Posted 7/16/12 on Medscape Connect’s Care and Cost
The news of my wife Elaine’s primary peritoneal cancer 27 months ago began a fevered effort to learn all we could about her disease and our options. Peritoneal cancer, which is close in form and behavior to ovarian, is rooted in the abdominal lining. “Gold standard” treatments notwithstanding, the prognosis isn’t good. After a 12-36 month remission in which tumors are inactive, the disease generally returns, and a high percentage of women are gone within 5 years of diagnosis.
Cancer elicits a primal fear that can provoke fantasy and baseless speculation. Cancer patients in remission have told us they are cured. Others, well-meaning, have announced they know someone with “exactly what you have,” and that theirs went away by applying a strict dietary or spiritual discipline.
The long-term success of N-of-One, a Waltham Mass.-based company offering personalized cancer information, will undoubtedly be shaped by the vision of its newly appointed CEO, Christine Cournoyer, and strategic partnerships with companies like Foundation Medicine, announced this week.
But ultimately it comes down to whether the company’s original direct-to-patient strategy works for cancer patients like Elaine Waples.
“In the future we might not prescribe drugs all the time, we might prescribe apps.” Singularity University‘s executive director of FutureMed Daniel Kraft M.D. sat down with me to discuss the biggest emerging trends in HealthTech. Here we’ll look at how A.I, big data, 3D printing, social health networks and other new technologies will help you get better medical care. Kraft believes that by analyzing where the field is going, we have the ability to reinvent medicine and build important new business models.
For background, Daniel Kraft studied medicine at Stanford and did his residency at Harvard. He’s the founder of StemCore systems and inventor of the MarrowMiner, a minimally invasive bone marrow stem cell harvesting device. The following is rough transcript of the 6 big ideas Kraft outlined for me at the Practice Fusion conference.
Our day-to-day lives were reformatted when the consumer mobile wireless device era, beyond cell phones, was ushered in by iPods in 2001 and followed in short order by Blackberries, smartphones, e-readers, and tablets. Nurturing our peripatetic existence, we could immediately and virtually anywhere download music, books, videos, periodical, games and movies. Television is soon to follow. But these forms of digital communication and entertainment are a far cry from digitizing people.
This decade will be marked by the intersection of the digital world with the medical cocoon, which until now have been largely circulating in separate orbits. The remarkable digital infrastructure that has been built—which includes broadband Internet, cloud and supercomputing, pluripotent mobile devices and social networking― is ripe to provide the framework for a most extraordinary upgrade and rebooting of medicine.
Like a true advocate, you write here in what I call “present tense hopeful.” In actual English, “has arrived” means something is here. And so it is for a very few cancers in a very few ways, none of which are generally curative. (See current Medscape article that came out this week.)
Scandals often clarify issues. A researcher at Duke Medical Center recently departed after his ballyhooed genomics tests for identifying lung and other cancers was unmasked as based on falsified data. The scheme unraveled after Paul Goldberg’s Cancer Letter revealed the scientist had falsely proclaimed himself a Rhodes scholar.
The scandal is roiling the world of genomics testing, on which so much of the promise of personalized medicine rests. Today’s New York Times Science section belatedly recognizes problems in the “gene signature” field by noting “the few successes in this brave new world of cancer research.”
By now most people understand the promise of pharmaceuticals being customized to “YOU” based on your individual genetic code. While this isn’t prevalent today, we understand that this will be possible in a few years.
Let’s take a minute to consider the mechanics of how this will occur. You’ve received a prescription, and it directs the pharmacist to tailor the medicine to YOUR genetic profile.
Consider two possible scenarios of how this transaction might happen. You’re on the phone with your pharmacist:
“OK, you need my DNA sequence. I keep my genetic profile in my mattress…let me get it and I’ll read it out loud to you. C, A, T, G, G, A, T… no, that was actually a G…let me start over. C, A, T, G, G, A, T… (19 hours later) … T, and G. Can you read that back to me to make sure you got it right?”
“You have permission to access my DNA sequence at my health URL (or maybe a health record bank, or perhaps hand her a flash drive, or ??).