Hi EricI think the long QT syndrome could be the “Rosetta stone” for such an approach, as it is quite well understood at the molecular/cellular level. A company could identify the mutation in each patient/family and then elucidate how the mutation changes the function of the channel with a combination of in vitro expression and heavy-duty computer modeling. The next step would be to design a molecule that selectively interacts with the mutated channel to restore function without being promiscuous with other potential pharmacological targets. The molecule could then be tested in the in vitro model and finally in the patient. I have no idea if such a business model would be economically feasible in a small market. And how would the FDA or other regulatory agencies manage the “approval” process?  I hope I see something like this in my lifetime.

Hi Sergio,

You have come up with the perfect example of individualized medicine. For a person with long QT, DNA sequencing would provide the specific mutations and iPS generated cardiomyocytes could define the specific drug response. This has already been done for research, but would be eminently feasible for patient care and guidance. Would be hard to argue at the regulatory level. Medicine of the future!

Dr. Topol:

Reading your book right now.

You have a ton of great ideas. 

What is your interest in getting involved in a technology company that will bring some of your ideas to reality?

Significant ventured-backed experience and significant iOS development expertise that can be applied to your ideas.

Let me know off line. 

The book is visionary and a must read. However it may take a generational change for clinicians to accept this, as the fields you discuss are not in the current vernacular. Bioinformatics, body-area-networks, 'omic science and Cloud-based elastic supercomputing are foreign concepts. The supportive literature is scattered over numerous journals and the significance underappreciated. Here are some examples: http://www.ncbi.nlm.nih.gov/pubmed/20566956 Ohio supercomputing cluster used to find patterns in otherwise mundane CBC data, http://www.ncbi.nlm.nih.gov/pubmed/22032711 complex modeling performed on CTCA imaging data to estimate coronary FFR. The initial reaction from clinical colleagues is usually skepticism. Add to that the potential for automating clinical data interpretation and there will be significant resistance. The burden of proof will be huge. How will these barriers be overcome?

Great point, Patrick....the real reason I wrote the book. I think that this can only be advanced through a consumer driven health revolution (Think Health Spring). With the emerging and extraordinary power of social networking, that transcends the DTC Pharma "Ask Your Doctor" era, this has been made possible. And, as you allude to, the timing is just right since we didn't have the tools until now.

The book does something in addition to empowering the consumer. It emboldens the inventors and researchers who see the same vision, and make it a reality. Thank you.

Dr.

We are a technology company attempting to blend together the medical community and the consumer.  We beleive that  March 1, 2012 begins a new era for healthcare as 10,000 Baby Boomers turn 65 yrs old and on March 2, 2012 10,000 baby Boomers turn 65 yrs old....etc with 10,000 more each day for the next 18 years.  This influx of medicare qualified population will change the way medicine is practiced. 

We believe that the informed consumer can become their own healthcare advocate and assist the medical community.  Our corporate focus is on "helping healthy people stay healthy".  We will do this by providing an ECG service designed to screen for AF and SCD.  These are conditions where the majority of persons have no symptoms.  Without cardiac symptoms you will most likely not get insurance to pay for a test.  We have developed a program to bring ECG screening directly to the consumer in their home.  This is a web-based program using the best technology available(3 lead, high resolution, automatic function, Holter/event recorder).  We will be seeking FDA over the counter approval to sell without a prescription. We will encourage those without symptoms to transmit their ECG data on an ongoing basis to screen for AF. We also have exclusive rights to a well validated QTVI algorithm which is highly predictive for SCD. (Ron Berger, MD, Ph.D,)

Those customers who have no symptoms, are not seeing a doctor who receive an abnormal finding from our ECG analysis will be encouraged to go see a doctor.  These customers will become new patients who hopefully have found a problem early, lowering healthcare cost and improving mortality.

Our focus groups have found most physicians resistant to this model. Maybe we have done a poor job of communicating the many benefits?

Thank you for your vision.

Bruce Rollie

 

 

Dr. Topol,

 I really enjoyed your video and the concepts that your are discussing and I'll look for your book.  

 I've been developing technology that has intereting parallels to the technologies that you discuss.  Our company has developed software to allow physician offices, hospitals, transfers centers, medical toursim companies to invite patients to upload their imaging studies via browser, so the phsicicans team can view, triage, and coordinate patient care bedore the patient arrives.

 Unfortunately, this is a challenging time to try to promote anything that has the word or concept of "IT" related to it.  With the HiTech act , meaningful use, ICD-10, and other major changes in clinical information systems occuring now and over the next several years, the bandwidth in many organizations seem overwhelmed and understaffed.

 I wonder if this will be a significant factor in physician or hospital adoption of these new, innovative technologies.   Our system is very "IT light" being browser based, and requiring absolutely no integration, but still the barriers to change (despite good ROI) are substantial.  And there is a significant culture of conservatism that seems to make it difficult for visionary innovative people in large institutions to prevail in pushing for exactly these sort of innovations.

With this in mind, I think that iwe will be more dependent on the  consumer to keep driving these sorts of innovations, until such time as the larger healthcare organizations stop reeling from the huge changes occuring now and have more time to consider innovations

 

Jeffrey E. Terrell

MeAndMyDocs.com

 

 

 

I just completed your book.  A passage near the end outlines a few methods that could help the average person nudge their healthcare provider closer to precision medicine.  You missed an important technique ... Gift wrap the book and Offer it as a good will gesture!

 

I am a broadcast engineer interested in the world of genetics.  I spend a great deal of time reading about and trying to understand the current level of science that is available today.  I guess I might be similar to a backyard hobbyist mechanic wanting to learn more about their car.  I found the book very easy to read and was excited to get a glimpse into the future from someone that understands the field.

 

Let me know if you would like to entertain the idea of talking about your book on Television.

 

Thanks again for sharing your vision.

 

Dale