The Future of the Diagnosis: TransHumanCode.com and WISeKey joining forces to develop personalizing genetic digital profiling
The current issues over diagnostic testing have dominated US headlines about (COVID-19). Technical challenges with the first test developed by the Centers for Disease Control and Prevention left the nation with minimal diagnostic capacity during the first few weeks of the epidemic.
One of the major changes in emphasis will be on how diagnoses are made. The care that is given will be based on thousands of biomarkers, genes, transcriptomes, proteomes — sometimes called “all omics medicine.” We will be able to measure many more variables (millions per sample or more) and make decisions based on the kind of complexity no human doctor could ever master. It will be possible to even specify dosage for drugs for each patient’s current state and monitor disease progression along with side effects, all the way down to the molecular level.
It seems silly that we still have one dosage prescription for aspirin or opioids for seven billion people on the planet, taking virtually no specific characteristics into account. But in the near future, we will see drug discovery and surgery change over primarily to computational techniques. Procedures like anesthesia could become entirely robotized, either with a human assisting the robot or the other way around.
Heart disease is the number one killer in the United States, and often the question is, should you have bypass surgery or a stent? Currently, most of that medicine is based on debatable evidence. According to the American Heart Association, there is class A evidence for only about 11 percent of their cardiac-related recommendations, meaning evidence from multiple randomized trials or meta-analyses exists to support the diagnosis. But 45 percent of their recommendations are based, not on evidence, but on expert opinion (this is referred to as level C evidence, the worst kind).
In this new world, we will move away from using symptoms to diagnose disease; instead, data science will be used to diagnose, treat, and follow up. As I described on Quora last year, one should take a million people and measure hundreds, if not thousands, of variables, including information about their blood, their microbiome, and their physiology. This data should be gathered every week for a year. Imagine the mine of information that would give us: fifty million data points, each data point actually being thousands of data points in itself. Such a data set would allow us to predict and diagnose most diseases, and do it early, when the disease is truly beginning and before it becomes symptomatic. This approach would contribute not only to preventive health but would also combat diseases and cancer.
Right now, most people with heart disease first learn about it when they have a heart attack, when in reality the path that led them to the heart attack began 20 years earlier. When this late-stage recognition of diseases is no longer the norm, we will move closer to healthcare and away from the sick care we offer today. Granted, medicine is much better than it has ever been, so we need to acknowledge the improvements made over the last ten, thirty or one hundred years. But that doesn’t mean it’s as good as it can be.
The Future is Now
So where are we seeing these changes and innovations in the real world?
Companies like Alivecor enable personal cardiologist-like functions, such as diagnosing atrial fibrillation or reading an ECG for normality, to be performed by AI. And although AI is not providing anything as advanced as a full cardiologist or an interventional cardiologist yet, advancements are being made all the time. Ginger.io has been able to partially substitute AI for a therapist, while Forward is working on creating AI for primary care. AI and data-driven changes are already in place, moving us from the “practice of medicine to the science of medicine,” and we’re beginning to see more and more cutting-edge healthcare companies exploring virtual primary care doctors, cardiologists, psychiatrists, and oncologists.
An organization called Color is impacting health by making accessible, population-scale genetics services while others are transforming xenotransplantation into an everyday, lifesaving medical procedure. Genalyte is tackling blood testing results and making it easier to get them to the doctor’s office in real-time instead of going through a third-party lab. Rethinking Oncology is the domain of Guardant Health or Oncobox, which is personalizing genetic profiling to help oncologists decide which drug to use when fighting cancer. Conquering infectious diseases through the innovative use of next-generation sequencing to analyze microbial cell-free DNA is something Karius does, being able to scan for 1,300 viruses simultaneously.
Other companies are using data-centric design to entirely rebuild a next-gen health insurance company. Neurotrak is anticipating diseases with tools that enable physicians to predict Alzheimer’s before the symptoms appear. Using the microbiome, others are creating microbial therapeutics for inflammatory diseases (Siolta) or to target bacteria based on the genome (Eligo).
Two Pore Guys is building a digital, hand-held, testing platform for DNA and RNA that’s as accurate as medical lab equipment, but is as inexpensive and easy to use as a blood glucose monitor. Zebra is using AI to rethink most radiologist functions for MRI, CT, and x-rays, while Vicarious Surgical is enabling surgeons to do much more with robots and AR (augmented reality). Heartvista is developing a robust commercial MRI system that will give comprehensive cardiovascular evaluation — real-time data with much less skilled technicians. Q Bio is trying to reinvent the annual physical to be far more quantitative and useful.
The future is here. It’s all around us.
And yet more progress is required to ensure vast numbers of people on the planet are not left behind. For example, the developing countries must benefit from the cure of very basic sickness that are still killing millions of people, diseases like malaria and other viral infections. As these sicknesses are eradicated, the life expectancy in many countries, which is still very low, will improve substantially.
Human life is being extended, and questions about equality are emerging. People with money will be able to access very complex solutions, allowing them to live longer than most, if they wish. Age will no longer limit us to the extent it has in history thus far. Will the concept of death fade away if you have the money to sustain your health, artificially or otherwise? In the very least, life expectancy will be determined more and more by one’s personal resources. Perhaps this isn’t all that different than the world we live in now where citizens in developed nations have access to cutting edge advances that developing nations don’t. The path emerging, however, will put more power in the hands of individuals. The question is whether this will allow for more or less sharing of resources. At a national level, the world has yet to figure out how to equalize resources. Perhaps we, as individuals united by the pursuit of life and not by nationality, can do better.
This is where the key questions surrounding health emerge. How much will one’s personal wealth determine the kind of treatment that is received? At what point does the extension of one’s life become less desirable when measured against the quality of one’s life? Will we trust AI as it takes on a larger role in our health? Whose desires in regard to treatment, life, and ultimately death will take precedence: the patient’s, the patient’s family, or the interests of the state or some other ruling body?
We are on the cusp of redefining what is possible when it comes to global health. We need to know what we’re ultimately after before we get there. The more united we are, the more progress we can make. If we remain fractured, a dangerous detachment is likely.
For more information about The transHuman Code: How to Program Your Future, or to obtain a copy, the book is available for purchase online at Amazon, Barnes & Noble, Target, Walmart, as well as Indiebound, and NetGalley.
About the authors:
Carlos Moreira is a multi-award-winning technology pioneer whose IT, online security, and trust management experience with the United Nations and World Trade Organization led to the creation, twenty years ago, of one of the world's first cybersecurity companies, WISeKey, of which he is the CEO. Today, he is also an active leader and member of several institutions and organizations focused on the advancement of technological innovation and preservation of human identity. He resides in Geneva, Switzerland with his family.
Connect with Carlos on Twitter @CreusMoreira, and on LinkedIn
David Fergusson is a corporate finance leader specializing in global mergers and acquisitions and Executive Director of M&A with Generational Equity. He engages regularly with business, media, political, and academic leaders on the factors influencing corporate growth. He is a pioneer and international award winner for cross-border investment between the United States and China. Chairman of the finance industry's leading think tank, he is recognized as an expert on the impact of technology on business, government, and humankind. He resides with his family in Westchester, New York.
Connect with David on Twitter @dafergusson , and on LinkedIn
Chairman & CEO, WISeKey
Tel: +41 22 594 3000