David Kerr: Deus ex machina

David KerrForget complementary therapies, the big question is can engineering succeed where traditional medicine has failed? Anyone following the online technology bible “TechCrunch” might be persuaded by this idea. Here in the US and on the West Coast in particular, the belief is growing that the combination of money and mathematical and engineering brilliance (and also increasingly youth), has the potential to solve many of human kind’s ills. Only the other day, one start-up company in Stanford (Healthtap) secured early funding to the tune of $2.5 million to create an “expert health companion.” Their blurb describes what they are trying to do as “help define the new field of ‘interactive health'” — the sector that is moving consumer health information to new platforms, like smartphones and tablets, to provide portability and immediate access to actionable information. The company plans to “integrate personalisation, game dynamics, and social networking to increase our engagement with our health and well-being.” 

Likewise another health technology company (Doximity) has received almost $11 million in a recent funding round to support its aim of enabling physicians to use their iPhone, iPad, Android device or computer to connect with any other healthcare professional related to patient care. At present this is only available to US clinicians.

Last week the US National Institutes of Health announced a 10 year plan for diabetes research with the holy grail of creating an artificial pancreas being at the top of their agenda. The “closed loop” as it is otherwise known also continues to be one of the top priorities of the Juvenile Diabetes Research Foundation, a major non-profit organisation for people with the condition and it also featured in a European long term plan for diabetes research published at the end of 2010 (www.diamap.eu).  This is not a new idea by any means, creating computer code and writing algorithms for matching glucose and insulin is just the beginning – progress is easily scuppered by the combination of uncooperative biology and psychology.

What makes technology valuable to its human master and why doesn’t everyone warm to the idea of living with a machine? For an answer it is perhaps valuable to look at the approach taken by the current ruler of the electronics world. Apple, even in the temporary absence of its enigmatic founder, Steve Jobs. Apple offers new features for established (and excellent) platforms on a frequent and regular basis with the (very successful) aim of keeping people interested and enthusiastic about using the company’s products. Even near the home of Apple, purchasing the latest version of the iconic iPad means standing in line at some unearthly hour to have a chance of securing one of the 25 or so available each day in the Apple Palo Alto store.

For many medical academics and researchers the Apple approach is an anathema to evidence based medicine. New features on established medical devices are invariably introduced without being subject to the research requirements that a new medicine would require. In reality, to do otherwise would be commercial suicide for a company.

For new device features and software, social media is now the new peer review anyway. These online reviewers are a mixture of professionals, interested parties, and essentially anyone with an opinion. Nowadays, good ideas and devices can go viral and be successful rapidly with poorly thought out ones given an immediate burial after launch. This might lead to the creation of a new generation of what are termed by industry as “key opinion leaders,” whose excellence in clinical practice and empathy with patients will help device development rather than traditional academic excellence per se.

Love or hate the concept, the idea that machines can make medicine more personal and therefore more effective is being increasingly accepted (and funded), at least here in the epicenter of the technology universe. Not everyone will approve of the direction this aspect of medical practice is taking but as history has shown, dinosaurs became extinct for a reason.

David Kerr is the managing editor of the Journal of Diabetes Science and Technology.