How things should work when you have a medical question

I sat down at my computer a short time ago and received a message from a dear friend via Facebook. This Facebook friend has his own friend who very unfortunately has a recently discovered advanced cancer. One of the reasons I was contacted was because I had just posted a link to an article discussing some astounding possibilities in the field of nano science and its applicability to cancer treatments. Legitimately, my friend asked if this technology was available and applicable to his friend with cancer.

This is really the way things should work. We should be able to ask a computer interface [whether Siri or Cortana or Google Now, etc] the same questions I was asked. In return, these virtual assistants should be able to answer in the same way that I did. Whether based on a deep learning approach which is a computer mimicry of how humans learn, or on a hardcoded database of doctor names, the computer should be able to immediately link the patient to the key people in the same geographical region, or across the world, who can address the specific medical problem.

Admittedly, when it comes to a topic like cancer, there are a few standard names of medical centers which are the best options available. Each of these centers does cutting-edge work both in therapy and in research. Each of these centers runs clinical trials, some of which have compassionate care clauses that allows patients with terminal disease to gain access to, effectively, a Hail Mary type of treatment. For those who live in Israel, we are astoundingly lucky that there are centers across this small country that parallel the tremendous work being done around the world. It is true that Israel is still not top-of-the-line in every type of cancer treatment. But it is damn close. And due to our amazing healthcare insurance system, if it is deemed true that a patient must travel abroad to receive the best possible care, in many cases, the entire cost is covered by insurance.

As my friend and I were exchanging messages on Facebook, a list of cancer centers, specializing in the specific area we were discussing, should have appeared on the side of the screen, i.e. this should be a built in feature. Google docs has a really nice feature called “research” which does this. It follows what you type and suggests appropriate literature related to the topic of your writing. I have used this resource frequently when researching a topic for clients. Microsoft also has a similar feature, although I have never really used it. I am at this point, a Google groupie and as such, am not in a position to discuss other resources. But I can say that the Google product has been a tremendous help.

Once my friend and I mentioned the term “clinical trials”, a future computerized assistant should be capable enough to find every appropriate open clinical trial in our geographical area as well as around the world. At this point, it should be possible to simply click through a series of questions, submit a digital copy of one’s entire medical record, and simply wait for a response in relation to the  appropriateness of the clinical trial for the patient. More so, the computerized assistant should send off a parallel submission to potentially hundreds if not thousands of such clinical trials. This would be a win-win situation. The patients would gain easy access to the most cutting edge work being done, and the research teams would gain access to patients that they would otherwise never know about.

This is actually one of the amazing advances included within Apple’s latest health products, HealthKit and ResearchKit. The ultimate purpose of these two software systems is to keep a complete record of the patient’s health and then offer the patient a link to clinical research that would be appropriate for the patient. These technologies together could dramatically cut the time down for recruiting appropriate patients for clinical studies. Anything that saves time in recruiting patients, also saves money. Considering how tremendously expensive clinical research still is, expediting patient recruitment is of tremendous value.

After a few clicks that already have shared the patient’s entire chart with the appropriate representatives of each clinical trial, the patient should receive responses very quickly. At this point, the problem could actually be, which one to choose. How does one choose between a clinical trial being done at Sloan-Kettering Memorial using Immunobiology versus a clinical trial being done  at Cedars-Sinai using a totally new molecule that has early research showing it can cure metastatic disease? In most cases, though, this would be a blessing to have more options than one knows what to do with.

There is nothing magical in what I am describing. This is a classic example of linking individuals and their data to other databases that are specifically looking for certain types of patients. One can easily compare this to a “” model for clinical research.  The point is that there is no need to develop new algorithms and wait for quantum computing in order to make such a system a reality. This is mostly about building a very user-friendly interface and making sure that there is someone on the other side, ready and waiting to receive the digital charts of the patients seeking care.

As of my most recent reading, there is a community of developers who are working to create an android version of Apple’s HealthKit and ResearchKit. This will unquestionably expand the reach of such services to hundreds of millions more people. The key is to get everybody on board. And specifically for those people who are already dealing with the stress and fear of their diagnosis, it is all the more important to make the process as easy and humane as possible.

We are close. We are frustratingly close to getting all the pieces together that will finally connect patients to successful therapies, that just a couple of years ago were considered science fiction. My own brother  passed away many years ago from cancer. My mother-in-law died around a decade ago from a totally different cancer [not that it really makes a difference]. I know that the day will come when a life-saving treatment for both of them will be just a few clicks away. Basically, that means that their “fault” was being born a few years/decades too early. I truly pray that we are only a couple of decades away from making sure that no one else has to suffer as they did.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.