The annual physical exam is under fire. Increasingly, physicians believe that the yearly ritual of having our bodies poked and prodded is completely useless, save for the fraction of patients who have a chronic illness or predisposition to disease. Worse, the annual physical is estimated to cost our healthcare system approximately $8 billion for arguably little benefit.
It is unlikely, however, that check-ups will go away completely. Despite the growing consensus against them among medical professionals, 92 percent of Americans believe that the exams are still important. Perhaps that shouldn’t be a surprise. Health anxiety has become something of a national pastime for many of us.
Fad diets have been around for decades. Various foods have been alternately praised as miracle cures or demonized as evil carcinogens. Social media floods popular culture with medical myths and half-truths. And the proliferation of health apps—which allow people to monitor everything from their heartbeat to the number of calories they consume—indicates the extent of our obsession.
America’s demand for up-to-date, personalized health information appears insatiable. Yet, doctors seem convinced that this obsession is a waste of time at best and socially harmful at worst. Still, everyone agrees that preventive medicine is preferable to reactive medicine. Is there a way to accomplish this effectively?
We think there is. The answer is to work toward developing technologies that allow real-time monitoring of biomarkers.
Biomarkers are metabolic indicators of health. When the doctor takes a blood sample, for instance, the laboratory determines the concentration of a variety of substances, such as ions, cholesterol, and white blood cells or even DNA and protein. If one of these biomarkers is outside of what is considered a healthy range, it could indicate that a health problem is beginning to develop.
Companies are already building devices that serve as real-time biomarker sensors. GlySens is developing an implantable sensor that detects blood glucose levels in diabetics and sends information wirelessly to a smartphone app. Stanford University has developed a sensor that monitors blood pressure. And Swiss researchers have created an implant that detects the biomarkers associated with heart attacks.
We envision someday that, similar to modern all-in-one smartphones, medical devices incorporating multiple sensors could be used to detect all relevant biomarkers found in the blood or other bodily fluids, such as saliva and urine. These could be small table-top devices or tiny implants, perhaps placed in the shoulder, that could serve as portable, miniaturized diagnostic facilities. If anything ever goes awry, an app would notify you and your doctor.
Of course, there will be many challenges to address before such technology will be reliable. Overdiagnosis and other “false alarms” are probably the biggest concern. Today, many public health officials are questioning the utility of population-wide breast cancer screens. Because of the relatively high rate of false positives, the costs incurred (e.g., stress to the patient and wasted money) appear to greatly outweigh the benefits.
Furthermore, the current state of diagnostic technology is inadequate. Doctors are better at diagnosing disease than symptom checking apps. Therefore, the algorithms that will govern diagnostic implants will need to be extensively researched and tested.
Baseline data that indicates the “normal range” for biomarkers must be collected from thousands, maybe even millions, of people spanning every age, gender, and ethnicity. (A proliferation of biomarker gathering devices would greatly assist with this data collection.) Additionally, biomarker data should be linked to a patient’s genotype. If a person has a genetic predisposition to say, type 2 diabetes, his or her biomarker data will need to be processed with this relevant information factored in.
This will be a gargantuan undertaking, likely far larger than the Human Genome Project. But with the advent of Big Data and advanced computer technology, we believe it is entirely feasible.
If successful, the benefits of real-time biomarker monitoring could constitute a revolution in modern medicine. First, it will eliminate billions in wasted “preventive healthcare” that is neither preventive nor healthy. Second, and more importantly, it will make catching a problem when it actually starts far more likely.
Bona diagnosis, bona curatio.
Alex Berezow is Senior Fellow of Biomedical Science at the American Council on Science and Health. He holds a Ph.D. in microbiology. Eric Tan is an Associate at Zoic Capital, a venture capital firm. He holds a Ph.D. in applied life sciences and an MBA.