[Script Info] Title: [Events] Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text Dialogue: 0,0:00:18.17,0:00:19.17,Default,,0000,0000,0000,,Hi, there. Dialogue: 0,0:00:20.17,0:00:21.33,Default,,0000,0000,0000,,A couple of years ago, Dialogue: 0,0:00:21.36,0:00:24.46,Default,,0000,0000,0000,,when I was attending\Nthe TED conference in Long Beach, Dialogue: 0,0:00:24.49,0:00:25.85,Default,,0000,0000,0000,,I met Harriet. Dialogue: 0,0:00:25.88,0:00:29.28,Default,,0000,0000,0000,,We'd actually met online before --\Nnot the way you're thinking. Dialogue: 0,0:00:31.10,0:00:33.54,Default,,0000,0000,0000,,We were introduced\Nbecause we both knew Linda Avey, Dialogue: 0,0:00:33.56,0:00:37.26,Default,,0000,0000,0000,,one of the founders of the first\Nonline personal genomic companies. Dialogue: 0,0:00:37.29,0:00:39.98,Default,,0000,0000,0000,,And because we shared\Nour genetic information with Linda, Dialogue: 0,0:00:40.01,0:00:42.15,Default,,0000,0000,0000,,she could see that Harriet and I shared Dialogue: 0,0:00:42.84,0:00:46.73,Default,,0000,0000,0000,,a very rare type of mitochondrial DNA,\Nhaplotype K1a1b1a, Dialogue: 0,0:00:46.75,0:00:48.75,Default,,0000,0000,0000,,which meant we were distantly related. Dialogue: 0,0:00:48.77,0:00:51.60,Default,,0000,0000,0000,,We actually share the same\Ngenealogy with Ötzi the Iceman. Dialogue: 0,0:00:51.63,0:00:53.14,Default,,0000,0000,0000,,So -- Ötzi, Harriet and me. Dialogue: 0,0:00:53.16,0:00:56.76,Default,,0000,0000,0000,,And being the current day, of course,\Nwe started our own Facebook group. Dialogue: 0,0:00:56.79,0:00:58.09,Default,,0000,0000,0000,,You're all welcome to join. Dialogue: 0,0:00:58.71,0:01:01.79,Default,,0000,0000,0000,,When I met Harriet in person\Nthe next year at the TED conference, Dialogue: 0,0:01:01.82,0:01:04.80,Default,,0000,0000,0000,,she'd gone online and ordered\Nour own happy haplotype T-shirts. Dialogue: 0,0:01:04.83,0:01:05.84,Default,,0000,0000,0000,,(Laughter) Dialogue: 0,0:01:06.16,0:01:07.71,Default,,0000,0000,0000,,Why am I telling you this story? Dialogue: 0,0:01:07.73,0:01:10.07,Default,,0000,0000,0000,,What does it have to do\Nwith the future of health? Dialogue: 0,0:01:10.10,0:01:12.07,Default,,0000,0000,0000,,Well, the way I met Harriet is an example Dialogue: 0,0:01:12.10,0:01:15.85,Default,,0000,0000,0000,,of how leveraging cross-disciplinary,\Nexponentially growing technologies Dialogue: 0,0:01:15.87,0:01:18.18,Default,,0000,0000,0000,,is affecting our future\Nof health and wellness -- Dialogue: 0,0:01:18.21,0:01:19.56,Default,,0000,0000,0000,,from low-cost gene analysis Dialogue: 0,0:01:19.58,0:01:21.70,Default,,0000,0000,0000,,to the ability to do\Npowerful bioinformatics Dialogue: 0,0:01:21.72,0:01:24.53,Default,,0000,0000,0000,,to the connection of the Internet\Nand social networking. Dialogue: 0,0:01:25.09,0:01:26.69,Default,,0000,0000,0000,,What I'd like to talk about today Dialogue: 0,0:01:26.71,0:01:28.97,Default,,0000,0000,0000,,is understanding\Nthese exponential technologies. Dialogue: 0,0:01:28.100,0:01:30.55,Default,,0000,0000,0000,,We often think linearly. Dialogue: 0,0:01:30.78,0:01:33.37,Default,,0000,0000,0000,,But if you think about it,\Nif you have a lily pad Dialogue: 0,0:01:33.39,0:01:35.35,Default,,0000,0000,0000,,and it just divided every single day -- Dialogue: 0,0:01:35.38,0:01:39.03,Default,,0000,0000,0000,,two, four, eight, sixteen --\Nin 15 days, you'd have 32,000. Dialogue: 0,0:01:39.06,0:01:40.99,Default,,0000,0000,0000,,What do you think you'd have in a month? Dialogue: 0,0:01:41.02,0:01:42.17,Default,,0000,0000,0000,,We're at a billion. Dialogue: 0,0:01:42.49,0:01:44.16,Default,,0000,0000,0000,,If we start to think exponentially, Dialogue: 0,0:01:44.19,0:01:47.64,Default,,0000,0000,0000,,we can see how this is starting to affect\Nall the technologies around us. Dialogue: 0,0:01:47.66,0:01:50.77,Default,,0000,0000,0000,,Many of these technologies,\Nspeaking as a physician and innovator, Dialogue: 0,0:01:50.79,0:01:53.88,Default,,0000,0000,0000,,we can start to leverage,\Nto impact the future of our own health Dialogue: 0,0:01:53.91,0:01:55.56,Default,,0000,0000,0000,,and of health care, Dialogue: 0,0:01:55.58,0:01:58.67,Default,,0000,0000,0000,,and to address many of the major\Nchallenges in health care today, Dialogue: 0,0:01:58.69,0:02:02.65,Default,,0000,0000,0000,,ranging from the exponential costs\Nto the aging population, Dialogue: 0,0:02:02.68,0:02:05.98,Default,,0000,0000,0000,,the way we really don't use\Ninformation very well today, Dialogue: 0,0:02:06.00,0:02:07.49,Default,,0000,0000,0000,,the fragmentation of care Dialogue: 0,0:02:07.52,0:02:11.25,Default,,0000,0000,0000,,and the often very difficult course\Nof adoption of innovation. Dialogue: 0,0:02:11.57,0:02:15.37,Default,,0000,0000,0000,,And one of the major things we can do\Nis move the curve to the left. Dialogue: 0,0:02:15.39,0:02:18.11,Default,,0000,0000,0000,,We spend most of our money\Non the last 20 percent of life. Dialogue: 0,0:02:18.13,0:02:21.19,Default,,0000,0000,0000,,What if we could incentivize physicians\Nin the health care system Dialogue: 0,0:02:21.22,0:02:22.37,Default,,0000,0000,0000,,and our own selves Dialogue: 0,0:02:22.40,0:02:24.91,Default,,0000,0000,0000,,to move the curve to the left\Nand improve our health, Dialogue: 0,0:02:24.93,0:02:26.38,Default,,0000,0000,0000,,leveraging technology as well? Dialogue: 0,0:02:26.40,0:02:29.12,Default,,0000,0000,0000,,Now my favorite example\Nof exponential technology, Dialogue: 0,0:02:29.15,0:02:30.45,Default,,0000,0000,0000,,we all have in our pocket. Dialogue: 0,0:02:30.47,0:02:33.74,Default,,0000,0000,0000,,If you think about it,\Nthese are really dramatically improving. Dialogue: 0,0:02:33.77,0:02:35.68,Default,,0000,0000,0000,,I mean, this is the iPhone 4. Dialogue: 0,0:02:35.70,0:02:38.89,Default,,0000,0000,0000,,Imagine what the iPhone 8\Nwill be able to do. Dialogue: 0,0:02:38.91,0:02:40.83,Default,,0000,0000,0000,,Now, I've gained some insight into this. Dialogue: 0,0:02:40.85,0:02:43.43,Default,,0000,0000,0000,,I've been the track share\Nfor the medicine portion Dialogue: 0,0:02:43.45,0:02:45.96,Default,,0000,0000,0000,,of a new institution\Ncalled Singularity University, Dialogue: 0,0:02:45.98,0:02:47.37,Default,,0000,0000,0000,,based in Silicon Valley. Dialogue: 0,0:02:47.40,0:02:51.46,Default,,0000,0000,0000,,We bring together each summer\Nabout 100 very talented students Dialogue: 0,0:02:51.48,0:02:52.65,Default,,0000,0000,0000,,from around the world. Dialogue: 0,0:02:52.67,0:02:55.54,Default,,0000,0000,0000,,And we look at these exponential\Ntechnologies from medicine, Dialogue: 0,0:02:55.56,0:02:58.71,Default,,0000,0000,0000,,biotech, artificial intelligence,\Nrobotics, nanotechnology, space, Dialogue: 0,0:02:58.73,0:03:01.21,Default,,0000,0000,0000,,and address how we can cross-train\Nand leverage these Dialogue: 0,0:03:01.23,0:03:02.57,Default,,0000,0000,0000,,to impact major unmet goals. Dialogue: 0,0:03:02.60,0:03:04.60,Default,,0000,0000,0000,,We also have seven-day executive programs. Dialogue: 0,0:03:04.63,0:03:07.01,Default,,0000,0000,0000,,And coming up next month is FutureMed, Dialogue: 0,0:03:07.04,0:03:10.41,Default,,0000,0000,0000,,a program to help cross-train\Nand leverage technologies into medicine. Dialogue: 0,0:03:10.43,0:03:11.95,Default,,0000,0000,0000,,Now, I mentioned the phone. Dialogue: 0,0:03:12.88,0:03:16.19,Default,,0000,0000,0000,,These mobile phones have over 20,000\Ndifferent mobile apps available. Dialogue: 0,0:03:17.11,0:03:20.36,Default,,0000,0000,0000,,There's one out of the UK\Nwhere you can pee on a little chip, Dialogue: 0,0:03:20.38,0:03:21.66,Default,,0000,0000,0000,,connect it to your iPhone, Dialogue: 0,0:03:21.68,0:03:22.84,Default,,0000,0000,0000,,and check for an STD. Dialogue: 0,0:03:22.86,0:03:25.17,Default,,0000,0000,0000,,I don't know if I'd try that,\Nbut it's available. Dialogue: 0,0:03:25.19,0:03:27.02,Default,,0000,0000,0000,,There are other sorts of applications. Dialogue: 0,0:03:27.04,0:03:29.32,Default,,0000,0000,0000,,Merging your phone\Nand diagnostics, for example, Dialogue: 0,0:03:29.34,0:03:31.38,Default,,0000,0000,0000,,measuring your blood glucose\Non your iPhone Dialogue: 0,0:03:31.40,0:03:34.11,Default,,0000,0000,0000,,and sending that to your physician, Dialogue: 0,0:03:34.14,0:03:36.90,Default,,0000,0000,0000,,so they can better understand\Nand you can better understand Dialogue: 0,0:03:36.93,0:03:39.21,Default,,0000,0000,0000,,your blood sugars as a diabetic. Dialogue: 0,0:03:39.73,0:03:42.85,Default,,0000,0000,0000,,So let's see how exponential\Ntechnologies are taking health care. Dialogue: 0,0:03:42.88,0:03:44.04,Default,,0000,0000,0000,,Let's start with faster. Dialogue: 0,0:03:44.06,0:03:46.47,Default,,0000,0000,0000,,It's no secret that computers,\Nthrough Moore's law, Dialogue: 0,0:03:46.50,0:03:48.14,Default,,0000,0000,0000,,are speeding up faster and faster. Dialogue: 0,0:03:48.16,0:03:50.23,Default,,0000,0000,0000,,We can do more powerful things with them. Dialogue: 0,0:03:50.25,0:03:53.45,Default,,0000,0000,0000,,They're really approaching --\Nin many cases, surpassing -- Dialogue: 0,0:03:53.48,0:03:54.92,Default,,0000,0000,0000,,the ability of the human mind. Dialogue: 0,0:03:54.94,0:03:58.78,Default,,0000,0000,0000,,But where I think computational speed\Nis most applicable is in imaging. Dialogue: 0,0:03:58.80,0:04:01.44,Default,,0000,0000,0000,,The ability now to look\Ninside the body in real time Dialogue: 0,0:04:01.46,0:04:02.92,Default,,0000,0000,0000,,with very high resolution Dialogue: 0,0:04:02.94,0:04:04.40,Default,,0000,0000,0000,,is really becoming incredible. Dialogue: 0,0:04:04.42,0:04:07.46,Default,,0000,0000,0000,,And we're layering multiple\Ntechnologies -- PET scans, CT scans Dialogue: 0,0:04:07.48,0:04:09.51,Default,,0000,0000,0000,,and molecular diagnostics -- Dialogue: 0,0:04:09.53,0:04:11.80,Default,,0000,0000,0000,,to find and seek things\Nat different levels. Dialogue: 0,0:04:12.86,0:04:16.31,Default,,0000,0000,0000,,Here you're going to see the very highest\Nresolution MRI scan done today, Dialogue: 0,0:04:16.33,0:04:19.55,Default,,0000,0000,0000,,of Marc Hodosh, the curator of TEDMED. Dialogue: 0,0:04:19.57,0:04:21.72,Default,,0000,0000,0000,,And now we can see inside of the brain Dialogue: 0,0:04:21.74,0:04:24.33,Default,,0000,0000,0000,,at a resolution and ability\Nnever before available, Dialogue: 0,0:04:24.36,0:04:28.42,Default,,0000,0000,0000,,and essentially learn how to reconstruct\Nand maybe even reengineer Dialogue: 0,0:04:28.45,0:04:30.13,Default,,0000,0000,0000,,or backwards engineer the brain, Dialogue: 0,0:04:30.16,0:04:33.13,Default,,0000,0000,0000,,so we can better understand\Npathology, disease and therapy. Dialogue: 0,0:04:33.16,0:04:36.45,Default,,0000,0000,0000,,We can look inside with real-time\NfMRI in the brain at real time. Dialogue: 0,0:04:36.47,0:04:39.76,Default,,0000,0000,0000,,And by understanding these sorts\Nof processes and these connections, Dialogue: 0,0:04:39.78,0:04:42.85,Default,,0000,0000,0000,,we're going to understand the effects\Nof medication or meditation Dialogue: 0,0:04:42.87,0:04:45.48,Default,,0000,0000,0000,,and better personalize\Nand make effective, for example, Dialogue: 0,0:04:45.50,0:04:47.11,Default,,0000,0000,0000,,psychoactive drugs. Dialogue: 0,0:04:47.13,0:04:49.90,Default,,0000,0000,0000,,The scanners for these are getting\Nsmaller, less expensive Dialogue: 0,0:04:49.92,0:04:51.07,Default,,0000,0000,0000,,and more portable. Dialogue: 0,0:04:51.40,0:04:54.77,Default,,0000,0000,0000,,And this sort of data explosion\Navailable from these Dialogue: 0,0:04:54.79,0:04:57.22,Default,,0000,0000,0000,,is really almost becoming a challenge. Dialogue: 0,0:04:57.25,0:05:00.63,Default,,0000,0000,0000,,The scan of today takes up\Nabout 800 books, or 20 gigabytes. Dialogue: 0,0:05:00.65,0:05:03.92,Default,,0000,0000,0000,,The scan in a couple of years\Nwill be one terabyte, or 800,000 books. Dialogue: 0,0:05:03.95,0:05:05.72,Default,,0000,0000,0000,,How do you leverage that information? Dialogue: 0,0:05:06.44,0:05:07.59,Default,,0000,0000,0000,,Let's get personal. Dialogue: 0,0:05:07.61,0:05:10.82,Default,,0000,0000,0000,,I won't ask who here's had a colonoscopy,\Nbut if you're over age 50, Dialogue: 0,0:05:10.84,0:05:12.84,Default,,0000,0000,0000,,it's time for your screening colonoscopy. Dialogue: 0,0:05:12.86,0:05:15.29,Default,,0000,0000,0000,,How'd you like to avoid\Nthe pointy end of the stick? Dialogue: 0,0:05:15.32,0:05:17.37,Default,,0000,0000,0000,,Now there's essentially\Nvirtual colonoscopy. Dialogue: 0,0:05:19.69,0:05:20.98,Default,,0000,0000,0000,,Compare those two pictures. Dialogue: 0,0:05:21.01,0:05:24.27,Default,,0000,0000,0000,,As a radiologist, you can basically\Nfly through your patient's colon, Dialogue: 0,0:05:24.30,0:05:26.59,Default,,0000,0000,0000,,and augmenting that\Nwith artificial intelligence, Dialogue: 0,0:05:26.62,0:05:29.25,Default,,0000,0000,0000,,potentially identify a lesion\Nthat we might have missed, Dialogue: 0,0:05:29.27,0:05:30.85,Default,,0000,0000,0000,,but using AI on top of radiology, Dialogue: 0,0:05:30.87,0:05:32.92,Default,,0000,0000,0000,,we can find lesions\Nthat were missed before. Dialogue: 0,0:05:32.94,0:05:35.47,Default,,0000,0000,0000,,Maybe this will encourage\Npeople to get colonoscopies Dialogue: 0,0:05:35.50,0:05:36.88,Default,,0000,0000,0000,,that wouldn't have otherwise. Dialogue: 0,0:05:36.90,0:05:38.92,Default,,0000,0000,0000,,This is an example of this paradigm shift. Dialogue: 0,0:05:38.94,0:05:42.34,Default,,0000,0000,0000,,We're moving to this integration\Nof biomedicine, information technology, Dialogue: 0,0:05:42.36,0:05:45.67,Default,,0000,0000,0000,,wireless and, I would say, mobile now --\Nthis era of digital medicine. Dialogue: 0,0:05:45.69,0:05:49.24,Default,,0000,0000,0000,,Even my stethoscope is now digital,\Nand of course, there's an app for that. Dialogue: 0,0:05:49.66,0:05:52.20,Default,,0000,0000,0000,,We're moving, obviously,\Nto the era of the tricorder. Dialogue: 0,0:05:52.22,0:05:55.07,Default,,0000,0000,0000,,So the handheld ultrasound\Nis basically surpassing Dialogue: 0,0:05:55.09,0:05:57.09,Default,,0000,0000,0000,,and supplanting the stethoscope. Dialogue: 0,0:05:57.12,0:06:00.58,Default,,0000,0000,0000,,These are now at a price point\Nof what used to be 100,000 euros Dialogue: 0,0:06:00.60,0:06:02.44,Default,,0000,0000,0000,,or a couple hundred-thousand dollars. Dialogue: 0,0:06:02.46,0:06:03.62,Default,,0000,0000,0000,,For about 5,000 dollars, Dialogue: 0,0:06:03.64,0:06:06.97,Default,,0000,0000,0000,,I can have the power of a very powerful\Ndiagnostic device in my hand. Dialogue: 0,0:06:06.99,0:06:10.08,Default,,0000,0000,0000,,Merging this now with the advent\Nof electronic medical records -- Dialogue: 0,0:06:10.11,0:06:13.19,Default,,0000,0000,0000,,in the US, we're still\Nless than 20 percent electronic; Dialogue: 0,0:06:13.21,0:06:16.01,Default,,0000,0000,0000,,here in the Netherlands,\NI think it's more than 80 percent. Dialogue: 0,0:06:16.23,0:06:18.52,Default,,0000,0000,0000,,Now that we're switching\Nto merging medical data, Dialogue: 0,0:06:18.54,0:06:20.22,Default,,0000,0000,0000,,making it available electronically, Dialogue: 0,0:06:20.24,0:06:23.39,Default,,0000,0000,0000,,we can crowd-source the information,\Nand as a physician, Dialogue: 0,0:06:23.42,0:06:26.49,Default,,0000,0000,0000,,I can access my patients' data\Nfrom wherever I am, Dialogue: 0,0:06:27.18,0:06:28.61,Default,,0000,0000,0000,,just through my mobile device. Dialogue: 0,0:06:29.03,0:06:32.14,Default,,0000,0000,0000,,And now, of course, we're in the era\Nof the iPad, even the iPad 2. Dialogue: 0,0:06:32.17,0:06:33.32,Default,,0000,0000,0000,,Just last month, Dialogue: 0,0:06:33.34,0:06:35.56,Default,,0000,0000,0000,,the first FDA-approved\Napplication was approved Dialogue: 0,0:06:35.58,0:06:39.07,Default,,0000,0000,0000,,to allow radiologists to do actual\Nreading on these sorts of devices. Dialogue: 0,0:06:39.70,0:06:42.32,Default,,0000,0000,0000,,So certainly, the physicians\Nof today, including myself, Dialogue: 0,0:06:42.34,0:06:44.32,Default,,0000,0000,0000,,are completely reliable on these devices. Dialogue: 0,0:06:44.34,0:06:46.16,Default,,0000,0000,0000,,And as you saw just about a month ago, Dialogue: 0,0:06:46.19,0:06:49.18,Default,,0000,0000,0000,,Watson from IBM beat\Nthe two champions in "Jeopardy." Dialogue: 0,0:06:49.20,0:06:51.64,Default,,0000,0000,0000,,So I want you to imagine\Nwhen, in a couple of years, Dialogue: 0,0:06:51.67,0:06:54.13,Default,,0000,0000,0000,,we've started to apply\Nthis cloud-based information, Dialogue: 0,0:06:54.15,0:06:57.75,Default,,0000,0000,0000,,when we really have the AI physician\Nand leverage our brains to connectivity Dialogue: 0,0:06:57.77,0:07:01.74,Default,,0000,0000,0000,,to make decisions and diagnostics\Nat a level never done. Dialogue: 0,0:07:04.35,0:07:07.55,Default,,0000,0000,0000,,Already today, you don't need to go\Nto your physician in many cases. Dialogue: 0,0:07:07.57,0:07:11.11,Default,,0000,0000,0000,,Only in about 20 percent of visits\Ndo you need to lay hands on the patient. Dialogue: 0,0:07:11.14,0:07:12.100,Default,,0000,0000,0000,,We're now in the era of virtual visits. Dialogue: 0,0:07:13.02,0:07:15.52,Default,,0000,0000,0000,,From Skype-type visits\Nyou can do with American Well, Dialogue: 0,0:07:15.54,0:07:18.90,Default,,0000,0000,0000,,to Cisco, that's developed a very complex\Nhealth presence system, Dialogue: 0,0:07:18.92,0:07:22.13,Default,,0000,0000,0000,,the ability to interact with\Nyour health care provider is different. Dialogue: 0,0:07:22.15,0:07:25.18,Default,,0000,0000,0000,,And these are being augmented\Neven by our devices, again, today. Dialogue: 0,0:07:25.20,0:07:27.97,Default,,0000,0000,0000,,My friend Jessica sent me\Na picture of her head laceration, Dialogue: 0,0:07:27.99,0:07:30.20,Default,,0000,0000,0000,,so I can save her a trip\Nto the emergency room, Dialogue: 0,0:07:30.22,0:07:31.65,Default,,0000,0000,0000,,and do diagnostics that way. Dialogue: 0,0:07:31.68,0:07:34.07,Default,,0000,0000,0000,,Or maybe we can leverage\Ntoday's gaming technology, Dialogue: 0,0:07:34.10,0:07:35.34,Default,,0000,0000,0000,,like the Microsoft Kinect, Dialogue: 0,0:07:35.37,0:07:39.04,Default,,0000,0000,0000,,hack that to enable diagnostics,\Nfor example, in diagnosing stroke, Dialogue: 0,0:07:39.07,0:07:41.94,Default,,0000,0000,0000,,using simple motion detection,\Nusing $100 devices. Dialogue: 0,0:07:42.98,0:07:46.16,Default,,0000,0000,0000,,We can actually now visit\Nour patients robotically. Dialogue: 0,0:07:46.19,0:07:47.92,Default,,0000,0000,0000,,This is the RP7; Dialogue: 0,0:07:49.66,0:07:52.62,Default,,0000,0000,0000,,if I'm a hematologist,\NI can visit another clinic or hospital. Dialogue: 0,0:07:54.55,0:07:56.94,Default,,0000,0000,0000,,These are being augmented\Nby a whole suite of tools Dialogue: 0,0:07:56.96,0:07:58.16,Default,,0000,0000,0000,,actually in the home now. Dialogue: 0,0:07:58.18,0:08:00.04,Default,,0000,0000,0000,,We already have wireless scales. Dialogue: 0,0:08:00.06,0:08:02.77,Default,,0000,0000,0000,,You step on the scale,\Ntweet your weight to your friends, Dialogue: 0,0:08:02.79,0:08:04.03,Default,,0000,0000,0000,,they can keep you in line. Dialogue: 0,0:08:04.06,0:08:05.88,Default,,0000,0000,0000,,We have wireless blood pressure cuffs. Dialogue: 0,0:08:05.90,0:08:08.41,Default,,0000,0000,0000,,A whole gamut of technologies\Nare being put together. Dialogue: 0,0:08:08.43,0:08:11.24,Default,,0000,0000,0000,,Instead of wearing kludgy devices,\Nwe put on a simple patch. Dialogue: 0,0:08:11.27,0:08:12.76,Default,,0000,0000,0000,,This was developed at Stanford. Dialogue: 0,0:08:12.79,0:08:16.36,Default,,0000,0000,0000,,It's called iRhythm; it completely\Nsupplants the prior technology Dialogue: 0,0:08:16.39,0:08:19.87,Default,,0000,0000,0000,,at a much lower price point,\Nwith much more effectivity. Dialogue: 0,0:08:20.26,0:08:22.74,Default,,0000,0000,0000,,We're also in the era today\Nof quantified self. Dialogue: 0,0:08:22.76,0:08:26.37,Default,,0000,0000,0000,,Consumers now can basically buy\N$100 devices, like this little Fitbit. Dialogue: 0,0:08:26.39,0:08:28.41,Default,,0000,0000,0000,,I can measure my steps,\Nmy caloric outtake. Dialogue: 0,0:08:28.44,0:08:30.49,Default,,0000,0000,0000,,I can get insight into that\Non a daily basis Dialogue: 0,0:08:30.52,0:08:32.52,Default,,0000,0000,0000,,and share it with my friends or physician. Dialogue: 0,0:08:32.55,0:08:35.63,Default,,0000,0000,0000,,There's watches that measure\Nyour heart rate, Zeo sleep monitors, Dialogue: 0,0:08:35.65,0:08:37.73,Default,,0000,0000,0000,,a suite of tools\Nthat enable you to leverage Dialogue: 0,0:08:37.76,0:08:39.57,Default,,0000,0000,0000,,and have insight into your own health. Dialogue: 0,0:08:39.60,0:08:41.60,Default,,0000,0000,0000,,As we start to integrate this information, Dialogue: 0,0:08:41.63,0:08:44.51,Default,,0000,0000,0000,,we'll know better what to do with it,\Nand have better insight Dialogue: 0,0:08:44.53,0:08:46.96,Default,,0000,0000,0000,,into our own pathologies,\Nhealth and wellness. Dialogue: 0,0:08:47.28,0:08:49.93,Default,,0000,0000,0000,,There's even mirrors\Nthat can pick up your pulse rate. Dialogue: 0,0:08:49.95,0:08:51.71,Default,,0000,0000,0000,,And I would argue, in the future, Dialogue: 0,0:08:51.73,0:08:54.90,Default,,0000,0000,0000,,we'll have wearable devices\Nin our clothes, monitoring us 24/7. Dialogue: 0,0:08:54.92,0:08:58.34,Default,,0000,0000,0000,,And just like the OnStar system\Nin cars, your red light might go on. Dialogue: 0,0:08:58.36,0:09:01.40,Default,,0000,0000,0000,,It won't say "check engine";\Nit'll be a "check your body" light, Dialogue: 0,0:09:01.43,0:09:03.11,Default,,0000,0000,0000,,and you'll go get it taken care of. Dialogue: 0,0:09:03.74,0:09:04.91,Default,,0000,0000,0000,,Probably in a few years, Dialogue: 0,0:09:04.93,0:09:07.74,Default,,0000,0000,0000,,you'll look in your mirror\Nand it'll be diagnosing you. Dialogue: 0,0:09:07.76,0:09:08.99,Default,,0000,0000,0000,,(Laughter) Dialogue: 0,0:09:09.41,0:09:11.49,Default,,0000,0000,0000,,For those of you with kiddos at home, Dialogue: 0,0:09:11.51,0:09:14.46,Default,,0000,0000,0000,,how would you like a wireless\Ndiaper that supports your -- Dialogue: 0,0:09:14.48,0:09:15.54,Default,,0000,0000,0000,,(Laughter) Dialogue: 0,0:09:15.57,0:09:17.76,Default,,0000,0000,0000,,More information, I think,\Nthan you might need, Dialogue: 0,0:09:17.79,0:09:19.22,Default,,0000,0000,0000,,but it's going to be here. Dialogue: 0,0:09:19.95,0:09:23.05,Default,,0000,0000,0000,,Now, we've heard a lot today\Nabout technology and connection. Dialogue: 0,0:09:23.07,0:09:24.88,Default,,0000,0000,0000,,And I think some of these technologies Dialogue: 0,0:09:24.91,0:09:28.33,Default,,0000,0000,0000,,will enable us to be more connected\Nwith our patients, to take more time Dialogue: 0,0:09:28.35,0:09:30.93,Default,,0000,0000,0000,,and do the important\Nhuman-touch elements of medicine, Dialogue: 0,0:09:30.96,0:09:33.17,Default,,0000,0000,0000,,as augmented by these technologies. Dialogue: 0,0:09:33.56,0:09:35.93,Default,,0000,0000,0000,,Now, we've talked about\Naugmenting the patient. Dialogue: 0,0:09:35.95,0:09:37.63,Default,,0000,0000,0000,,How about augmenting the physician? Dialogue: 0,0:09:37.65,0:09:40.74,Default,,0000,0000,0000,,We're now in the era\Nof super-enabling the surgeon, Dialogue: 0,0:09:40.76,0:09:44.23,Default,,0000,0000,0000,,who can now go into the body and do\Nrobotic surgery, which is here today, Dialogue: 0,0:09:44.25,0:09:47.71,Default,,0000,0000,0000,,at a level that was not really possible\Neven five years ago. Dialogue: 0,0:09:47.74,0:09:50.86,Default,,0000,0000,0000,,And now this is being augmented\Nwith further layers of technology, Dialogue: 0,0:09:50.88,0:09:52.04,Default,,0000,0000,0000,,like augmented reality. Dialogue: 0,0:09:52.06,0:09:54.99,Default,,0000,0000,0000,,So the surgeon can see\Ninside the patient, through their lens, Dialogue: 0,0:09:55.02,0:09:57.33,Default,,0000,0000,0000,,where the tumor is,\Nwhere the blood vessels are. Dialogue: 0,0:09:57.35,0:09:59.46,Default,,0000,0000,0000,,This can be integrated\Nwith decision support. Dialogue: 0,0:09:59.48,0:10:02.64,Default,,0000,0000,0000,,A surgeon in New York can help\Na surgeon in Amsterdam, for example. Dialogue: 0,0:10:02.66,0:10:06.44,Default,,0000,0000,0000,,And we're entering an era\Nof truly scarless surgery called NOTES, Dialogue: 0,0:10:06.46,0:10:09.06,Default,,0000,0000,0000,,where the robotic endoscope\Ncan come out the stomach Dialogue: 0,0:10:09.08,0:10:10.53,Default,,0000,0000,0000,,and pull out that gallbladder, Dialogue: 0,0:10:10.55,0:10:12.90,Default,,0000,0000,0000,,all in a scarless way and robotically. Dialogue: 0,0:10:12.93,0:10:16.24,Default,,0000,0000,0000,,This is called NOTES, and it's coming --\Nbasically scarless surgery, Dialogue: 0,0:10:16.27,0:10:18.32,Default,,0000,0000,0000,,as mediated by robotic surgery. Dialogue: 0,0:10:19.15,0:10:21.24,Default,,0000,0000,0000,,Now, how about controlling other elements? Dialogue: 0,0:10:21.27,0:10:23.70,Default,,0000,0000,0000,,For those who have\Ndisabilities -- the paraplegic, Dialogue: 0,0:10:24.12,0:10:26.91,Default,,0000,0000,0000,,there's the brain-computer\Ninterface, or BCI, Dialogue: 0,0:10:26.93,0:10:29.12,Default,,0000,0000,0000,,where chips have been put\Non the motor cortex Dialogue: 0,0:10:29.15,0:10:30.97,Default,,0000,0000,0000,,of completely quadriplegic patients, Dialogue: 0,0:10:33.19,0:10:35.85,Default,,0000,0000,0000,,and they can control\Na cursor or a wheelchair Dialogue: 0,0:10:35.87,0:10:37.41,Default,,0000,0000,0000,,or, potentially, a robotic arm. Dialogue: 0,0:10:37.43,0:10:39.03,Default,,0000,0000,0000,,These devices are getting smaller Dialogue: 0,0:10:39.05,0:10:41.28,Default,,0000,0000,0000,,and going into more and more\Nof these patients. Dialogue: 0,0:10:41.30,0:10:42.51,Default,,0000,0000,0000,,Still in clinical trials, Dialogue: 0,0:10:42.54,0:10:44.94,Default,,0000,0000,0000,,but imagine when we can connect\Nthese, for example, Dialogue: 0,0:10:44.96,0:10:46.58,Default,,0000,0000,0000,,to the amazing bionic limb, Dialogue: 0,0:10:46.60,0:10:49.42,Default,,0000,0000,0000,,such as the DEKA Arm,\Nbuilt by Dean Kamen and colleagues, Dialogue: 0,0:10:49.45,0:10:51.47,Default,,0000,0000,0000,,which has 17 degrees\Nof motion and freedom, Dialogue: 0,0:10:51.49,0:10:53.52,Default,,0000,0000,0000,,and can allow the person who's lost a limb Dialogue: 0,0:10:53.54,0:10:57.74,Default,,0000,0000,0000,,to have much higher dexterity or control\Nthan they've had in the past. Dialogue: 0,0:10:58.10,0:11:01.95,Default,,0000,0000,0000,,So we're really entering the era\Nof wearable robotics, actually. Dialogue: 0,0:11:01.97,0:11:04.19,Default,,0000,0000,0000,,If you haven't lost a limb\Nbut had a stroke, Dialogue: 0,0:11:04.21,0:11:05.90,Default,,0000,0000,0000,,you can wear these augmented limbs. Dialogue: 0,0:11:05.92,0:11:09.42,Default,,0000,0000,0000,,Or if you're a paraplegic -- I've visited\Nthe folks at Berkeley Bionics -- Dialogue: 0,0:11:09.44,0:11:10.61,Default,,0000,0000,0000,,they've developed eLEGS. Dialogue: 0,0:11:10.63,0:11:12.00,Default,,0000,0000,0000,,I took this video last week. Dialogue: 0,0:11:12.02,0:11:15.81,Default,,0000,0000,0000,,Here's a paraplegic patient, walking\Nby strapping on these exoskeletons. Dialogue: 0,0:11:15.83,0:11:17.84,Default,,0000,0000,0000,,He's otherwise completely\Nwheelchair-bound. Dialogue: 0,0:11:17.87,0:11:19.88,Default,,0000,0000,0000,,This is the early era\Nof wearable robotics. Dialogue: 0,0:11:19.91,0:11:22.19,Default,,0000,0000,0000,,And by leveraging\Nthese sorts of technologies, Dialogue: 0,0:11:22.21,0:11:24.55,Default,,0000,0000,0000,,we're going to change\Nthe definition of disability Dialogue: 0,0:11:24.57,0:11:27.10,Default,,0000,0000,0000,,to, in some cases, be superability,\Nor super-enabling. Dialogue: 0,0:11:27.13,0:11:30.32,Default,,0000,0000,0000,,This is Aimee Mullins, who lost\Nher lower limbs as a young child, Dialogue: 0,0:11:30.34,0:11:33.05,Default,,0000,0000,0000,,and Hugh Herr, who's a professor at MIT, Dialogue: 0,0:11:33.08,0:11:35.08,Default,,0000,0000,0000,,who lost his limbs in a climbing accident. Dialogue: 0,0:11:35.10,0:11:38.50,Default,,0000,0000,0000,,And now both of them can climb better,\Nmove faster, swim differently Dialogue: 0,0:11:38.52,0:11:42.01,Default,,0000,0000,0000,,with their prosthetics\Nthan us normal-abled persons. Dialogue: 0,0:11:42.23,0:11:43.67,Default,,0000,0000,0000,,How about other exponentials? Dialogue: 0,0:11:43.70,0:11:45.57,Default,,0000,0000,0000,,We've heard a bit today\Nabout obesity. Dialogue: 0,0:11:45.60,0:11:49.01,Default,,0000,0000,0000,,Clearly the obesity trend is exponentially\Ngoing in the wrong direction, Dialogue: 0,0:11:49.03,0:11:50.46,Default,,0000,0000,0000,,including with huge costs. Dialogue: 0,0:11:50.49,0:11:53.61,Default,,0000,0000,0000,,But the trend in medicine\Nis to get exponentially smaller. Dialogue: 0,0:11:53.64,0:11:57.21,Default,,0000,0000,0000,,A few examples: we're now in the era\Nof "Fantastic Voyage," the iPill. Dialogue: 0,0:11:57.24,0:11:59.64,Default,,0000,0000,0000,,You can swallow this\Ncompletely integrated device. Dialogue: 0,0:11:59.66,0:12:01.53,Default,,0000,0000,0000,,It can take pictures of your GI system, Dialogue: 0,0:12:01.55,0:12:04.31,Default,,0000,0000,0000,,help diagnose and treat\Nas it moves through your GI tract. Dialogue: 0,0:12:04.33,0:12:06.15,Default,,0000,0000,0000,,We get into even smaller micro-robots Dialogue: 0,0:12:06.17,0:12:09.07,Default,,0000,0000,0000,,that will eventually, autonomously,\Nmove through your system, Dialogue: 0,0:12:09.09,0:12:12.05,Default,,0000,0000,0000,,and be able to do things surgeons can't do Dialogue: 0,0:12:12.08,0:12:13.61,Default,,0000,0000,0000,,in a much less invasive manner. Dialogue: 0,0:12:14.64,0:12:17.22,Default,,0000,0000,0000,,Sometimes these might\Nself-assemble in your GI system, Dialogue: 0,0:12:17.25,0:12:19.60,Default,,0000,0000,0000,,and be augmented in that reality. Dialogue: 0,0:12:19.90,0:12:22.39,Default,,0000,0000,0000,,On the cardiac side,\Npacemakers are getting smaller Dialogue: 0,0:12:22.41,0:12:23.75,Default,,0000,0000,0000,,and much easier to place, Dialogue: 0,0:12:23.77,0:12:26.86,Default,,0000,0000,0000,,so no need to train an interventional\Ncardiologist to place them. Dialogue: 0,0:12:26.88,0:12:29.82,Default,,0000,0000,0000,,And they'll be wirelessly telemetered\Nto your mobile devices, Dialogue: 0,0:12:29.84,0:12:32.33,Default,,0000,0000,0000,,so you can go places\Nand be monitored remotely. Dialogue: 0,0:12:32.95,0:12:34.55,Default,,0000,0000,0000,,These are shrinking even further. Dialogue: 0,0:12:34.60,0:12:38.54,Default,,0000,0000,0000,,This one is in prototyping\Nby Medtronic; it's smaller than a penny. Dialogue: 0,0:12:39.55,0:12:42.98,Default,,0000,0000,0000,,Artificial retinas, the ability to put\Narrays on the back of the eyeball Dialogue: 0,0:12:43.00,0:12:44.42,Default,,0000,0000,0000,,and allow the blind to see -- Dialogue: 0,0:12:44.45,0:12:46.76,Default,,0000,0000,0000,,also in early trials,\Nbut moving into the future. Dialogue: 0,0:12:46.78,0:12:48.52,Default,,0000,0000,0000,,These are going to be game-changing. Dialogue: 0,0:12:48.54,0:12:50.23,Default,,0000,0000,0000,,Or for those of us who are sighted, Dialogue: 0,0:12:51.05,0:12:53.41,Default,,0000,0000,0000,,how about having\Nthe assisted-living contact lens? Dialogue: 0,0:12:53.44,0:12:56.86,Default,,0000,0000,0000,,Bluetooth, Wi-Fi available --\Nbeams back images to your eye. Dialogue: 0,0:12:57.68,0:12:58.71,Default,,0000,0000,0000,,(Laughter) Dialogue: 0,0:12:58.73,0:13:00.93,Default,,0000,0000,0000,,Now, if you have trouble\Nmaintaining your diet, Dialogue: 0,0:13:00.96,0:13:02.91,Default,,0000,0000,0000,,it might help to have some extra imagery Dialogue: 0,0:13:02.94,0:13:06.57,Default,,0000,0000,0000,,to remind you how many calories\Nare going to be coming at you. Dialogue: 0,0:13:08.30,0:13:11.34,Default,,0000,0000,0000,,How about enabling the pathologist\Nto use their cell phone Dialogue: 0,0:13:11.37,0:13:12.92,Default,,0000,0000,0000,,to see at a microscopic level Dialogue: 0,0:13:12.94,0:13:16.25,Default,,0000,0000,0000,,and to lumber that data back to the cloud\Nand make better diagnostics? Dialogue: 0,0:13:16.28,0:13:18.56,Default,,0000,0000,0000,,In fact, the whole era\Nof laboratory medicine Dialogue: 0,0:13:18.59,0:13:19.74,Default,,0000,0000,0000,,is completely changing. Dialogue: 0,0:13:19.76,0:13:21.72,Default,,0000,0000,0000,,We can now leverage microfluidics, Dialogue: 0,0:13:21.74,0:13:23.96,Default,,0000,0000,0000,,like this chip made\Nby Steve Quake at Stanford. Dialogue: 0,0:13:23.98,0:13:26.62,Default,,0000,0000,0000,,Microfluidics can replace\Nan entire lab of technicians; Dialogue: 0,0:13:28.54,0:13:32.08,Default,,0000,0000,0000,,put it on a chip, enable thousands\Nof tests at the point of care, Dialogue: 0,0:13:32.10,0:13:33.26,Default,,0000,0000,0000,,anywhere in the world. Dialogue: 0,0:13:33.28,0:13:36.68,Default,,0000,0000,0000,,This will really leverage technology\Nto the rural and the underserved Dialogue: 0,0:13:36.71,0:13:40.22,Default,,0000,0000,0000,,and enable what used to be thousand-dollar\Ntests to be done for pennies, Dialogue: 0,0:13:40.25,0:13:41.60,Default,,0000,0000,0000,,and at the point of care. Dialogue: 0,0:13:42.02,0:13:44.52,Default,,0000,0000,0000,,If we go down the small\Npathway a little bit further, Dialogue: 0,0:13:44.55,0:13:46.45,Default,,0000,0000,0000,,we're entering the era of nanomedicine, Dialogue: 0,0:13:46.47,0:13:48.39,Default,,0000,0000,0000,,the ability to make devices super-small, Dialogue: 0,0:13:48.42,0:13:50.74,Default,,0000,0000,0000,,to the point where we can\Ndesign red blood cells Dialogue: 0,0:13:50.76,0:13:53.84,Default,,0000,0000,0000,,or microrobots that monitor\Nour blood system or immune system, Dialogue: 0,0:13:53.86,0:13:56.95,Default,,0000,0000,0000,,or even those that might clear out\Nthe clots from our arteries. Dialogue: 0,0:13:57.47,0:13:59.21,Default,,0000,0000,0000,,Now how about exponentially cheaper? Dialogue: 0,0:13:59.24,0:14:02.07,Default,,0000,0000,0000,,Not something we usually think\Nabout in the era of medicine, Dialogue: 0,0:14:02.09,0:14:07.50,Default,,0000,0000,0000,,but hard disks used to be 3,400 dollars\Nfor 10 megabytes -- exponentially cheaper. Dialogue: 0,0:14:07.52,0:14:10.18,Default,,0000,0000,0000,,In genomics now, the genome\Ncost about a billion dollars Dialogue: 0,0:14:10.21,0:14:12.47,Default,,0000,0000,0000,,about 10 years ago,\Nwhen the first one came out. Dialogue: 0,0:14:12.49,0:14:15.86,Default,,0000,0000,0000,,We're now approaching essentially\Na $1,000 genome, probably next year. Dialogue: 0,0:14:15.88,0:14:17.41,Default,,0000,0000,0000,,And in two years, a $100 genome. Dialogue: 0,0:14:17.44,0:14:19.76,Default,,0000,0000,0000,,What will we do with $100 genomes? Dialogue: 0,0:14:19.78,0:14:22.14,Default,,0000,0000,0000,,Soon we'll have millions\Nof these tests available. Dialogue: 0,0:14:22.16,0:14:25.65,Default,,0000,0000,0000,,Then it gets interesting, when we start\Nto crowd-source that information, Dialogue: 0,0:14:25.68,0:14:27.92,Default,,0000,0000,0000,,and enter the era\Nof true personalized medicine: Dialogue: 0,0:14:27.95,0:14:30.48,Default,,0000,0000,0000,,the right drug for the right person\Nat the right time, Dialogue: 0,0:14:30.50,0:14:33.80,Default,,0000,0000,0000,,instead of what we're doing now,\Nwhich is the same drug for everybody, Dialogue: 0,0:14:33.82,0:14:36.93,Default,,0000,0000,0000,,blockbuster drug medications,\Nwhich don't work for the individual. Dialogue: 0,0:14:36.95,0:14:40.17,Default,,0000,0000,0000,,Many different companies are working\Non leveraging these approaches. Dialogue: 0,0:14:40.19,0:14:42.60,Default,,0000,0000,0000,,I'll show you a simple example,\Nfrom 23andMe again. Dialogue: 0,0:14:42.62,0:14:44.73,Default,,0000,0000,0000,,My data indicates\NI've got about average risk Dialogue: 0,0:14:44.76,0:14:47.45,Default,,0000,0000,0000,,for developing macular degeneration,\Na kind of blindness. Dialogue: 0,0:14:47.47,0:14:50.10,Default,,0000,0000,0000,,But if I take that same data,\Nupload it to deCODEme, Dialogue: 0,0:14:50.32,0:14:54.58,Default,,0000,0000,0000,,I can look at my risk for type 2 diabetes;\NI'm at almost twice the risk. Dialogue: 0,0:14:54.60,0:14:57.82,Default,,0000,0000,0000,,I might want to watch how much dessert\NI have at lunch, for example. Dialogue: 0,0:14:57.84,0:14:59.19,Default,,0000,0000,0000,,It might change my behavior. Dialogue: 0,0:14:59.22,0:15:01.46,Default,,0000,0000,0000,,Leveraging my knowledge\Nof my pharmacogenomics: Dialogue: 0,0:15:01.48,0:15:04.82,Default,,0000,0000,0000,,how my genes modulate,\Nwhat my drugs do and what doses I need Dialogue: 0,0:15:04.84,0:15:06.53,Default,,0000,0000,0000,,will become increasingly important, Dialogue: 0,0:15:06.56,0:15:08.91,Default,,0000,0000,0000,,and once in the hands\Nof individuals and patients, Dialogue: 0,0:15:08.93,0:15:11.45,Default,,0000,0000,0000,,will make better drug dosing\Nand selection available. Dialogue: 0,0:15:11.48,0:15:14.32,Default,,0000,0000,0000,,So again, it's not just genes,\Nit's multiple details -- Dialogue: 0,0:15:14.34,0:15:17.76,Default,,0000,0000,0000,,our habits, our environmental exposures. Dialogue: 0,0:15:17.79,0:15:20.60,Default,,0000,0000,0000,,When was the last time your doctor\Nasked where you've lived? Dialogue: 0,0:15:20.62,0:15:23.33,Default,,0000,0000,0000,,Geomedicine: where you live,\Nwhat you've been exposed to, Dialogue: 0,0:15:23.36,0:15:25.07,Default,,0000,0000,0000,,can dramatically affect your health. Dialogue: 0,0:15:25.10,0:15:26.63,Default,,0000,0000,0000,,We can capture that information. Dialogue: 0,0:15:26.65,0:15:28.56,Default,,0000,0000,0000,,Genomics, proteomics, the environment -- Dialogue: 0,0:15:28.58,0:15:31.45,Default,,0000,0000,0000,,all this data streaming at us\Nindividually and as physicians: Dialogue: 0,0:15:31.47,0:15:32.63,Default,,0000,0000,0000,,How do we manage it? Dialogue: 0,0:15:32.65,0:15:35.71,Default,,0000,0000,0000,,We're now entering the era\Nof systems medicine, systems biology, Dialogue: 0,0:15:35.74,0:15:38.24,Default,,0000,0000,0000,,where we can start to integrate\Nall this information. Dialogue: 0,0:15:38.26,0:15:41.07,Default,,0000,0000,0000,,And by looking at the patterns,\Nfor example, in our blood, Dialogue: 0,0:15:41.09,0:15:42.91,Default,,0000,0000,0000,,of 10,000 biomarkers in a single test, Dialogue: 0,0:15:42.93,0:15:46.46,Default,,0000,0000,0000,,we can look at patterns and detect disease\Nat a much earlier stage. Dialogue: 0,0:15:47.09,0:15:50.52,Default,,0000,0000,0000,,This is called by Lee Hood,\Nthe father of the field, P4 Medicine. Dialogue: 0,0:15:50.55,0:15:53.17,Default,,0000,0000,0000,,We'll be predictive and know\Nwhat you're likely to have. Dialogue: 0,0:15:53.20,0:15:56.02,Default,,0000,0000,0000,,We can be preventative;\Nthat prevention can be personalized. Dialogue: 0,0:15:56.04,0:15:58.57,Default,,0000,0000,0000,,More importantly,\Nit'll be increasingly participatory. Dialogue: 0,0:15:58.60,0:16:00.44,Default,,0000,0000,0000,,Through websites like PatientsLikeMe Dialogue: 0,0:16:00.46,0:16:04.57,Default,,0000,0000,0000,,or managing your data on Microsoft\NHealthVault or Google Health, Dialogue: 0,0:16:04.60,0:16:06.74,Default,,0000,0000,0000,,leveraging this together\Nin participatory ways Dialogue: 0,0:16:06.77,0:16:08.25,Default,,0000,0000,0000,,will be increasingly important. Dialogue: 0,0:16:08.27,0:16:10.23,Default,,0000,0000,0000,,I'll finish up with exponentially better. Dialogue: 0,0:16:10.25,0:16:12.77,Default,,0000,0000,0000,,We'd like to get therapies\Nbetter and more effective. Dialogue: 0,0:16:13.20,0:16:15.68,Default,,0000,0000,0000,,Today we treat high blood pressure\Nmostly with pills. Dialogue: 0,0:16:15.70,0:16:17.09,Default,,0000,0000,0000,,What if we take a new device, Dialogue: 0,0:16:17.11,0:16:20.90,Default,,0000,0000,0000,,knock out the nerve vessels\Nthat help mediate blood pressure, Dialogue: 0,0:16:20.92,0:16:23.53,Default,,0000,0000,0000,,and in a single therapy,\Nbasically cure hypertension? Dialogue: 0,0:16:23.55,0:16:25.61,Default,,0000,0000,0000,,This is a new device\Ndoing essentially that. Dialogue: 0,0:16:25.64,0:16:27.70,Default,,0000,0000,0000,,It should be on the market\Nin a year or two. Dialogue: 0,0:16:27.72,0:16:29.82,Default,,0000,0000,0000,,How about more targeted\Ntherapies for cancer? Dialogue: 0,0:16:29.85,0:16:33.40,Default,,0000,0000,0000,,I'm an oncologist and know that most\Nof what we give is essentially poison. Dialogue: 0,0:16:33.42,0:16:37.21,Default,,0000,0000,0000,,We learned at Stanford and other places\Nthat we can discover cancer stem cells, Dialogue: 0,0:16:37.24,0:16:41.46,Default,,0000,0000,0000,,the ones that seem to be really\Nresponsible for disease relapse. Dialogue: 0,0:16:41.49,0:16:43.41,Default,,0000,0000,0000,,So if you think of cancer as a weed, Dialogue: 0,0:16:43.43,0:16:46.32,Default,,0000,0000,0000,,we often can whack the weed away\Nand it seems to shrink, Dialogue: 0,0:16:46.35,0:16:47.52,Default,,0000,0000,0000,,but it often comes back. Dialogue: 0,0:16:47.54,0:16:49.28,Default,,0000,0000,0000,,So we're attacking the wrong target. Dialogue: 0,0:16:49.30,0:16:50.76,Default,,0000,0000,0000,,The cancer stem cells remain, Dialogue: 0,0:16:50.79,0:16:53.04,Default,,0000,0000,0000,,and the tumor can return\Nmonths or years later. Dialogue: 0,0:16:53.07,0:16:55.55,Default,,0000,0000,0000,,We're now learning to identify\Nthe cancer stem cells Dialogue: 0,0:16:55.57,0:16:58.69,Default,,0000,0000,0000,,and identify those as targets\Nand go for the long-term cure. Dialogue: 0,0:16:58.71,0:17:01.00,Default,,0000,0000,0000,,We're entering the era\Nof personalized oncology, Dialogue: 0,0:17:01.03,0:17:03.39,Default,,0000,0000,0000,,the ability to leverage\Nall of this data together, Dialogue: 0,0:17:03.42,0:17:04.57,Default,,0000,0000,0000,,analyze the tumor Dialogue: 0,0:17:04.59,0:17:07.90,Default,,0000,0000,0000,,and come up with a real, specific cocktail\Nfor the individual patient. Dialogue: 0,0:17:08.23,0:17:10.06,Default,,0000,0000,0000,,I'll close with regenerative medicine. Dialogue: 0,0:17:10.08,0:17:11.83,Default,,0000,0000,0000,,I've studied a lot about stem cells. Dialogue: 0,0:17:11.85,0:17:14.05,Default,,0000,0000,0000,,Embryonic stem cells\Nare particularly powerful. Dialogue: 0,0:17:14.08,0:17:16.19,Default,,0000,0000,0000,,We have adult stem cells\Nthroughout our body; Dialogue: 0,0:17:16.21,0:17:18.34,Default,,0000,0000,0000,,we use those in bone marrow\Ntransplantation. Dialogue: 0,0:17:18.76,0:17:23.66,Default,,0000,0000,0000,,Geron, last year, started the first trial\Nusing human embryonic stem cells Dialogue: 0,0:17:23.69,0:17:25.25,Default,,0000,0000,0000,,to treat spinal cord injuries. Dialogue: 0,0:17:25.28,0:17:27.33,Default,,0000,0000,0000,,Still a phase I trial, but evolving. Dialogue: 0,0:17:27.35,0:17:31.12,Default,,0000,0000,0000,,We've been using adult stem cells\Nin clinical trials for about 15 years Dialogue: 0,0:17:31.15,0:17:34.73,Default,,0000,0000,0000,,to approach a whole range of topics,\Nparticularly cardiovascular disease. Dialogue: 0,0:17:34.75,0:17:38.47,Default,,0000,0000,0000,,If we take our own bone marrow cells\Nand treat a patient with a heart attack, Dialogue: 0,0:17:38.49,0:17:41.40,Default,,0000,0000,0000,,we can see much improved\Nheart function and better survival Dialogue: 0,0:17:41.43,0:17:44.38,Default,,0000,0000,0000,,using our own bone marrow derived cells\Nafter a heart attack. Dialogue: 0,0:17:44.63,0:17:45.78,Default,,0000,0000,0000,,As mentioned earlier, Dialogue: 0,0:17:45.80,0:17:47.84,Default,,0000,0000,0000,,I invented a device\Ncalled the MarrowMiner, Dialogue: 0,0:17:47.86,0:17:50.30,Default,,0000,0000,0000,,a much less invasive way\Nfor harvesting bone marrow. Dialogue: 0,0:17:50.32,0:17:53.58,Default,,0000,0000,0000,,It's now been FDA approved;\Nhopefully on the market in the next year. Dialogue: 0,0:17:53.61,0:17:55.48,Default,,0000,0000,0000,,Hopefully you can appreciate the device Dialogue: 0,0:17:55.51,0:17:59.28,Default,,0000,0000,0000,,going through the patient's body removing\Nbone marrow, not with 200 punctures, Dialogue: 0,0:17:59.30,0:18:01.70,Default,,0000,0000,0000,,but with a single puncture,\Nunder local anesthesia. Dialogue: 0,0:18:01.72,0:18:03.30,Default,,0000,0000,0000,,Where is stem-cell therapy going? Dialogue: 0,0:18:03.33,0:18:04.48,Default,,0000,0000,0000,,If you think about it, Dialogue: 0,0:18:04.50,0:18:08.78,Default,,0000,0000,0000,,every cell in your body has the same DNA\Nyou had when you were an embryo. Dialogue: 0,0:18:08.80,0:18:10.74,Default,,0000,0000,0000,,We can now reprogram your skin cells Dialogue: 0,0:18:10.77,0:18:13.68,Default,,0000,0000,0000,,to actually act like a pluripotent\Nembryonic stem cell Dialogue: 0,0:18:13.71,0:18:17.35,Default,,0000,0000,0000,,and utilize those, potentially, to treat\Nmultiple organs in the same patient, Dialogue: 0,0:18:17.38,0:18:19.10,Default,,0000,0000,0000,,making personalized stem cell lines. Dialogue: 0,0:18:19.12,0:18:21.91,Default,,0000,0000,0000,,I think there'll be a new era\Nof your own stem cell banking Dialogue: 0,0:18:21.93,0:18:25.40,Default,,0000,0000,0000,,to have in the freezer your own cardiac\Ncells, myocytes and neural cells Dialogue: 0,0:18:25.43,0:18:27.78,Default,,0000,0000,0000,,to use them in the future,\Nshould you need them. Dialogue: 0,0:18:27.80,0:18:31.02,Default,,0000,0000,0000,,We're integrating this now\Nwith a whole era of cellular engineering, Dialogue: 0,0:18:31.05,0:18:34.62,Default,,0000,0000,0000,,and integrating exponential technologies\Nfor essentially 3D organ printing, Dialogue: 0,0:18:34.64,0:18:36.32,Default,,0000,0000,0000,,replacing the ink with cells, Dialogue: 0,0:18:36.35,0:18:39.15,Default,,0000,0000,0000,,and essentially building\Nand reconstructing a 3D organ. Dialogue: 0,0:18:39.17,0:18:40.70,Default,,0000,0000,0000,,That's where things are heading. Dialogue: 0,0:18:40.72,0:18:41.88,Default,,0000,0000,0000,,Still very early days, Dialogue: 0,0:18:41.90,0:18:44.65,Default,,0000,0000,0000,,but I think, as integration\Nof exponential technologies, Dialogue: 0,0:18:44.68,0:18:45.84,Default,,0000,0000,0000,,this is the example. Dialogue: 0,0:18:46.16,0:18:48.65,Default,,0000,0000,0000,,So in closing, as you think\Nabout technology trends Dialogue: 0,0:18:48.68,0:18:50.52,Default,,0000,0000,0000,,and how to impact health and medicine, Dialogue: 0,0:18:50.54,0:18:52.52,Default,,0000,0000,0000,,we're entering an era of miniaturization, Dialogue: 0,0:18:52.54,0:18:54.76,Default,,0000,0000,0000,,decentralization and personalization. Dialogue: 0,0:18:54.79,0:18:56.68,Default,,0000,0000,0000,,And by pulling these things together - Dialogue: 0,0:18:56.70,0:18:59.29,Default,,0000,0000,0000,,we heard at the beginning\Nof this event about the why - Dialogue: 0,0:18:59.32,0:19:02.30,Default,,0000,0000,0000,,if we start to think about\Nhow to understand and leverage them, Dialogue: 0,0:19:02.33,0:19:05.68,Default,,0000,0000,0000,,we're going to empower the patient,\Nenable the doctor, enhance wellness Dialogue: 0,0:19:05.70,0:19:08.15,Default,,0000,0000,0000,,and begin to cure the well\Nbefore they get sick. Dialogue: 0,0:19:08.17,0:19:11.71,Default,,0000,0000,0000,,Because I know as a doctor, if someone\Ncomes to me with stage I disease, Dialogue: 0,0:19:11.74,0:19:13.53,Default,,0000,0000,0000,,I'm thrilled; we can often cure them. Dialogue: 0,0:19:13.55,0:19:14.72,Default,,0000,0000,0000,,But often it's too late, Dialogue: 0,0:19:14.74,0:19:16.87,Default,,0000,0000,0000,,and it's stage III or IV\Ncancer, for example. Dialogue: 0,0:19:16.90,0:19:19.01,Default,,0000,0000,0000,,So by leveraging\Nthese technologies together, Dialogue: 0,0:19:19.04,0:19:22.27,Default,,0000,0000,0000,,I think we'll enter a new era\Nthat I like to call stage 0 medicine. Dialogue: 0,0:19:22.30,0:19:25.57,Default,,0000,0000,0000,,And as a cancer doctor,\NI'm looking forward to being out of a job. Dialogue: 0,0:19:25.59,0:19:26.81,Default,,0000,0000,0000,,Thanks very much. Dialogue: 0,0:19:26.84,0:19:28.81,Default,,0000,0000,0000,,(Applause) Dialogue: 0,0:19:28.84,0:19:30.54,Default,,0000,0000,0000,,Host: Thank you. Thank you. Dialogue: 0,0:19:30.56,0:19:32.36,Default,,0000,0000,0000,,(Applause) Dialogue: 0,0:19:32.38,0:19:34.38,Default,,0000,0000,0000,,Take a bow, take a bow. Dialogue: 0,0:19:35.02,0:19:37.35,Default,,0000,0000,0000,,Daniel Kraft, ladies and gentleman.