Know Thyself: Continuous Health Monitoring for Personalized Healthcare

Shana Spindler PhD
Shana Spindler PhD
July 22, 2021

Travel back in time to the entrance of Apollo’s temple in Delphi, Greece, and according to ancient writers you would find a stone column with the phrase: Γνῶθι σεαυτόν, translated to “know thyself.” No one knows who wrote this kernel of wisdom, but Greek philosophers have written about its significance throughout history. In modern times, I can’t think of two better words to capture the future of human health and medicine than know thyself.

To know thyself, you need data. One way to collect personalized data is through routine and consistent tracking of health measures. On June 9, 2021, the journal Science Translational Medicine highlighted the concept of using continuous health monitoring for personalized healthcare in a viewpoint article by Stanford University researchers.

“We must understand the healthy state as thoroughly as the disease state,” the authors wrote. Their research focuses on disease prevention and early disease recognition—a topic that hits close to home for the team. The lead author, Dr. Sanjiv S. Gambhir, passed away from cancer before publication of the article. He had devoted his career to early cancer detection and healthcare imaging. I appreciate his work as I, too, have a history with cancer. At the age of 29, I underwent months of aggressive chemotherapy to treat lymphoma, a cancer of the blood.

I didn’t think about it at the time of treatment, but I had been the recipient of personalized medicine based on regular health monitoring. Following each cycle of chemotherapy, the doctors measured my white blood cell levels to decide if I needed a dosage adjustment. If my cell count dropped close to zero, my medical team knew that the drug dosage was high enough to kill my cancer cells. If blood counts remained high, my body would need more of the chemo cocktail to eliminate the cancer. Each cycle I wondered: would they get it right?

Precision healthcare is based on the individual

One-size-fits-all advice is shifting into personalized approaches to disease prevention and care. Health decisions that benefit some people might not work for others. In their article, Dr. Gambhir and his colleagues discuss the need to create “personalized risk assessments.” They argue that healthcare decision-making should take into account more than a combination of average disease risk with a few doctor checkups and screenings. “These screening tests provide only a snapshot of one’s health, a still frame from a movie for which we do not know the backstory,” the authors write.

Contributors to disease risk are varied and complex. Gene mutations, pollution, pathogens, good and bad gut bacteria, underlying health conditions, lifestyle choices, socio-economic status (and many more factors than I could possibly list) all factor into an individualized risk profile.

But what should we measure in people, and when should we take action based on the resulting data? The answers to these questions will depend on the individual. “By combining models of human health and disease with continuous health data from wearables and home devices, we can achieve individualized disease predictions,” Dr. Gambhir and his colleagues write.

Types of continuous health monitoring

Setting up sensors in our homes is common practice for many people. We have smoke alarms to alert us of fire, thermostats that measure temperature, and carbon monoxide detectors to protect us from harmful gasses. Some homes take it a step further and incorporate smart appliances, like a refrigerator that monitors food storage and expiration. We have created an abundance of technology to monitor our belongings and behavior; next is our biology.

Dr. Gambhir and his colleagues paint a picture of continuous health monitoring through everyday activities and home sensors: “Perhaps a toothbrush would collect your saliva while you brush your teeth, your toilet would automatically analyze your urine and stool to monitor for disease, and your car would check your vital signs while you drive to work.”

Wearable technologies are already in the marketplace. Watches measure heart rate, exercise, sleeping patterns, and more. Other categories of continuous health monitors include implantable devices (such as cardiac monitors) and ingestible sensors (such as endoscopy capsules). For individuals who want to track blood sugar levels, continuous glucose monitors provide a live stream of data direct to smartphone apps. 

The information is resident in our bodies and environments. Continuous monitoring is the key to extracting that information. But to utilize the data, Dr. Gambhir and his colleagues envision the development of a “digital twin” for healthcare.

Building a digital twin for healthcare

A digital twin is a computerized version of a physical entity, programmed to behave in the same way as the object. Scientists hope to incorporate a person’s genetic and environmental profile into a digital twin. With continuous data input and refinement of this technology, doctors could make healthcare decisions with the help of digital twin predictions.

To put this in perspective: my doctors never increased my chemotherapy dosage because my white blood cells always went to zero. It’s possible I received more hazardous chemotherapy drugs than needed, but the risk of lowering my dose was too great. A digital twin may have helped doctors predict the optimal chemotherapy amount for my body, eliminating cancerous cells while sparing my healthy cells from excess harm. 

I am in full remission today thanks to the amazing work of a highly skilled team of physicians (I was part of a clinical trial to test more effective treatments for my cancer). Future cancer patients, though, might have a digital twin to help their doctors make even more optimized treatment decisions. My personal hope is that digital twins could even prevent cancers from occurring in the first place. 

Returning back in time to the Temple of Apollo at Delphi, the two phrases that followed "know thyself" roughly translate to "nothing to excess" and "surety brings ruin.

Those cautionary words should motivate us to always seek improvements to our health, even when our continuous health monitors indicate we’re doing well. 

Reference

Continuous health monitoring: An opportunity for precision health

Travel back in time to the entrance of Apollo’s temple in Delphi, Greece, and according to ancient writers you would find a stone column with the phrase: Γνῶθι σεαυτόν, translated to “know thyself.” No one knows who wrote this kernel of wisdom, but Greek philosophers have written about its significance throughout history. In modern times, I can’t think of two better words to capture the future of human health and medicine than know thyself.

To know thyself, you need data. One way to collect personalized data is through routine and consistent tracking of health measures. On June 9, 2021, the journal Science Translational Medicine highlighted the concept of using continuous health monitoring for personalized healthcare in a viewpoint article by Stanford University researchers.

“We must understand the healthy state as thoroughly as the disease state,” the authors wrote. Their research focuses on disease prevention and early disease recognition—a topic that hits close to home for the team. The lead author, Dr. Sanjiv S. Gambhir, passed away from cancer before publication of the article. He had devoted his career to early cancer detection and healthcare imaging. I appreciate his work as I, too, have a history with cancer. At the age of 29, I underwent months of aggressive chemotherapy to treat lymphoma, a cancer of the blood.

I didn’t think about it at the time of treatment, but I had been the recipient of personalized medicine based on regular health monitoring. Following each cycle of chemotherapy, the doctors measured my white blood cell levels to decide if I needed a dosage adjustment. If my cell count dropped close to zero, my medical team knew that the drug dosage was high enough to kill my cancer cells. If blood counts remained high, my body would need more of the chemo cocktail to eliminate the cancer. Each cycle I wondered: would they get it right?

Precision healthcare is based on the individual

One-size-fits-all advice is shifting into personalized approaches to disease prevention and care. Health decisions that benefit some people might not work for others. In their article, Dr. Gambhir and his colleagues discuss the need to create “personalized risk assessments.” They argue that healthcare decision-making should take into account more than a combination of average disease risk with a few doctor checkups and screenings. “These screening tests provide only a snapshot of one’s health, a still frame from a movie for which we do not know the backstory,” the authors write.

Contributors to disease risk are varied and complex. Gene mutations, pollution, pathogens, good and bad gut bacteria, underlying health conditions, lifestyle choices, socio-economic status (and many more factors than I could possibly list) all factor into an individualized risk profile.

But what should we measure in people, and when should we take action based on the resulting data? The answers to these questions will depend on the individual. “By combining models of human health and disease with continuous health data from wearables and home devices, we can achieve individualized disease predictions,” Dr. Gambhir and his colleagues write.

Types of continuous health monitoring

Setting up sensors in our homes is common practice for many people. We have smoke alarms to alert us of fire, thermostats that measure temperature, and carbon monoxide detectors to protect us from harmful gasses. Some homes take it a step further and incorporate smart appliances, like a refrigerator that monitors food storage and expiration. We have created an abundance of technology to monitor our belongings and behavior; next is our biology.

Dr. Gambhir and his colleagues paint a picture of continuous health monitoring through everyday activities and home sensors: “Perhaps a toothbrush would collect your saliva while you brush your teeth, your toilet would automatically analyze your urine and stool to monitor for disease, and your car would check your vital signs while you drive to work.”

Wearable technologies are already in the marketplace. Watches measure heart rate, exercise, sleeping patterns, and more. Other categories of continuous health monitors include implantable devices (such as cardiac monitors) and ingestible sensors (such as endoscopy capsules). For individuals who want to track blood sugar levels, continuous glucose monitors provide a live stream of data direct to smartphone apps. 

The information is resident in our bodies and environments. Continuous monitoring is the key to extracting that information. But to utilize the data, Dr. Gambhir and his colleagues envision the development of a “digital twin” for healthcare.

Building a digital twin for healthcare

A digital twin is a computerized version of a physical entity, programmed to behave in the same way as the object. Scientists hope to incorporate a person’s genetic and environmental profile into a digital twin. With continuous data input and refinement of this technology, doctors could make healthcare decisions with the help of digital twin predictions.

To put this in perspective: my doctors never increased my chemotherapy dosage because my white blood cells always went to zero. It’s possible I received more hazardous chemotherapy drugs than needed, but the risk of lowering my dose was too great. A digital twin may have helped doctors predict the optimal chemotherapy amount for my body, eliminating cancerous cells while sparing my healthy cells from excess harm. 

I am in full remission today thanks to the amazing work of a highly skilled team of physicians (I was part of a clinical trial to test more effective treatments for my cancer). Future cancer patients, though, might have a digital twin to help their doctors make even more optimized treatment decisions. My personal hope is that digital twins could even prevent cancers from occurring in the first place. 

Returning back in time to the Temple of Apollo at Delphi, the two phrases that followed "know thyself" roughly translate to "nothing to excess" and "surety brings ruin.

Those cautionary words should motivate us to always seek improvements to our health, even when our continuous health monitors indicate we’re doing well. 

Reference

Continuous health monitoring: An opportunity for precision health