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