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44 | OCTOBER 1, 2016 | GENengnews.com | Genetic Engineering & Biotechnology News to bring a doctor to your house. On-demand medicine is a big part of the democratization of medicine. But the big shift going forward will not be the capability to have a video chat with the doctor, or summon the doctor to your house, but rather the ability to generate data and share it with the doctor. The patient- doctor exchange will go beyond chatting. It will involve the review of data, getting oversight of the data, and getting guidance and an injection of wisdom, experience, and compassion. Smartphone labs are part of the story. For example, it is possible to make a diagnosis of infection through a smartphone. That has been demonstrated in as remote a place as Rwanda, where 99% accuracy was achieved for detecting HIV and syphilis, at a cost of 50 cents, with results available in minutes. Additionally, we now have the ability to consider portable sequencing in the field, to provide an agnostic approach to iden- tifying pathogens. This is still some years away, but it's becoming technically increas- ingly likely. Many companies are working on pro- cessing the breath using a smartphone, for example, to be able to measure aldehydes and other organic compounds that would increase the suspicion for cancer—not just lung cancer, but any type of cancer. We will also be able to monitor the environment in general, for radiation exposure or for air quality and pollutants. GEN The increasing reliance on sensors and remote monitoring may make hospital stays obso- lete—except for surgical proce- dures and emergency or intensive care. Eventually, it may even be commonplace to use blood-based nanosensors to enable continuous monitoring of the physiome. What advances are needed to realize these scenarios? Dr. Topol We need to overcome the "edifice complex," our habitual reliance on big hos- pitals, clinics, and professional buildings. We should question the value of regular patient rooms in a hospital, which in the United States average more than $4,300 a night. By the same token, we should consider how many visits to doctors' offices could be avoid- ed if telemedicine were more common. The only thing in the technology area that is missing for this transformation to happen is being able to take the data from remote monitoring and apply it to patient care. We need remote data-monitoring centers. The only one I know of is at Mercy Hospital in St. Louis. With sufficiently exquisite remote monitoring, we may, eventually, be able to show that the "hospital room of the future" should be the patient's bedroom. Another exciting technology is the liquid biopsy. Nearly 40 companies are now trying to harness the information from circulating DNA in the blood to make the earliest possi- ble diagnosis of cancer, or to monitor people after treatment for cancer. The use of circulating free DNA or RNA can be extended beyond cancer to study methylation and other epigenomic changes and to monitor various organs and systems. This relates to the idea of using nanosensors in the bloodstream, coupled with genomic signaling, with the results being reported to a mobile phone app. We are also working on cardiac applica- tions. We hope to pick up genomic signals that predict heart attacks. But the regulatory path to validate this type of test is long. You have to get the blood test approved first, then the sensor approved, before you can then get the combination of the sensor and the blood test approved. It takes multiple years and large clinical trials. GEN You say that the extensive sharing of data from little devices presents bit opportunities for Massive Open Online Medicine (MOOM). Why is MOOM important? Dr. Topol MOOM is about achieving open medicine through massive medical data shar- ing. Today, doctors do not share patient data. For example, many oncologists in the United Better Health Continued from page 42 TRANSLATIONAL MEDICINE