Future Medicine
[Music]
[Applause]
as a small child i was lucky to be at
the launch of apollo 17
the last manned mission to the moon and
i’ve remained enamored with space ever
since
and fortunate as a physician to have
contributed to national life sciences
research
and to practice aerospace medicine
inspired by the cross-disciplinary
teamwork required to tackle audacious
challenges
and how spaces often brought the world
together through the lens of seeing our
planet as one without borders
now just as the historic apollo moon
landings were transformational
inflection points in history
so too is the global health crisis of
covenant 19
which despite its many challenges and
tragedies
like the sinister cold war setting which
launched the space race
can have silver linings as regina dugan
former head of darpa wrote sputnik set
off the space age
covet can spark the health age the silva
linings include
the unprecedented acceleration of
innovation collaboration and discovery
catalyzing a future of health and
medicine that can help us reimagine
and bring us a healthier smarter more
equitable postcoded world
now many solutions ride the rails of
rapidly or exponentially developing
technologies
that are rapidly doubling in their speed
price performance as exemplified by
moore’s law
which has enabled the billion-fold
improvements in memory and computation
resulting in the ubiquitous
supercomputer smartphones
most of us carry in our pockets i still
have my now ancient iphone 2 here
still works which felt magical 12 years
ago but now feels slow and clutchy
i’m sure my iphone 11 will soon seem
antique perhaps as its features dissolve
into the rumor to soon arrive
augmented reality smart classes now
exponential technologies
packed into our smart devices are
becoming increasingly medicalized their
sensors able to detect an ear infection
and more so what used to fit on a
desktop computer now fits on our wrist
and these are now entering the domain of
fda approved medical devices
but the future isn’t about any one
technology but their conversions as they
get faster
cheaper better in fact creating entire
new fields at their interfaces
from computational biology robotic
surgery to geoceuticals
telemedicine to ai enabled radiology
and while many industries have been
disrupted and reached the fourth
industrial age
health and medicine often feels stuck in
the second
or third critical data is still
stuck being shared on fax machines paper
forms
we’re stuck in waiting rooms waiting for
our visits
i recently had my own echocardiogram
only made available to share with me on
a cd-rom
i don’t even own the cd-rom player
anymore
tools for managing pandemics of 2020
rely on the same core technologies
used in the pandemic of 1918 face masks
social distancing hand washing so part
of the challenge in advancing global
local health
are our models and our mindsets we don’t
really practice
health care we practice sick care sick
care is based on
intermittent episodic data usually only
obtained within the four walls of the
clinic
or hospital bed and leads to our
reactive
sick care model where we wait for the
patient to show up in the emergency room
with a heart attack
stroke or late stage cancer or for the
pandemic to arrive on our shores
i believe the convergence of many of the
accelerating technologies and approaches
being catalyzed by covet
will bring us from intermittent sick
care to an age of continuous
proactive personalized crowdsourced
healthcare
that can increasingly bring care anytime
anywhere
more effectively and lower costs around
the planet
for example the convergence of ever
smaller interconnected devices
now riding 5g is creating not just an
internet of things but an internet of
medical things
much of this convergence is in the field
of digital health the ability
to connect the dots between data sources
for personal genomics and medical
records
with apps and services that match the
needs of an individual
patient or caregiver and as incentives
and reimbursements align
covert has pushed us to an increasingly
virtualized care
from the hospital to home to our phone
to on and even
inside our bodies the age of hospital to
hospital is upon us
now the challenge of this
hyper-connected age is that we’re
creating exponential amounts of big data
that’s too often
siloed in formats that can’t even talk
to each other
so we need to narrow that gap between
data
turning that into actionable information
for the patient physician
public health worker and speed at safe
and effective use
in the community clinic and bedside the
pandemic has instigated an immense
amount of international sharing and
collaboration amongst clinicians and
researchers
to narrow that gap what was learned in
managing patients in wuhan
and then in the intensive care units of
in italy have helped new york city
hospitals and their learning since
in turn and spread to centers around the
world
let’s take a quick dive into some
examples of what’s happening across the
healthcare
paradigm in the age of covid and their
implications
for the future from new forms of data to
prediction and prevention
to faster diagnostics more tailored
therapy
and increasingly crowd-sourced discovery
let’s start with prevention you know
while our genomes impact our health
outcomes and our health spans
our social determinants of health our
socio and our day-to-day behaviors
drive most of our risk for disease and
associated costs
and we now have an explosion of new
tools to help measure and improve our
healthy behaviors
the first fitbit only launched in 2009
wearables are now ubiquitous and can
measure almost every element of our
physiology
behavior and even mental health and
they’re evolving all the way from
disposable tattoos that can stream vital
signs
24 7 to an integration of
big data that can even be small data
from a simple wearable tracking a
patient discharged home after hip
replacement
or a coronavis infection can determine
if
the patient’s recovering as expected
walking more doing great
or not so great and trigger early
intervention
we’re evolving from a world of quantify
itself where our
digital data remains silent on our
devices to one of quantified health
where the data can be shared securely
with clinical teams and researchers to
help optimize prevention
diagnose disease early and with feedback
loops personalized
and optimized therapy from wristband
vitals including blood pressure now
obtainable without a cuff
and soon sensors that will measure our
blood oxygenation levels to continuous
blood sugar monitoring
to shockables hearables ringables that
can
replace an entire sleep lab fitting on
our finger to incitables chips beneath
our skin to track our physiology and lab
values
to even under wearables internet of
medical things sensors so
cheap today you can get a pack of 10 of
them have one in each band of your
underwear
now being used to do what’s called
remote patient monitoring
to help detect signs of respiratory
decompensation in patients
with bronchitis or coping
breathables are showing promise nano
noses that can detect molecules in our
breath
correlating to cancer metabolic disease
and even diagnosing
infectious disease in fact we now don’t
need to wear
anything invisibles ambient sensing from
ai enabled cameras can
track our vital signs to voices of
biomarker
to manage and detect mental health
challenges signs of heart disease
now being able to differentiate between
a cough from a common cold
to that one caused by coronavirus
and we’ll soon be exuding our digital
exhaust 24 7
our digitone how can we make sense and
truly leverage it
one path is through crowdsourcing the
million participant
all of us trial from the national
institutes of health is doing just that
where data donors and i’m one
can contribute our medical records
genomes and wearable data
to build a much better and diverse data
set crossing racial and socioeconomic
groups
to help foster better precision medicine
for all of us
integrating this information for the
individual in public health will lead to
predictalytics
our own personal check engine lights
that can give us
early proactive warning and recent work
is demonstrating that
wearables can detect pre-symptomatically
the onset of the flu
or as recently published by stanford in
eighty-three percent of clover patients
smart watchers can detect coveted
infections early often days before onset
of symptoms
self-reporting websites like covet near
you enable us to locally generate
infections maps
and combined with our social graphs and
contact tracing apps
may provide us detailed suggestions
about who we might want to consider
being near
or socially distanced from what about
advancements in diagnostics and
monitoring
what used to require a full clinic or
laboratory can now fit into a digital
doctor’s bag
or the pocket of a patient from covered
quarantine kits
enabling tracking of oxygen saturation
temperature
and lung sounds we’re starting to
integrate these into virtual visits
providing real-time enhancements of a
virtual physical exam
and the diagnostic tools are becoming
increasingly infused with
ai machine learning including consumer
ultrasounds which can bring diagnostics
anywhere at very low cost including the
ability to evaluate the lungs
in suspected covalent patients the
laboratory
has shrunk to microfluidic platforms
that can be attached to our smartphones
and enable anyone to obtain measurements
from blood or saliva
many of these diagnostics are leveraging
the smartphone and its camera for
a medical selfie for example instead of
taking your urine to the lab to diagnose
a
potential urinary tract infection in the
privacy of your home simply
dip the urine dipstick take a picture
with your smartphone camera
and have the results made available
immediately to your doctor and pharmacy
similar phone-based apps and approaches
are being used and developed for fast
frequent cheap and easy coveted testing
novel approaches to community level
diagnostics are also being explored
including next-gen sequencing of sewage
for early detection of cobit 19
identifying hot spots and predicted
outbreaks
a week or more early
the explosion of data sources however is
really beyond the capacity of the human
mind to effectively integrate
we’re now getting help from ai or as i
call it ia
intelligence augmentation ia is being
leveraged in reading ct scans to
diagnose covid
to enhancing the vision of a
gastroenterologist performing a
colonoscopy
to identify lesions they might have
missed and ai is playing an active role
in helping identify and develop
new antivirals and while a.i is often
perceived as a threat by some clinicians
it can’t replace the human touch or
empathy i don’t think
doctors or nurses will be replaced by ai
but doctors in healthcare systems who
work collaboratively with ai
in the future will be replacing those
who don’t
finally therapy the pandemic has
dramatically accelerated the use of
virtual visits telemedicine business
drop on the order of a thousand percent
in many settings and i don’t think we’ll
ever
revert to pre-covered levels as patients
and clinicians are discovering
the compelling convenience and efficacy
even before virtual zoom or face time
with the clinician
asynchronous screening and support is
being provided by ever smarter chatbots
that can help discern symptoms and help
triage problems effectively at lower
cost
this includes virtualization and virtual
augmentation to meet our mental health
crisis
exacerbated by the many economic and
other stressors which accompany this
pandemic
3d printing is finding a role in
healthcare with newfound applications
from
printing personal masks to critical
parts of ventilators
and being leveraged by the growing maker
movement which is playing a major role
in pandemic response from making
face shields and masks to improvising
do-it-yourself ventilators
all together these efforts are enabling
the potential for democratization of
health
and medicine across the planet and
access to information and care that was
previously inaccessible
clinical trials are being reshaped
leveraging smart devices
cloud-based analytic platforms and
collaborators around the world
it’s at this convergence of many rapid
developing
and exponential technologies that we
have the real potential
to reshape and scale healthcare in our
pandemic age
one where we can dramatically expand
access to basic healthcare
increasingly personalized and proactive
leveraging the scale of digital
platforms and technologies
enhancing digital connection and empathy
and the ability to blend virtual and
in-person care
and leveraging the power of the crowd to
share and build better maps that guide
our
individual health and public health
journeys and develop
validated and scaled solutions
so imagine a new generation of
volunteers a global health corps
similar to the volunteer paramedics and
firemen of today
that can be upskilled and use the
powerful new tools
to respond early and collectively to
enhance
contact tracing isolation and quarantine
and to help
identify and address social and other
disparities
so coming full circle 24 years after i
was at the launch of apollo 17
i found myself as a medical student on a
research clerkship
at johnson space center and much to my
surprise one day in the clinic i ran
right into gene cernan the apollo 17
commander
and the last man to walk on the moon
after enthusiastically sharing my
childhood memories of his launch
he shared one of his famous lines i
walked on the moon
what can’t you do indeed what can’t
we do if we work together as one in the
face of this pandemic
and just as the near tragedy of apollo
13
rallied nasa to work creatively and
collectively
so too can this in our pandemic age
lead to our finest hour and bring on a
true health age
i believe this is possible if we all get
out of our linear mindsets
take exponential steps and
collaboratively
go forth collectively not only to solve
the challenges of this pandemic
and predict the future of health and
medicine but boldly
to go forth together to accelerate a far
better one
for everyone on spaceship earth
[Music]
thanks
you