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Ethical Issues of The Future of Medicine: The Top 10

While I was writing my book, The Guide to the Future of Medicine, I was constantly thinking about all the ethical issues disruptive technologies will make us face in the coming years. I’m a born optimist and if you look at recent developments in medicine & healthcare, you realize optimism can now be based on facts. Although, without being prepared for the coming waves of change, physicians, patients and all stakeholders will only come across threats, ethical issues and serious problems when they try to implement technology into everyday care.

I remain confident that we are still in time and we can still prepare for the amazing yet uncertain future of medicine. What is definitely needed, among others things such as new skills, is initiating public discussions now. It was my intention when I made a list of 10 potential ethical issues we will all have to deal with soon.

1) Hacking medical devices

It has already been proven that pacemakers and insulin pumps can be hacked. Security experts have warned us that someone would be murdered through these methods any time soon. How can we prevent wearable devices that are connected to our physiological system from being hacked and controlled from a distance?

2) Defending our privacy

We share much more information about ourselves now than we think. Check mypermissions.org to see what services and apps you have given permission to access your personal information already. What if we start using augmented reality contact lenses and get information about people immediately? Kids being born these years represent the first generation of which every life detail is getting logged. While such big data could significantly improve healthcare, how to prevent companies and governments from using these?

3) Scanning ourselves at home

Now physicians are worried because patients do Google their symptoms and treatments and they might take the misinformation they find there to the caregiver. What will be doctors worried about when patients scan themselves, do a blood test and even genetic analysis at home? Will we able to persuade such patients to turn to doctors and not only trust algorithms? If you think that is still science fiction, check the finalist of the Nokia Sensing XChallenge.

4) Healthy people switching to technology

Matthew James was born with dysmelia, a congenital disorder causing deformed limbs. James wrote to his favorite Formula One team, Mercedes, at age 14 that he was ready to display their logo on his prosthesis if they could support him financially. He received £30,000 but was not taken up on his offer of advertising space. This story shows that the implementation of such innovations in the everyday lives cannot depend purely on individual entrepreneurship. As a consequence, what if people start asking their doctors to replace their healthy limbs for robotic ones?

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5) Biological differences

Today, societies struggle to fight gender and financial inequality. But from the time technology can truly augment human capabilities, people will get smarter, healthier and faster only by being able to afford them. How do we prepare society for a time when financial differences lead to biological ones?

6) How society changes if we can prolong life

Longevity studies have been going on for decades. Several aspects about the ultimate secrets of long life have been discovered, but we haven’t really got closer to significantly prolong life. Sooner or later, we will. What happens with the basics of society if the majority of us start living for more than 100 years? How can we make sure that ageing doesn’t necessarily get associated with severe decline in health?

7) Bioterrorism due to nanotechnology

In the wildest futuristic scenarios, tiny nanorobots in our bloodstream could detect diseases. After a few decades they might even eradicate the word symptom inasmuch as no one would have them any longer. These microscopic robots would send alerts to our smartphones or digital contact lenses before disease could develop in our body. If it becomes reality, and microrobots swimming in bodily fluids are already out there, how can we prevent terrorists from trying to hack these devices controlling not only our health but our lives?

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8) Technological developments vs. evidence based medicine

Over the last few years, technological advances have become so fast, it’s really hard to keep track of them any more. In the meantime, evidence based medicine shapes how we deliver healthcare. The latter is a fundamentally long process. Certain solutions such as simulations with cognitive computers might make them faster but these could never be as fast as technological developments. When patients start seeing the amazing innovations out there not being accessible to them in the everyday care, how will it transform the basic ways of practicing medicine?

9) Transhumanism & Singularitarianism

There are movements and philosophies that highlight one concept or approach even though it is highly unlikely that one solution will lead to a prosperous future. A network of interconnected people, devices, and concepts is intended to solve global issues. It is advisable not to trust just one movement or philosophy such as transhumanism or singularitarians. The most plausible solution will be a mix of all the concepts trying to describe the coming decades. We should be skeptical and analytical before accepting major philosophies about the future. In the history of mankind the number of new philosophies has never increased as fast as it is doing now. But it has never been easier to learn more about them.

10) Sexuality becoming technological

A man named Davecat lives with his wife and mistress, both of whom are Synthetiks––specially designed, life–sized Dolls. Accordingly, Davecat calls himself a technosexual. While some will not understand how Davecat thinks about his partners, his story represents perfectly the diversity of concepts and theories that will arise in the next couple of years. How can we prepare for all these if we cannot even solve today’s issues in sexuality?

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What have I missed? Please leave a comment and start the discussion now!

Read more about the ethical issues of the future of medicine in my recent book, The Guide to the Future of Medicine!

The Guide to the Future of Medicine ebook cover

Twelve Things We Can 3D Print in Medicine Now

Kaiba Gionfriddo was born prematurely in 2011. After 8 months his lung development caused concerns, although he was sent home with his parents as his breathing was normal. Six weeks later, Kaiba stopped breathing and turned blue. He was diagnosed with tracheobronchomalacia, a long Latin word that means his windpipe was so weak that it collapsed. He had a tracheostomy and was put on a ventilator––the conventional treatment. Still, Kaiba would stop breathing almost daily. His heart would stop, too. His caregivers 3D printed a bioresorbable device that instantly helped Kaiba breathe. This case is considered a prime example of how customized 3D printing is transforming healthcare as we know it.

Since then this area has been skyrocketing. The list of objects that have been successfully printed out in 3D demonstrates the potential this technology holds for the near future of medicine.

Tissues with blood vessels: Researchers at Harvard University were the first to use a custom–built 3D printer and a dissolving ink to create a swatch of tissue that contains skin cells interwoven with structural material interwoven that can potentially function as blood vessels.

Low–Cost Prosthetic Parts: Creating traditional prosthetics is very time–consuming and destructive, which means that any modifications would destroy the original molds. Researchers at the University of Toronto, in collaboration with Autodesk Research and CBM Canada, used 3D printing to quickly produce cheap and easily customizable prosthetic sockets for patients in the developing world. 1371558697309.cached

Drugs: Lee Cronin, a chemist at the University of Glasgow, wants to do for the discovery and distribution of prescription drugs what Apple did for music. In a TED talk he described a prototype 3D printer capable of assembling chemical compounds at the molecular level. Patients would go to an online drugstore with their digital prescription, buy the blueprint and the chemical ink needed, and then print the drug at home. In the future he said we might sell not drugs but rather blueprints or apps.

Tailor–made sensors: Researchers have used scans of animal hearts to create printed models, and then added stretchy electronics on top of those models. The material can be peeled off the printed model and wrapped around the real heart for a perfect fit. The next step is to enhance the electronics with multiple sensors.

Tumor Models: Researchers in China and the US have both printed models of cancerous tumors to aid discovery of new anti–cancer drugs and to better understand how tumors develop, grow, and spread.

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Bone: Professor Susmita Bose of Washington State University modified a 3D printer to bind chemicals to a ceramic powder creating intricate ceramic scaffolds that promote the growth of the bone in any shape.

Heart Valve: Jonathan Butcher of Cornell University has printed a heart valve that will soon be tested in sheep. He used a combination of cells and biomaterials to control the valve’s stiffness.

Ear cartilage: Lawrence Bonassar of Cornell University used 3D photos of human ears to create ear molds. The molds were then filled with a gel containing bovine cartilage cells suspended in collagen, which held the shape of the ear while cells grew their extracellular matrix.

Medical equipment: Already, 3D printing is occurring in underdeveloped areas. “Not Impossible Labs” based in Venice, California took 3D printers to Sudan where the chaos of war has left many people with amputated limbs. The organization’s founder, Mick Ebeling, trained locals how to operate the machinery, create patient–specific limbs, and fit these new, very inexpensive prosthetics.

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Cranium Replacement: Dutch surgeons replaced the entire top of a 22 year–old woman’s skull with a customized printed implant made from plastic.

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Synthetic skin: James Yoo at the Wake Forest School of Medicine in the US has developed a printer that can print skin straight onto the wounds of burn victims.

Organs: Organovo just announced that their bioprinted liver assays are able to function for more than 40 days. Organovo’s top executives and other industry experts suggest that within a decade we will be able to print solid organs such as liver, heart, and kidney. Hundreds of thousands of people worldwide are waiting for an organ donor. Imagine how such a technology could transform their lives.

Read more about the use of 3D printing in medicine in The Guide to the Future of Medicine!

The Guide to the Future of Medicine ebook cover

10 Things How Artificial Intelligence Could Make Me a Better Doctor

I was watching the movie Her for the second time and I was fascinated again about the scene in which the main character played by Joaquin Phoenix got his new operating system with artificial intelligence (AI) and started working with that. I couldn’t stop thinking about the ways I could use such an AI system in my life and how it actually could make me a better doctor.

Don’t get me wrong, I think empathy and great communication with patients can make a doctor better primarily, but as the amount of medical information out there is exponentially growing; as the time for dealing with patients and information is getting less, it is becoming humanly impossible to keep up with that. If I could devote the time it takes now to deal with technology (inputting information, looking for papers, etc.) to patients, that would be a huge step towards becoming better.

Here are 10 things how AI could make me a better doctor and consequently live a better life.

1) Eradicate waiting time: Not only patients have to wait a lot for their doctors, but doctors lose a lot of time everyday waiting for something (a patient, a lab result, etc.). An AI system that makes my schedule as efficient as possible directing me to the next logical task would be a jackpot.

2) Prioritize my emails: I deal with about 200 e-mails every single day. I try to teach GMail how to mark an e-mail important or categorize them automatically into social media messages, newsletters and personal e-mails, it’s still a challenge. In Her, the AI system prioritized all the 3000 unread e-mails in a second. Imagine that!

HER

3) Find me the information I need: I think I have mastered the skill of searching for information online using dozens of Google search operators and different kinds of search engines for different tasks, but it still takes time. What if an AI OS could answer my questions immediately by looking up the answer online?

4) Keep me up-to-date: There are 23 million papers on Pubmed.com. If I could read 3-4 papers of my field of interest per week, I couldn’t finish in a lifetime and meanwhile millions of new studies would come out. I need an AI to show me what I should really read that day. Now my curated social media networks do this job, although I’m sure it would be much more accurate with AI.

5) Work when I don’t: I can fulfil my online tasks (e-mails, reading papers, searching for information) when I use my PC or laptop, and I can do most of these on my smartphone. When I don’t use any of these, I obviously cannot work. An AI system could work on these when I don’t have any device in hand.

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6) Help me make hard decisions rational: A doctor must face a series of hard decisions every day. The best we can do is to make those decisions as informed as possible. Some of them are still hard to make. I can ask people of whom I value the opinions and that’s it. Imagine discussing these with an AI system that is even more rational than you are.

7) Help patients with urgent matters reach me: A doctor has a lot of calls, in-person questions, e-mails and even messages from social media channels on a daily basis. In this noise of information, not every urgent matter can reach you. What if an AI OS could select the crucial ones out of the mess and direct your attention to it when it’s actually needed.

8) Help me improve over time: People, even those who work on becoming better at their job, make the same mistakes again and again. By discussing every challenging task or decision with an AI, I could improve my overall well-being and the quality of my job. We could do that with people as well, but let’s be honest, it’s practically impossible.

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9) Help me collaborate more: In Her, the AI collected the letters the main character wrote and compiled them into one manuscript which she sent to a publisher that she thought would be willing to publish it. Similarly an AI could find the most potential collaborators and invite them to work on a paper or study I otherwise work on. This way, opening up my networks even more.

10) Do administrative work: Quite an essential percentage of an average day of a doctor is spent with administrative stuff. An AI could learn how to do it properly and do it better than me by time. It could write down my thoughts and compile them anytime just as if I decided to sit down and write them down saving me an enormous amount of time.

Read more about the use of AI in medicine in The Guide to the Future of Medicine!

The Guide to the Future of Medicine ebook cover

Would you use AI in your work? Please do share! Until then, here is how supercomputers make physicians better:

Exoskeletons let paralyzed people walk again! (VIDEO)

When I watched the movies Avatar, Elysium or Iron Man, I was thinking about how great it would be to have those so called exoskeletons in real life letting paralyzed people walk again. And then science fiction became reality.

On a sunny day in November, 2013 I attended the Europe Summit organized by the Singularity University in Budapest at the amazing venue of the Franz Liszt Academy of Music. We listened to Amanda Boxtel, who got paralyzed from a spinal cord injury in a ski accident in Aspen, Colorado in 1992. She told us how she felt after getting the diagnosis of never being able to walk again and how she refused to stop dreaming. Since then, she has established adaptive ski programs, carried the Olympic torch, organized disabled rafting expeditions, and even conducted research in the Antarctica. She has also become one of the ambassadors of an innovative company called Ekso Bionics.

Their exoskeletons are used by individuals with various degrees of paralysis and stemming by a variety of causes. Ekso Bionics have helped individuals take more than a million steps that would not otherwise have been possible. Boxtel is one of ten Ekso Bionics test pilots who received a customized exoskeleton. According to Boxtel, the project “represents the triumph of human creativity and technology that converged to restore my authentic functionality in a stunningly beautiful, fashionable and organic design.”

See it in action:

Another story includes Hugh Herr, who directs the Biomechatronics research group at MIT’s Media Lab and gave an amazing TED talk in 2014. Herr lost both his legs in a climbing accident 30 years earlier. He spoke of his plan to make flexible, smart prosthetics cheaper and widely available for those who need them. His team is pioneering a new class of smart biohybrid prostheses and exoskeletons for people with physical disabilities. It builds prosthetic knees, legs, and ankles that fuse biomechanics with microprocessors in order to restore normal gait, balance, and speed. They may even enhance biological functions including strength or speed. At the end of his talk came a surprise. Ballroom dancer Adrianne Haslet–Davis, who lost her left leg in the 2013 Boston Marathon bombing, performed on stage for us for the first time since her accident.

A San Francisco based company, Bespoke Innovations, went further in customization to make beautifully designed prosthetics based on the patient’s needs and personality. Scott Summit, the designer at Bespoke, explained that in single amputees, the remaining leg is scanned and mirrored to give the correct geometry.

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A recent study showed that flexible spinal cord implants will let paralyzed people walk again. These include “flexible electrodes, cracked gold electronic tracks and fluidic microchannels to deliver both electrical impulses and chemicals while mimicking the spine’s movements and avoiding friction”.

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There is a reason to be optimistic! The advances of 3D printing lead to better, more comfortable and cheaper prosthetics, as well as exoskeletons. Having a disability should soon mean no disadvantage to a patient. Moreover, it might lead to unexpected advantages. The first Olympic Games for people with robotic protheses or powered exoskeletons will take place in Zurich, Switzerland in 2016. It is going to be a milestone.

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The list of examples and real-life stories could go on forever and hopefully the group of powered exoskeletons is going to be the hottest example about how technology can truly improve people’s lives.

Read more about such stories, even neuroprosthetics and the ethical dilemmas we will soon have to face in in my book, The Guide to the Future of Medicine.

The Guide to the Future of Medicine ebook cover

My Story and The Future of Medicine in the Get Social Health Podcast

I was glad to get invited to do a podcast on Get Social Health. I hope you will enjoy listening to it. Here is the summary:

Dr. Bertalan Meskó is a digital renaissance man for healthcare. He is an author, TEDx speaker, teacher, consultant, and medical futurist. We had a wide ranging conversation about the future of medicine and the need for all medical professionals to be digitally literate. In addition to his newly published book, “The Future of Medicine,” Dr. Meskó shared his personal story of how he became a medical doctor, a PhD in genomics but still felt he had to honor “the geek” inside and embrace a career he designed for himself as a medical futurist. Listen to the episode of catch the highlights of the podcast at the time stamps below.

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Shall We Sequence Genomes At Homes? – The Future of Genomics

As a geneticist, talking with George Church or the President of the Personalized Medicine Coalition was a fascinating experience while writing my recently published book, The Guide to the Future of Medicine. This is still one of the most promising fields of medicine but without getting it closer to the general public, genomics will never play a pivotal role in practicing medicine.

Let’s start from the beginning. From the years of 2005, 2006 and 2007, patients have been able to order genetic tests online with 23andme, Navigenics or Pathway Genomics. In 2013, 23andme received a letter from FDA about ceasing marketing of the screening service. Since then, the market has been transforming into something new that could also meet the regulations of the FDA. At least, hopefully.

My Gentle Labs package.

My Gentle Labs package.

I’ve had 3 genomic tests with Navigenics, Pathway Genomics and My Gentle Labs with 3 different results and experience. I thought the direct-to-consumer (DTC) market is just not ready for prime time. I also analyzed my own raw data with Promethease and got to very interesting conclusions about the future of my life. I loved the possibility to get insights about my genome as well, not just measuring my vital signs. Here is my overall experience with genetic testing:

Similarly to how the wearable revolution is transforming into a world of smart clothes, disease prevention and insideables (swallowed sensors), the field of DTC genomics has been changing too. Here are some reasons why.

  • While the cost of sequencing one person’s genome was about $3 billion in 2003, now it’s possible for under $1-3000 (see figure below). The $1000 genome is still not here, but the trends are clear and soon the shipping cost of the sample will be higher than actually sequencing that genome.
  • The number of sequenced genomes is skyrocketing. Illumina said that 228,000 Human Genomes would be sequenced only in 2014 and the predictions for this year are even bigger. Soon we will all have access to our own genomes.
  • It is known that fetal DNA is circulating in the mother’s blood,and it can be separated from her blood to allow analysis of the fetus’s genetic makeup. Imagine the possibilities.
  • Large US hospitals are about to begin sequencing the genomes of healthy newborn babies as part of a government-funded research program called BabySeq. Major diseases could be pointed out and precautions could be made about others far in time.
  • Oxford Nanopore developed the MinION™ portable device for molecular analyses of DNA, RNA and proteins that is driven by nanopore technology. It might be the first step towards sequencing genes at home, despite early criticisms.
  • There are more and more targeted cancer therapies available. As certain tumors have specific genetic mutations such as BRCA in breast cancer or EGFR in lung cancer, among others, they might be sensitive to targeted drugs. Sequencing a tumor’s own genome is becoming a routine step in designing the therapy for cancer patients, although the costs are exceptionally high.
Cost of genome sequencing.

Cost of genome sequencing.

As you can see, examples underscore the notion that genomics could play a very important role in everyday medicine, but numerous steps and elements are needed for that.

  1. Comprehensive and thorough regulation from organizations such as the FDA or EMA about what DTC companies can offer and actually do. Can patients order tests online or only their caregivers?
  2. Innovative companies connecting patients to medical professionals through the genomic knowledge behind cancer and other diseases.
  3. Reliable algorithms that could help use the huge amount of data genome sequencing leads to in analyzing health outcomes. A great example is how Joel Dudley at Mount Sinai Medical Center is working on implementing big data in medical decision making. IBM Watson is also analyzing genomic data to find treatments in brain cancer.
  4. With the widespread of genetic testing and the decline in the cost, it should be a common thing to analyze my genome or get a detailed analysis. Moreover, caregivers should be trained to be able to use that data in patients’ health or disease management.
  5. A better understanding of what genomics can and cannot offer by the general public. Professor Church pointed out to me that without educating people about the pros and cons of the genomic revolution, we cannot make the right steps forward.

It has become clear, seeing the trends, that the technology letting us sequence genomes at home is coming. Although it’s still hard to make good, evidence-based decisions purely based on genetic background; to get reimbursed if genetics-based personalized treatments are cost-effective on the long term (but expensive on the short term); and to interpret the huge amount of data. Cognitive computers are meant to help us with that, but I’m sure ever-improving technologies will provide all of us with our own genomes far before we could do anything with that information.

Read more about the future of genomics in my book, The Guide to the Future of Medicine.

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The Future of Diabetes Management: 8 Reasons Why We Face Extraordinary Times!

Around 400 million patients have diabetes worldwide according to estimations. And over the last few years, diabetes management has been improving but due to the new technologies and devices coming to the market very soon, the whole management of diabetes will significantly change in the coming years. Let me show you some examples how.

Digital Contact Lenses

Google has an augmented reality glass called the Google Glass which they just stopped developing, but they also patented a digital contact lens through which we can get more information from the digital world plus it can measure blood glucose levels from tears as an added benefit. Google launched a partnership with the pharmaceutical company Novartis to develop these smart contact lenses that can track diabetes and fix farsightedness as well.

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Gamification

There are amazing applications for smartphones that can help you manage diabetes efficiently. MySugr, an Austrian company, released several applications that can add a little bit of gamification to the traditional diabetes management apps. The company also developed the mySugr Junior App designed for kids to learn how to manage diabetes properly. It also enables parents to keep control over the therapy when they are not around the kid. The app looks like a game in which the children get points for every entry and the goal is to score a particular amount of points every single day.

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Patient empowerment with big data

Databetes helps patients better manage their diabetes by providing a good way for logging and measuring data, as well as a revolutionary concept to analyze the big data behind one person’s disease. Patients can support each other through social media channels and become coaches for each other. Look at sixuntilme.com for best practice examples.

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Bionic pancreas

There is artificial pancreas which means that it’s a closed-loop insulin delivery system. The device can measure blood glucose levels constantly and decide upon the insulin delivery itself. Engineers from Boston University have developed a bionic pancreas system that uses continuous glucose monitoring along with subcutaneous delivery of both rapid-acting insulin and glucagon as directed by a computer algorithm.

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Food scanners

TellSpec, a Canadian company is coming up with a food scanner this year which by scanning your food can tell you how many and what kind of ingredients, how many allergens, toxins, how many carbohydrates you actually have in the food you are about to eat.

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Pocket-sized gadgets

When you live with diabetes, you get used to carting around with plenty of things such as meters, test strips, lancing devices, and so on therefore a pocket-sized gadget can change this called Dario that also comes with a diabetes management system.

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Wireless monitors

The medical company Abbott just released a FreeStyle Libre system which makes it possible to constantly measure blood glucose levels in a wireless way.

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Digital tattoos

Here is a digital tattoo that can measure glucose levels by using electric current to attract glucose to the surface of the skin. The proof-of-concept study was just published and it’s time to bring the era of wireless diabetes management to patients.

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So there are more and more technologies that can help people manage diabetes properly besides potentially future therapies such as new drugs or islet cell transplantation but it’s really time to manage diabetes in a gamified and comfortable way and I believe that the best gadgets and the best technological solutions are just yet to come.

Please share your experience and thoughts on this!

Further reading:

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