The Future of Health. Roberto Ascione

course, this phenomenon will also increasingly enable access to telemedicine and even robotic telesurgery. (The first practical demonstrations of 5G applications in this area date back to 2019, when a Chinese neurosurgeon was able to operate on a patient suffering from Parkinson's disease 3,000 kilometers away.)

The result of this health transformation, thanks to technology, is an increasingly better prepared and better cared-for population. More connectivity means an ever-increasing knowledge of health digitization, and consequently, an increasing demand for certain services. In a word, it will ensure greater and, subsequently, universal access to care. It is a real revolution, and as such, unstoppable, because everything is moving on an exponential scale and time frame, especially if we pause to reflect on concepts such as the speed and cost of technology availability, diffusion, and habits of digital culture.

      We might think about going even further, imagining leveraging technology, including widespread connectivity and continuous and integrated data collection, and placing the person at the center of the social health system and the care pathway. The great added value would be that individuals could monitor their own state of health or that of loved ones, and access dedicated digital services at any time, from anywhere. Furthermore, by cross-referencing our personal genetic information (we know genetic screening will be increasingly available to everyone) with the information in our digital health profile (all the data we actively or passively collect about our health), we will be able to make accurate predictions about the probability of developing a disease before it happens and implement countermeasures.

      The concept of digital health goes beyond telemedicine and the collection of large amounts of data; it includes, in fact, all the digital innovations that fuel this paradigm shift in a disruptive way. I am referring to wearables and integrated sensors, predictive analytics systems based on artificial intelligence (AI), and machine learning that is applicable to virtually every area of health, digital therapies, and much more.

      In part this is what has already happened during the pandemic, with digital solutions that have served to support patients, caregivers, and health professionals in adherence to therapies, or in the diagnosis and treatment of certain chronic conditions, thus beginning to shift the focus from therapy (cure) to the care of people (care).

PART I Digital Reflections

      Digital technologies are part of our life flow. We use them to study and work, to connect with people, and also to do our grocery shopping, entertain ourselves, and find love. Health is not an exception albeit it is a much more recent discovery.

      Through the usage of social media and other digital platforms we constantly create and nurture our digital footprint, often passively or without recognizing it. Despite this, many of these information or data points are relevant for our own health, even if we are not yet leveraging them to the fullest.

      Cheaper, smaller, faster computers together with ever-evolving form factors from laptop to wearable and beyond have been enabling all-new use cases and practices, showing us that it is possible to quantify our health experiences. Over time, this has inspired a continuous evolution of personal medical devices, adding an objective and quantitative dimension to health and medicine that was completely unheard of only 10 years ago.

Novel technologies also unlocked access to the human genome, popularizing a practice which, only few years back, was extremely expensive and available only to academia and primary research. In other words, for a few hundred dollars we can get our full genome mapping, and for even less we can investigate our genetic set-up regarding specific areas or conditions.

      This unprecedented amount of data, originated both by digital and genetic signals, needed completely new strategies and computer-science solutions, which we often refer to as AI, to make sense of them.

      AI and more appropriately data science are not only giving order to this vast amount of data but are also allowing us to correlate it with medical observations, unveiling connections and cause–effect implications which, in certain cases, we did not even imagine in the past.

      Once these connections are scientifically proven, we can start to introduce them into the medical practice, often allowing for predictions of future evolution of certain disease states even before such a disease would develop.

      Most of these innovations are coming from what we now identify as digital health startups, brave teams of young innovators and experienced professionals, often including doctors and other health-care professionals, engineers, designers, and patients, who are not afraid to challenge the status quo of health care and the implied inaccessibility, inconvenience, and uncertainty that are huge problems in the industry. This movement has been increasingly fueled by venture capital investments, which have been propelling this sector since 2011 and further accelerated through the Covid-19 pandemic of 2020.

      All of this is having a profound impact on health care and its determinates, including health literacy, access to care, ability to connect to the right health-care resources, cost of diagnoses and therapies, prevention strategies, and more.

      The first section of this book will review the most important technology innovations and provide examples of startups using them to foster this radical transformation of health care as we know it.

CHAPTER 1 Devices, Sensors, and Signals

      From Wearables to Ingestibles—Toward the Invisibility of Digital Health

Perhaps the most striking case of a radical health-care transformation, from a media point of view, was the launch of the Apple Watch on September 9, 2014. In reality, the market for wearables and network-connected devices had already been established for some time, especially in the sport sector: smart bracelets that calculated the number of steps taken in a day, the calories consumed, the amount and quality of sleep, and a whole host of other data were already on the market well before Apple launched itself into the enterprise.

According to Forbes, the wearables market was worth $27.9 billion in 2019 and is estimated to reach $74.03 billion in 2025. The sector includes smartwatches, fitness trackers, wristbands, and all those wearables that control physical activity or other vital parameters. And this value, according to estimates, is bound to grow even more. Technological developments have been leading to a progressive miniaturization of the components, to such an extent that nanotechnology-based devices are already available in the health-care field. (Nanotechnology refers to technological structures smaller than one nanometer, one billionth of a meter.) This advance allows for more precise and less invasive diagnostic analysis, or tools that can even carry out intervention therapies at the molecular level. As is often the case in the field of technology, while the instruments become more powerful and complex, their cost of production is constantly decreasing, making the various devices accessible to an ever-widening range of consumers. The great ductility of the materials produced makes it possible to integrate processors and sensors into nearly every object of everyday use: shoes, T-shirts, appliances, toys, balls, racquets—everything can be made smart and connected at the cost of just a few dollars. And in the health field? The adoption of digital devices is a natural and inevitable process. The possibility of remotely monitoring the various devices connected to the network, the miniaturization of the components, and the evolution of the various sensors to become increasingly precise and reliable, allow the creation of wearables that can track diverse vital parameters without being uncomfortable for the wearer. This reduces (or even excludes) the need for a patient to go to the hospital or to visit a health-care professional for ongoing tests for conditions that need constant monitoring. For example, a health-care professional can monitor a patient's health remotely by accessing, in real time, data transmitted by a pacemaker connected to his or her mobile phone. The possible variations are endless.

      Among the first pioneering therapies based on wearable technology, we remember the solution developed by Proteus Digital Health: a pill with a built-in micro-sensor. Once the pill is swallowed, the microcircuit sends signals to a patch on the patient's skin, which in turn communicates with the dedicated app on the patient's smartphone.