathologists as information specialists. JAMA. 2016 Nov 29. [Epub ahead of print]
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- Lanman RB, Mortimer SA, Zill OA, et al. Analytical and clinical validation of a digital sequencing panel for quantitative, highly accurate evaluation of cell-free circulating tumor DNA. PLoS One. 2015;10:e0140712.
- Cyranoski D. CRISPR gene-editing tested in a person for the first time. Nature. 2016;539:479.
- DeWitt MA, Magis W, Bray NL, et al. Selection-free genome editing of the sickle mutation in human adult hematopoietic stem/progenitor cells. Sci Transl Med. 2016;8:360ra134.
- Radin JM, Topol EJ, Andersen KG, Steinhubl SR. A laboratory in your pocket. Lancet. 2016;388:1875.
- Mirelman A, Rochester L, Maidan I, et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet. 2016;388:1170-1182.
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Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape or Sunshine Coast Cardiology.