0:00:18.169,0:00:19.169 Hi, there. 0:00:20.173,0:00:21.331 A couple of years ago, 0:00:21.355,0:00:24.464 when I was attending[br]the TED conference in Long Beach, 0:00:24.488,0:00:25.853 I met Harriet. 0:00:25.877,0:00:29.276 We'd actually met online before --[br]not the way you're thinking. 0:00:31.100,0:00:33.535 We were introduced[br]because we both knew Linda Avey, 0:00:33.559,0:00:37.262 one of the founders of the first[br]online personal genomic companies. 0:00:37.287,0:00:39.984 And because we shared[br]our genetic information with Linda, 0:00:40.008,0:00:42.150 she could see that Harriet and I shared 0:00:42.839,0:00:46.729 a very rare type of mitochondrial DNA,[br]haplotype K1a1b1a, 0:00:46.753,0:00:48.748 which meant we were distantly related. 0:00:48.772,0:00:51.605 We actually share the same[br]genealogy with Ötzi the Iceman. 0:00:51.629,0:00:53.140 So -- Ötzi, Harriet and me. 0:00:53.164,0:00:56.764 And being the current day, of course,[br]we started our own Facebook group. 0:00:56.789,0:00:58.088 You're all welcome to join. 0:00:58.712,0:01:01.792 When I met Harriet in person[br]the next year at the TED conference, 0:01:01.816,0:01:04.804 she'd gone online and ordered[br]our own happy haplotype T-shirts. 0:01:04.828,0:01:05.839 (Laughter) 0:01:06.163,0:01:07.706 Why am I telling you this story? 0:01:07.730,0:01:10.072 What does it have to do[br]with the future of health? 0:01:10.096,0:01:12.072 Well, the way I met Harriet is an example 0:01:12.096,0:01:15.847 of how leveraging cross-disciplinary,[br]exponentially growing technologies 0:01:15.871,0:01:18.182 is affecting our future[br]of health and wellness -- 0:01:18.206,0:01:19.556 from low-cost gene analysis 0:01:19.580,0:01:21.698 to the ability to do[br]powerful bioinformatics 0:01:21.722,0:01:24.531 to the connection of the Internet[br]and social networking. 0:01:25.089,0:01:26.689 What I'd like to talk about today 0:01:26.713,0:01:28.973 is understanding[br]these exponential technologies. 0:01:28.997,0:01:30.554 We often think linearly. 0:01:30.778,0:01:33.366 But if you think about it,[br]if you have a lily pad 0:01:33.390,0:01:35.353 and it just divided every single day -- 0:01:35.377,0:01:39.033 two, four, eight, sixteen --[br]in 15 days, you'd have 32,000. 0:01:39.057,0:01:40.992 What do you think you'd have in a month? 0:01:41.016,0:01:42.167 We're at a billion. 0:01:42.491,0:01:44.163 If we start to think exponentially, 0:01:44.187,0:01:47.639 we can see how this is starting to affect[br]all the technologies around us. 0:01:47.663,0:01:50.766 Many of these technologies,[br]speaking as a physician and innovator, 0:01:50.790,0:01:53.882 we can start to leverage,[br]to impact the future of our own health 0:01:53.906,0:01:55.556 and of health care, 0:01:55.581,0:01:58.666 and to address many of the major[br]challenges in health care today, 0:01:58.690,0:02:02.654 ranging from the exponential costs[br]to the aging population, 0:02:02.679,0:02:05.978 the way we really don't use[br]information very well today, 0:02:06.003,0:02:07.493 the fragmentation of care 0:02:07.517,0:02:11.247 and the often very difficult course[br]of adoption of innovation. 0:02:11.571,0:02:15.366 And one of the major things we can do[br]is move the curve to the left. 0:02:15.390,0:02:18.107 We spend most of our money[br]on the last 20 percent of life. 0:02:18.131,0:02:21.191 What if we could incentivize physicians[br]in the health care system 0:02:21.215,0:02:22.371 and our own selves 0:02:22.395,0:02:24.910 to move the curve to the left[br]and improve our health, 0:02:24.934,0:02:26.378 leveraging technology as well? 0:02:26.402,0:02:29.125 Now my favorite example[br]of exponential technology, 0:02:29.150,0:02:30.450 we all have in our pocket. 0:02:30.474,0:02:33.745 If you think about it,[br]these are really dramatically improving. 0:02:33.769,0:02:35.675 I mean, this is the iPhone 4. 0:02:35.699,0:02:38.887 Imagine what the iPhone 8[br]will be able to do. 0:02:38.911,0:02:40.829 Now, I've gained some insight into this. 0:02:40.853,0:02:43.428 I've been the track share[br]for the medicine portion 0:02:43.452,0:02:45.959 of a new institution[br]called Singularity University, 0:02:45.983,0:02:47.372 based in Silicon Valley. 0:02:47.396,0:02:51.455 We bring together each summer[br]about 100 very talented students 0:02:51.480,0:02:52.646 from around the world. 0:02:52.670,0:02:55.536 And we look at these exponential[br]technologies from medicine, 0:02:55.560,0:02:58.706 biotech, artificial intelligence,[br]robotics, nanotechnology, space, 0:02:58.730,0:03:01.209 and address how we can cross-train[br]and leverage these 0:03:01.233,0:03:02.573 to impact major unmet goals. 0:03:02.597,0:03:04.604 We also have seven-day executive programs. 0:03:04.628,0:03:07.011 And coming up next month is FutureMed, 0:03:07.035,0:03:10.409 a program to help cross-train[br]and leverage technologies into medicine. 0:03:10.433,0:03:11.954 Now, I mentioned the phone. 0:03:12.878,0:03:16.189 These mobile phones have over 20,000[br]different mobile apps available. 0:03:17.113,0:03:20.355 There's one out of the UK[br]where you can pee on a little chip, 0:03:20.379,0:03:21.660 connect it to your iPhone, 0:03:21.684,0:03:22.839 and check for an STD. 0:03:22.863,0:03:25.166 I don't know if I'd try that,[br]but it's available. 0:03:25.190,0:03:27.015 There are other sorts of applications. 0:03:27.039,0:03:29.315 Merging your phone[br]and diagnostics, for example, 0:03:29.339,0:03:31.380 measuring your blood glucose[br]on your iPhone 0:03:31.404,0:03:34.110 and sending that to your physician, 0:03:34.135,0:03:36.902 so they can better understand[br]and you can better understand 0:03:36.926,0:03:39.210 your blood sugars as a diabetic. 0:03:39.730,0:03:42.851 So let's see how exponential[br]technologies are taking health care. 0:03:42.875,0:03:44.041 Let's start with faster. 0:03:44.065,0:03:46.474 It's no secret that computers,[br]through Moore's law, 0:03:46.498,0:03:48.141 are speeding up faster and faster. 0:03:48.165,0:03:50.226 We can do more powerful things with them. 0:03:50.250,0:03:53.450 They're really approaching --[br]in many cases, surpassing -- 0:03:53.475,0:03:54.921 the ability of the human mind. 0:03:54.945,0:03:58.779 But where I think computational speed[br]is most applicable is in imaging. 0:03:58.803,0:04:01.435 The ability now to look[br]inside the body in real time 0:04:01.459,0:04:02.917 with very high resolution 0:04:02.941,0:04:04.401 is really becoming incredible. 0:04:04.425,0:04:07.461 And we're layering multiple[br]technologies -- PET scans, CT scans 0:04:07.485,0:04:09.507 and molecular diagnostics -- 0:04:09.531,0:04:11.796 to find and seek things[br]at different levels. 0:04:12.856,0:04:16.307 Here you're going to see the very highest[br]resolution MRI scan done today, 0:04:16.331,0:04:19.548 of Marc Hodosh, the curator of TEDMED. 0:04:19.574,0:04:21.716 And now we can see inside of the brain 0:04:21.741,0:04:24.333 at a resolution and ability[br]never before available, 0:04:24.357,0:04:28.423 and essentially learn how to reconstruct[br]and maybe even reengineer 0:04:28.447,0:04:30.131 or backwards engineer the brain, 0:04:30.155,0:04:33.132 so we can better understand[br]pathology, disease and therapy. 0:04:33.156,0:04:36.448 We can look inside with real-time[br]fMRI in the brain at real time. 0:04:36.472,0:04:39.761 And by understanding these sorts[br]of processes and these connections, 0:04:39.785,0:04:42.848 we're going to understand the effects[br]of medication or meditation 0:04:42.872,0:04:45.479 and better personalize[br]and make effective, for example, 0:04:45.503,0:04:47.106 psychoactive drugs. 0:04:47.130,0:04:49.898 The scanners for these are getting[br]smaller, less expensive 0:04:49.922,0:04:51.073 and more portable. 0:04:51.397,0:04:54.767 And this sort of data explosion[br]available from these 0:04:54.792,0:04:57.225 is really almost becoming a challenge. 0:04:57.250,0:05:00.626 The scan of today takes up[br]about 800 books, or 20 gigabytes. 0:05:00.651,0:05:03.922 The scan in a couple of years[br]will be one terabyte, or 800,000 books. 0:05:03.946,0:05:05.715 How do you leverage that information? 0:05:06.439,0:05:07.590 Let's get personal. 0:05:07.614,0:05:10.821 I won't ask who here's had a colonoscopy,[br]but if you're over age 50, 0:05:10.845,0:05:12.838 it's time for your screening colonoscopy. 0:05:12.862,0:05:15.293 How'd you like to avoid[br]the pointy end of the stick? 0:05:15.317,0:05:17.368 Now there's essentially[br]virtual colonoscopy. 0:05:19.692,0:05:20.983 Compare those two pictures. 0:05:21.007,0:05:24.274 As a radiologist, you can basically[br]fly through your patient's colon, 0:05:24.298,0:05:26.593 and augmenting that[br]with artificial intelligence, 0:05:26.617,0:05:29.246 potentially identify a lesion[br]that we might have missed, 0:05:29.270,0:05:30.846 but using AI on top of radiology, 0:05:30.870,0:05:32.921 we can find lesions[br]that were missed before. 0:05:32.945,0:05:35.472 Maybe this will encourage[br]people to get colonoscopies 0:05:35.496,0:05:36.879 that wouldn't have otherwise. 0:05:36.903,0:05:38.915 This is an example of this paradigm shift. 0:05:38.939,0:05:42.340 We're moving to this integration[br]of biomedicine, information technology, 0:05:42.364,0:05:45.670 wireless and, I would say, mobile now --[br]this era of digital medicine. 0:05:45.694,0:05:49.238 Even my stethoscope is now digital,[br]and of course, there's an app for that. 0:05:49.662,0:05:52.197 We're moving, obviously,[br]to the era of the tricorder. 0:05:52.221,0:05:55.069 So the handheld ultrasound[br]is basically surpassing 0:05:55.094,0:05:57.092 and supplanting the stethoscope. 0:05:57.116,0:06:00.577 These are now at a price point[br]of what used to be 100,000 euros 0:06:00.602,0:06:02.441 or a couple hundred-thousand dollars. 0:06:02.465,0:06:03.618 For about 5,000 dollars, 0:06:03.642,0:06:06.968 I can have the power of a very powerful[br]diagnostic device in my hand. 0:06:06.992,0:06:10.084 Merging this now with the advent[br]of electronic medical records -- 0:06:10.108,0:06:13.188 in the US, we're still[br]less than 20 percent electronic; 0:06:13.213,0:06:16.009 here in the Netherlands,[br]I think it's more than 80 percent. 0:06:16.233,0:06:18.521 Now that we're switching[br]to merging medical data, 0:06:18.545,0:06:20.220 making it available electronically, 0:06:20.244,0:06:23.391 we can crowd-source the information,[br]and as a physician, 0:06:23.416,0:06:26.494 I can access my patients' data[br]from wherever I am, 0:06:27.176,0:06:28.606 just through my mobile device. 0:06:29.030,0:06:32.143 And now, of course, we're in the era[br]of the iPad, even the iPad 2. 0:06:32.167,0:06:33.318 Just last month, 0:06:33.342,0:06:35.557 the first FDA-approved[br]application was approved 0:06:35.581,0:06:39.074 to allow radiologists to do actual[br]reading on these sorts of devices. 0:06:39.698,0:06:42.319 So certainly, the physicians[br]of today, including myself, 0:06:42.343,0:06:44.320 are completely reliable on these devices. 0:06:44.344,0:06:46.163 And as you saw just about a month ago, 0:06:46.187,0:06:49.179 Watson from IBM beat[br]the two champions in "Jeopardy." 0:06:49.204,0:06:51.642 So I want you to imagine[br]when, in a couple of years, 0:06:51.666,0:06:54.126 we've started to apply[br]this cloud-based information, 0:06:54.150,0:06:57.750 when we really have the AI physician[br]and leverage our brains to connectivity 0:06:57.774,0:07:01.743 to make decisions and diagnostics[br]at a level never done. 0:07:04.348,0:07:07.547 Already today, you don't need to go[br]to your physician in many cases. 0:07:07.571,0:07:11.113 Only in about 20 percent of visits[br]do you need to lay hands on the patient. 0:07:11.137,0:07:12.998 We're now in the era of virtual visits. 0:07:13.022,0:07:15.515 From Skype-type visits[br]you can do with American Well, 0:07:15.539,0:07:18.895 to Cisco, that's developed a very complex[br]health presence system, 0:07:18.920,0:07:22.127 the ability to interact with[br]your health care provider is different. 0:07:22.151,0:07:25.176 And these are being augmented[br]even by our devices, again, today. 0:07:25.200,0:07:27.969 My friend Jessica sent me[br]a picture of her head laceration, 0:07:27.993,0:07:30.201 so I can save her a trip[br]to the emergency room, 0:07:30.225,0:07:31.654 and do diagnostics that way. 0:07:31.678,0:07:34.072 Or maybe we can leverage[br]today's gaming technology, 0:07:34.096,0:07:35.342 like the Microsoft Kinect, 0:07:35.366,0:07:39.042 hack that to enable diagnostics,[br]for example, in diagnosing stroke, 0:07:39.067,0:07:41.939 using simple motion detection,[br]using $100 devices. 0:07:42.980,0:07:46.165 We can actually now visit[br]our patients robotically. 0:07:46.189,0:07:47.920 This is the RP7; 0:07:49.664,0:07:52.622 if I'm a hematologist,[br]I can visit another clinic or hospital. 0:07:54.546,0:07:56.941 These are being augmented[br]by a whole suite of tools 0:07:56.965,0:07:58.161 actually in the home now. 0:07:58.185,0:08:00.039 We already have wireless scales. 0:08:00.063,0:08:02.768 You step on the scale,[br]tweet your weight to your friends, 0:08:02.792,0:08:04.034 they can keep you in line. 0:08:04.058,0:08:05.876 We have wireless blood pressure cuffs. 0:08:05.900,0:08:08.407 A whole gamut of technologies[br]are being put together. 0:08:08.431,0:08:11.245 Instead of wearing kludgy devices,[br]we put on a simple patch. 0:08:11.269,0:08:12.762 This was developed at Stanford. 0:08:12.786,0:08:16.355 It's called iRhythm; it completely[br]supplants the prior technology 0:08:16.389,0:08:19.872 at a much lower price point,[br]with much more effectivity. 0:08:20.265,0:08:22.740 We're also in the era today[br]of quantified self. 0:08:22.764,0:08:26.369 Consumers now can basically buy[br]$100 devices, like this little Fitbit. 0:08:26.393,0:08:28.414 I can measure my steps,[br]my caloric outtake. 0:08:28.438,0:08:30.491 I can get insight into that[br]on a daily basis 0:08:30.515,0:08:32.523 and share it with my friends or physician. 0:08:32.547,0:08:35.626 There's watches that measure[br]your heart rate, Zeo sleep monitors, 0:08:35.650,0:08:37.732 a suite of tools[br]that enable you to leverage 0:08:37.756,0:08:39.571 and have insight into your own health. 0:08:39.595,0:08:41.602 As we start to integrate this information, 0:08:41.626,0:08:44.508 we'll know better what to do with it,[br]and have better insight 0:08:44.532,0:08:46.959 into our own pathologies,[br]health and wellness. 0:08:47.283,0:08:49.926 There's even mirrors[br]that can pick up your pulse rate. 0:08:49.950,0:08:51.709 And I would argue, in the future, 0:08:51.733,0:08:54.895 we'll have wearable devices[br]in our clothes, monitoring us 24/7. 0:08:54.919,0:08:58.336 And just like the OnStar system[br]in cars, your red light might go on. 0:08:58.360,0:09:01.405 It won't say "check engine";[br]it'll be a "check your body" light, 0:09:01.429,0:09:03.113 and you'll go get it taken care of. 0:09:03.737,0:09:04.910 Probably in a few years, 0:09:04.934,0:09:07.740 you'll look in your mirror[br]and it'll be diagnosing you. 0:09:07.764,0:09:08.986 (Laughter) 0:09:09.410,0:09:11.489 For those of you with kiddos at home, 0:09:11.513,0:09:14.458 how would you like a wireless[br]diaper that supports your -- 0:09:14.482,0:09:15.542 (Laughter) 0:09:15.566,0:09:17.763 More information, I think,[br]than you might need, 0:09:17.787,0:09:19.224 but it's going to be here. 0:09:19.948,0:09:23.048 Now, we've heard a lot today[br]about technology and connection. 0:09:23.072,0:09:24.884 And I think some of these technologies 0:09:24.908,0:09:28.326 will enable us to be more connected[br]with our patients, to take more time 0:09:28.350,0:09:30.931 and do the important[br]human-touch elements of medicine, 0:09:30.955,0:09:33.170 as augmented by these technologies. 0:09:33.557,0:09:35.926 Now, we've talked about[br]augmenting the patient. 0:09:35.950,0:09:37.626 How about augmenting the physician? 0:09:37.650,0:09:40.739 We're now in the era[br]of super-enabling the surgeon, 0:09:40.764,0:09:44.226 who can now go into the body and do[br]robotic surgery, which is here today, 0:09:44.250,0:09:47.713 at a level that was not really possible[br]even five years ago. 0:09:47.737,0:09:50.857 And now this is being augmented[br]with further layers of technology, 0:09:50.881,0:09:52.036 like augmented reality. 0:09:52.060,0:09:54.991 So the surgeon can see[br]inside the patient, through their lens, 0:09:55.015,0:09:57.326 where the tumor is,[br]where the blood vessels are. 0:09:57.350,0:09:59.455 This can be integrated[br]with decision support. 0:09:59.479,0:10:02.640 A surgeon in New York can help[br]a surgeon in Amsterdam, for example. 0:10:02.664,0:10:06.439 And we're entering an era[br]of truly scarless surgery called NOTES, 0:10:06.464,0:10:09.055 where the robotic endoscope[br]can come out the stomach 0:10:09.079,0:10:10.527 and pull out that gallbladder, 0:10:10.551,0:10:12.902 all in a scarless way and robotically. 0:10:12.926,0:10:16.242 This is called NOTES, and it's coming --[br]basically scarless surgery, 0:10:16.266,0:10:18.324 as mediated by robotic surgery. 0:10:19.148,0:10:21.244 Now, how about controlling other elements? 0:10:21.268,0:10:23.698 For those who have[br]disabilities -- the paraplegic, 0:10:24.122,0:10:26.909 there's the brain-computer[br]interface, or BCI, 0:10:26.933,0:10:29.122 where chips have been put[br]on the motor cortex 0:10:29.146,0:10:30.966 of completely quadriplegic patients, 0:10:33.190,0:10:35.850 and they can control[br]a cursor or a wheelchair 0:10:35.874,0:10:37.407 or, potentially, a robotic arm. 0:10:37.431,0:10:39.027 These devices are getting smaller 0:10:39.051,0:10:41.278 and going into more and more[br]of these patients. 0:10:41.302,0:10:42.514 Still in clinical trials, 0:10:42.538,0:10:44.939 but imagine when we can connect[br]these, for example, 0:10:44.963,0:10:46.579 to the amazing bionic limb, 0:10:46.603,0:10:49.425 such as the DEKA Arm,[br]built by Dean Kamen and colleagues, 0:10:49.449,0:10:51.469 which has 17 degrees[br]of motion and freedom, 0:10:51.493,0:10:53.521 and can allow the person who's lost a limb 0:10:53.545,0:10:57.736 to have much higher dexterity or control[br]than they've had in the past. 0:10:58.104,0:11:01.947 So we're really entering the era[br]of wearable robotics, actually. 0:11:01.972,0:11:04.186 If you haven't lost a limb[br]but had a stroke, 0:11:04.210,0:11:05.897 you can wear these augmented limbs. 0:11:05.921,0:11:09.417 Or if you're a paraplegic -- I've visited[br]the folks at Berkeley Bionics -- 0:11:09.441,0:11:10.610 they've developed eLEGS. 0:11:10.634,0:11:12.000 I took this video last week. 0:11:12.024,0:11:15.809 Here's a paraplegic patient, walking[br]by strapping on these exoskeletons. 0:11:15.833,0:11:17.844 He's otherwise completely[br]wheelchair-bound. 0:11:17.868,0:11:19.884 This is the early era[br]of wearable robotics. 0:11:19.908,0:11:22.187 And by leveraging[br]these sorts of technologies, 0:11:22.211,0:11:24.548 we're going to change[br]the definition of disability 0:11:24.572,0:11:27.102 to, in some cases, be superability,[br]or super-enabling. 0:11:27.126,0:11:30.316 This is Aimee Mullins, who lost[br]her lower limbs as a young child, 0:11:30.340,0:11:33.052 and Hugh Herr, who's a professor at MIT, 0:11:33.077,0:11:35.078 who lost his limbs in a climbing accident. 0:11:35.102,0:11:38.497 And now both of them can climb better,[br]move faster, swim differently 0:11:38.521,0:11:42.008 with their prosthetics[br]than us normal-abled persons. 0:11:42.232,0:11:43.672 How about other exponentials? 0:11:43.697,0:11:45.571 We've heard a bit today[br]about obesity. 0:11:45.596,0:11:49.006 Clearly the obesity trend is exponentially[br]going in the wrong direction, 0:11:49.030,0:11:50.465 including with huge costs. 0:11:50.489,0:11:53.612 But the trend in medicine[br]is to get exponentially smaller. 0:11:53.636,0:11:57.211 A few examples: we're now in the era[br]of "Fantastic Voyage," the iPill. 0:11:57.235,0:11:59.636 You can swallow this[br]completely integrated device. 0:11:59.660,0:12:01.526 It can take pictures of your GI system, 0:12:01.550,0:12:04.306 help diagnose and treat[br]as it moves through your GI tract. 0:12:04.330,0:12:06.149 We get into even smaller micro-robots 0:12:06.173,0:12:09.070 that will eventually, autonomously,[br]move through your system, 0:12:09.094,0:12:12.050 and be able to do things surgeons can't do 0:12:12.075,0:12:13.611 in a much less invasive manner. 0:12:14.635,0:12:17.224 Sometimes these might[br]self-assemble in your GI system, 0:12:17.248,0:12:19.599 and be augmented in that reality. 0:12:19.896,0:12:22.388 On the cardiac side,[br]pacemakers are getting smaller 0:12:22.412,0:12:23.749 and much easier to place, 0:12:23.773,0:12:26.856 so no need to train an interventional[br]cardiologist to place them. 0:12:26.880,0:12:29.816 And they'll be wirelessly telemetered[br]to your mobile devices, 0:12:29.840,0:12:32.326 so you can go places[br]and be monitored remotely. 0:12:32.950,0:12:34.548 These are shrinking even further. 0:12:34.595,0:12:38.543 This one is in prototyping[br]by Medtronic; it's smaller than a penny. 0:12:39.552,0:12:42.977 Artificial retinas, the ability to put[br]arrays on the back of the eyeball 0:12:43.001,0:12:44.425 and allow the blind to see -- 0:12:44.449,0:12:46.760 also in early trials,[br]but moving into the future. 0:12:46.784,0:12:48.515 These are going to be game-changing. 0:12:48.539,0:12:50.227 Or for those of us who are sighted, 0:12:51.051,0:12:53.413 how about having[br]the assisted-living contact lens? 0:12:53.437,0:12:56.858 Bluetooth, Wi-Fi available --[br]beams back images to your eye. 0:12:57.683,0:12:58.706 (Laughter) 0:12:58.730,0:13:00.933 Now, if you have trouble[br]maintaining your diet, 0:13:00.957,0:13:02.913 it might help to have some extra imagery 0:13:02.937,0:13:06.571 to remind you how many calories[br]are going to be coming at you. 0:13:08.295,0:13:11.338 How about enabling the pathologist[br]to use their cell phone 0:13:11.370,0:13:12.916 to see at a microscopic level 0:13:12.940,0:13:16.254 and to lumber that data back to the cloud[br]and make better diagnostics? 0:13:16.278,0:13:18.564 In fact, the whole era[br]of laboratory medicine 0:13:18.588,0:13:19.740 is completely changing. 0:13:19.764,0:13:21.717 We can now leverage microfluidics, 0:13:21.741,0:13:23.958 like this chip made[br]by Steve Quake at Stanford. 0:13:23.982,0:13:26.618 Microfluidics can replace[br]an entire lab of technicians; 0:13:28.542,0:13:32.080 put it on a chip, enable thousands[br]of tests at the point of care, 0:13:32.105,0:13:33.257 anywhere in the world. 0:13:33.281,0:13:36.685 This will really leverage technology[br]to the rural and the underserved 0:13:36.709,0:13:40.224 and enable what used to be thousand-dollar[br]tests to be done for pennies, 0:13:40.248,0:13:41.600 and at the point of care. 0:13:42.024,0:13:44.525 If we go down the small[br]pathway a little bit further, 0:13:44.549,0:13:46.448 we're entering the era of nanomedicine, 0:13:46.472,0:13:48.394 the ability to make devices super-small, 0:13:48.418,0:13:50.738 to the point where we can[br]design red blood cells 0:13:50.762,0:13:53.837 or microrobots that monitor[br]our blood system or immune system, 0:13:53.861,0:13:56.949 or even those that might clear out[br]the clots from our arteries. 0:13:57.473,0:13:59.213 Now how about exponentially cheaper? 0:13:59.237,0:14:02.070 Not something we usually think[br]about in the era of medicine, 0:14:02.094,0:14:07.497 but hard disks used to be 3,400 dollars[br]for 10 megabytes -- exponentially cheaper. 0:14:07.522,0:14:10.184 In genomics now, the genome[br]cost about a billion dollars 0:14:10.208,0:14:12.467 about 10 years ago,[br]when the first one came out. 0:14:12.491,0:14:15.855 We're now approaching essentially[br]a $1,000 genome, probably next year. 0:14:15.879,0:14:17.412 And in two years, a $100 genome. 0:14:17.436,0:14:19.759 What will we do with $100 genomes? 0:14:19.784,0:14:22.138 Soon we'll have millions[br]of these tests available. 0:14:22.162,0:14:25.653 Then it gets interesting, when we start[br]to crowd-source that information, 0:14:25.677,0:14:27.923 and enter the era[br]of true personalized medicine: 0:14:27.947,0:14:30.479 the right drug for the right person[br]at the right time, 0:14:30.503,0:14:33.796 instead of what we're doing now,[br]which is the same drug for everybody, 0:14:33.820,0:14:36.926 blockbuster drug medications,[br]which don't work for the individual. 0:14:36.950,0:14:40.169 Many different companies are working[br]on leveraging these approaches. 0:14:40.193,0:14:42.598 I'll show you a simple example,[br]from 23andMe again. 0:14:42.622,0:14:44.732 My data indicates[br]I've got about average risk 0:14:44.756,0:14:47.447 for developing macular degeneration,[br]a kind of blindness. 0:14:47.471,0:14:50.097 But if I take that same data,[br]upload it to deCODEme, 0:14:50.321,0:14:54.576 I can look at my risk for type 2 diabetes;[br]I'm at almost twice the risk. 0:14:54.600,0:14:57.817 I might want to watch how much dessert[br]I have at lunch, for example. 0:14:57.841,0:14:59.192 It might change my behavior. 0:14:59.216,0:15:01.458 Leveraging my knowledge[br]of my pharmacogenomics: 0:15:01.482,0:15:04.817 how my genes modulate,[br]what my drugs do and what doses I need 0:15:04.841,0:15:06.532 will become increasingly important, 0:15:06.556,0:15:08.907 and once in the hands[br]of individuals and patients, 0:15:08.931,0:15:11.453 will make better drug dosing[br]and selection available. 0:15:11.477,0:15:14.319 So again, it's not just genes,[br]it's multiple details -- 0:15:14.343,0:15:17.761 our habits, our environmental exposures. 0:15:17.786,0:15:20.597 When was the last time your doctor[br]asked where you've lived? 0:15:20.621,0:15:23.332 Geomedicine: where you live,[br]what you've been exposed to, 0:15:23.356,0:15:25.073 can dramatically affect your health. 0:15:25.097,0:15:26.628 We can capture that information. 0:15:26.652,0:15:28.561 Genomics, proteomics, the environment -- 0:15:28.585,0:15:31.450 all this data streaming at us[br]individually and as physicians: 0:15:31.474,0:15:32.626 How do we manage it? 0:15:32.650,0:15:35.712 We're now entering the era[br]of systems medicine, systems biology, 0:15:35.736,0:15:38.237 where we can start to integrate[br]all this information. 0:15:38.261,0:15:41.069 And by looking at the patterns,[br]for example, in our blood, 0:15:41.093,0:15:42.906 of 10,000 biomarkers in a single test, 0:15:42.930,0:15:46.465 we can look at patterns and detect disease[br]at a much earlier stage. 0:15:47.089,0:15:50.523 This is called by Lee Hood,[br]the father of the field, P4 Medicine. 0:15:50.547,0:15:53.173 We'll be predictive and know[br]what you're likely to have. 0:15:53.197,0:15:56.020 We can be preventative;[br]that prevention can be personalized. 0:15:56.044,0:15:58.573 More importantly,[br]it'll be increasingly participatory. 0:15:58.597,0:16:00.436 Through websites like PatientsLikeMe 0:16:00.460,0:16:04.570 or managing your data on Microsoft[br]HealthVault or Google Health, 0:16:04.595,0:16:06.742 leveraging this together[br]in participatory ways 0:16:06.766,0:16:08.250 will be increasingly important. 0:16:08.274,0:16:10.230 I'll finish up with exponentially better. 0:16:10.254,0:16:12.771 We'd like to get therapies[br]better and more effective. 0:16:13.195,0:16:15.676 Today we treat high blood pressure[br]mostly with pills. 0:16:15.700,0:16:17.087 What if we take a new device, 0:16:17.111,0:16:20.896 knock out the nerve vessels[br]that help mediate blood pressure, 0:16:20.921,0:16:23.526 and in a single therapy,[br]basically cure hypertension? 0:16:23.550,0:16:25.611 This is a new device[br]doing essentially that. 0:16:25.635,0:16:27.697 It should be on the market[br]in a year or two. 0:16:27.721,0:16:29.825 How about more targeted[br]therapies for cancer? 0:16:29.849,0:16:33.398 I'm an oncologist and know that most[br]of what we give is essentially poison. 0:16:33.422,0:16:37.211 We learned at Stanford and other places[br]that we can discover cancer stem cells, 0:16:37.235,0:16:41.462 the ones that seem to be really[br]responsible for disease relapse. 0:16:41.487,0:16:43.406 So if you think of cancer as a weed, 0:16:43.430,0:16:46.323 we often can whack the weed away[br]and it seems to shrink, 0:16:46.347,0:16:47.515 but it often comes back. 0:16:47.539,0:16:49.276 So we're attacking the wrong target. 0:16:49.300,0:16:50.762 The cancer stem cells remain, 0:16:50.786,0:16:53.042 and the tumor can return[br]months or years later. 0:16:53.066,0:16:55.547 We're now learning to identify[br]the cancer stem cells 0:16:55.571,0:16:58.687 and identify those as targets[br]and go for the long-term cure. 0:16:58.711,0:17:01.004 We're entering the era[br]of personalized oncology, 0:17:01.028,0:17:03.391 the ability to leverage[br]all of this data together, 0:17:03.415,0:17:04.566 analyze the tumor 0:17:04.589,0:17:07.904 and come up with a real, specific cocktail[br]for the individual patient. 0:17:08.228,0:17:10.060 I'll close with regenerative medicine. 0:17:10.085,0:17:11.827 I've studied a lot about stem cells. 0:17:11.851,0:17:14.053 Embryonic stem cells[br]are particularly powerful. 0:17:14.077,0:17:16.188 We have adult stem cells[br]throughout our body; 0:17:16.212,0:17:18.337 we use those in bone marrow[br]transplantation. 0:17:18.761,0:17:23.662 Geron, last year, started the first trial[br]using human embryonic stem cells 0:17:23.686,0:17:25.252 to treat spinal cord injuries. 0:17:25.276,0:17:27.326 Still a phase I trial, but evolving. 0:17:27.349,0:17:31.123 We've been using adult stem cells[br]in clinical trials for about 15 years 0:17:31.147,0:17:34.726 to approach a whole range of topics,[br]particularly cardiovascular disease. 0:17:34.750,0:17:38.466 If we take our own bone marrow cells[br]and treat a patient with a heart attack, 0:17:38.490,0:17:41.402 we can see much improved[br]heart function and better survival 0:17:41.426,0:17:44.379 using our own bone marrow derived cells[br]after a heart attack. 0:17:44.629,0:17:45.778 As mentioned earlier, 0:17:45.803,0:17:47.839 I invented a device[br]called the MarrowMiner, 0:17:47.863,0:17:50.300 a much less invasive way[br]for harvesting bone marrow. 0:17:50.324,0:17:53.583 It's now been FDA approved;[br]hopefully on the market in the next year. 0:17:53.607,0:17:55.484 Hopefully you can appreciate the device 0:17:55.508,0:17:59.278 going through the patient's body removing[br]bone marrow, not with 200 punctures, 0:17:59.302,0:18:01.695 but with a single puncture,[br]under local anesthesia. 0:18:01.719,0:18:03.303 Where is stem-cell therapy going? 0:18:03.327,0:18:04.478 If you think about it, 0:18:04.502,0:18:08.776 every cell in your body has the same DNA[br]you had when you were an embryo. 0:18:08.801,0:18:10.745 We can now reprogram your skin cells 0:18:10.769,0:18:13.682 to actually act like a pluripotent[br]embryonic stem cell 0:18:13.706,0:18:17.354 and utilize those, potentially, to treat[br]multiple organs in the same patient, 0:18:17.378,0:18:19.101 making personalized stem cell lines. 0:18:19.125,0:18:21.910 I think there'll be a new era[br]of your own stem cell banking 0:18:21.934,0:18:25.402 to have in the freezer your own cardiac[br]cells, myocytes and neural cells 0:18:25.426,0:18:27.779 to use them in the future,[br]should you need them. 0:18:27.803,0:18:31.025 We're integrating this now[br]with a whole era of cellular engineering, 0:18:31.049,0:18:34.617 and integrating exponential technologies[br]for essentially 3D organ printing, 0:18:34.641,0:18:36.325 replacing the ink with cells, 0:18:36.349,0:18:39.146 and essentially building[br]and reconstructing a 3D organ. 0:18:39.170,0:18:40.696 That's where things are heading. 0:18:40.720,0:18:41.881 Still very early days, 0:18:41.905,0:18:44.652 but I think, as integration[br]of exponential technologies, 0:18:44.676,0:18:45.840 this is the example. 0:18:46.164,0:18:48.651 So in closing, as you think[br]about technology trends 0:18:48.675,0:18:50.515 and how to impact health and medicine, 0:18:50.539,0:18:52.516 we're entering an era of miniaturization, 0:18:52.540,0:18:54.762 decentralization and personalization. 0:18:54.786,0:18:56.676 And by pulling these things together - 0:18:56.701,0:18:59.293 we heard at the beginning[br]of this event about the why - 0:18:59.318,0:19:02.303 if we start to think about[br]how to understand and leverage them, 0:19:02.327,0:19:05.678 we're going to empower the patient,[br]enable the doctor, enhance wellness 0:19:05.702,0:19:08.149 and begin to cure the well[br]before they get sick. 0:19:08.173,0:19:11.711 Because I know as a doctor, if someone[br]comes to me with stage I disease, 0:19:11.735,0:19:13.526 I'm thrilled; we can often cure them. 0:19:13.550,0:19:14.720 But often it's too late, 0:19:14.744,0:19:16.873 and it's stage III or IV[br]cancer, for example. 0:19:16.897,0:19:19.012 So by leveraging[br]these technologies together, 0:19:19.036,0:19:22.273 I think we'll enter a new era[br]that I like to call stage 0 medicine. 0:19:22.297,0:19:25.566 And as a cancer doctor,[br]I'm looking forward to being out of a job. 0:19:25.590,0:19:26.812 Thanks very much. 0:19:26.836,0:19:28.814 (Applause) 0:19:28.838,0:19:30.535 Host: Thank you. Thank you. 0:19:30.559,0:19:32.359 (Applause) 0:19:32.383,0:19:34.383 Take a bow, take a bow. 0:19:35.021,0:19:37.354 Daniel Kraft, ladies and gentleman.