1 00:00:18,169 --> 00:00:19,169 Hi, there. 2 00:00:20,173 --> 00:00:21,331 A couple of years ago, 3 00:00:21,355 --> 00:00:24,464 when I was attending the TED conference in Long Beach, 4 00:00:24,488 --> 00:00:25,853 I met Harriet. 5 00:00:25,877 --> 00:00:29,276 We'd actually met online before -- not the way you're thinking. 6 00:00:31,100 --> 00:00:33,535 We were introduced because we both knew Linda Avey, 7 00:00:33,559 --> 00:00:37,262 one of the founders of the first online personal genomic companies. 8 00:00:37,287 --> 00:00:39,984 And because we shared our genetic information with Linda, 9 00:00:40,008 --> 00:00:42,150 she could see that Harriet and I shared 10 00:00:42,839 --> 00:00:46,729 a very rare type of mitochondrial DNA, haplotype K1a1b1a, 11 00:00:46,753 --> 00:00:48,748 which meant we were distantly related. 12 00:00:48,772 --> 00:00:51,605 We actually share the same genealogy with Ötzi the Iceman. 13 00:00:51,629 --> 00:00:53,140 So -- Ötzi, Harriet and me. 14 00:00:53,164 --> 00:00:56,764 And being the current day, of course, we started our own Facebook group. 15 00:00:56,789 --> 00:00:58,088 You're all welcome to join. 16 00:00:58,712 --> 00:01:01,792 When I met Harriet in person the next year at the TED conference, 17 00:01:01,816 --> 00:01:04,804 she'd gone online and ordered our own happy haplotype T-shirts. 18 00:01:04,828 --> 00:01:05,839 (Laughter) 19 00:01:06,163 --> 00:01:07,706 Why am I telling you this story? 20 00:01:07,730 --> 00:01:10,072 What does it have to do with the future of health? 21 00:01:10,096 --> 00:01:12,072 Well, the way I met Harriet is an example 22 00:01:12,096 --> 00:01:15,847 of how leveraging cross-disciplinary, exponentially growing technologies 23 00:01:15,871 --> 00:01:18,182 is affecting our future of health and wellness -- 24 00:01:18,206 --> 00:01:19,556 from low-cost gene analysis 25 00:01:19,580 --> 00:01:21,698 to the ability to do powerful bioinformatics 26 00:01:21,722 --> 00:01:24,531 to the connection of the Internet and social networking. 27 00:01:25,089 --> 00:01:26,689 What I'd like to talk about today 28 00:01:26,713 --> 00:01:28,973 is understanding these exponential technologies. 29 00:01:28,997 --> 00:01:30,554 We often think linearly. 30 00:01:30,778 --> 00:01:33,366 But if you think about it, if you have a lily pad 31 00:01:33,390 --> 00:01:35,353 and it just divided every single day -- 32 00:01:35,377 --> 00:01:39,033 two, four, eight, sixteen -- in 15 days, you'd have 32,000. 33 00:01:39,057 --> 00:01:40,992 What do you think you'd have in a month? 34 00:01:41,016 --> 00:01:42,167 We're at a billion. 35 00:01:42,491 --> 00:01:44,163 If we start to think exponentially, 36 00:01:44,187 --> 00:01:47,639 we can see how this is starting to affect all the technologies around us. 37 00:01:47,663 --> 00:01:50,766 Many of these technologies, speaking as a physician and innovator, 38 00:01:50,790 --> 00:01:53,882 we can start to leverage, to impact the future of our own health 39 00:01:53,906 --> 00:01:55,556 and of health care, 40 00:01:55,581 --> 00:01:58,666 and to address many of the major challenges in health care today, 41 00:01:58,690 --> 00:02:02,654 ranging from the exponential costs to the aging population, 42 00:02:02,679 --> 00:02:05,978 the way we really don't use information very well today, 43 00:02:06,003 --> 00:02:07,493 the fragmentation of care 44 00:02:07,517 --> 00:02:11,247 and the often very difficult course of adoption of innovation. 45 00:02:11,571 --> 00:02:15,366 And one of the major things we can do is move the curve to the left. 46 00:02:15,390 --> 00:02:18,107 We spend most of our money on the last 20 percent of life. 47 00:02:18,131 --> 00:02:21,191 What if we could incentivize physicians in the health care system 48 00:02:21,215 --> 00:02:22,371 and our own selves 49 00:02:22,395 --> 00:02:24,910 to move the curve to the left and improve our health, 50 00:02:24,934 --> 00:02:26,378 leveraging technology as well? 51 00:02:26,402 --> 00:02:29,125 Now my favorite example of exponential technology, 52 00:02:29,150 --> 00:02:30,450 we all have in our pocket. 53 00:02:30,474 --> 00:02:33,745 If you think about it, these are really dramatically improving. 54 00:02:33,769 --> 00:02:35,675 I mean, this is the iPhone 4. 55 00:02:35,699 --> 00:02:38,887 Imagine what the iPhone 8 will be able to do. 56 00:02:38,911 --> 00:02:40,829 Now, I've gained some insight into this. 57 00:02:40,853 --> 00:02:43,428 I've been the track share for the medicine portion 58 00:02:43,452 --> 00:02:45,959 of a new institution called Singularity University, 59 00:02:45,983 --> 00:02:47,372 based in Silicon Valley. 60 00:02:47,396 --> 00:02:51,455 We bring together each summer about 100 very talented students 61 00:02:51,480 --> 00:02:52,646 from around the world. 62 00:02:52,670 --> 00:02:55,536 And we look at these exponential technologies from medicine, 63 00:02:55,560 --> 00:02:58,706 biotech, artificial intelligence, robotics, nanotechnology, space, 64 00:02:58,730 --> 00:03:01,209 and address how we can cross-train and leverage these 65 00:03:01,233 --> 00:03:02,573 to impact major unmet goals. 66 00:03:02,597 --> 00:03:04,604 We also have seven-day executive programs. 67 00:03:04,628 --> 00:03:07,011 And coming up next month is FutureMed, 68 00:03:07,035 --> 00:03:10,409 a program to help cross-train and leverage technologies into medicine. 69 00:03:10,433 --> 00:03:11,954 Now, I mentioned the phone. 70 00:03:12,878 --> 00:03:16,189 These mobile phones have over 20,000 different mobile apps available. 71 00:03:17,113 --> 00:03:20,355 There's one out of the UK where you can pee on a little chip, 72 00:03:20,379 --> 00:03:21,660 connect it to your iPhone, 73 00:03:21,684 --> 00:03:22,839 and check for an STD. 74 00:03:22,863 --> 00:03:25,166 I don't know if I'd try that, but it's available. 75 00:03:25,190 --> 00:03:27,015 There are other sorts of applications. 76 00:03:27,039 --> 00:03:29,315 Merging your phone and diagnostics, for example, 77 00:03:29,339 --> 00:03:31,380 measuring your blood glucose on your iPhone 78 00:03:31,404 --> 00:03:34,110 and sending that to your physician, 79 00:03:34,135 --> 00:03:36,902 so they can better understand and you can better understand 80 00:03:36,926 --> 00:03:39,210 your blood sugars as a diabetic. 81 00:03:39,730 --> 00:03:42,851 So let's see how exponential technologies are taking health care. 82 00:03:42,875 --> 00:03:44,041 Let's start with faster. 83 00:03:44,065 --> 00:03:46,474 It's no secret that computers, through Moore's law, 84 00:03:46,498 --> 00:03:48,141 are speeding up faster and faster. 85 00:03:48,165 --> 00:03:50,226 We can do more powerful things with them. 86 00:03:50,250 --> 00:03:53,450 They're really approaching -- in many cases, surpassing -- 87 00:03:53,475 --> 00:03:54,921 the ability of the human mind. 88 00:03:54,945 --> 00:03:58,779 But where I think computational speed is most applicable is in imaging. 89 00:03:58,803 --> 00:04:01,435 The ability now to look inside the body in real time 90 00:04:01,459 --> 00:04:02,917 with very high resolution 91 00:04:02,941 --> 00:04:04,401 is really becoming incredible. 92 00:04:04,425 --> 00:04:07,461 And we're layering multiple technologies -- PET scans, CT scans 93 00:04:07,485 --> 00:04:09,507 and molecular diagnostics -- 94 00:04:09,531 --> 00:04:11,796 to find and seek things at different levels. 95 00:04:12,856 --> 00:04:16,307 Here you're going to see the very highest resolution MRI scan done today, 96 00:04:16,331 --> 00:04:19,548 of Marc Hodosh, the curator of TEDMED. 97 00:04:19,574 --> 00:04:21,716 And now we can see inside of the brain 98 00:04:21,741 --> 00:04:24,333 at a resolution and ability never before available, 99 00:04:24,357 --> 00:04:28,423 and essentially learn how to reconstruct and maybe even reengineer 100 00:04:28,447 --> 00:04:30,131 or backwards engineer the brain, 101 00:04:30,155 --> 00:04:33,132 so we can better understand pathology, disease and therapy. 102 00:04:33,156 --> 00:04:36,448 We can look inside with real-time fMRI in the brain at real time. 103 00:04:36,472 --> 00:04:39,761 And by understanding these sorts of processes and these connections, 104 00:04:39,785 --> 00:04:42,848 we're going to understand the effects of medication or meditation 105 00:04:42,872 --> 00:04:45,479 and better personalize and make effective, for example, 106 00:04:45,503 --> 00:04:47,106 psychoactive drugs. 107 00:04:47,130 --> 00:04:49,898 The scanners for these are getting smaller, less expensive 108 00:04:49,922 --> 00:04:51,073 and more portable. 109 00:04:51,397 --> 00:04:54,767 And this sort of data explosion available from these 110 00:04:54,792 --> 00:04:57,225 is really almost becoming a challenge. 111 00:04:57,250 --> 00:05:00,626 The scan of today takes up about 800 books, or 20 gigabytes. 112 00:05:00,651 --> 00:05:03,922 The scan in a couple of years will be one terabyte, or 800,000 books. 113 00:05:03,946 --> 00:05:05,715 How do you leverage that information? 114 00:05:06,439 --> 00:05:07,590 Let's get personal. 115 00:05:07,614 --> 00:05:10,821 I won't ask who here's had a colonoscopy, but if you're over age 50, 116 00:05:10,845 --> 00:05:12,838 it's time for your screening colonoscopy. 117 00:05:12,862 --> 00:05:15,293 How'd you like to avoid the pointy end of the stick? 118 00:05:15,317 --> 00:05:17,368 Now there's essentially virtual colonoscopy. 119 00:05:19,692 --> 00:05:20,983 Compare those two pictures. 120 00:05:21,007 --> 00:05:24,274 As a radiologist, you can basically fly through your patient's colon, 121 00:05:24,298 --> 00:05:26,593 and augmenting that with artificial intelligence, 122 00:05:26,617 --> 00:05:29,246 potentially identify a lesion that we might have missed, 123 00:05:29,270 --> 00:05:30,846 but using AI on top of radiology, 124 00:05:30,870 --> 00:05:32,921 we can find lesions that were missed before. 125 00:05:32,945 --> 00:05:35,472 Maybe this will encourage people to get colonoscopies 126 00:05:35,496 --> 00:05:36,879 that wouldn't have otherwise. 127 00:05:36,903 --> 00:05:38,915 This is an example of this paradigm shift. 128 00:05:38,939 --> 00:05:42,340 We're moving to this integration of biomedicine, information technology, 129 00:05:42,364 --> 00:05:45,670 wireless and, I would say, mobile now -- this era of digital medicine. 130 00:05:45,694 --> 00:05:49,238 Even my stethoscope is now digital, and of course, there's an app for that. 131 00:05:49,662 --> 00:05:52,197 We're moving, obviously, to the era of the tricorder. 132 00:05:52,221 --> 00:05:55,069 So the handheld ultrasound is basically surpassing 133 00:05:55,094 --> 00:05:57,092 and supplanting the stethoscope. 134 00:05:57,116 --> 00:06:00,577 These are now at a price point of what used to be 100,000 euros 135 00:06:00,602 --> 00:06:02,441 or a couple hundred-thousand dollars. 136 00:06:02,465 --> 00:06:03,618 For about 5,000 dollars, 137 00:06:03,642 --> 00:06:06,968 I can have the power of a very powerful diagnostic device in my hand. 138 00:06:06,992 --> 00:06:10,084 Merging this now with the advent of electronic medical records -- 139 00:06:10,108 --> 00:06:13,188 in the US, we're still less than 20 percent electronic; 140 00:06:13,213 --> 00:06:16,009 here in the Netherlands, I think it's more than 80 percent. 141 00:06:16,233 --> 00:06:18,521 Now that we're switching to merging medical data, 142 00:06:18,545 --> 00:06:20,220 making it available electronically, 143 00:06:20,244 --> 00:06:23,391 we can crowd-source the information, and as a physician, 144 00:06:23,416 --> 00:06:26,494 I can access my patients' data from wherever I am, 145 00:06:27,176 --> 00:06:28,606 just through my mobile device. 146 00:06:29,030 --> 00:06:32,143 And now, of course, we're in the era of the iPad, even the iPad 2. 147 00:06:32,167 --> 00:06:33,318 Just last month, 148 00:06:33,342 --> 00:06:35,557 the first FDA-approved application was approved 149 00:06:35,581 --> 00:06:39,074 to allow radiologists to do actual reading on these sorts of devices. 150 00:06:39,698 --> 00:06:42,319 So certainly, the physicians of today, including myself, 151 00:06:42,343 --> 00:06:44,320 are completely reliable on these devices. 152 00:06:44,344 --> 00:06:46,163 And as you saw just about a month ago, 153 00:06:46,187 --> 00:06:49,179 Watson from IBM beat the two champions in "Jeopardy." 154 00:06:49,204 --> 00:06:51,642 So I want you to imagine when, in a couple of years, 155 00:06:51,666 --> 00:06:54,126 we've started to apply this cloud-based information, 156 00:06:54,150 --> 00:06:57,750 when we really have the AI physician and leverage our brains to connectivity 157 00:06:57,774 --> 00:07:01,743 to make decisions and diagnostics at a level never done. 158 00:07:04,348 --> 00:07:07,547 Already today, you don't need to go to your physician in many cases. 159 00:07:07,571 --> 00:07:11,113 Only in about 20 percent of visits do you need to lay hands on the patient. 160 00:07:11,137 --> 00:07:12,998 We're now in the era of virtual visits. 161 00:07:13,022 --> 00:07:15,515 From Skype-type visits you can do with American Well, 162 00:07:15,539 --> 00:07:18,895 to Cisco, that's developed a very complex health presence system, 163 00:07:18,920 --> 00:07:22,127 the ability to interact with your health care provider is different. 164 00:07:22,151 --> 00:07:25,176 And these are being augmented even by our devices, again, today. 165 00:07:25,200 --> 00:07:27,969 My friend Jessica sent me a picture of her head laceration, 166 00:07:27,993 --> 00:07:30,201 so I can save her a trip to the emergency room, 167 00:07:30,225 --> 00:07:31,654 and do diagnostics that way. 168 00:07:31,678 --> 00:07:34,072 Or maybe we can leverage today's gaming technology, 169 00:07:34,096 --> 00:07:35,342 like the Microsoft Kinect, 170 00:07:35,366 --> 00:07:39,042 hack that to enable diagnostics, for example, in diagnosing stroke, 171 00:07:39,067 --> 00:07:41,939 using simple motion detection, using $100 devices. 172 00:07:42,980 --> 00:07:46,165 We can actually now visit our patients robotically. 173 00:07:46,189 --> 00:07:47,920 This is the RP7; 174 00:07:49,664 --> 00:07:52,622 if I'm a hematologist, I can visit another clinic or hospital. 175 00:07:54,546 --> 00:07:56,941 These are being augmented by a whole suite of tools 176 00:07:56,965 --> 00:07:58,161 actually in the home now. 177 00:07:58,185 --> 00:08:00,039 We already have wireless scales. 178 00:08:00,063 --> 00:08:02,768 You step on the scale, tweet your weight to your friends, 179 00:08:02,792 --> 00:08:04,034 they can keep you in line. 180 00:08:04,058 --> 00:08:05,876 We have wireless blood pressure cuffs. 181 00:08:05,900 --> 00:08:08,407 A whole gamut of technologies are being put together. 182 00:08:08,431 --> 00:08:11,245 Instead of wearing kludgy devices, we put on a simple patch. 183 00:08:11,269 --> 00:08:12,762 This was developed at Stanford. 184 00:08:12,786 --> 00:08:16,355 It's called iRhythm; it completely supplants the prior technology 185 00:08:16,389 --> 00:08:19,872 at a much lower price point, with much more effectivity. 186 00:08:20,265 --> 00:08:22,740 We're also in the era today of quantified self. 187 00:08:22,764 --> 00:08:26,369 Consumers now can basically buy $100 devices, like this little Fitbit. 188 00:08:26,393 --> 00:08:28,414 I can measure my steps, my caloric outtake. 189 00:08:28,438 --> 00:08:30,491 I can get insight into that on a daily basis 190 00:08:30,515 --> 00:08:32,523 and share it with my friends or physician. 191 00:08:32,547 --> 00:08:35,626 There's watches that measure your heart rate, Zeo sleep monitors, 192 00:08:35,650 --> 00:08:37,732 a suite of tools that enable you to leverage 193 00:08:37,756 --> 00:08:39,571 and have insight into your own health. 194 00:08:39,595 --> 00:08:41,602 As we start to integrate this information, 195 00:08:41,626 --> 00:08:44,508 we'll know better what to do with it, and have better insight 196 00:08:44,532 --> 00:08:46,959 into our own pathologies, health and wellness. 197 00:08:47,283 --> 00:08:49,926 There's even mirrors that can pick up your pulse rate. 198 00:08:49,950 --> 00:08:51,709 And I would argue, in the future, 199 00:08:51,733 --> 00:08:54,895 we'll have wearable devices in our clothes, monitoring us 24/7. 200 00:08:54,919 --> 00:08:58,336 And just like the OnStar system in cars, your red light might go on. 201 00:08:58,360 --> 00:09:01,405 It won't say "check engine"; it'll be a "check your body" light, 202 00:09:01,429 --> 00:09:03,113 and you'll go get it taken care of. 203 00:09:03,737 --> 00:09:04,910 Probably in a few years, 204 00:09:04,934 --> 00:09:07,740 you'll look in your mirror and it'll be diagnosing you. 205 00:09:07,764 --> 00:09:08,986 (Laughter) 206 00:09:09,410 --> 00:09:11,489 For those of you with kiddos at home, 207 00:09:11,513 --> 00:09:14,458 how would you like a wireless diaper that supports your -- 208 00:09:14,482 --> 00:09:15,542 (Laughter) 209 00:09:15,566 --> 00:09:17,763 More information, I think, than you might need, 210 00:09:17,787 --> 00:09:19,224 but it's going to be here. 211 00:09:19,948 --> 00:09:23,048 Now, we've heard a lot today about technology and connection. 212 00:09:23,072 --> 00:09:24,884 And I think some of these technologies 213 00:09:24,908 --> 00:09:28,326 will enable us to be more connected with our patients, to take more time 214 00:09:28,350 --> 00:09:30,931 and do the important human-touch elements of medicine, 215 00:09:30,955 --> 00:09:33,170 as augmented by these technologies. 216 00:09:33,557 --> 00:09:35,926 Now, we've talked about augmenting the patient. 217 00:09:35,950 --> 00:09:37,626 How about augmenting the physician? 218 00:09:37,650 --> 00:09:40,739 We're now in the era of super-enabling the surgeon, 219 00:09:40,764 --> 00:09:44,226 who can now go into the body and do robotic surgery, which is here today, 220 00:09:44,250 --> 00:09:47,713 at a level that was not really possible even five years ago. 221 00:09:47,737 --> 00:09:50,857 And now this is being augmented with further layers of technology, 222 00:09:50,881 --> 00:09:52,036 like augmented reality. 223 00:09:52,060 --> 00:09:54,991 So the surgeon can see inside the patient, through their lens, 224 00:09:55,015 --> 00:09:57,326 where the tumor is, where the blood vessels are. 225 00:09:57,350 --> 00:09:59,455 This can be integrated with decision support. 226 00:09:59,479 --> 00:10:02,640 A surgeon in New York can help a surgeon in Amsterdam, for example. 227 00:10:02,664 --> 00:10:06,439 And we're entering an era of truly scarless surgery called NOTES, 228 00:10:06,464 --> 00:10:09,055 where the robotic endoscope can come out the stomach 229 00:10:09,079 --> 00:10:10,527 and pull out that gallbladder, 230 00:10:10,551 --> 00:10:12,902 all in a scarless way and robotically. 231 00:10:12,926 --> 00:10:16,242 This is called NOTES, and it's coming -- basically scarless surgery, 232 00:10:16,266 --> 00:10:18,324 as mediated by robotic surgery. 233 00:10:19,148 --> 00:10:21,244 Now, how about controlling other elements? 234 00:10:21,268 --> 00:10:23,698 For those who have disabilities -- the paraplegic, 235 00:10:24,122 --> 00:10:26,909 there's the brain-computer interface, or BCI, 236 00:10:26,933 --> 00:10:29,122 where chips have been put on the motor cortex 237 00:10:29,146 --> 00:10:30,966 of completely quadriplegic patients, 238 00:10:33,190 --> 00:10:35,850 and they can control a cursor or a wheelchair 239 00:10:35,874 --> 00:10:37,407 or, potentially, a robotic arm. 240 00:10:37,431 --> 00:10:39,027 These devices are getting smaller 241 00:10:39,051 --> 00:10:41,278 and going into more and more of these patients. 242 00:10:41,302 --> 00:10:42,514 Still in clinical trials, 243 00:10:42,538 --> 00:10:44,939 but imagine when we can connect these, for example, 244 00:10:44,963 --> 00:10:46,579 to the amazing bionic limb, 245 00:10:46,603 --> 00:10:49,425 such as the DEKA Arm, built by Dean Kamen and colleagues, 246 00:10:49,449 --> 00:10:51,469 which has 17 degrees of motion and freedom, 247 00:10:51,493 --> 00:10:53,521 and can allow the person who's lost a limb 248 00:10:53,545 --> 00:10:57,736 to have much higher dexterity or control than they've had in the past. 249 00:10:58,104 --> 00:11:01,947 So we're really entering the era of wearable robotics, actually. 250 00:11:01,972 --> 00:11:04,186 If you haven't lost a limb but had a stroke, 251 00:11:04,210 --> 00:11:05,897 you can wear these augmented limbs. 252 00:11:05,921 --> 00:11:09,417 Or if you're a paraplegic -- I've visited the folks at Berkeley Bionics -- 253 00:11:09,441 --> 00:11:10,610 they've developed eLEGS. 254 00:11:10,634 --> 00:11:12,000 I took this video last week. 255 00:11:12,024 --> 00:11:15,809 Here's a paraplegic patient, walking by strapping on these exoskeletons. 256 00:11:15,833 --> 00:11:17,844 He's otherwise completely wheelchair-bound. 257 00:11:17,868 --> 00:11:19,884 This is the early era of wearable robotics. 258 00:11:19,908 --> 00:11:22,187 And by leveraging these sorts of technologies, 259 00:11:22,211 --> 00:11:24,548 we're going to change the definition of disability 260 00:11:24,572 --> 00:11:27,102 to, in some cases, be superability, or super-enabling. 261 00:11:27,126 --> 00:11:30,316 This is Aimee Mullins, who lost her lower limbs as a young child, 262 00:11:30,340 --> 00:11:33,052 and Hugh Herr, who's a professor at MIT, 263 00:11:33,077 --> 00:11:35,078 who lost his limbs in a climbing accident. 264 00:11:35,102 --> 00:11:38,497 And now both of them can climb better, move faster, swim differently 265 00:11:38,521 --> 00:11:42,008 with their prosthetics than us normal-abled persons. 266 00:11:42,232 --> 00:11:43,672 How about other exponentials? 267 00:11:43,697 --> 00:11:45,571 We've heard a bit today about obesity. 268 00:11:45,596 --> 00:11:49,006 Clearly the obesity trend is exponentially going in the wrong direction, 269 00:11:49,030 --> 00:11:50,465 including with huge costs. 270 00:11:50,489 --> 00:11:53,612 But the trend in medicine is to get exponentially smaller. 271 00:11:53,636 --> 00:11:57,211 A few examples: we're now in the era of "Fantastic Voyage," the iPill. 272 00:11:57,235 --> 00:11:59,636 You can swallow this completely integrated device. 273 00:11:59,660 --> 00:12:01,526 It can take pictures of your GI system, 274 00:12:01,550 --> 00:12:04,306 help diagnose and treat as it moves through your GI tract. 275 00:12:04,330 --> 00:12:06,149 We get into even smaller micro-robots 276 00:12:06,173 --> 00:12:09,070 that will eventually, autonomously, move through your system, 277 00:12:09,094 --> 00:12:12,050 and be able to do things surgeons can't do 278 00:12:12,075 --> 00:12:13,611 in a much less invasive manner. 279 00:12:14,635 --> 00:12:17,224 Sometimes these might self-assemble in your GI system, 280 00:12:17,248 --> 00:12:19,599 and be augmented in that reality. 281 00:12:19,896 --> 00:12:22,388 On the cardiac side, pacemakers are getting smaller 282 00:12:22,412 --> 00:12:23,749 and much easier to place, 283 00:12:23,773 --> 00:12:26,856 so no need to train an interventional cardiologist to place them. 284 00:12:26,880 --> 00:12:29,816 And they'll be wirelessly telemetered to your mobile devices, 285 00:12:29,840 --> 00:12:32,326 so you can go places and be monitored remotely. 286 00:12:32,950 --> 00:12:34,548 These are shrinking even further. 287 00:12:34,595 --> 00:12:38,543 This one is in prototyping by Medtronic; it's smaller than a penny. 288 00:12:39,552 --> 00:12:42,977 Artificial retinas, the ability to put arrays on the back of the eyeball 289 00:12:43,001 --> 00:12:44,425 and allow the blind to see -- 290 00:12:44,449 --> 00:12:46,760 also in early trials, but moving into the future. 291 00:12:46,784 --> 00:12:48,515 These are going to be game-changing. 292 00:12:48,539 --> 00:12:50,227 Or for those of us who are sighted, 293 00:12:51,051 --> 00:12:53,413 how about having the assisted-living contact lens? 294 00:12:53,437 --> 00:12:56,858 Bluetooth, Wi-Fi available -- beams back images to your eye. 295 00:12:57,683 --> 00:12:58,706 (Laughter) 296 00:12:58,730 --> 00:13:00,933 Now, if you have trouble maintaining your diet, 297 00:13:00,957 --> 00:13:02,913 it might help to have some extra imagery 298 00:13:02,937 --> 00:13:06,571 to remind you how many calories are going to be coming at you. 299 00:13:08,295 --> 00:13:11,338 How about enabling the pathologist to use their cell phone 300 00:13:11,370 --> 00:13:12,916 to see at a microscopic level 301 00:13:12,940 --> 00:13:16,254 and to lumber that data back to the cloud and make better diagnostics? 302 00:13:16,278 --> 00:13:18,564 In fact, the whole era of laboratory medicine 303 00:13:18,588 --> 00:13:19,740 is completely changing. 304 00:13:19,764 --> 00:13:21,717 We can now leverage microfluidics, 305 00:13:21,741 --> 00:13:23,958 like this chip made by Steve Quake at Stanford. 306 00:13:23,982 --> 00:13:26,618 Microfluidics can replace an entire lab of technicians; 307 00:13:28,542 --> 00:13:32,080 put it on a chip, enable thousands of tests at the point of care, 308 00:13:32,105 --> 00:13:33,257 anywhere in the world. 309 00:13:33,281 --> 00:13:36,685 This will really leverage technology to the rural and the underserved 310 00:13:36,709 --> 00:13:40,224 and enable what used to be thousand-dollar tests to be done for pennies, 311 00:13:40,248 --> 00:13:41,600 and at the point of care. 312 00:13:42,024 --> 00:13:44,525 If we go down the small pathway a little bit further, 313 00:13:44,549 --> 00:13:46,448 we're entering the era of nanomedicine, 314 00:13:46,472 --> 00:13:48,394 the ability to make devices super-small, 315 00:13:48,418 --> 00:13:50,738 to the point where we can design red blood cells 316 00:13:50,762 --> 00:13:53,837 or microrobots that monitor our blood system or immune system, 317 00:13:53,861 --> 00:13:56,949 or even those that might clear out the clots from our arteries. 318 00:13:57,473 --> 00:13:59,213 Now how about exponentially cheaper? 319 00:13:59,237 --> 00:14:02,070 Not something we usually think about in the era of medicine, 320 00:14:02,094 --> 00:14:07,497 but hard disks used to be 3,400 dollars for 10 megabytes -- exponentially cheaper. 321 00:14:07,522 --> 00:14:10,184 In genomics now, the genome cost about a billion dollars 322 00:14:10,208 --> 00:14:12,467 about 10 years ago, when the first one came out. 323 00:14:12,491 --> 00:14:15,855 We're now approaching essentially a $1,000 genome, probably next year. 324 00:14:15,879 --> 00:14:17,412 And in two years, a $100 genome. 325 00:14:17,436 --> 00:14:19,759 What will we do with $100 genomes? 326 00:14:19,784 --> 00:14:22,138 Soon we'll have millions of these tests available. 327 00:14:22,162 --> 00:14:25,653 Then it gets interesting, when we start to crowd-source that information, 328 00:14:25,677 --> 00:14:27,923 and enter the era of true personalized medicine: 329 00:14:27,947 --> 00:14:30,479 the right drug for the right person at the right time, 330 00:14:30,503 --> 00:14:33,796 instead of what we're doing now, which is the same drug for everybody, 331 00:14:33,820 --> 00:14:36,926 blockbuster drug medications, which don't work for the individual. 332 00:14:36,950 --> 00:14:40,169 Many different companies are working on leveraging these approaches. 333 00:14:40,193 --> 00:14:42,598 I'll show you a simple example, from 23andMe again. 334 00:14:42,622 --> 00:14:44,732 My data indicates I've got about average risk 335 00:14:44,756 --> 00:14:47,447 for developing macular degeneration, a kind of blindness. 336 00:14:47,471 --> 00:14:50,097 But if I take that same data, upload it to deCODEme, 337 00:14:50,321 --> 00:14:54,576 I can look at my risk for type 2 diabetes; I'm at almost twice the risk. 338 00:14:54,600 --> 00:14:57,817 I might want to watch how much dessert I have at lunch, for example. 339 00:14:57,841 --> 00:14:59,192 It might change my behavior. 340 00:14:59,216 --> 00:15:01,458 Leveraging my knowledge of my pharmacogenomics: 341 00:15:01,482 --> 00:15:04,817 how my genes modulate, what my drugs do and what doses I need 342 00:15:04,841 --> 00:15:06,532 will become increasingly important, 343 00:15:06,556 --> 00:15:08,907 and once in the hands of individuals and patients, 344 00:15:08,931 --> 00:15:11,453 will make better drug dosing and selection available. 345 00:15:11,477 --> 00:15:14,319 So again, it's not just genes, it's multiple details -- 346 00:15:14,343 --> 00:15:17,761 our habits, our environmental exposures. 347 00:15:17,786 --> 00:15:20,597 When was the last time your doctor asked where you've lived? 348 00:15:20,621 --> 00:15:23,332 Geomedicine: where you live, what you've been exposed to, 349 00:15:23,356 --> 00:15:25,073 can dramatically affect your health. 350 00:15:25,097 --> 00:15:26,628 We can capture that information. 351 00:15:26,652 --> 00:15:28,561 Genomics, proteomics, the environment -- 352 00:15:28,585 --> 00:15:31,450 all this data streaming at us individually and as physicians: 353 00:15:31,474 --> 00:15:32,626 How do we manage it? 354 00:15:32,650 --> 00:15:35,712 We're now entering the era of systems medicine, systems biology, 355 00:15:35,736 --> 00:15:38,237 where we can start to integrate all this information. 356 00:15:38,261 --> 00:15:41,069 And by looking at the patterns, for example, in our blood, 357 00:15:41,093 --> 00:15:42,906 of 10,000 biomarkers in a single test, 358 00:15:42,930 --> 00:15:46,465 we can look at patterns and detect disease at a much earlier stage. 359 00:15:47,089 --> 00:15:50,523 This is called by Lee Hood, the father of the field, P4 Medicine. 360 00:15:50,547 --> 00:15:53,173 We'll be predictive and know what you're likely to have. 361 00:15:53,197 --> 00:15:56,020 We can be preventative; that prevention can be personalized. 362 00:15:56,044 --> 00:15:58,573 More importantly, it'll be increasingly participatory. 363 00:15:58,597 --> 00:16:00,436 Through websites like PatientsLikeMe 364 00:16:00,460 --> 00:16:04,570 or managing your data on Microsoft HealthVault or Google Health, 365 00:16:04,595 --> 00:16:06,742 leveraging this together in participatory ways 366 00:16:06,766 --> 00:16:08,250 will be increasingly important. 367 00:16:08,274 --> 00:16:10,230 I'll finish up with exponentially better. 368 00:16:10,254 --> 00:16:12,771 We'd like to get therapies better and more effective. 369 00:16:13,195 --> 00:16:15,676 Today we treat high blood pressure mostly with pills. 370 00:16:15,700 --> 00:16:17,087 What if we take a new device, 371 00:16:17,111 --> 00:16:20,896 knock out the nerve vessels that help mediate blood pressure, 372 00:16:20,921 --> 00:16:23,526 and in a single therapy, basically cure hypertension? 373 00:16:23,550 --> 00:16:25,611 This is a new device doing essentially that. 374 00:16:25,635 --> 00:16:27,697 It should be on the market in a year or two. 375 00:16:27,721 --> 00:16:29,825 How about more targeted therapies for cancer? 376 00:16:29,849 --> 00:16:33,398 I'm an oncologist and know that most of what we give is essentially poison. 377 00:16:33,422 --> 00:16:37,211 We learned at Stanford and other places that we can discover cancer stem cells, 378 00:16:37,235 --> 00:16:41,462 the ones that seem to be really responsible for disease relapse. 379 00:16:41,487 --> 00:16:43,406 So if you think of cancer as a weed, 380 00:16:43,430 --> 00:16:46,323 we often can whack the weed away and it seems to shrink, 381 00:16:46,347 --> 00:16:47,515 but it often comes back. 382 00:16:47,539 --> 00:16:49,276 So we're attacking the wrong target. 383 00:16:49,300 --> 00:16:50,762 The cancer stem cells remain, 384 00:16:50,786 --> 00:16:53,042 and the tumor can return months or years later. 385 00:16:53,066 --> 00:16:55,547 We're now learning to identify the cancer stem cells 386 00:16:55,571 --> 00:16:58,687 and identify those as targets and go for the long-term cure. 387 00:16:58,711 --> 00:17:01,004 We're entering the era of personalized oncology, 388 00:17:01,028 --> 00:17:03,391 the ability to leverage all of this data together, 389 00:17:03,415 --> 00:17:04,566 analyze the tumor 390 00:17:04,589 --> 00:17:07,904 and come up with a real, specific cocktail for the individual patient. 391 00:17:08,228 --> 00:17:10,060 I'll close with regenerative medicine. 392 00:17:10,085 --> 00:17:11,827 I've studied a lot about stem cells. 393 00:17:11,851 --> 00:17:14,053 Embryonic stem cells are particularly powerful. 394 00:17:14,077 --> 00:17:16,188 We have adult stem cells throughout our body; 395 00:17:16,212 --> 00:17:18,337 we use those in bone marrow transplantation. 396 00:17:18,761 --> 00:17:23,662 Geron, last year, started the first trial using human embryonic stem cells 397 00:17:23,686 --> 00:17:25,252 to treat spinal cord injuries. 398 00:17:25,276 --> 00:17:27,326 Still a phase I trial, but evolving. 399 00:17:27,349 --> 00:17:31,123 We've been using adult stem cells in clinical trials for about 15 years 400 00:17:31,147 --> 00:17:34,726 to approach a whole range of topics, particularly cardiovascular disease. 401 00:17:34,750 --> 00:17:38,466 If we take our own bone marrow cells and treat a patient with a heart attack, 402 00:17:38,490 --> 00:17:41,402 we can see much improved heart function and better survival 403 00:17:41,426 --> 00:17:44,379 using our own bone marrow derived cells after a heart attack. 404 00:17:44,629 --> 00:17:45,778 As mentioned earlier, 405 00:17:45,803 --> 00:17:47,839 I invented a device called the MarrowMiner, 406 00:17:47,863 --> 00:17:50,300 a much less invasive way for harvesting bone marrow. 407 00:17:50,324 --> 00:17:53,583 It's now been FDA approved; hopefully on the market in the next year. 408 00:17:53,607 --> 00:17:55,484 Hopefully you can appreciate the device 409 00:17:55,508 --> 00:17:59,278 going through the patient's body removing bone marrow, not with 200 punctures, 410 00:17:59,302 --> 00:18:01,695 but with a single puncture, under local anesthesia. 411 00:18:01,719 --> 00:18:03,303 Where is stem-cell therapy going? 412 00:18:03,327 --> 00:18:04,478 If you think about it, 413 00:18:04,502 --> 00:18:08,776 every cell in your body has the same DNA you had when you were an embryo. 414 00:18:08,801 --> 00:18:10,745 We can now reprogram your skin cells 415 00:18:10,769 --> 00:18:13,682 to actually act like a pluripotent embryonic stem cell 416 00:18:13,706 --> 00:18:17,354 and utilize those, potentially, to treat multiple organs in the same patient, 417 00:18:17,378 --> 00:18:19,101 making personalized stem cell lines. 418 00:18:19,125 --> 00:18:21,910 I think there'll be a new era of your own stem cell banking 419 00:18:21,934 --> 00:18:25,402 to have in the freezer your own cardiac cells, myocytes and neural cells 420 00:18:25,426 --> 00:18:27,779 to use them in the future, should you need them. 421 00:18:27,803 --> 00:18:31,025 We're integrating this now with a whole era of cellular engineering, 422 00:18:31,049 --> 00:18:34,617 and integrating exponential technologies for essentially 3D organ printing, 423 00:18:34,641 --> 00:18:36,325 replacing the ink with cells, 424 00:18:36,349 --> 00:18:39,146 and essentially building and reconstructing a 3D organ. 425 00:18:39,170 --> 00:18:40,696 That's where things are heading. 426 00:18:40,720 --> 00:18:41,881 Still very early days, 427 00:18:41,905 --> 00:18:44,652 but I think, as integration of exponential technologies, 428 00:18:44,676 --> 00:18:45,840 this is the example. 429 00:18:46,164 --> 00:18:48,651 So in closing, as you think about technology trends 430 00:18:48,675 --> 00:18:50,515 and how to impact health and medicine, 431 00:18:50,539 --> 00:18:52,516 we're entering an era of miniaturization, 432 00:18:52,540 --> 00:18:54,762 decentralization and personalization. 433 00:18:54,786 --> 00:18:56,676 And by pulling these things together - 434 00:18:56,701 --> 00:18:59,293 we heard at the beginning of this event about the why - 435 00:18:59,318 --> 00:19:02,303 if we start to think about how to understand and leverage them, 436 00:19:02,327 --> 00:19:05,678 we're going to empower the patient, enable the doctor, enhance wellness 437 00:19:05,702 --> 00:19:08,149 and begin to cure the well before they get sick. 438 00:19:08,173 --> 00:19:11,711 Because I know as a doctor, if someone comes to me with stage I disease, 439 00:19:11,735 --> 00:19:13,526 I'm thrilled; we can often cure them. 440 00:19:13,550 --> 00:19:14,720 But often it's too late, 441 00:19:14,744 --> 00:19:16,873 and it's stage III or IV cancer, for example. 442 00:19:16,897 --> 00:19:19,012 So by leveraging these technologies together, 443 00:19:19,036 --> 00:19:22,273 I think we'll enter a new era that I like to call stage 0 medicine. 444 00:19:22,297 --> 00:19:25,566 And as a cancer doctor, I'm looking forward to being out of a job. 445 00:19:25,590 --> 00:19:26,812 Thanks very much. 446 00:19:26,836 --> 00:19:28,814 (Applause) 447 00:19:28,838 --> 00:19:30,535 Host: Thank you. Thank you. 448 00:19:30,559 --> 00:19:32,359 (Applause) 449 00:19:32,383 --> 00:19:34,383 Take a bow, take a bow. 450 00:19:35,021 --> 00:19:37,354 Daniel Kraft, ladies and gentleman.