Medicines future Theres an app for that Daniel Kraft
a couple of years ago when I was
attending the TED conference in Long
Beach I met Harriet now we’d actually
met online before you know not the way
you’re thinking we were actually
introduced because we both knew Linda av
one of the founders of the first online
personal genomic companies and because
we shared our genetic information with
Linda she could see that Harriet and I
shared a very rare type of mitochondrial
DNA haplotype K 1 a 1 B 1 a which meant
that we were distantly related we
actually shared the same genealogy with
Ozzie the iceman so Ozzie Harriet and me
and being the current day of course we
start our own Facebook group you’re all
welcome to join and when I met Harriet
and person the next year at the TED
conference she’d gone online and ordered
our own happy haplotype t-shirts
now why am I telling you this story what
does this have to do with the future of
health well the way I met Harriet is
actually an example of how leveraging
cross-disciplinary exponentially growing
technologies is affecting our future of
health and wellness from low cost gene
analysis to the ability to do powerful
bioinformatics to the connection of the
internet and social networking what I
like to talk about today is
understanding these exponential
technologies you know we often think
linearly but if you think about it if
you have a lily pad and it just divided
every single day 2 4 8 16 15 days of
32,000 what do you think you have in a
month or at a billion so if we start to
think exponentially we can see how this
is starting to affect all the
technologies around us and many of these
technologies speaking as a physician and
innovator we can really start to
leverage to impact the future of our own
health and of healthcare and to address
many of the major challenges that we
have in healthcare today ranging from
the really exponential costs to the
aging population the way we really don’t
use information very well today the
fragmentation of care and often the very
difficult course of adoption of
innovation and one of the major things
we can do we’ve talked a bit about here
today is moving the curve to the left we
spend most of our money on the last 20%
of life what if we get spend and
incentivize physicians and healthcare
system in our own self to move the curve
to left improve our health leveraging
technology as well
now my favorite technology example of
exponential technology we all have in
our pocket so if you just think about it
these are really dramatically improving
I mean this is the iPhone 4
imagine what the iPhone 8 will be able
to do now I’ve gained some insight into
this I’ve been the track chair for the
medicine portion of a new institution
called singularity University based in
Silicon Valley and we bring together
each summer about 100 very talented
students from around the world and we
look at these exponential technologies
from medicine biotech artificial
intelligence robotics nanotechnology
space and address how could cross train
and leverage these to impact major unmet
goals we also have seven-day executive
programs and coming up next month is
actually future mat a program to help
cross train and leverage technologies
into medicine now I mentioned the phone
these mobile phones have over I think
20,000 different mobile apps available
to the point where there’s one out of
the UK where you can pee in a little
chip connect it to your iPhone and check
yourself for an STD and
I try that yet but that’s available
there other sorts of applications
merging your phone and diagnostics for
example measuring your blood glucose on
your iPhone and sending that Prudential
e to your physician so they can better
understand and you can better understand
your blood sugars as a diabetic so let’s
see now how exponential technologies are
taking healthcare let’s start with
faster well it’s no secret that
computers through Moore’s law are
speeding up faster and faster we have
the ability to do more powerful things
with them they’re really approaching in
many cases surpassing the ability of the
human mind but what I think
computational speed is most applicable
is that of imaging the ability now to
look inside the body in real time with
very high resolution is really becoming
incredible we’re layering multiple
technologies PET scan CT scans and
molecular diagnostics to find and seek
things at different levels here you’re
going to see the very highest resolution
MRI scan done to date reconstructed of
Bartho - the curator of TEDMED and now
we can see inside of the brain at a
resolution and ability that was never
before available and essentially learn
how to reconstruct and maybe even
re-engineer or backwards engineer the
brain so we can better understand
pathology disease and therapy we can
look at side with real-time fMRI in the
brain at real-time and by understanding
these sorts of processes in these
connections we’re going to understand
the effects of medication or meditation
and better personalize and make
effective for example psychoactive drugs
the scanners for these are getting
smaller and less expensive and more
portable and this sort of data explosion
available from these is really almost
becoming a challenge the scan of today
takes up about 800 books or 20 gigabytes
the scan of just in a couple years will
be one terabyte or 800,000 books how do
we leverage the information let’s get
personal I won’t ask you here’s how to
colonoscopy but if you’re over age 50
it’s time for your screening colonoscopy
how would you like to avoid the pointy
end of the stick well now there’s
essentially virtual colonoscopy compare
those two pictures and now as the
radiologist you can Sochi fly through
your patients calling and augmenting
that with artificial intelligence
identify potential as you see here a
lesion that we might have missed it but
using AI on top of radiology we can find
lesions that were missed before and
maybe this will encourage people to get
colonoscopies that wouldn’t have
otherwise and this is an example this
paradigm shift we’re moving to this
integration of biomedicine information
technology wireless and I would say
mobile now
this era of digital medicine so even my
stethoscope is now digital and of course
there’s an app for that we’re moving
obviously to the era of the tricorder
so the handheld ultrasound is facially
surpassing and supplanting the
stethoscope these are now at a price
point of what used to be a hundred
thousand euros or a couple hundred
thousand dollars for about five thousand
dollars I can have the power with very
powerful diagnostic device in my hand
and merging this now with the advent of
electronic medical records in the United
States we’re still less than 20%
electronic here in the Netherlands I
think it’s more than 80% but now that
we’re switching to merging medical data
making it available electronically we
can crowdsource that information and now
as a physician I can access my patients
data from wherever I am just through my
mobile device
and now of course we’re in the era of
the iPad even the iPad 2 and just last
month the first fda-approved application
was approved to allow radiologists to do
actual reading on these sorts of devices
so certainly the physicians of the day
including myself are completely reliable
on these devices and as you saw just
about a month ago Watson from IBM beat
the two champions in jeopardy so I want
you to imagine we’re in a couple years
we start to apply this cloud-based
information well we really have the AI
physician and leverage our own brains
and connectivity to make decisions and
diagnostics at a level never done RT
today you don’t need to go to visit your
physician in many cases only about 20%
of actual visits you need to lay hands
on the patient we’re now in the era of
virtual visits from sort of the Skype
type visits you can do with American
well to Cisco that’s developed a very
complex health presence system the
ability to interact with your healthcare
provider is different and these are on
being augmented even by our devices
again today here my friend Jessica sent
me a picture of her head laceration so I
can save her a trip to the emergency
room I can do some Diagnostics in that
way or might we be able to leverage
today’s gaming technology like the
Microsoft Kinect and hack that to enable
let’s say Diagnostics for example in
diagnosing stroke using simple motion
detection using $100 devices we can
actually now visit our patients
robotically this is the rp7 if I’m a
hematologist visit another clinic for
visit a hospital these are being
augmented by a whole suite of tools
actually in the home now
so imagine we already have wireless
scales you can step on the scale you can
tweet your way to your friends and they
can keep you in line we out wireless
blood pressure cuffs a whole gamut of
these technologies are being put
together so instead of wearing these
glue G devices we can put on a simple
this is developed by colleagues at
Stanford called the eye rhythm
completely supplants the prior
technology and a much lower price point
with much more effective ‘ti now we’re
also in the ear today of quantified self
consumers now can buy basically
hundred-dollar devices like this little
Fitbit I can measure my steps my caloric
outtake I can get insight to that on a
daily basis I can share that with my
friends with my physician
there’s watches coming now that I’ll
measure your heart rate Zeo sleep
monitors all suite of tools that can
able get a leverage and have insight
into your own health and if we start to
integrate this information we’re going
to know better what to do with it and
how better to have insight into our own
pathologies health and wellness
there’s even mirrors today I can pick up
your pulse rate and I would argue in the
future we’ll have wearable devices in
our clothes modern in ourselves 24/7 and
just like we have the OnStar system in
cars your red light might go on and once
a check engine light it’s going to be
check your body light and go in and get
and take care of and probably in a few
years we’ll check in to your mirror and
it’s going to be diagnosing you okay for
those of you with with kiddos at home
how would you like to have the the
wireless diaper that sir supports here
too much information I think that you
might need but it’s it’s gonna be here
now we’ve heard a lot today about
technology and connection and I think
actually some of these technologies will
enable us to be more connected with our
patients and take more time and actually
do the important human touch elements of
Medicine as augmented by these sorts of
technologies now we talk about
augmenting the patient to some degree
how about augmenting the physician we’re
now near super labeling the surgeon who
can now go inside the body and do things
with robotic surgery which is here today
at a level that was not really possible
even five years ago and now this has
been automated further layers of
technology like augmented reality so the
surgeon can see inside the patient
through their lens where the tumor is
where the blood vessels are this can be
integrated with decision support a
surgeon in New York and be helping a
surgeon in Amsterdam for example and
we’re entering era a really truly
scarless surgery called notes where the
endoscope robotic endoscope can come out
the stomach and pull out that
gallbladder all on a scarless wedding
and robotically and this is called notes
and this is coming basically scarless
surgery is mediated by robotic surgery
now how about controlling other elements
for those who have disabilities
the paraplegic there’s the ear of brain
computer interface or BCI where chips
have been put on the motor cortex of
completely quadriplegic patients and
they can control a cursor or a
wheelchair or initially a robotic arm
and these devices are getting smaller
and going into more and more of these
patients still in clinical trials but
imagine when we can connect these for
example to the amazing bionic limb such
as those of the DECA arm
built by Dean Kaman and colleagues which
has 17 degrees of motion and freedom and
can allow the person who’s lost a limb
to have much higher levels of dexterity
or control than they’ve had in the past
so we’re really entering the era of
wearable robotics actually if you
haven’t lost a limb you’ve had a stroke
for example you can wear these augmented
lambs or if you’re a paraplegic like I
visited the folks at Brooklyn bionics
they’ve developed a legs I took this
video last week here’s a paraplegic
patient actually walking by strapping on
these exoskeletons these otherwise
complete world’s you’re bound and now
this is the early era of wearable
robotics and I think by leveraging these
sorts of technologies we’re going to
change the definition of disability to
in some cases be super ability or super
enabling this is Aimee Mullins who lost
her lower limbs as a young child and
Hugh her who is a professor at MIT who
lost his limbs in a climbing accident
and now both of these can climb better
move faster swim differently with their
prosthetics than us normal abled persons
now how about other Exponential’s
consider the obesity trend is
exponentially going in the wrong
direction including with huge costs but
the trend in medicine actually is to get
exponentially smaller so a few examples
we’re now in the era of Fantastic Voyage
the eye pill you can swallow this
completely integrated device it can take
pictures of your GI system help diagnose
and treat as it moves through your GI
tract we need to even smaller micro
robots that will eventually autonomously
move through your system again and be
able to do things that surgeons can’t do
in much less invasive manner sometimes
it might have self-assemble in your GI
system and be augmented that reality on
the cardiac side pacemakers are getting
small are much easier to place so you
don’t need to train an interventional
cardiologist to place them and they’re
going to be wirelessly to limit it again
to your mobile devices so you can go
places and be monitored remotely these
are shrinking even further here’s one
that’s in prototyping by Medtronic
that’s smaller than a penny artificial
retinas the ability to put these arrays
on the back of the eyeball and allow the
blind to see again in early trials but
moving into the future these are going
to be gained changing or for those of us
who are sighted how about having the
assisted living contact lens Bluetooth
Wi-Fi available beams back images to
your eye now if you have trouble
maintaining your diet it might help to
have some extra imagery to remind you
how many calories are going to be coming
at you
how about enabling the pathologist to
use their cellphone again to see at a
microscopic level and tell ember that
data back to the cloud and make better
diagnostics in fact the whole era of
laboratory medicine is completely
changing we can now leveraging micro
fluidics like this chip made by Steve
quake at Stanford micro fluidics can
replace an entire lab of technicians and
put it on a chip enable thousands of
tests to be done at the point-of-care
anywhere in the world and this is really
going to leverage technology to the
rural and the underserved and unable
what used to be thousand-dollar tests to
be done at pennies and at the
point-of-care if we go down the small
pathway a little bit further we’re
learning the era of nano medicine the
ability to make devices super small to
the point where we can design red blood
cells or micro robots that will monitor
our blood system or immune system or
even those that might even clear out the
class from our arteries now how about
exponentially cheaper not something we
usually think about in the era of
medicine
that hard just used to be $3,400 for 10
megabytes expletive cheaper in genomics
now the genome cost about a billion
dollars about ten years ago when the
first one came out we’re now approaching
essentially a thousand dollar genome
probably next year in two years about a
hundred dollar genome what are we going
to do with hundred dollar genomes and
soon we’ll have millions of these tests
available and that’s when it gets
interesting when we start to crowdsource
that information and we enter the era of
true personalized medicine the right
drug for the right person at the right
time instead of what we’re doing today
which is essentially the same drug for
everybody so two blockbuster drug
medications many cases which don’t work
for you the individual and many many
different companies are working on on
leveraging these approaches and I’ll
just show you a simple example from 20
through me again
my data indicates that I’ve got by
average risk for developing macular
degeneration two kind of blindness but
if I take that same data upload it to
decode me I can look at my risk for
example type 2 diabetes I’m at almost
twice the risk for type 2 diabetes I
might want to watch how much dessert I
have the lunch break for example it
might change my behavior leveraging my
knowledge of my pharmacogenetics how my
genes modulate what my drugs do and what
doses I need are going to become
increasingly important and what’s in the
hands of the individual and the patient
will make better drug dosing and
selection available so again it’s not
just genes it’s multiple details our
habits our environmental exposures when
was the last time your physician asked
you where you’ve lived
geo medicine where you live what you’ve
been exposed to can dramatically affect
your health we can capture that
information so genomics proteomics the
environment all this data streaming at
us individually and as us as poor
physicians how do we manage it well
we’re now entering the era of systems
medicine or systems biology where we can
start to integrate all this information
and by looking at the patterns for
example in our blood of 10,000
biomarkers at a single test we can start
to look with these little patterns and
detect disease in a much earlier stage
and this is being called by Li hood the
father of the fear of p4 medicine we’re
going to be predictive we’re going to
know what you’re likely to have we can
be preventive that prevention can be
personalized and more importantly it’s
going to become increasingly
participatory through websites like
patients like me or managing your data
on a Microsoft Health fault or a Google
health leveraging this together in
participatory ways is going to become
increasingly important so I’ll finish up
with exponentially better we’d like to
get therapies better and more effective
now today we treat high blood pressure
mostly with pills what if we take a new
device and knock out the nerve vessels
that
me delayed blood pressure and a single
therapy basically cure hypertension this
is a new device that essentially is
doing that that should be on the market
within a year or two how about more
targeted therapies for cancer right I’m
an oncologist and I know today most of
what we give is essentially poison we’ve
learned at Stanford and other places
that we can discover it cancer stem
cells so once it seemed to be really
responsible for disease relapse so if
you think of cancer as a weed we often
can whack the weed away it seems to
shrink it often comes back so we’re
tacking the wrong target the cancer stem
cells remain and the tumor can return
months or years later we’re now learning
to identify the cancer stem cells and
identify those as targets and go for the
long term cure and we’re ending the era
of personalized oncology the ability to
leverage all this data together analyze
the tumor and come up with a real
specific cocktail for the individual
patient now I’ll close with regenerative
medicine so I’ve studied a lot about
stem cells embryonic stem cells are
particularly powerful we also have adult
stem cells throughout our body we use
those in my field of bone marrow
transplantation
Geron just last year start of the first
trial using human embryonic stem cells
to treat spinal cord injuries still a
phase one trial but evolving we’ve been
actually using adult stem cells now in
clinical trials for about 15 years to
approach a whole range of topics
particularly in treating cardiovascular
disease if we take our own bone marrow
cells and treat a patient with a heart
attack
we can see much improved heart function
and actually better survival using our
own bone marrow drive cells after a
heart attack I invented a bicycle the
marrow miner a much less invasive way
for harvesting bone marrow it’s now been
FDA approved and will hopefully be on
the market in the next year so hopefully
you can appreciate the device that are
curving through the patient’s body and
removing the bone marrow instead of with
200 punctures which is a single puncture
under local anesthesia but where stem
cell therapy really going if you think
about it every cell in your body has the
same DNA as you had when you were an
embryo we can have reprogram your skin
cells to actually act like a pluripotent
embryonic stem cell and utilize those
potentially to treat multiple organs in
that same patient making your own
personalized stem cell lines and I think
there’ll be a new era of your own stem
cell banking to you know have in the
freezer your own cardiac cells myocytes
neural cells to use them in the future
should you need them
and we’re integrating this now with a
whole year of cellular engineering and
integrating exponential technologies for
essentially 3d organ printing replacing
the ink with cells and essentially
building and
reconstructing a 3d organ that’s where
things are going to head still very
early days but I think as integration of
exponential technologies this is the
example so enclosed as you think about
technology turns on how to impact health
and medicine we’re entering an era of
miniaturization decentralization and
personalization and I think by pulling
these things together we can start to
think about how to understand and
leverage these we’re going to empower
the patient enable the doctor enhance
wellness and begin to cure the well
before they get sick because I know as a
doctor if someone comes to me with stage
one disease I’m thrilled we can often
cure them but often is too late and it’s
stage three or four cancer for example
so by leveraging these technologies
together I think we’ll enter a new era
that I like to call stage zero medicine
and as a cancer doctor I’m looking
forward to being out of a job thanks
very much