The Bad News that Everyone Will Get: Unless They Are 1st Hit by a Bus

I was sitting in the dermatologist office preparing to get a biopsy of my inner lip. I went to see the doctor a month earlier to have another mole checked that I found out was just a mole. I also had a dark spot on my inner lip for at least the last 4 years. The last time I had it check, the doctor said it was fine but this time the doctor thought I should get a biopsy to make sure it was nothing serious. (Maybe the doctor was also purchasing a new car around this time) I asked the doctor what was the probability that is was cancer.) He was hesitant to give me an answer but when I pressed him, he told me about 20%.

Side note: I got the feeling that he just gave me a number to make me happy and stop asking questions. If I would have pressed him for the reason why he told me 20%, he would not be able to site any data but he would be more likely to take the biopsy without local anesthesia.

Side - side note: if you are going to make up a number. It is better to use 18.5% than 20%. 20% makes it seem like you are just making it up. 18.5% with more significant digits makes it seem like you know.

In my mind, I questioned if I really needed the procedure but I was trusting the doctor that his 12 years of medical schooling and +20 years of medical experience was more valuable than my 10 minutes of medical googling and so, here I sat to get my biopsy. As I was waiting for the doctor to come in to do the biopsy, I was reading the CYA document I was just given by the nurse and I had to sign before the biopsy.

Key points in the document:

• “The following point has been discussed with me: The possible alternative procedure or treatment
  • [no – was there a possibility of taking a few drops of blood to do a molecular / biomarker test? No! I guess I need to wait 5 to 10 more years for that!]
• Acknowledge that potential risks of the procedure/treatment I am consenting to have been reviewed with me. Those outcomes included, but not limited to [I always like the "but not limited to" clause when signing documents]: bleeding/bruising, swelling, infection, scarring, hyperpigmentation, hypopigmentation. Incomplete removal of lesion, need for additional treatment, persistent redness, local nerve damage/numbness, … [again these were not reviewed before! and now, I am getting a little nervous.]
• I am also aware that other unforeseeable complications could occur.”
  • [Isn't this what the “not limited to clause” is all about? They should have included death in the list since death is always a possibility. Of course, this is just a lip biopsy.]

Given that I had never had a skin biopsy, I was not sure how bad the procedure was going to be. I tried to ask the doctor as nice as I could (so I would get local anesthesia) about the “possible alternative procedure or treatment” [there were none], risk to “nerve damage” [very low] and decide to go ahead. The doctor said he would just be taking a 4 mm section of my lip away for the biopsy. It turns out that the biopsy was not any more painful than what I would expect a teenager goes through to get their lip pierced for fun or fashion. Of course being an engineer, I do not find lip piercing either fun or fashionable.

One week later, I was sitting in the doctor’s office waiting for the results of the biopsy. As I was waiting, I was generating my list of questions if the biopsy was negative and another list if it was positive - so I would be prepared. I was hoping for good new but wanted to be prepared for bad news. As I was waiting, it occurred to me that even if it was good news today, unless I was hit by a bus in the future, I will be sitting in a doctor’s office in the future and I will receive bad news - If not in the next 10 years, certainly in the next 50. This got me thinking about medical testing in general and how we handle bad medical news.

Surgeons no longer do exploratory surgery to just "cut you open and see what is inside" because today, we have much better noninvasive testing. Today, the laboratory-diagnostic industry is a $76 billion industry that “According to American Clinical Laboratory Association, more than 7 billion lab tests are performed in the U.S. annually and lab results dictate 80% of clinical decisions." https://money.cnn.com/2014/10/16/technology/theranos-elizabeth-holmes/ I believe the medical diagnostics industry is poised to make similar dramatic changes in the next few years as surgery has done in the last 50. Advances in diagnostic testing, wearables, smart phones and the IoT can make a significant improvement to people’s health.

I am really excited about what the future can hold for companies like Theranos with the mission "to make actionable information accessible to everyone at the time it matters. By making actionable health information accessible to people everywhere in the world at the time it matters most, we’re working to enable early detection and intervention of disease and empower individuals to live the lives they want to live." https://www.theranos.com/our-company

I was also pleased that my company sponsored THE $2.25 MILLION NOKIA SENSING XCHALLENGE

Where they stated: “Envision a future where everyone has access to affordable, personalized healthcare through sophisticated sensing technologies that put you in charge of your own health. Where sensors and devices recognize and measure your personal health information, provide insights and recommendations relevant to you and communicate that information to your physician. That’s the aim of this competition: a whole new level of personalized, digital health.” https://sensing.xprize.org/ I wanted to highlight the 2 grand prize winner:

Nanobiosym Health Radar Grand Prize award in 2013.

–Enables testing of a drop of blood or saliva with a nano chip inserted into a mobile device. It detects the presence (or absence) of selected disease's pathogen in real-time, with gold standard accuracy.

DNA Medicine Institute (DMI) Grand Prize award in 2014.

–DMI has developed a portable device that can run hundreds of clinical lab tests on a very small sample of blood. Results are available in a matter of minutes and are highly accurate despite the matchbox size of the device.

I am also excited that Sprint has a focus on medical health as well and it will have another Accelerator this year https://sprintaccel.com/ “The Sprint Accelerator powered by Techstars is a three-month, immersive, mentorship-driven startup accelerator based in Kansas City, Missouri. Located in the thriving Crossroads Arts District of Kansas City, the program helps startups build the future of mobile health that changes the world one patient or consumer at a time.”

But with all this promise of health technology, for the medical professional, if you think you have problems now with patients Googling health information about their health problems and second guessing your decades of medical experience, just wait until patients have access to low cost sensors that measure their health and biomarkers with lab on a chip technology on their smart phones or even smart toilets. https://thecolbertreport.cc.com/videos/9nzwjt/vessyl-digital-cup

I am sure these medical professionals roll their eyes when a patient starts a sentence with “Well, WebMD said…” Now it will be, “my smart phone said …”

“In modern medicine, Dr. Atul Gawande said, there are 13,600 diagnoses, or ways in which the human body can fail, and no patient comes in with just one diagnosis at a time. Now more than 6,000 drugs can be prescribed, and 4,000 medical and surgical procedures can be performed.” The key question is how do we maximize positive health outcomes? https://news.harvard.edu/gazette/story/2011/09/the-battle-for-medicine%E2%80%99s-soul/ https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine

I am a big believer in the best way to maximize health is to do what our mothers told us long ago: eat right, exercise, get plenty of rest, do not smoke or do drugs; drink in moderation (ok, my Mom did not say this to me when I was 10), do not do stupid things (i.e. do not play with matches and gasoline even if Jimmy B. is doing it - I have lots of Jimmy B. stories), make friends, go outside and play (but be careful - especially when playing with Jimmy B.) and do not stress out about life. This advice will not solve all the health problems in the country but they will make a big difference. In the end, we will all die. Focus on the things you can control and do not stress about the things you cannot. Remember stress can cause illness. “Can any one of you by worrying add a single hour to your life” Matt 6:27

I work as a strategy and business development manager. My focus is working on telecommunication; future mobile technology; and the Internet of Things (IoT) but I has a long standing interest and passion in mobile health, telemedicine, genetics and social networks that can improve the health of people. When I worked at Motorola, I was involved in a project with Cerner supporting Motorola’s telemedicine activities. I believe that the mobile health and IT industry can significantly help improve the health of people by focusing on how we prevent, diagnose, and treat disease.

I am involved in a KU med student organization Collab that is working to connect innovators on the KU med campus and the business community. wecollab.org I may be presenting at one of the meetings the following topic:

Internet of Things (IoT) and the Future of Mobile Health Agenda:

• How the internet and smartphone have changed society and how the IoT with 25-50 billion sensors by 2020 and 1 trillion by 2030 will impact society and the medical industry
• R&D Investment and where the money is flowing and Interesting medical startups to track - Focusing on companies like
  • Theranos (https://www.theranos.com/)
  • startups that won the $2.25 MILLION NOKIA SENSING XCHALLENGE
  • Sprint Accelerator powered by Techstars startups
  • The Qualcomm $10 million Tricorder XPRIZE
• Danger of relying on technology too much but finding the right tool for the right job to make your job most efficient

If I do give this talk and you are interested in attending in the KC area, let me know.

In closing, I have a cousin who is a Hospice Chaplain. He told me that when he meets with people that are dying, he tells them that people who "die well," come to peace in 3 areas.

• with themselves
• with those they love (family and friends)
• with God

I told him that these 3 areas are also good for people who want to "live well."

A book that expands on this is “Anticancer, A New Way of Life” by David Servan-Schreiber MD PhD

In this Christmas season, I wish you all such peace as you live your life to the fullest and wellest.

p.s.

"Now for the rest of the story," It turns out that I had a “Labial melanotic macule” a well-defined, oval, brown to black, flat patch on the central third of the lower lip. In non-doctor’s speak, I had a freckle - but at least now I know what if feels like to get my lip pierced.

Medical googling can be useful for some things.