From Part I
WHEN MARTY COOPER invented the cell phone in 1973, he could not have dreamed or estimated that there would be over five billion cell phones by 2010 and that this platform would ultimately have a major impact on the future of health and medicine. The invention of the personal computer by Michael Wise in 1975,followed soon thereafter by the innovations of Steve Jobs and Steve Wozniak the following year, led to over one billion personal computers in use by 2008 and an anticipated two billion in 2014.2 The internet began to hit its stride by the mid-1990s, and now well over two billion individuals are connected with such expanded bandwidth that video files have become the dominant medium of exchange as measured by file size.3
But the biggest leap came in the first decade of the twenty-first century.The six billion bases of the human genome were sequenced,and this led to the discovery of the underpinnings of over one hundred common diseases, including most cancers, heart disease, diabetes, autoimmune disorders, and neurologic conditions. While scientists were busy sorting out the genome’s zip codes, engineers were building on the wireless phone platform to add emails, texting, cameras, multimedia, global positioning, and access to the Internet. Concurrently, the bandwidth of the Internet was quickly expanding, and the ability to rapidly search it was increasing exponentially.The unprecedented transformative impact and uptake of mobile digital devices in the same decade, from the introduction of iPods in late 2001 and Blackberries in2002 to the iPhone and Kindle e-reader in 2007, cumulatively changed the way we listen to music, communicate by text or phone, surf the Web, move from place to place, take pictures, make videos, play, read, and think.
In that same decade the number of discrete mobile phone users increased from five hundred million to over three billion, representing almost half of all people and the vast majority of adults on the planet.4 And they’re now sending over two trillion text messages a year.5 Our ever-increasing computing power is exemplified by unfathomable data storage capacity. Last year we stored enough data to fill 60,000 Libraries of Congresses, and we can now purchase a device for $600 that will store the entire collection of the world’s recorded music.6
The global growth of cameras as a result of being embedded in cell phones has been logarithmic: from a few million in 2000 to well over a billion in a decade.7 Digital cameras can be considered the most widely available sensor since they are incorporated in most mobile phones; as O’Reilly and Battelle pointed out in their “Web Squared” white paper, “Our cameras, our microphones, are becoming the eyes and ears of the web.”8
Even our games have remarkable digitizing capability. In late 2006, the Nintendo Wii came out with wireless accelerometer sensors and infrared to detect an individual’s motion in three dimensions. By 2010,gaming had made major advances, such as Microsoft’s Kinect for recognizing faces and gestures, responding to voice commands, and being able to play the games that display on-screen avatars with body motions instead of needing to use controllers or any button pushers. Five million of these were sold in the first two months of availability.9
When Mark Zuckerberg started Facebook in 2004, how could anyone have predicted there would be over eight hundred million registered users by the end of 2011? Or a projected one billion by2012? Over 25 percent of Internet users are connected through this particular social network—only third in population size compared with the countries of China and India. Over 1.5 trillion messages are now sent per year via Facebook. In 2011 Facebook had substantially overridden Google as the dominant website, with Facebook users looking at 103billion pages and spending an average of 375 minutes per month, compared to Google users viewing 46 billion pages over 231 minutes. More than 40 percent of us are “hyper-connected” as defined by “using 7 different devices and 9 different applications in order to stay as screen connected as possible, in restaurants, from bed, and even in places of worship.”10
These extraordinary accomplishments,from dissecting and defining DNA to creating such pervasive electronic technologies that immediately and intimately connect most individuals around the world, have unwittingly set up a profound digital disruption of medicine. Until now we did not have the digital infrastructure to even contemplate such a sea change in medicine. And until now the digital revolution has barely intersected the medical world. But the emergence of powerful tools to digitize human beings with full support of such infrastructure creates an unparalleled opportunity to inevitably and forever change the face of how health care is delivered.
This really boils down to a story of big convergence: a convergence of all six of the major technologic advances, likely representing the greatest convergence in the history of humankind. When we just had a cell phone, we could only talk to one another, but it could occur on the go. As personal computer hardware developed from a work station to a laptop, we gained mobility, but we were still not connected to one another. The Internet strikingly changed both of these platforms. Nicholas Negroponte wrote in his 1995 book Being Digital, “The information superhighway may be mostly hype today,but it is an understatement about tomorrow. It will exist beyond people’s wildest predictions.”11 Clearly,that was a prescient call. Although the first BlackBerry devices were inadequate cell phones, they were extraordinary at receiving and sending emails. This new capability engendered such addictive behavior that the devices were quickly known as “CrackBerries.” But it took almost five years before the morphed cell phone, powered with emails and texting, faithfully performed its original purpose of making voice calls and also became a wholly functional Web surfing tool.
This transition from a “mail and text”phone to a “smart phone” relied on a much greater Internet bandwidth, broad connectivity via networks such as AT&T, Verizon, and others in the United States,along with appropriate, tailored mobile operating system development. Late in2007, Apple’s introduction of the 3G iPhone was a veritable game changer, and most would even qualify it as a life changer. It was dubbed the “Jesus” phone,and Steve Jobs was later pictured in 2010 on the cover of the Economist as “The Book of Jobs.”12
For the first time, surfing the Web via a cell phone was performed rapidly with ease, enabling many other new found pocket mobile functions such as global positioning and most importantly a sea of applications—downloadable software that runs on mobile devices. By 2011,just for the iPhone there were over 300,000 apps downloaded over 6.5 billion times.13 This was made possible because writing code for the mobile phone had become an open platform. In a way the app era represents a reverse Web surf. Instead of any individual searching the Web, the Web was surfing the population for “worldwide developers,”a new term denoting the search for people to create apps.
Within a matter of months, hundreds of thousands of apps were created that accelerated the capabilities of smart phones in ways most people could not have imagined: from using the phones to determine a bird species by its picture or call, to instantly translating a page in English to Spanish or vice versa, to discerning colors correctly for people who are color-blind, to playing thousands of new games, to accessing or playing music. One can even convert the iPhone to a stethoscope to listen to heart and breath sounds.
The hybridization of the maturing Internet and the mobile phone were the two most vital components of the convergence. As Nicholas Carr aptly wrote, “With the exception of alphabets and number systems, the Net may well be the single most powerful mind-altering technology that has ever come into general use.”14 Just the ability to instantly search virtually anything on the Web, in itself—a peripheral brain—is still awe-inspiring. Nevertheless, it is hard to be intimate with the Internet per se. By contrast, almost 70 percent of individuals sleep with their cell phone. That figure goes up to 90 percent for digital natives, as defined by people under age thirty.15 There are more mobile phones in the world than toothbrushes, and far more than toilets.16
We are preternaturally on the move, a peripatetic culture, and our phones are always with us. Many rank the mobile phone above food, shelter, and water as their most essential possession. The Economist put it simply: “mobile phones have made a bigger difference to the lives of more people, more quickly, than any previous technology.”17 Nature, the leading biomedical peer review journal, pointed out that we will have six billion mobile phones by 2013, with over 85 percent of the world’s population having access to a mobile signal, and that “we’ve really never had a technology other than human observation that is as pervasively deployed in the world.”18 The extraordinarily rapid uptake of phones helps to tell the story. In 2001, it took ninety-one weeks for one million iPods to be sold, a record for digital devices at that time. By 2009, it took only three days for one million iPhone 3GS to be purchased.19 By 2013, it is projected that the number of smart phoneswill surpass personal computers, not counting tablets.20
In 2009 judges at the Wharton School of the University of Pennsylvania were asked what were the biggest innovations, the “life changers,” of the past thirty years. Their response in rank order was: (1) Internet, broadband; (2) PC and laptop; (3) mobile phones; (4) email; and (5) DNA testing and sequencing.21 The smart phone had already captured four of five life changers and, as it continues to evolve, is working its way to incorporating the fifth.
Like a syzygy with alignment of the sun, the moon, and the Earth, we have a propitious convergence of a maturing Internet, ever-increasing bandwidth, near-ubiquitous connectivity, and remarkable miniature pocket computers in the form of mobile phones. And with data storage and processing fortified with cloud computing, under the stars,most of the people on this planet have been quickly and deeply affected in ways few really recognize.
2.Gary Wolf, “The World According to Woz,” Wired (June2009), www.wired.com/wired/archive/6.09/woz_pr.html.
3.Chris Anderson and Michael Wolff, “The Web Is Dead: Long Live the Internet,” Wired(September2010), www.wired.com/magazine/2010/08/ff_webrip/all/1.
4.Clay Shirky, Cognitive Surplus: Creativity and Generosity in a Connected Age (New York: Penguin Press, 2010); “Building with Big Data,” Economist,May 29, 2001, 74.
5.Nicholas Carr, The Shallows: What the Internet Is Doing to Our Brains (New York: Norton,
2010);Bill Keller, “The Twitter Trap,” New York Times Magazine, May 22, 2011, 12.
6.Shirky, Cognitive Surplus.
7.Anderson and Wolff, “The Web Is Dead.”
8.Tim O’Reilly and John Battelle, “Web Squared: Web 2.0 Five Years On,” Web 2.0 Summit,
9.David Pogue, “Kinect Pushes Users into a Sweaty New Dimension,” New York Times, November 4, 2010,www.nytimes.com/2010/11/04/technology/personaltech/04pogue.html; Ashlee Vance, “Microsoft’sPush into Gesture Technology,” New York Times,October 29, 2010, www.nytimes.com/2010/10/30/technology/30chip.html; SusanOrlean, “Connected,” New Yorker (December2010).
10.“Person of the Year 2010: Mark Zuckerberg,” Time (December2010); Richard Stengel, “Only
Connect,”Time (December 2010); Claire Cain Miller, “Another Try by Google to Take on Facebook,” New York Times, June 28, 2011; William Powers, Hamlet’s BlackBerry: A Practical Philosophy for Buildinga Good Life in the Digital Age (New York: Harper, 2010), 32.
11.Nicholas Negroponte, Being Digital (New York: Vintage, 1996), 221.
12.“The Book of Jobs: Hope, Hype, and Apple’s iPad,” Economist,January 30–February 5, 2010.
13.David Pogue, “Apps We Wish We Had,” New York Times,July 14, 2010.
14.Carr, The Shallows, 116.
15.Aaron Smith, Mobile Access 2010, Pew Internet & American Life Project Report, July 2010,
16.R. Kwok, “Personal Technology: Phoning in Data,” Nature458 (2009): 959–61; An and Giridharadas, “Where a Cellphone Is Still Cutting Edge,” New York Times,April 10, 2010, www.nytimes.com/2010/04/11/weekinreview/11giridharadas.html.9780465025503-text_topol9/8/11 10:03 AM Page 253
17.“Mobile Marvels: A Special Report on Telecoms in Emerging Markets,” Economist,September 24, 2009, www.economist.com/node/14483896.
18.Kwok, “Personal Technology.”
19.“Apple Scrambles to Secure iPad Deal,” Wall Street Journal, March 18, 2010, online.wsj.com/
20.Michael Malone and Tom Hayes, “Bye-Bye, PCs and Laptops: Smart Phones and Tablets Will
Soon Handle the Majority of Our Personal Computing Needs,” Wall Street Journal, January 7, 2011, online.wsj.com/article/SB10001424052970204527804576043803826627110.html.
21.Phyllis Korkki, “Internet, Mobile Phones Named Most Important Inventions,” New York Times, March 9, 2009,www.nytimes.com/2009/03/08/business/08count.html.