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42 | OCTOBER 1, 2016 | GENengnews.com | Genetic Engineering & Biotechnology News Swiping and Tapping for Better Health Vicki Glaser Mobile. Smart. Disruptive. These words dominate discussions of technology-driven trends in e-commerce, social networking, and the sharing economy. And soon these words will apply to healthcare, which represents the next barricade to be stormed by smartphone- wielding revolutionaries. Already, the popu- lar press is celebrating the "doctor in your pocket." In the vanguard of the new medicine are "think different" types such as Eric Topol, M.D. As if his duties as the director of the Scripps Translational Science Institute weren't enough to keep him fully occupied, Dr. Topol has found the time to write a popular book about the medical impact of smart, handheld, networked devices. The book is titled "The Patient Will See You Now: The Future of Medicine Is in Your Hands" (Basic Books, 2015). It describes the democratization and individualization of medicine. As Dr. Topol explains in this inter- view, these developments will ultimately be enabled by the digitalization of essentially all forms of omics and biomedical imaging and analysis. GEN If your technological vision is realized, will medicine cease to be as much an art as a science? Dr. Topol Traditional medicine sees people from 30,000 feet and misses granular detail. It has been much more art than science. We lacked the ability to digitize a human being. Now we can develop a kind of Google medi- cal map with multiple layers that include the phenome, anatome, physiome, and all of the different biological "omes." We now have a mosaic composite of the individual. We can capture data about a per- son through wearable biosensors, obtain a DNA sequence, profile the gut microbiome —and many of these examples represent real- time, streaming data. Medicine is becoming a much more quantitative science. It is changing to accom- modate a new level of data, big data, for each individual. When you refer to the patient-doctor rela- tionship, I would emphasize that the individ- ual will soon be a big driver of this relation- ship going forward, because a lot of the data will be individual-generated through sensors or by doing self-lab tests or self-imaging. The changing dynamics of the patient- doctor relationship will mean more individu- alized care and greater patient safety. To give you an idea of how bad things are now, there are 12 million serious medical diagnostic er- rors each year, and these errors have been es- timated to cost physician practices more than $15 billion per year. I think that a big part of the problem is the imprecision that exists due to the lack of understanding of each person at the level that is needed. GEN Please explain what the phrase "the democratization of healthcare" implies. Dr. Topol Democratization of healthcare means that everything is available to all in the medical sphere. Many things that are happening today reinforce that democrati- zation is taking hold. One of the first things is that people are generating data through their smartphones. People are performing their own electro- cardiograms or taking images of skin lesions or rashes, and they can receive diagnoses im- mediately via algorithms. Parents can get a child's ear infection diagnosed using a smart- phone and algorithms. Sleep apnea can be assessed in the comfort of a patient's own bedroom, and the results would more ac- curate than those from a hospital sleep lab, while saving about $3,500. For the first time, over the past year, one of the major central laboratories, LabCorp, has enabled people to order their own lab tests without needing a doctor's order. That's a big step forward, especially in light of the falling costs of genetic testing. Soon, patients may no longer be totally dependent on doctors, hospitals, and health systems. Consumer surveys indicate that at least 80% of people want to be able to take much greater charge and direction of their medical care. That said, I do not believe that democratization of healthcare will be truly achieved until all individuals have ownership rights to their data, protected by new laws and legislation, with technology that pro- tects the privacy and security of that data. GEN In your book, you present a vast array of smartphone attach- ments, apps, and uses available or in development, including various kinds of biosensors. You describe "some of the remarkably diverse lab-on-a-chip assays that have been or soon will be integrated with a smartphone." You even suggest a future of smartphone- based genotyping capabilities. Is all of this possible with today's smartphone technology? Dr. Topol The digital transformation of med- icine is already happening. 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