There is a slick new television commercial advertising Apple's iPad. It includes a cool medical application that can be used for medical imaging. The advertisement shows a trend in medicine: in the last two years there has been an explosion of growth in wireless medicine, which includes digestible smart pills, networked implantable devices, and smart phone applications. The United States is an innovator in this technology, which has the capability to connect patients and healthcare providers, empower patients (akin to the way the Internet changed information flow), and create a vast health network that can lead to faster cures. Investment in wireless medicine is an important way for the United States to continue its lead as a healthcare innovator.
To continue this innovation, and to have a larger more, profound, global impact, the United States needs to let developers innovate; the popular sentiment that medical technology is expensive needs to be re-examined; and, more importantly, we need to harness our technologic investments to help the world’s poor.
The United States medical community, Silicon Valley and telecom companies have the moral responsibility to help create wireless health applications for the developing world. This is not only an ethical no-brainer, it is also an economically smart move---a healthier world will save costs at home too. The United States healthcare system not only absorbs millions of the world's sick, the U.S. spends billions each year to put band-aids on health issues abroad.
Of course, the world's poor don't own Apple iPads, but many of them own a more sophisticated device than what was used for the first moon landing: it's called a cell phone.
There are now more than 5 billion mobile phone subscribers worldwide and the vast majority of those individuals are from emerging economies. This global platform means that there is now the opportunity to place a diagnostic and communications tool in the hands of nearly everyone on the planet.
Using mobile technology applications can be sophisticated or basic. For example, on September 2 in Zanzibar, Tanzania, hundreds of cartons of counterfeit drugs were impounded by the Zanzibar Food, Drugs, and Cosmetics Board and Interpol in a special operation dubbed “Mamba 111.” Countering the world’s counterfeit drug problem has become a growing issue in the developing world. According to the World Health Organization (WHO) records, 10 percent of drugs circulating the world market are not genuine and 25 per cent of all counterfeit goods are consumed in poor countries—counterfeit medicines are 45 percent of the market in Nigeria and Ghana, for example.
Using fake drugs has tragic consequences—there is decreased immunity and people lose faith in life-saving medicine. Technologists came up with a solution: individuals can verify the authenticity of medicine by sending a text message with an ID number printed on the box of legitimate medicine, then the drug company text back verifying that the medicine is ok to use.
There are different problems in the developed world. Developed countries spend almost 75 percent of costs on chronic disease management. For example, millions of Americans live with a chronic condition called heart failure and heart failure is the most common cause of hospital admission for Medicare recipients. Heart failure and repeated heart failure hospitalizations represent a huge cost to our healthcare system. Patients discharged after treatment for heart failure face a very high risk of re-admission in the first six months. A cell phone or smart phone that receives information from simple sensors worn inconspicuously on the body can help patients and family members (often living far away) monitor how well their drugs are working. This offers both patients and families a chance to recognize early signs of heart failure worsening, before symptoms occur, so that doctors can intervene early. This type of technology has the potential to significantly reduce the need for re-admission as well as creating a much need connectivity and dialogue or partnership between the patients/families and doctors.
Apple’s iPad commercial not withstanding, the United States can be laughably slow at widely adopting mobile computing solutions. While the United States takes pride in leading the information economy through its innovations, applying and using these technology innovations at scale is another issue. In the world of medicine new technologies typically take 15 years to be widely used. Legacy systems and high regulatory hurdles, often slow things down incredibly. We can’t afford to fall behind in this manner when it comes to wireless health.
As the director of the University of Southern California’s Center for Body Computing--a cross-disciplinary center that develops products, establishes predictive studies and policy, and creatively meets the needs of patients and physicians in wireless medicine—I see new products all of the time. Many of them come from the developing world or individual application developers. Some of these apps, which can promote better health and solve healthcare problems, never leave the engineering bench. Many of the most elegant medical applications of the last two years come from individual iPhone/iPad developers.
For example, one product takes information from a wireless watch that collects continuous data from hospitalized patients like heart rate, blood pressure and temperature and can continuously stream this data to an iPad or iPhone for physicians to review anywhere, anytime. This allows the doctor caring for the patient to continuously “round” on the patient and provide more immediate care as the patient’s condition requires. This liberation of information to the most senior physicians enables a more continuous care model and replaces the traditional early morning rounds where decisions are made for an entire 24-hour period based on one review of the patients’ data taken from the prior day.
Another application monitors blood sugar through an iPhone app. Applied widely in the United States, and in the developing world, these applications could save millions of lives at much lower costs.
We live in a global economy and we need to continue our leadership in healthcare as we enter the Healthcare Digital Age. The physician-patient model--patient comes into the doctor's office and tries to explain his or her sickness without any hard data while the physician attempts to analyze--hasn't changed since Hippocrates. It is easy to romanticize medicine, but the system is really outmoded in the Information Age. We can all be much more efficient and we can use technology, much of it already in our hands, to make the system better and less expensive.
We have a responsibility to not only use our technologic might to help the weakest in our country, and others, but we need our healthcare policies to reflect the era of the Information Age, not Ancient Greece.
Leslie A. Saxon, M.D., is Chief of Cardiology and the Executive Director of the University of Southern California's Center for Body Computing.