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What has colon cancer screening got to do with self-driving cars? An excerpt from Scope Forward: The Future of Gastroenterology Is Now in Your Hands.
Over a decade ago, many of us still used landline phones, watched cable TV, rented DVDs, called for taxis, took photos using cameras, and drove over to Borders to browse and buy books. During the past 10 years, we watched each of these fields permanently getting altered. Today, we stream movies on Netflix, call Uber to get somewhere, and we keep buying new phones to take better photos. We can’t think of what not to use Amazon for. It’s true—our life has turned digital. Most of us are so hooked to a device that to disconnect digitally is considered being mindful now.
Whether we realize it or not, we are living in exponential times. We are part of a grander, digital game.
How does a field become digitized? By finding a way to convert itself into zeros and ones, the basic language of computers. When music became digitized, we could more easily transmit a song as zeros and ones through the internet. When photography became digitized, we could convert pixels into zeros and ones. When books became digitized, we could access it via Amazon Kindle, a digital device. Industries and companies failing to recognize that shift are inevitably disrupted.
With $16 billion in annual revenues, Kodak’s leadership position was unquestionable in 1996. Maybe that’s why its executives didn’t see (or didn’t want to see) the wave of digital photography. When photography became digital, it moved from a physical setup of bulky cameras with film rolls to a more virtual environment—a smartphone in your pocket. Moving to digital, photography became cheaper and cheaper to the point where it became virtually free. You could distribute your photos infinitely. Companies like Instagram built apps that made average people take cool photographs. Meanwhile, Kodak went bankrupt in less than 20 years from its peak in mid-1990s.
Stool DNA tests and self-driving cars
Back in 2012, I sat in a very different-looking Lexus—it was one of Google’s early self-driving cars. Wires ran from a laptop to the steering wheel and into the mechanics of the vehicle. A gray-looking device called the LIDAR scanner sat on top of the car. It rotated all the time and scanned the entire environment. The LIDAR served as the eyes of the self-driving car. From what I gathered, it cost $200,000 to convert the Lexus into a self-driving unit. The LIDAR itself cost $75,000. The automotive industry dismissed Google’s effort as a research project. Well, it was one.
The Google Self Driving Car Project started in 2009. A decade later, Google’s self-driving car, called Waymo, is a Chrysler Pacifica minivan. On their website, the company says that they are “building the World’s Most Experienced Driver.” They can make that claim because when one Waymo car drives a mile, the entire Waymo system learns.
We can clearly see that exponential technologies are disrupting cars and phones. So why wouldn’t these technologies find their way into healthcare and gastroenterology?
What do stool tests have to do with self-driving cars? We’ll soon find out. But let’s first go back to the discussion we had earlier on the shift to digital. Screening for cancer through colonoscopy, while a gold standard, reminds me of a field that’s at the crossroads of disruption—much like music or photography was before iTunes or smartphones.
If you consider the argument for a moment, a colonoscopy is largely limited to one doctor and one patient at a time. When a doctor performs a colonoscopy, he or she can’t scale beyond the procedure. With each procedure, the learning happens within the capacity of that one doctor. To put that into context, only a very small percentage of doctors become endoscopists. And an even smaller percentage achieve mastery in endoscopy. Statistically speaking, we are talking of a very few highly qualified individuals who can reliably screen for cancer using sophisticated methods.
Ask yourself what could make the field of cancer screening go digital? Something that can accelerate cancer screening and give control to the nonexperts. I’m sure you might have arrived at DNA testing or artificial intelligence.
Now ask yourself these five questions:
1. Can stool DNA testing be ultimately represented in zeros and ones, the language of computers?
2. iTunes allows musicians to reach millions of people. With DNA testing, is it technically possible to screen millions of people for colon cancer?
3. The more Google’s self-driving car drives, the more it learns as a system. Could it be technically feasible to reduce screening error rates with more screening data?
4. Smartphones made the average user into a photographer. Could a DNA testing kit (backed by a sophisticated lab) simplify screening to a point where the patient has more control?
5. Amazon made it easier for people to buy books. Could DNA testing make cancer screening dramatically more convenient?
By going digital, we would take a physical environment (endoscopy room to detect cancer) and convert it into a virtual, information-enabled, machine-driven environment (DNA testing to detect cancer).
Looking at it differently, the demand for early cancer screening will continue to rise. According to the World Cancer Research Fund, colorectal cancer is the third most commonly occurring cancer in men and the second most in women. It’s an expanding need. By taking advantage of exponential tools, gastroenterologists can screen more patients than they have in the past.
We must find ways to ride and harness this digital wave to scope forward. Not fight or escape it.


Originally published on KevinMD


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