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Book Excerpt: The Creative Destruction of Medicine

May 17, 2012

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WHEN MARTY COOPER invented the cell phone in 1973, he could not have dreamed or estimated that there would be over five billion cell phones by 2010 and that this platform would ultimately have a major impact on the future of health and medicine. The invention of the personal computer by Michael Wise in 1975, followed soon thereafter by the innovations of Steve Jobs and Steve Wozniak the following year, led to over one billion personal computers in use by 2008 and an anticipated two billion in 2014. The internet began to hit its stride by the mid-1990s, and now well over two billion individuals are connected.

But the biggest leap came in the first decade of the twenty-first century. The six billion bases of the human genome were sequenced, and this led to the discovery of the underpinnings of over one hundred common diseases, including most cancers, heart disease, diabetes, autoimmune disorders, and neurologic conditions.

In that same decade the number of discrete mobile phone users increased from five hundred million to over three billion, representing almost half of all people and the vast majority of adults on the planet…When Mark Zuckerberg started Facebook in 2004, how could anyone have predicted there would be over eight hundred million registered users by the end of 2011? Or a projected one billion by 2012?...More than 40 percent of us are “hyper-connected” as defined by “using 7 different devices and 9 different applications in order to stay as screen connected as possible, in restaurants, from bed, and even in places of worship.”

These extraordinary accomplishments…have unwittingly set up a profound digital disruption of medicine. Until now we did not have the digital infrastructure to even contemplate such a sea change in medicine. And until now the digital revolution has barely intersected the medical world. But the emergence of powerful tools to digitize human beings with full support of such infrastructure creates an unparalleled opportunity to inevitably and forever change the face of how health care is delivered.

This really boils down to a story of big convergence: a convergence of all six of the major technologic advances, likely representing the greatest convergence in the history of humankind. When we just had a cell phone, we could only talk to one another, but it could occur on the go. As personal computer hardware developed from a work station to a laptop, we gained mobility, but we were still not connected to one another. The Internet strikingly changed both of these platforms. Nicholas Negroponte wrote in his 1995 book Being Digital, “The information superhighway may be mostly hype today, but it is an understatement about tomorrow. It will exist beyond people’s wildest predictions.” Clearly, that was a prescient call. Although the first BlackBerry devices were inadequate cell phones, they were extraordinary at receiving and sending emails…But it took almost five years before the morphed cell phone, powered with emails and texting, faithfully performed its original purpose of making voice calls and also became a wholly functional Web surfing tool.

This transition from a “mail and text” phone to a “smart phone” relied on a much greater Internet bandwidth, broad connectivity via networks such as AT&T, Verizon, and others in the United States, along with appropriate, tailored mobile operating system development. Late in 2007, Apple’s introduction of the iPhone was a veritable game changer, and most would even qualify it as a life changer.

By 2011, just for the iPhone there were over 300,000 apps downloaded over 6.5 billion times. This was made possible because writing code for the mobile phone had become an open platform.

Within a matter of months, hundreds of thousands of apps were created that accelerated the capabilities of smart phones in ways most people could not have imagined: from using the phones to determine a bird species by its picture or call, to instantly translating a page in English to Spanish or vice versa, to discerning colors correctly for people who are color-blind, to playing thousands of new games, to accessing or playing music. One can even convert the iPhone to a stethoscope to listen to heart and breath sounds.

The hybridization of the maturing Internet and the mobile phone were the two most vital components of the convergence…It is hard to be intimate with the Internet per se. By contrast, almost 70 percent of individuals sleep with their cell phone. That figure goes up to 90 percent for digital natives, as defined by people under age thirty. There are more mobile phones in the world than toothbrushes, and far more than toilets.

We are preternaturally on the move, a peripatetic culture, and our phones are always with us. Many rank the mobile phone above food, shelter, and water as their most essential possession. The Economist put it simply: “mobile phones have made a bigger difference to the lives of more people, more quickly, than any previous technology.” Nature, the leading biomedical peer review journal, pointed out that we will have six billion mobile phones by 2013, with over 85 percent of the world’s population having access to a mobile signal, and that “we’ve really never had a technology other than human observation that is as pervasively deployed in the world.”

In 2009 judges at the Wharton School of the University of Pennsylvania were asked what were the biggest innovations, the “life changers,” of the past thirty years. Their response in rank order was: (1) Internet, broadband; (2) PC and laptop; (3) mobile phones; (4) email; and (5) DNA testing and sequencing.21 The smart phone had already captured four of five life changers and, as it continues to evolve, is working its way to incorporating the fifth.

Like a syzygy with alignment of the sun, the moon, and the Earth, we have a propitious convergence of a maturing Internet, ever-increasing bandwidth, near-ubiquitous connectivity, and remarkable miniature pocket computers in the form of mobile phones. And with data storage and processing fortified with cloud computing, under the stars, most of the people on this planet have been quickly and deeply affected in ways few really recognize.




Excerpted with permission from The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care by Eric Topol, M.D. Available from Basic Books, a member of The Perseus Books Group. Copyright © 2012.

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Dr. Eric Topol