Smartphones and medical apps provide new opportunities for digital medicine and big data analysis of personal health information. However, issues around privacy, regulation, and the limitations of correlation versus causation still need to be addressed. Future directions may include remote monitoring via implanted sensors, predictive analytics, and shifting from treatment to prevention through personalized metrics.

1. Maximizing The Use of Your
Smart Phone: Medical Apps &
Digital Medicine
Kent Bottles, MD
Kent@kentbottlesmd.com
www.kentbottlesmd.com
610 639 4956
37th Semi-Annual Spring Temple University Family Practice
Review Course
March 22, 2013

2. The Talk
• Smartphones as a window onto Digital
Medicine and Big Data

3. Harvard Health Letter on
Smartphone Apps
• Harness phone’s computing power, cameras,
audio, video, motion sensors, and GPS to
create new ways to manage your health and
wellness
• Uncharted
• Unstable
• Unregulated
http://ow.ly/3gVzg

4. Smartphones
• “The paradigm of healthcare has changed.
You used to bring the patient to the doctor.
Now you take the doctor, hospital, and
entire healthcare ecosystem to the patient”
• “You cannot call your gastroenterologist
every time you buy a new product.”
• “The technology of telehealth is well ahead
of the socialization of the telehealth idea
and we are at tipping point for utilization to
take off.”

5. Traditional Medicine
• Biomedical model reduces every illness to a
biological mechanism of cause and effect
• Attention on acute episodic illness
• Generalists replaced by specialists
• Focus on individuals
• Cure as uncompromised goal
• Focus on disease
• Antibiotics & infectious disease

6. Traditional Medicine
• Diagnose and treat
• Health is defined as absence of disease
• Patient story is subjective and
untrustworthy
• Lab results are objective and true
• Pathologists are the most important doctors
• Clinicians are paralyzed until lab provides
dx

7. Digital Medicine
• Digitizing a human being
– Genome
– Remotely, continuously monitor vital signs,
mood, activity
– Image any part of body, 3d reconstruction, print
an organ
– Readily available on your smartphone,
integrated with traditional medical record,
constantly updated

8. Digital Medicine Convergence
• Genomics
• Wireless sensors
• Imaging
• Information Systems
• Social networks
• Ubiquity of smartphones
• Unlimited computing power via cloud server
farms

9. Eric Topol on MI prevention
• “Monitoring would ideally use an implanted
nanosensor, smaller than a grain of sand
and capable of finding its targets in even
one-millionth of a liter of blood,
communicating with a patient’s
smartphone. Individuals who would get the
nanosensors would be those whose genome
sequence or other biomarkers had already
put them at risk for a heart attack.

10. Eric Topol on MI prevention
• Well before the horse was out of the barn,
the nanosensor could alert the individual to
seek attention; therapy then would consist
of both ant-clotting and anti-inflammatory
medications. At some point in the future,
nanosensors will likely have the capacity to
release medications on their own in
response to high levels of circulating cells
or nucleic acids”

11. Digital Medicine of Present &
Future
• Human body and disease is complex
emergent system that may never be fully
understood
• Attention on chronic diseases
• Managing chronic diseases rather than cure
• Focus on person and the disease

12. Digital Medicine of Present &
Future
• Predict and Prevent
• Health is a state of complete physical,
mental, and social well-being and not
merely absence of disease
• Patient story is essential for development of
personal metrics which will be unique to
each individual
• Pathologist sadly becomes less important

13. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Google Nature article predicts flu spread in USA
• Compared 50 million search terms with CDC data
on spread of flu from 2003 to 2008
• 450 million different mathematical models
• 45 search terms had strong correlation with spread
of flu
• H1N1 crisis in 2009 Google approach worked

14. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Big data refers to things one can do at a
large scale that cannot be done at a smaller
one, to extract new insights or create new
forms of value, in ways that change
markets, organizations, the relationship
between citizens and governments.
• Causality is replaced by correlation
• Not knowing why but only what

15. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Statistics allows richest findings using the
smallest amount of data
• Randomness trumped sample size
• 2007 300 exabytes of stored data
• 2013 1,200 exabytes of stored data
• 2013 only 2% is non-digital

16. Big Data
WSJ March 11, 2013
• 1950s 600 megabytes (John Hancock)
• 1960s 807 megabytes (AA Sabre)
• 1970s 80 gigabytes (Fed Express Cosmos)
• 1980s 450 gigabytes (CitiCorp NAIB)
• 1990s 180 terabytes (WalMart)
• 2000s 25 petabytes (Google)
• 2010s 100 petabytes (Facebook)

17. Big Data
WSJ March 11, 2013
• 1 Bit = Binary Digit
• 8 Bits = 1 Byte
• 1000 Bytes = 1 Kilobyte
• 1000 Kilobytes = 1 Megabyte
• 1000 Megabytes = 1 Gigabyte
• 1000 Gigabytes = 1 Terabyte
• 1000 Terabytes = 1 Petabyte
• 1000 Petabytes = 1 Exabyte
• 1000 Exabytes = 1 Zettabyte

18. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Increasing volume of data leads to inexactitude
• Big data is probabilistic rather than precise
• Microsoft’s Banko & Brill tested 4 algorithms
with 10 million, 100 million, 1 billion words
• Accuracy rate of one went from 75% to 95%
• Only 5% of digital data is structured
• Without accepting messiness 95% of unstructured
data is useless

19. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• To analyze & understand the world we used to test
hypotheses driven by theories
• Big data discards theories & causality for
correlations
• Univ of Ontario premature baby studies
• 1,260 data points per second
• Diagnose infections 24 hours before apparent
• Very constant vital signs indicate impending
infection

20. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Datafication: unearthing data from material
nobody thought held any value
• Digitization: process of converting analog
information into zeroes and ones of binary
code so computers can handle it.
• Data is something that allows it to be
recorded, analyzed, and reorganized

21. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• GPS allows us to establish location quickly,
cheaply, and without requiring specialized
knowledge
• UPS uses geo-loc data from sensors,
wireless modules, and GPS on vehicles
• 2011 UPS shaved 30 million miles off
routes, saved 3 million gallons of fuel, and
30,000 metric tons of carbon dioxide
emissions

22. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Datafication of acts of living
• Zeo large database of sleep patterns
• Asthmapolis sensor to inhaler that tracks
location via GPS identifies environmental
triggers
• Fitbit and Jawbone
• iTrem monitors Parkinson’s tremors almost
as well as the tri-axial accelerometer used in
specialized office medical equipment

23. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Search data can be reused
• Hitwise is web traffic measurement
company that lets clients mine search traffic
to detect consumer preferences
• Telefonica mobile phone created Telefonica
Digital Insights to sell subscriber location
data to retailer

24. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Recombinant data
• Danish Cancer Society study on cell phone/cancer
• Cellphone users from 1987 to 1995 (358,403)
• Brain cancer patients (10,729)
• Registry of education and disposable income
• Combining the three databases found no increase in risk of
cancer for those who used cell phones
• Not based on sample size; based on N=all

25. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Multiple uses of same database
• Data exhaust: digital trail people leave in
their wake
• Google spell checking system uses bad data
to improve search, autocomplete feature in
Gmail, Google Docs, and translation system

26. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Paralyzing privacy
– Notice and consent
– Cannot give informed consent for secondary uses
– Anonymization does not work
• AOL 2006 20 million search queries from 657,000
users: NY Times identified user number 4417749 as
Thelma Arnold (“My goodness, it’s my whole
personal life. I had no idea somebody was looking
over my shoulder”)
• Netflix Prize 100 million rental records from
500,000 users. Mother and closeted lesbian in
Midwest was reidentified

27. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Probability and punishment
– Minority Report: People are imprisoned not for what
they did, but for what they are foreseen to do, even
though they never actually commit the crime
– Blue CRUSH (Crime Reduction, Utilizing Statistical
History in Memphis, Tennessee
– Homeland Security FAST (Future Attribute Screening
Technology)
– Big data based on correlation unsuitable tool to judge
causality and thus assign individual culpability

28. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Dictatorship of Data
– Relying on numbers when they are far more fallible
than we think
– Robert McNamara’s body count numbers in Viet Nam
– Michael Eisen tried to buy The Making of a Fly on
Amazon in April 2011. Two established sellers offering
the book for $1,730,045 and $2,198,177. Two week
escalation to a peak of $23,698,655.93 on April 18
– Unsupervised algorithms priced the books for the two
sellers.

29. Big Data
Viktor Mayer-Schonberger & Kenneth Cukier, 2013
• Regulatory shift from “privacy by consent”
to “privacy through accountability”
• “Differential privacy” through deliberately
blurring the data so hard to reidentify
people
• Openness, Certification, Disprovability
• Algorithmists to perform “audits”

30. What Big Data Can’t Do
David Brooks, NY Times, February 26, 2013
• Data struggles with the social
• Data struggles with context
• Data creates bigger haystacks (spurious
correlations that are statistically significant)
• Data has trouble with big problems
• Data favors memes over masterpieces
• Data obscures values