What Can Health 3.0 Do for Women? Beyond the Current Clichés in Health Tech
By Dana Knight
The topic of women’s health in technology today is full of clichés. Reading the titles of specialist magazines or female-focused talks at tech conferences, you get the impression it’s all about reproductive and sexual health, with various period & fertility trackers, the latest connected devices for pumping breast milk or enhancing your pelvic floor muscles, smart tampons or at home pap smear tests making headlines (1).
But sex differences don’t stop here. Our reproductive organs are not everything that distinguishes us from men and it’s time to delve deeper into other biological differences that may prove a mater of life and death when it comes to women’s health.
Until recently, the medical profession has been operating with a unisex view of the human genome but science has revealed that the chromosomes that stand us apart, XX and XY respectively, make cells work differently in every organ throughout the body, especially when it comes to creating proteins, the building blocks of cells.
Just think of this fun fact: any two males differ by only 0.1 percent at the genetic level, whereas women are sharing only 98.5 percent of their genetic makeup with men. That’s a 15x greater difference, making human males as genetically similar to male chimpanzees as to human females!
“Our genome has somehow evolved to be read in fundamentally two different ways,” says Dr. David C. Page, Director of the Whitehead Institute and a Professor of Biology (2). The first consequence of this scientific insight is that men and women are not created equal when it comes to health and disease.
First off, incidence and severity of disease differs dramatically in men and women: there are four times as many males diagnosed with autism as there are females but about three times as many women than men with the autoimmune disorder rheumatoid arthritis. Of those who suffer from lupus, 90% are women. Thyroid disorders such as Hashimoto’s are also more prevalent in women. And the examples could continue.
While auto-immune diseases don’t pose an immediate threat, there is another silent killer that has been on the rise in women recently: heart disease. This has become the №1 cause of death for women throughout the world, according to WHO (3).
The European Cardiovascular Disease Statistics has similarly worrying statistics: CVD is the main cause of death in men in all but 12 countries of Europe and is the main cause of death in women in all but two countries (4).
Moreover, a study published in JAHA (Journal of the American Heart Association) has found that women are up to three times more likely to die following a serious heart attack than men, as a result of receiving unequal care and treatment (5). This is often due to medical bias that associates heart attacks with overweight middle-aged men who smoke, and also to misdiagnosis, since symptoms of a heart attack are very different in men than women.
While men tend to have a sudden onset of chest pain and severe symptoms, sometimes called a “Hollywood heart attack” because of the typical way heart attacks have been portrayed in movies and television, in women, symptoms can be much more subtle. Chest pain is not always the most prominent symptom or it may be absent altogether. What women usually experience can be described as pressure, tightness or a feeling of “fullness” that can be mistaken for heartburn. They may also experience lightheadedness or dizziness, unusual fatigue, pain in areas of the body that don’t get enough blood supply (usually the left arm, neck, jaw, shoulder, upper back), shortness of breath, coughing or wheezing, breaking into a cold sweat. This is because in women the blockages affect not only the main arteries but also the microcirculation, the smaller arteries that supply blood to the heart, a condition called coronary microvascular disease. Also, women’s symptoms occur more often when women are resting or even when they’re asleep. Or they may have no symptoms at all. These are called silent heart attacks.
With no data to go by and few to no warning signs, how can deaths from heart disease be prevented in women? This is where health 3.0 comes into play. With the use of technology, we now have the extraordinary ability to gather a substantial amount of data about the functioning of our bodies that can warn us of undesirable changes that predispose to disease. When it comes to heart disease, we don’t have to wait for vague symptoms to set in, we can accurately determine individual risk based on genetic and lifestyle factors, and more crucially, we can prevent a heart attack that is about to happen.
Let’s start with data. The future of medicine will rely on combining and integrating multiple layers of information to create what Eric Topol calls “the human GIS” (Geographic Information System), your “medical essence” (6). This will comprise key data about:
- your phenome — all your phenotypic traits: height, weight, eye and skin colour
- your physiome — the collection of your physiologic metrics. These are all crucial for keeping an eye on heart health: heart rate variability, heart rhythm, blood pressure, blood oxygen saturation, respiratory rate, cardiac output & stroke volume, body temperature, galvanic skin response, blood glucose, brain waves, intracranial pressure, etc.
- your anatome — your individual anatomy. Until recently, this could only be revealed with the use of expensive hospital imaging equipment but now, with the emergence of pocket devices that obtain high-resolution ultrasounds or X-rays, one can literally perform the physical exam of one’s heart, lungs, neck vessels and fully review one’s anatomy on a tablet or smartphone
- your genome — data about the 6 billion letters that make up your DNA
- your transcriptome — the unique ways in which your DNA is expressed across your whole genome
- your proteome — the vast array of proteins your body produces, plus protein-protein interactions, autoantibodies
- your metabolome — the compounds resulting from your metabolism at a particular point in time
- your microbiome — the trillion of bacteria, fungi and viruses that live within you, exerting a tremendous influence over your health, including heart health
- your epigenome — the side-chains of your DNA and how it’s packaged
- your exposome — everything that you’re exposed to in your environment: be it radiation, pesticides in food, water contaminants, air pollution, pollen count. This has a profound impact on your medical essence.
Being able to to enjoy truly personalised medicine relies on integrating all the detailed data from this multi-layered health system. Thanks to AI-driven smart algorithms, the non-invasive biosensors in our wearables that capture our physiologic data on a smartphone will alert us in real time when we need to start taking better care of ourselves, what lifestyle changes to adopt, or when it’s time for an in-depth health check-up. Individuals who are at risk for a specific health issue will benefit from nanochips and embedded sensors in the blood that can monitor all kinds of things from the appearance of tumour DNA to picking up genomic signals that could alert one of a forthcoming heart attack or stroke.
If all this extensive health data collection and self-monitoring feels like too much or if you’re wondering whether it’s feasible at all, there are already people out there doing it and setting the trend. And some of them are women, such as Kim Goodsell, known as “the patient of the future”. A formerly world-ranked Iron Man triathlete and enthusiastic kite surfer, she started getting episodes of irregular heartbeat in her thirties. As years passed these became increasingly common and her fine motor skills were disappearing. 18 years ago she collapsed and was resuscitated. After an extensive workup, doctors told her she suffered from a very rare heart condition called arrhythmogenic right ventricular dysplasia (ARVD) for which she had an internal defibrillator implanted in her heart that could detect serious arrhythmias and would deliver an internal shock to restore her heart rhythm to normal. The shock was extremely traumatic and Kim was subjected to it repeatedly, but at the same time she continued to lead a very dynamic lifestyle. After a while, she started developing muscle weakness and many new neurologic symptoms to the extent that she couldn’t hold an utensil to eat anymore. This led to another diagnosis: Charcot-Marie-Tooth (CMT), Type 2, another rare disease.
Since Kim had no family history of either ARVD or CMT, she started wondering why she developed two rare diseases. Unwilling to accept her doctors’ explanation that she had very bad luck, she started a two-year search to find out the root cause of her illness. She discovered she had a rare mutation of a gene called LMNA that tied both her health problems together (7). Knowing the biologic pathway involved in this mutation led her to change her diet: she eliminated processed foods that contain excitotoxins (free glutamates), gluten and solanine (a natural toxin found in nightshades like peppers, tomatoes, and eggplant, which she previously loved to eat) and the dietary changes alleviated her symptoms.
Like Kim who was very eager to learn about herself, the patient of the future will take charge of their own health by monitoring what goes on in their body and being ready to act when prompted. However, this doesn’t mean frantically and fanatically monitoring every health parameter possible.
Going back to the worrying rise in heart disease among women, there are already medical-grade portable connected devices on the market for personal use that can help detect problems before it’s too late. One of these is AliveCor, an FDA-approved device that allows you to do an ECG at home. In 30 seconds, it analyses your data and reports any abnormalities such as atrial fibrillation — a leading cause of stroke that can be prevented most of the time if detected and treated in time. You can request your ECG to be remotely interpreted by ECG experts for a small price. Using this device, people who had been dismissed by their doctors with the explanation that their palpitations were caused by anxiety, were able to demonstrate that they have serious heart problems. Over 15 peer-reviewed papers show that this is not a gadget but a medical device that is available over the counter (8).
And the future of medicine will offer a wealth of such devices, most of them tracking physiological parameters pertaining to issues other than what the media got us used to labelling as “women’s health”. Don’t fall into the trap of thinking that HRV tracking is for men (because they are the most prone to heart disease) and hormone tracking is for women (since reproduction is their job). This would be oversimplifying things, and as far as the media are concerned, misleading the public. Societal roles are changing fast and with more women than ever in highly stressful executive positions, it is no wonder that illnesses traditionally associated with “middle-aged men who smoke” are now becoming more prevalent in women.
- Alabas O. A., Gale, C. P., Hall, M., Rutherford, M. J., Szummer, K., Lawesson, S. S., Jernberg, T. (2017). Sex Differences in Treatments, Relative Survival, and Excess Mortality Following Acute Myocardial Infarction: National Cohort Study Using the SWEDEHEART Registry. Journal of the American Heart Association, 6(12). doi:10.1161/jaha.117.007123
- Topol, E. (2015) The Patient Will See You Now, Basic Books, New York
- Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study (https://www.ncbi.nlm.nih.gov/pubmed/28851729)