Technology-driven diagnostics: From smart doctor to smartphone

This review explores recent innovations in four seemingly unrelated areas of medical diagnostics, which, when used concurrently, promise to revolutionize the future of medicine. Novel microfluidics and microelectronics, combined with smartphones, allow individuals to test themselves at anytime and anywhere, thus providing instant health information. An emerging development is the availability of genomic testing directly to consumers for assessing disease predisposition. Some organizations have opened diagnostic laboratories in pharmacies and other public outlets, are encouraging consumers to test themselves, and claim that by doing so consumers will be empowered to diagnose the early disease that could be effectively treated or prevented. Another recent development is the initiation of large studies that aim to better understand wellness and disease processes, through the frequent and sometimes continuous monitoring of hundreds or thousands of parameters. These are then analyzed by health coaches who advise participants on follow-up steps to correct the abnormalities and return to wellness. A number of these approaches have now entered the health market and the services can be purchased. It is highly likely that further technological innovations will contribute to the popularity of these approaches among millions of health-conscious consumers. However, the evidence for the effectiveness of these strategies to prevent or detect early disease, or to promote wellness, does not yet exist. We here analyze the perceived benefits and (neglected) harms of these approaches, in an effort to balance the optimism about their utility, until the evidence for their benefit is clearly demonstrated.