The Medical Futurist | December 11, 2018
Instead of mind-boggling inventions, 2018 was the year when national governments, as well as healthcare regulators, started to embrace digital health technologies at scale. The year when Google, Amazon, Apple or Microsoft competed head-to-head for the biggest chunks on the healthcare market, and when the buzzword of the year award went to the blockchain. Here’s our guide to the top digital health stories from last year.
2018: Under the spell of cosmos and microcosmos
Every year, The Medical Futurist team sits down and collects the top stories of the past 12 months in healthcare. We put the novelties under the microscope, and carefully consider which technologies and/or scientific methods could prove to be a passing fling and which are here to stay for longer.
Looking at the scientific field in general and considering a much broader context, it is safe to say that 2018 was both the year of Mars and genetics/genomics: humanity has considerably widened its horizon regarding the infinite space and the microparticle level. In practice, that means, for example, that paleogeneticists discovered that a woman who died 90,000 years ago was parented by two different species of human. According to genome analysis of a bone found in Denisova Cave in the Altai Mountains of Russia, the woman was half Neanderthal, half Denisovan. But not only that finding was made possible by the incredible advancement of genetics and genomics. In March 2018, NASA announced their twin studies program revealed that time in space can actually change the expressions of certain genes. Upon returning from the cosmos, Scott Kelly’s DNA, especially the telomeres underwent some changes.
In connection with humanity’s other space adventures, on July 25, 2018, the Italian Space Agency announced researchers discovered an underground lake on Mars. Using a ground-penetrating radar, scientists uncovered a subglacial lake. Later on, the Mars camera HiRISE discovered several spots of eroded land that allowed for more direct access to the planet’s ice supply. What is more, NASA’s Mars rover Curiosity found an assortment of organic molecules on the red planet’s surface, an indication of the possibility of biological life forms on Mars. And according to the latest news, the space agency’s Insight robot landed on the red planet after a six-month journey on 28 November. Now, even if we are not sure yet whether we can travel to Mars within 15 years, we might have a broader frame to understand humanity’s aspirations and its achievements so far this year, so let’s look at what happened at the forefront of health innovation in the recent past.
1) The importance of good policies
While there’s an abundance of digital health technologies out there, neither a level of adoption nor a manner of embracement beneficial for both the patient and the doctor comes naturally. While it could help solve critical problems in care, it could create new ones. For example, a study found that clinician-oriented solutions such as electronic health records (EHRs) are contributing to physician burnout instead of facilitating patient care in the US. Many anticipated that health information technology would reduce costs by limiting the duplication of tests and studies, but there is little evidence that it has accomplished this. And while patient-oriented digital solutions have proliferated in number, their clinical impact has been limited.
That’s where guidelines and good policies come into the picture: for a successful implementation of digital health practices and for embedding them into the daily lives of patients and doctors – without further complications. Recognizing the gravity of the issue, The Medical Futurist Institute published its best practice guidance for policy-makers in March 2018, which aims at making it easier to choose the most fitting technology for a given care setting.
That might come in handy as some countries already started to map out digital health policies much earlier – just look at Estonia and its digital democracy. Many others launched the process last year, for example, Canada, or this year. Denmark published its digital health strategy in January, while New Zealand, Australia, Israel or Rwanda are all in the process of working out their way how to embrace digital health. It is an unprecedented number of countries trying to bridge digital technologies with their healthcare system, and The Medical Futurist assumes that the process will continue with many more in 2019.
2) Big tech marches into healthcare
For the last couple of years, there is a clear trend showing how the big fish in technology are making a push into healthcare. Never was it so evident than in 2018 and nothing can prove it better than the top-level healthcare professionals hired to tech companies.
After Amazon, Berkshire Hathaway, and JPMorgan Chase announced a partnership to cut healthcare costs and improve services for their US employees, Jeff Bezos’ company recruited recognized surgeon, author, and journalist Atul Gawande to lead their new healthcare company as a CEO. In June 2018, Microsoft hired two top healthcare professionals to enhance its open cloud architecture and A.I. solutions and focus on partnerships and cross-company strategy for both healthcare and life sciences. In the case of Google, its parent company, Alphabet has such a vast portfolio in healthcare – with Verily Life Sciences, Google Genomics, Deepmind, Calico or Google Fit – that at the beginning of November, it hired Geisinger Health CEO David Feinberg to oversee its many initiatives.
The high-profile hires certainly mean new health projects or the advancement of already existing ones. Amazon was likely to prepare its dynamic move into the pharma scene, while as its latest move, it announced to sell software that mines patient medical records for information doctors and hospitals could use to improve treatment and cut costs. Google strengthens its positions throughout the entire health spectrum, while Tim Cook’s company polishes the capabilities of its smartphones. In January 2018, Apple announced that it is bringing health records to iPhones. That means some patients in the US can reach their medical histories with one tap into the Health app already. Also, back in December 2017, Tim Cook & Co. announced the development of an advanced heart-monitoring feature for future versions of its smartwatch.
Tech companies clearly see the vast potential in the digitization of health services and are in a neck-and-neck race for gaining the most from the healthcare market. That was definitely one of the most defining trends in 2018.
3) The spotlight on the blockchain
Don Tapscott, author of the book entitled Blockchain Revolution said in his superb, no-frills TED Talkthat blockchain is likely to have the most significant impact on the next few decades. Well, the technology already has an indisputable achievement: the buzzword of the year award will definitely go to it in 2018. The craze and hype around it remind some experts even of the dotcom bubble. As Reuters explained in its analysis, the average share price of companies who have jumped on the blockchain bandwagon and visualized the change at least in their name has risen more than threefold since their re-branding.
No wonder that there are hundreds of companies, start-ups, enterprises, ventures experimenting with blockchain technology – also in healthcare. One of the most exciting initiatives, Nebula Genomics, co-founded by renown geneticist George Church and officially launched in November 2018, uses a blockchain-secured service to sequence people’s genomeswithout charging a fee, and they offer rewards to those who let third parties access their data. The company even believes that the genomic big data market, which will soon emerge, could be secured by blockchain.
However, genomic data storage is not the only way blockchain could be useful in healthcare. Numerous countries started to follow Estonia’s lead in securing their medical health records with the technology, including the United Arab Emirates. Moreover, pharma companies are eager to protect their drug distribution chains through the blockchain to reduce the chance to counterfeit drugs.
In another example, in March 2018, the Medicalchain, a decentralized, blockchain-based platform to securely store health records announced a partnership with The Groves Medical Group, an organization with 30,000 registered NHS patients. It’s the first medical practice in the UK that started to use blockchain technology through an app to give more control to patients over their medical records. What’s more, users can easily buy medicine-related services via MyClinic.com using the Medicalchain cryptocurrency, MedTokens (MTN). The project is in its pilot phase, but we are curious how it will unfold in 2019.
4) Diabetes ups and downs
When we went through the most exciting stories in 2017, we came to the conclusion that the beginning of a new era in diabetes care is upon us with such realities at that time as the FDA-approved artificial pancreas or such small, but significant innovations as a glucose monitor built into phone cases. This year, advancement in the field continued under the watchful eye of the FDA, for example, in June, the organization has extended its approval of the MiniMed 670G system (Medtronic) hybrid closed-looped system for glucose measurement and insulin delivery (the so-called artificial pancreas) to include children with type 1 diabetes. Also, as many experts suspected a year earlier, the artificial pancreas is gaining momentum: its market is anticipated to reach $390.4 million by 2024, according to a new report by Grand View Research, Inc.
However, one of the year’s most exciting announcement came from a French company, PKvitality, announced in November that it’s getting ever closer to unveiling the world’s first glucose measuring smartwatch. The watch is supposed to be able to continue to measure glucose levels in real-time, providing results when needed and eventually triggering alarms to warn users of abnormal levels. Although we cannot place our hopes too high this time, as claims about easy and accurate assessment have already been made without tangible results.
For example, it turned out irrevocably that the project for manufacturing contact lenses for detecting diabetes failed. Alphabet’s company, Verily Life Sciences halted one of its longest running projects with the announcement in November. The company said that the reason for shutting down the initiative was that it couldn’t get the experimental lens, which measures glucose in tears, to deliver assessments of blood glucose with enough consistency to be used as a medical device. Although we somewhat expected the disappointing news as there was no word about the undertaking for months, we still had a pinch of hope around the research.
5) Chatbot struggles
Chatbots have the potential to free up time for GPs by responding to simpler medical questions, making sense of health data or supporting medication management. The general idea is that in the future, patients will not contact physicians or nurses or any medical professional with every one of their health questions but turn to chatbots first. After the little medical helper cannot comfortably respond to the raised issues, it will transfer the case to a real-life doctor. It seems that the youngest generation is already comfortable with the idea: a survey involving “Generation Z” from Roche UK showed that nearly two-thirds (63 percent) of surveyed 16-24-year-olds said they would be okay with being diagnosed by a chatbot.
Several similar digital solutions are on the market: Izzy helps women track their period and serves as a birth control pill reminder. Bots like HealthTap, Ada Health, Your.Md aim to help patients find a solution to the most common symptoms through A.I. One of India’s top pharma companies, Lupin, launched a chatbot named ‘ANYA’ designed to provide medically verified information for health-related queries.
However, 2018 was about the struggles of the first experiences with chatbots instead of successes. Babylon Health, one of the new breed of paid, doctor-on-demand services partnered with the NHS in two projects. Some patients in London can sign up to use the app’s video consultations to communicate with a doctor instead of registering with the traditional GP service, while Babylon also delivers a telephone advice service called NHS 111 in north London. However, it was reported late last year that some pilots in North West London were dropped as patients participating in the trial indicated that they would play the system to get an appointment with the doctor quicker. In July 2018, it was announced that Babylon Health faces regulatory scrutiny after complaints from doctors, who warn it can miss signs of serious illness. Babylon Health’s other claim that its chatbot is being able to diagnose medical conditions as accurately as a GP was also contested by physicians.
These phenomena indicate that neither doctors nor patients do have trust in health chatbots yet and need reassurance. If they are patients, that should come from a medical professional and if they are GPs, from evidence and conviction that chatbots are accurate.
6) FDA embracing digital health
The US Food and Drug Administration (FDA) has been proactive throughout the past 12 months in welcoming the latest digital health tech solutions and incorporating them cautiously into the practice of mainstream medicine. For example, as already mentioned before, in June, the organization has extended its approval of the MiniMed artificial pancreas system. Also, the FDA announced the release of an at-home gene test that checks for three mutations associated with breast and ovarian cancer. As a direct-to-consumer test is affordable and can be obtained without a doctor’s permission, more people would be able to test themselves for common risks without the barrier of cost or access to the right facilities. The regulatory agency also approved Spark Therapeutics’ one-time gene therapy, for the treatment of patients with vision loss due to an inherited retinal disease.
Regarding artificial intelligence, Arterys built the first deep learning algorithm for cardiac imaging, approved by the FDA in 2017. Already a year later, the agency cleared another 12 smart algorithms in healthcare. For example, Viz.ai, that analyzes CT results and tries to assess whether the patient has any signs of stroke or DreaMed which is a diabetes treatment decision support product that analyzes data from continuous glucose monitors.
Nonetheless, one of the biggest news came in October when Novarad’s OpenSight Augmented Reality System received FDA clearance for pre-operative surgical planning using the tech company’s AR headset. With the system, physicians can see both the 3D patient image from previous scans as well as the patient physically in front of them. The tool could be used as an aid for surgical planning and going through a complex procedure.
7) CRISPR and the potentials of gene editing
The issue of gene editing with all its legal, ethical and biological consequences, with its potential to alter the lives of future generations, has to be taken seriously. Everyone was reminded on that when the most significant piece of news came a couple of days ago. A Chinese scientist claims to have modified the very blueprint of life, the DNA code of two babies to try to bestow them a trait that few people naturally have – an ability to resist possible future infection with HIV, the Aids virus.
As in many countries, including the US and the UK, it is illegal to create genetically modified babies, and scientists in the field have reached a broad consensus that it would be profoundly unethical to try, the scientific community stands united in condemning the experiment. Genome editing is not considered as safe, and any genetic modifications – whether beneficial or unintentionally harmful – affect not only the child but their children and future generations. Jennifer Doudna, professor of chemistry and molecular & cell biology at UC Berkeley and co-inventor of CRISPR-Cas9 genome editing technology announced that human germline editing should not proceed at the present time. Eric Topol, a professor of molecular medicine at the Scripps Research Institute said the Chinese scientist went too far and it’s way too early to use the CRISPR method on humans.
On the other hand, research efforts are underway with regards to other species or gene therapies for adult patients with inherited genetic diseases. For example, researchers in Oxford’s Nuffield Laboratory of Ophthalmology help restore eyesight to patients with genetic vision defects. One of the methods is to inject working genes into the back of the eye. In the case of mosquitos, experts want to „make” the insects entirely resistant to the parasite that causes malaria. Testing might start within 4-5 years.
8) Deep learning in medicine: the battle of A.I. and humans continue
In the assumed battle between artificial intelligence and mankind, the Institute of Electrical and Electronics Engineers (IEEE) created an excellent visualization tool to see whether smart algorithms or humans are better in providing healthcare solutions.
There’s no question about the continuous advancement of deep learning algorithms, especially in medical imaging. In April, a group of German scientists and their colleagues showed these systems are better than experienced dermatologists at detecting skin cancer. In another study, researchers found that commercial software for automatically classifying breast density, and thus detecting breast cancer, can perform on par with human radiologists. What’s more, in the same month, the FDA approved the first AI system that can be used for medical diagnosis without the input of a human clinician. Researchers in the Personal Genome Diagnostics in Baltimore announced in September that they have developed a new method involving machine learning that automates the tumor DNA diagnostic process.
At the same time, Harvard Medical School researchers demonstrated that A.I. systems meant to analyze medical images are vulnerable to attacks. The experts modified the pixels within some medical images waiting for classification. That amount of modification might seem like a minimal amount of noise to humans but tricked the algorithms into classifying these pictures incorrectly. The scientists noted their attacks could make deep learning systems misclassify images up to 100 percent of the time, and that modified images were imperceptible from real ones to the human eye. That’s incredibly worrying and shows how vulnerable smart algorithms are – when it comes to phenomena outside of their scope.
2018 was yet again a great and turbulent year in science and healthcare. As nothing is certain except for the fact that more and more medical innovations will come next year, we can only promise that whatever happens, The Medical Futurist team will continue to cover every exciting development in health technology on every single one of our channels and provide the much-needed context in order to step into the future well-informed and confident.