0:00:00.738,0:00:02.952 I have a tendency to assume the worst, 0:00:03.757,0:00:06.620 and once in a while,[br]this habit plays tricks on me. 0:00:06.644,0:00:09.925 For example, if I feel[br]unexpected pain in my body 0:00:09.949,0:00:13.456 that I have not experienced before[br]and that I cannot attribute, 0:00:13.480,0:00:18.000 then all of a sudden, my mind[br]might turn a tense back into heart disease 0:00:18.024,0:00:20.920 or calf muscle pain[br]into deep vein thrombosis. 0:00:21.699,0:00:25.217 But so far, I haven't been diagnosed[br]with any deadly or incurable disease. 0:00:25.241,0:00:27.653 Sometimes things just hurt[br]for no clear reason. 0:00:29.098,0:00:31.318 But not everyone is as lucky as me. 0:00:31.970,0:00:35.215 Every year, more than[br]50 million people die worldwide. 0:00:36.287,0:00:39.820 Especially in high-income[br]economies like ours, 0:00:39.844,0:00:44.599 a large fraction of deaths is caused[br]by slowly progressing diseases: 0:00:44.623,0:00:48.931 heart disease, chronic lung disease,[br]cancer, Alzheimer's, diabetes, 0:00:48.955,0:00:50.325 just to name a few. 0:00:51.300,0:00:55.804 Now, humanity has made tremendous progress[br]in diagnosing and treating many of these. 0:00:56.859,0:01:00.060 But we are at a stage[br]where further advancement in health 0:01:00.084,0:01:03.374 cannot be achieved only[br]by developing new treatments. 0:01:03.398,0:01:05.798 And this becomes evident[br]when we look at one aspect 0:01:05.822,0:01:08.188 that many of these[br]diseases have in common: 0:01:09.418,0:01:12.246 the probability for successful treatment 0:01:12.270,0:01:14.912 strongly depends on[br]when treatment is started. 0:01:15.370,0:01:18.814 But a disease is typically only detected[br]once symptoms occur. 0:01:19.632,0:01:24.025 The problem here is that, in fact,[br]many diseases can remain asymptomatic, 0:01:24.049,0:01:26.902 hence undetected,[br]for a long period of time. 0:01:27.902,0:01:31.803 Because of this, there is[br]a persisting need for new ways 0:01:31.827,0:01:33.775 of detecting disease at early stage, 0:01:33.799,0:01:35.937 way before any symptoms occur. 0:01:37.135,0:01:39.411 In health care, this is called screening. 0:01:39.435,0:01:42.600 And as defined by[br]the World Health Organization, 0:01:42.624,0:01:48.282 screening is "the presumptive[br]identification of unrecognized disease 0:01:48.306,0:01:50.867 in an apparently healthy person, 0:01:50.891,0:01:54.680 by means of tests ... that can be applied[br]rapidly and easily ..." 0:01:55.429,0:01:57.618 That's a long definition,[br]so let me repeat it: 0:01:58.237,0:02:01.722 identification of unrecognized disease 0:02:01.746,0:02:04.230 in an apparently healthy person 0:02:04.254,0:02:08.268 by means of tests that can be applied[br]both rapidly and easily. 0:02:08.292,0:02:11.671 And I want to put special emphasis[br]on the words "rapidly" and "easily" 0:02:11.695,0:02:13.945 because many of the existing[br]screening methods 0:02:13.969,0:02:15.628 are exactly the opposite. 0:02:16.189,0:02:18.888 And those of you[br]who have undergone colonoscopy 0:02:18.912,0:02:22.111 as part of a screening program[br]for colorectal cancer 0:02:22.135,0:02:23.482 will know what I mean. 0:02:25.209,0:02:28.285 Obviously, there's a variety[br]of medical tools available 0:02:28.309,0:02:29.838 to perform screening tests. 0:02:30.298,0:02:33.984 This ranges from imaging techniques[br]such as radiography 0:02:34.008,0:02:36.138 or magnetic resonance imaging 0:02:36.162,0:02:38.166 to the analysis of blood or tissue. 0:02:38.190,0:02:40.106 We have all had such tests. 0:02:41.344,0:02:44.917 But there's one medium[br]that for long has been overlooked: 0:02:45.674,0:02:48.416 a medium that is easily accessible, 0:02:48.440,0:02:50.461 basically nondepletable, 0:02:50.485,0:02:53.732 and it holds tremendous promise[br]for medical analysis. 0:02:54.994,0:02:56.522 And that is our breath. 0:02:58.514,0:03:01.895 Human breath is essentially[br]composed of five components: 0:03:02.649,0:03:09.325 nitrogen, oxygen, carbon dioxide,[br]water and argon. 0:03:09.349,0:03:12.748 But besides these five, there are[br]hundreds of other components 0:03:12.772,0:03:15.155 that are present in very low quantity. 0:03:15.179,0:03:17.732 These are called volatile[br]organic compounds, 0:03:17.756,0:03:20.089 and we release hundreds,[br]even thousands of them 0:03:20.113,0:03:21.872 every time we exhale. 0:03:23.110,0:03:26.479 The analysis of these volatile[br]organic compounds in our breath 0:03:26.503,0:03:28.204 is called breath analysis. 0:03:29.545,0:03:33.309 In fact, I believe that many of you[br]have already experienced breath analysis. 0:03:33.333,0:03:36.934 Imagine: you're driving home[br]late at night, 0:03:36.958,0:03:39.656 when suddenly, there's[br]a friendly police officer 0:03:39.680,0:03:42.472 who asks you kindly but firmly 0:03:42.496,0:03:45.899 to pull over and blow[br]into a device like this one. 0:03:47.486,0:03:50.709 This is an alcohol breath tester 0:03:50.733,0:03:54.440 that is used to measure[br]the ethanol concentration in your breath 0:03:54.464,0:03:57.821 and determine whether driving[br]in your condition is a clever idea. 0:03:58.509,0:04:00.456 Now, I'd say my driving was pretty good, 0:04:00.480,0:04:01.700 but let me check. 0:04:02.788,0:04:04.715 (Beep) 0:04:08.445,0:04:11.405 0.0, so nothing[br]to worry about, all fine. 0:04:11.429,0:04:12.696 (Laughter) 0:04:14.298,0:04:16.959 Now imagine a device like this one, 0:04:16.983,0:04:19.927 that does not only measure[br]alcohol levels in your breath, 0:04:19.951,0:04:23.767 but that detects diseases[br]like the ones I've shown you 0:04:23.791,0:04:25.507 and potentially many more. 0:04:26.868,0:04:30.666 The concept of correlating[br]the smell of a person's breath 0:04:30.690,0:04:32.810 with certain medical conditions, 0:04:32.834,0:04:35.254 in fact, dates back to Ancient Greece. 0:04:35.905,0:04:40.876 But only recently, research efforts[br]on breath analysis have skyrocketed, 0:04:40.900,0:04:44.307 and what once was a dream[br]is now becoming reality. 0:04:45.307,0:04:48.321 And let me pull up this list again[br]that I showed you earlier. 0:04:49.047,0:04:51.813 For the majority of diseases listed here, 0:04:52.495,0:04:54.688 there's substantial scientific evidence 0:04:54.712,0:04:58.369 suggesting that the disease[br]could be detected by breath analysis. 0:04:59.917,0:05:01.612 But how does it work, exactly? 0:05:02.421,0:05:05.199 The essential part is a sensor device 0:05:05.223,0:05:08.435 that detects the volatile[br]organic compounds in our breath. 0:05:09.364,0:05:12.294 Simply put: when exposed[br]to a breath sample, 0:05:12.318,0:05:15.002 the sensor outputs a complex signature 0:05:15.026,0:05:19.006 that results from the mixture of volatile[br]organic compounds that we exhale. 0:05:20.141,0:05:24.457 Now, this signature represents[br]a fingerprint of your metabolism, 0:05:24.481,0:05:25.646 your microbiome 0:05:25.670,0:05:29.273 and the biochemical processes[br]that occur in your body. 0:05:29.980,0:05:31.573 If you have a disease, 0:05:31.597,0:05:33.884 your organism will change, 0:05:33.908,0:05:36.868 and so will the composition[br]of your exhaled breath. 0:05:37.479,0:05:42.609 And then the only thing that is left to do[br]is to correlate a certain signature 0:05:42.633,0:05:45.739 with the presence or absence[br]of certain medical conditions. 0:05:47.921,0:05:51.156 The technology promises[br]several undeniable benefits. 0:05:51.719,0:05:54.816 Firstly, the sensor can be miniaturized 0:05:54.840,0:05:57.686 and integrated into small,[br]handheld devices 0:05:57.710,0:05:59.548 like this alcohol breath tester. 0:06:00.437,0:06:03.450 This would allow the test to be used[br]in many different settings 0:06:03.474,0:06:05.248 and even at home, 0:06:05.272,0:06:07.266 so that a visit at the doctor's office 0:06:07.290,0:06:10.049 is not needed each time[br]a test shall be performed. 0:06:10.946,0:06:14.326 Secondly, breath analysis is noninvasive 0:06:14.350,0:06:17.997 and can be as simple as blowing[br]into an alcohol breath tester. 0:06:18.900,0:06:23.894 Such simplicity and ease of use[br]would reduce patient burden 0:06:23.918,0:06:27.361 and provide an incentive[br]for broad adoption of the technology. 0:06:27.973,0:06:32.081 And thirdly, the technology is so flexible 0:06:32.105,0:06:34.345 that the same device could be used 0:06:34.369,0:06:37.509 to detect a broad range[br]of medical conditions. 0:06:38.224,0:06:42.909 Breath analysis could be used to screen[br]for multiple diseases at the same time. 0:06:44.195,0:06:47.526 Nowadays, each disease typically requires[br]a different medical tool 0:06:47.550,0:06:49.006 to perform a screening test. 0:06:49.561,0:06:52.645 But this means you can only find[br]what you're looking for. 0:06:54.637,0:06:58.496 With all of these features,[br]breath analysis is predestined 0:06:58.520,0:07:01.584 to deliver what many traditional[br]screening tests are lacking. 0:07:02.671,0:07:04.310 And most importantly, 0:07:04.334,0:07:07.684 all of these features should[br]eventually provide us 0:07:07.708,0:07:10.214 with a platform for medical analysis 0:07:10.238,0:07:13.943 that can operate at attractively[br]low cost per test. 0:07:15.713,0:07:18.963 On the contrary, existing medical tools 0:07:18.987,0:07:21.373 often lead to rather high cost per test. 0:07:21.920,0:07:24.198 Then, in order to keep costs down, 0:07:24.222,0:07:26.832 the number of tests[br]needs to be restricted, 0:07:27.562,0:07:30.803 and this means (a) that the tests[br]can only be performed 0:07:30.827,0:07:35.511 on a narrow part of the population,[br]for example, the high-risk population; 0:07:35.535,0:07:40.690 and (b) that the number of tests[br]per person needs to be kept at a minimum. 0:07:41.459,0:07:43.303 But wouldn't it actually be beneficial 0:07:43.327,0:07:46.287 if the test was performed[br]on a larger group of people, 0:07:46.311,0:07:50.559 and more often and over a longer period[br]of time for each individual? 0:07:51.845,0:07:55.706 Especially the latter would give access[br]to something very valuable 0:07:55.730,0:07:57.997 that is called longitudinal data. 0:07:58.950,0:08:03.052 Longitudinal data is a data set[br]that tracks the same patient 0:08:03.076,0:08:05.572 over the course of many months or years. 0:08:07.318,0:08:12.368 Nowadays, medical decisions[br]are often based on a limited data set, 0:08:12.392,0:08:15.584 where only a glimpse[br]of a patient's medical history 0:08:15.608,0:08:17.662 is available for decision-making. 0:08:18.210,0:08:20.509 In such a case, 0:08:20.533,0:08:23.326 abnormalities are typically detected 0:08:23.350,0:08:25.916 by comparing a patient's health profile 0:08:25.940,0:08:29.212 to the average health profile[br]of a reference population. 0:08:30.419,0:08:34.337 Longitudinal data would[br]open up a new dimension 0:08:34.361,0:08:37.229 and allow abnormalities to be detected 0:08:37.253,0:08:39.950 based on a patient's own medical history. 0:08:40.862,0:08:43.685 This will pave the way[br]for personalized treatment. 0:08:44.741,0:08:46.305 Sounds pretty great, right? 0:08:47.194,0:08:50.169 Now you will certainly have a question[br]that is something like, 0:08:50.193,0:08:54.988 "If the technology is as great as he says,[br]then why aren't we using it today?" 0:08:55.012,0:08:57.490 And the only answer I can give you is: 0:08:57.514,0:09:00.094 not everything is as easy as it sounds. 0:09:00.983,0:09:04.470 There are technical[br]challenges, for example. 0:09:04.494,0:09:07.508 There's the need for[br]extremely reliable sensors 0:09:07.532,0:09:10.800 that can detect mixtures[br]of volatile organic compounds 0:09:10.824,0:09:12.917 with sufficient reproducibility. 0:09:13.629,0:09:16.064 And another technical challenge is this: 0:09:16.088,0:09:21.074 How do you sample a person's breath[br]in a very defined manner 0:09:21.098,0:09:23.446 so that the sampling process itself 0:09:23.470,0:09:26.123 does not alter the result of the analysis? 0:09:27.187,0:09:28.975 And there's the need for data. 0:09:29.556,0:09:33.514 Breath analysis needs[br]to be validated in clinical trials, 0:09:33.538,0:09:36.030 and enough data needs to be collected 0:09:36.054,0:09:40.296 so that individual conditions[br]can be measured against baselines. 0:09:41.167,0:09:43.640 Breath analysis can only succeed 0:09:43.664,0:09:46.437 if a large enough data set[br]can be generated 0:09:46.461,0:09:48.811 and made available for broad use. 0:09:51.050,0:09:53.880 If breath analysis[br]holds up to its promises, 0:09:54.745,0:09:57.271 this is a technology[br]that could truly aid us 0:09:57.295,0:09:59.538 to transform our health care system -- 0:10:00.410,0:10:03.564 transform it from a reactive system 0:10:03.588,0:10:06.750 where treatment is triggered[br]by symptoms of disease 0:10:06.774,0:10:08.789 to a proactive system, 0:10:08.813,0:10:12.027 where disease detection,[br]diagnosis and treatment 0:10:12.051,0:10:13.935 can happen at early stage, 0:10:13.959,0:10:16.058 way before any symptoms occur. 0:10:17.590,0:10:20.976 Now this brings me to my last point,[br]and it's a fundamental one. 0:10:21.537,0:10:23.526 What exactly is a disease? 0:10:24.590,0:10:28.625 Imagine that breath analysis[br]can be commercialized as I describe it, 0:10:28.649,0:10:31.255 and early detection becomes routine. 0:10:32.417,0:10:34.721 A problem that remains[br]is, in fact, a problem 0:10:34.745,0:10:37.733 that any screening activity has to face 0:10:37.757,0:10:39.578 because, for many diseases, 0:10:39.602,0:10:43.426 it is often impossible to predict[br]with sufficient certainty 0:10:43.450,0:10:45.992 whether the disease[br]would ever cause any symptoms 0:10:46.016,0:10:48.138 or put a person's life at risk. 0:10:48.990,0:10:51.549 This is called overdiagnosis, 0:10:51.573,0:10:53.211 and it leads to a dilemma. 0:10:53.927,0:10:56.011 If a disease is identified, 0:10:56.035,0:10:58.079 you could decide not to treat it 0:10:58.103,0:11:02.074 because there's a certain probability[br]that you would never suffer from it. 0:11:02.955,0:11:04.454 But how much would you suffer 0:11:04.478,0:11:07.865 just from knowing that you have[br]a potentially deadly disease? 0:11:07.889,0:11:10.813 And wouldn't you actually regret[br]that the disease was detected 0:11:10.823,0:11:12.080 in the first place? 0:11:13.281,0:11:17.169 Your second option[br]is to undergo early treatment 0:11:17.193,0:11:18.843 with the hope for curing it. 0:11:19.485,0:11:22.314 But often, this would not come[br]without side effects. 0:11:25.623,0:11:27.727 To be precise: 0:11:27.751,0:11:30.325 the bigger problem is not overdiagnosis, 0:11:30.349,0:11:31.802 it's overtreatment, 0:11:31.826,0:11:34.841 because not every disease[br]has to be treated immediately 0:11:34.865,0:11:36.925 just because a treatment is available. 0:11:39.441,0:11:42.139 The increasing adoption[br]of routine screening 0:11:42.163,0:11:43.912 will raise the question: 0:11:45.082,0:11:49.173 What do we call a disease[br]that can rationalize treatment, 0:11:49.197,0:11:53.785 and what is just an abnormality[br]that should not be a source of concern? 0:11:55.404,0:12:00.336 My hopes are that routine screening[br]using breath analysis 0:12:00.360,0:12:03.120 can provide enough data and insight 0:12:03.144,0:12:07.690 so that at some point,[br]we'll be able to break this dilemma 0:12:07.714,0:12:10.144 and predict with sufficient certainty 0:12:10.168,0:12:12.858 whether and when to treat at early stage. 0:12:14.794,0:12:19.513 Our breath and the mixture of volatile[br]organic compounds that we exhale 0:12:19.537,0:12:24.207 hold tremendous amounts of information[br]on our physiological condition. 0:12:25.262,0:12:28.602 With what we know today,[br]we have only scratched the surface. 0:12:29.993,0:12:34.234 As we collect more and more data[br]and breath profiles across the population, 0:12:34.258,0:12:38.790 including all varieties of gender,[br]age, origin and lifestyle, 0:12:38.814,0:12:41.147 the power of breath analysis[br]should increase. 0:12:42.147,0:12:47.725 And eventually, breath analysis[br]should provide us with a powerful tool 0:12:47.749,0:12:52.215 not only to proactively detect[br]specific diseases 0:12:52.239,0:12:55.888 but to predict[br]and ultimately prevent them. 0:12:57.110,0:12:59.728 And this should be enough motivation 0:12:59.752,0:13:03.935 to embrace the opportunities[br]and challenges 0:13:03.959,0:13:06.420 that breath analysis can provide, 0:13:06.444,0:13:09.846 even for people that are not[br]part-time hypochondriacs like me. 0:13:10.532,0:13:11.689 Thank you. 0:13:11.713,0:13:15.730 (Applause)