reflections on the technium

Recently I noticed that the X-Prize Foundation has — in cooperation with Qualcomm — decided to offer a “Tricorder X PRIZE, a $10 million prize to develop a mobile solution that can diagnose patients better than or equal to a panel of board certified physicians.”  This reminded me of a letter I wrote last year regarding metabolomics…

Mr. Bill Gates
Bill & Melinda Gates Foundation
PO Box 23350
Seattle, WA 98102

2 June 2010

Re:  Putting the personal in medicine.

Mr. Gates,

I’m an engineer.  When I’ve got a problem I apply a simple objective process – identify, measure, and improve (IMI).  In contrast, medicine follows a subjective process of observation (signs, symptoms) and instant test results to determine a diagnosis.  Given that there are over 10,000 known diseases, 3,000 drugs, and more than 1,000 lab tests, it’s highly unlikely that any given doctor has the knowledge and experience to arrive at a correct diagnosis.

What would happen if medicine followed IMI?

1) The medical version of identify is a science called metabolome and is:

The “complete set of small-molecule metabolites (such as metabolic intermediates, hormones and other signaling molecules, and secondary metabolites) to be found within a biological sample, such as a single organism.” — Wikipedia

2) The medical version of measure is a technique called metabolomics (or metabolic profiling) and is:

The “systematic study of the unique chemical fingerprints that specific cellular processes leave behind” – specifically, the study of their small-molecule metabolite profiles. – Wikipedia

Dr. Art Robinson, one of the pioneers of modern metabolomics, offers:

“These [unique chemical fingerprints] are the immediate result of most biochemical activity.  Moreover, they are interlocked in many different biochemical pathways.  Therefore, it is not necessary to measure every one.  There may be 5,000 substances of importance, but a sample of 500 carries information about the other 4,500 as well.  For example, about 30% of the substances in urine are correlated with physiological age.  Some go up with age.  Some go down with age.  It is not necessary to measure 5,000 compounds.  A subset of 200 is sufficient to reliably measure physiologic age.” – Dr Art Robinson paper

3) The medical version of improve is the correlation of an individual’s metabolome with disease profiles so appropriate corrective/preventive action can be taken.

How can this be personalized?

A consumer-based personal analytical device is now possible that would allow for the quantitative measurement of human health (your personal health, not the population norms now standard in medicine).  This analytical device could measure metabolic profiles in breath and urine, and monitor parameters such as heartbeat and blood pressure.  This device could be packaged to be about the same size as a personal laser printer.  It would use your home PC for data reduction and archiving and as the gateway to your electronic medical records, and to access the world’s foremost experts in the analysis of physiological and biomedical data.  This is possible because technological advances have given us miniaturized mass spectrometers and gas-chromatographs (not unlike those being used by the Mars Rovers in the search for Martian life).  For instance, the Ionchip®, by Microsaic Systems Ltd, is a miniaturized mass spectrometer that “determines the chemical composition of a sample by ionizing molecules of the sample and sorting them by [their] mass-to-charge ratio.”

[Update 11 June 2011: A cool new sensor technology is based on Raman scattering, EDN magazine summarizes: “The university describes the sensor as being able to boost faint signals generated by the scattering of laser light from a material placed on it, allowing the identification of various substances based on the color of light they reflect.”]

The creation of a personal analytical device has entered the realm of engineering; the science being a settled proposition.  Unfortunately even though this is possible, no one is doing it.  The Shirky Principle holds that “institutions will try to preserve the problem to which they are the solution.”  Medical institutions — especially diagnostics — resist change and are ripe for a disruptive technology to empower the individual (much like the personal empowerment revolution PCs ignited).  This is where your foundation can come in.

I’d like to suggest that your foundation sponsor a competition to develop a personal analytical device.  It should have three levels, with the first level resulting in five contenders.  The second narrowing this down to two and the third selecting the best.  The reason for multiple levels (and a large winner pool) is to allow other promising solutions to be developed independently (if investors are so moved).  Minor competitions could also be developed for electronic data interchange, electronic medical records, big data storage, search, and pattern matching.

In closing I’d like to say that I admire the good work you’re undertaking through your foundation and wish you well in those endeavor.

Respectfully,

Chuck

To which I received the standard reply:

Subject: 	Bill & Melinda Gates Foundation
Date: 	Mon, 21 Jun 2010 10:46:17 -0700
From: 	Info <info@gatesfoundation.org>
To: 	Charles.Petras@xxxxxxxx.xxx <Charles.Petras@xxxxxxxx.xxx>

Dear Mr. Petras,

Thank you for contacting the Bill & Melinda Gates Foundation.

We appreciate the time you have taken to suggest sponsoring a contest to
develop a personal analytical device with the foundation. It is always
encouraging to hear from individuals like you who are dedicated to
helping others and spreading awareness about important issues.

As you may already know, the foundation’s work stems from our belief
that all lives have equal value. We think all people deserve the chance
to live healthy, productive lives. In developing countries, we focus on
improving people’s health and giving them the chance to lift themselves
out of hunger and extreme poverty. In the United States, we seek to
ensure that all people—especially those with the fewest resources—have
access to the opportunities they need to succeed in school and life.

We invite you to visit our web site at www.gatesfoundation.org for more
information about our programs.

Again, many thanks for writing and best wishes for the future.

Sincerely,

Bill & Melinda Gates Foundation
Grants Inquiry
www.gatesfoundation.org