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← Medicine's future? There's an app for that | Daniel Kraft | TEDxMaastricht

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Showing Revision 2 created 06/02/2017 by TED Translators admin.

  1. Hi, there.
  2. A couple of years ago,
  3. when I was attending
    the TED conference in Long Beach,
  4. I met Harriet.
  5. We'd actually met online before --
    not the way you're thinking.
  6. We were introduced
    because we both knew Linda Avey,
  7. one of the founders of the first
    online personal genomic companies.
  8. And because we shared
    our genetic information with Linda,
  9. she could see that Harriet and I shared
  10. a very rare type of mitochondrial DNA,
    haplotype K1a1b1a,
  11. which meant we were distantly related.
  12. We actually share the same
    genealogy with Ötzi the Iceman.
  13. So -- Ötzi, Harriet and me.
  14. And being the current day, of course,
    we started our own Facebook group.
  15. You're all welcome to join.
  16. When I met Harriet in person
    the next year at the TED conference,
  17. she'd gone online and ordered
    our own happy haplotype T-shirts.
  18. (Laughter)
  19. Why am I telling you this story?
  20. What does it have to do
    with the future of health?
  21. Well, the way I met Harriet is an example
  22. of how leveraging cross-disciplinary,
    exponentially growing technologies
  23. is affecting our future
    of health and wellness --
  24. from low-cost gene analysis
  25. to the ability to do
    powerful bioinformatics
  26. to the connection of the Internet
    and social networking.
  27. What I'd like to talk about today
  28. is understanding
    these exponential technologies.
  29. We often think linearly.
  30. But if you think about it,
    if you have a lily pad
  31. and it just divided every single day --
  32. two, four, eight, sixteen --
    in 15 days, you'd have 32,000.
  33. What do you think you'd have in a month?
  34. We're at a billion.
  35. If we start to think exponentially,
  36. we can see how this is starting to affect
    all the technologies around us.
  37. Many of these technologies,
    speaking as a physician and innovator,
  38. we can start to leverage,
    to impact the future of our own health
  39. and of health care,
  40. and to address many of the major
    challenges in health care today,
  41. ranging from the exponential costs
    to the aging population,
  42. the way we really don't use
    information very well today,
  43. the fragmentation of care
  44. and the often very difficult course
    of adoption of innovation.
  45. And one of the major things we can do
    is move the curve to the left.
  46. We spend most of our money
    on the last 20 percent of life.
  47. What if we could incentivize physicians
    in the health care system
  48. and our own selves
  49. to move the curve to the left
    and improve our health,
  50. leveraging technology as well?
  51. Now my favorite example
    of exponential technology,
  52. we all have in our pocket.
  53. If you think about it,
    these are really dramatically improving.
  54. I mean, this is the iPhone 4.
  55. Imagine what the iPhone 8
    will be able to do.
  56. Now, I've gained some insight into this.
  57. I've been the track share
    for the medicine portion
  58. of a new institution
    called Singularity University,
  59. based in Silicon Valley.
  60. We bring together each summer
    about 100 very talented students
  61. from around the world.
  62. And we look at these exponential
    technologies from medicine,
  63. biotech, artificial intelligence,
    robotics, nanotechnology, space,
  64. and address how we can cross-train
    and leverage these
  65. to impact major unmet goals.
  66. We also have seven-day executive programs.
  67. And coming up next month is FutureMed,
  68. a program to help cross-train
    and leverage technologies into medicine.
  69. Now, I mentioned the phone.
  70. These mobile phones have over 20,000
    different mobile apps available.
  71. There's one out of the UK
    where you can pee on a little chip,
  72. connect it to your iPhone,
  73. and check for an STD.
  74. I don't know if I'd try that,
    but it's available.
  75. There are other sorts of applications.
  76. Merging your phone
    and diagnostics, for example,
  77. measuring your blood glucose
    on your iPhone
  78. and sending that to your physician,
  79. so they can better understand
    and you can better understand
  80. your blood sugars as a diabetic.
  81. So let's see how exponential
    technologies are taking health care.
  82. Let's start with faster.
  83. It's no secret that computers,
    through Moore's law,
  84. are speeding up faster and faster.
  85. We can do more powerful things with them.
  86. They're really approaching --
    in many cases, surpassing --
  87. the ability of the human mind.
  88. But where I think computational speed
    is most applicable is in imaging.
  89. The ability now to look
    inside the body in real time
  90. with very high resolution
  91. is really becoming incredible.
  92. And we're layering multiple
    technologies -- PET scans, CT scans
  93. and molecular diagnostics --
  94. to find and seek things
    at different levels.
  95. Here you're going to see the very highest
    resolution MRI scan done today,
  96. of Marc Hodosh, the curator of TEDMED.
  97. And now we can see inside of the brain
  98. at a resolution and ability
    never before available,
  99. and essentially learn how to reconstruct
    and maybe even reengineer
  100. or backwards engineer the brain,
  101. so we can better understand
    pathology, disease and therapy.
  102. We can look inside with real-time
    fMRI in the brain at real time.
  103. And by understanding these sorts
    of processes and these connections,
  104. we're going to understand the effects
    of medication or meditation
  105. and better personalize
    and make effective, for example,
  106. psychoactive drugs.
  107. The scanners for these are getting
    smaller, less expensive
  108. and more portable.
  109. And this sort of data explosion
    available from these
  110. is really almost becoming a challenge.
  111. The scan of today takes up
    about 800 books, or 20 gigabytes.
  112. The scan in a couple of years
    will be one terabyte, or 800,000 books.
  113. How do you leverage that information?
  114. Let's get personal.
  115. I won't ask who here's had a colonoscopy,
    but if you're over age 50,
  116. it's time for your screening colonoscopy.
  117. How'd you like to avoid
    the pointy end of the stick?
  118. Now there's essentially
    virtual colonoscopy.
  119. Compare those two pictures.
  120. As a radiologist, you can basically
    fly through your patient's colon,
  121. and augmenting that
    with artificial intelligence,
  122. potentially identify a lesion
    that we might have missed,
  123. but using AI on top of radiology,
  124. we can find lesions
    that were missed before.
  125. Maybe this will encourage
    people to get colonoscopies
  126. that wouldn't have otherwise.
  127. This is an example of this paradigm shift.
  128. We're moving to this integration
    of biomedicine, information technology,
  129. wireless and, I would say, mobile now --
    this era of digital medicine.
  130. Even my stethoscope is now digital,
    and of course, there's an app for that.
  131. We're moving, obviously,
    to the era of the tricorder.
  132. So the handheld ultrasound
    is basically surpassing
  133. and supplanting the stethoscope.
  134. These are now at a price point
    of what used to be 100,000 euros
  135. or a couple hundred-thousand dollars.
  136. For about 5,000 dollars,
  137. I can have the power of a very powerful
    diagnostic device in my hand.
  138. Merging this now with the advent
    of electronic medical records --
  139. in the US, we're still
    less than 20 percent electronic;
  140. here in the Netherlands,
    I think it's more than 80 percent.
  141. Now that we're switching
    to merging medical data,
  142. making it available electronically,
  143. we can crowd-source the information,
    and as a physician,
  144. I can access my patients' data
    from wherever I am,
  145. just through my mobile device.
  146. And now, of course, we're in the era
    of the iPad, even the iPad 2.
  147. Just last month,
  148. the first FDA-approved
    application was approved
  149. to allow radiologists to do actual
    reading on these sorts of devices.
  150. So certainly, the physicians
    of today, including myself,
  151. are completely reliable on these devices.
  152. And as you saw just about a month ago,
  153. Watson from IBM beat
    the two champions in "Jeopardy."
  154. So I want you to imagine
    when, in a couple of years,
  155. we've started to apply
    this cloud-based information,
  156. when we really have the AI physician
    and leverage our brains to connectivity
  157. to make decisions and diagnostics
    at a level never done.
  158. Already today, you don't need to go
    to your physician in many cases.
  159. Only in about 20 percent of visits
    do you need to lay hands on the patient.
  160. We're now in the era of virtual visits.
  161. From Skype-type visits
    you can do with American Well,
  162. to Cisco, that's developed a very complex
    health presence system,
  163. the ability to interact with
    your health care provider is different.
  164. And these are being augmented
    even by our devices, again, today.
  165. My friend Jessica sent me
    a picture of her head laceration,
  166. so I can save her a trip
    to the emergency room,
  167. and do diagnostics that way.
  168. Or maybe we can leverage
    today's gaming technology,
  169. like the Microsoft Kinect,
  170. hack that to enable diagnostics,
    for example, in diagnosing stroke,
  171. using simple motion detection,
    using $100 devices.
  172. We can actually now visit
    our patients robotically.
  173. This is the RP7;
  174. if I'm a hematologist,
    I can visit another clinic or hospital.
  175. These are being augmented
    by a whole suite of tools
  176. actually in the home now.
  177. We already have wireless scales.
  178. You step on the scale,
    tweet your weight to your friends,
  179. they can keep you in line.
  180. We have wireless blood pressure cuffs.
  181. A whole gamut of technologies
    are being put together.
  182. Instead of wearing kludgy devices,
    we put on a simple patch.
  183. This was developed at Stanford.
  184. It's called iRhythm; it completely
    supplants the prior technology
  185. at a much lower price point,
    with much more effectivity.
  186. We're also in the era today
    of quantified self.
  187. Consumers now can basically buy
    $100 devices, like this little Fitbit.
  188. I can measure my steps,
    my caloric outtake.
  189. I can get insight into that
    on a daily basis
  190. and share it with my friends or physician.
  191. There's watches that measure
    your heart rate, Zeo sleep monitors,
  192. a suite of tools
    that enable you to leverage
  193. and have insight into your own health.
  194. As we start to integrate this information,
  195. we'll know better what to do with it,
    and have better insight
  196. into our own pathologies,
    health and wellness.
  197. There's even mirrors
    that can pick up your pulse rate.
  198. And I would argue, in the future,
  199. we'll have wearable devices
    in our clothes, monitoring us 24/7.
  200. And just like the OnStar system
    in cars, your red light might go on.
  201. It won't say "check engine";
    it'll be a "check your body" light,
  202. and you'll go get it taken care of.
  203. Probably in a few years,
  204. you'll look in your mirror
    and it'll be diagnosing you.
  205. (Laughter)
  206. For those of you with kiddos at home,
  207. how would you like a wireless
    diaper that supports your --
  208. (Laughter)
  209. More information, I think,
    than you might need,
  210. but it's going to be here.
  211. Now, we've heard a lot today
    about technology and connection.
  212. And I think some of these technologies
  213. will enable us to be more connected
    with our patients, to take more time
  214. and do the important
    human-touch elements of medicine,
  215. as augmented by these technologies.
  216. Now, we've talked about
    augmenting the patient.
  217. How about augmenting the physician?
  218. We're now in the era
    of super-enabling the surgeon,
  219. who can now go into the body and do
    robotic surgery, which is here today,
  220. at a level that was not really possible
    even five years ago.
  221. And now this is being augmented
    with further layers of technology,
  222. like augmented reality.
  223. So the surgeon can see
    inside the patient, through their lens,
  224. where the tumor is,
    where the blood vessels are.
  225. This can be integrated
    with decision support.
  226. A surgeon in New York can help
    a surgeon in Amsterdam, for example.
  227. And we're entering an era
    of truly scarless surgery called NOTES,
  228. where the robotic endoscope
    can come out the stomach
  229. and pull out that gallbladder,
  230. all in a scarless way and robotically.
  231. This is called NOTES, and it's coming --
    basically scarless surgery,
  232. as mediated by robotic surgery.
  233. Now, how about controlling other elements?
  234. For those who have
    disabilities -- the paraplegic,
  235. there's the brain-computer
    interface, or BCI,
  236. where chips have been put
    on the motor cortex
  237. of completely quadriplegic patients,
  238. and they can control
    a cursor or a wheelchair
  239. or, potentially, a robotic arm.
  240. These devices are getting smaller
  241. and going into more and more
    of these patients.
  242. Still in clinical trials,
  243. but imagine when we can connect
    these, for example,
  244. to the amazing bionic limb,
  245. such as the DEKA Arm,
    built by Dean Kamen and colleagues,
  246. which has 17 degrees
    of motion and freedom,
  247. and can allow the person who's lost a limb
  248. to have much higher dexterity or control
    than they've had in the past.
  249. So we're really entering the era
    of wearable robotics, actually.
  250. If you haven't lost a limb
    but had a stroke,
  251. you can wear these augmented limbs.
  252. Or if you're a paraplegic -- I've visited
    the folks at Berkeley Bionics --
  253. they've developed eLEGS.
  254. I took this video last week.
  255. Here's a paraplegic patient, walking
    by strapping on these exoskeletons.
  256. He's otherwise completely
  257. This is the early era
    of wearable robotics.
  258. And by leveraging
    these sorts of technologies,
  259. we're going to change
    the definition of disability
  260. to, in some cases, be superability,
    or super-enabling.
  261. This is Aimee Mullins, who lost
    her lower limbs as a young child,
  262. and Hugh Herr, who's a professor at MIT,
  263. who lost his limbs in a climbing accident.
  264. And now both of them can climb better,
    move faster, swim differently
  265. with their prosthetics
    than us normal-abled persons.
  266. How about other exponentials?
  267. We've heard a bit today
    about obesity.
  268. Clearly the obesity trend is exponentially
    going in the wrong direction,
  269. including with huge costs.
  270. But the trend in medicine
    is to get exponentially smaller.
  271. A few examples: we're now in the era
    of "Fantastic Voyage," the iPill.
  272. You can swallow this
    completely integrated device.
  273. It can take pictures of your GI system,
  274. help diagnose and treat
    as it moves through your GI tract.
  275. We get into even smaller micro-robots
  276. that will eventually, autonomously,
    move through your system,
  277. and be able to do things surgeons can't do
  278. in a much less invasive manner.
  279. Sometimes these might
    self-assemble in your GI system,
  280. and be augmented in that reality.
  281. On the cardiac side,
    pacemakers are getting smaller
  282. and much easier to place,
  283. so no need to train an interventional
    cardiologist to place them.
  284. And they'll be wirelessly telemetered
    to your mobile devices,
  285. so you can go places
    and be monitored remotely.
  286. These are shrinking even further.
  287. This one is in prototyping
    by Medtronic; it's smaller than a penny.
  288. Artificial retinas, the ability to put
    arrays on the back of the eyeball
  289. and allow the blind to see --
  290. also in early trials,
    but moving into the future.
  291. These are going to be game-changing.
  292. Or for those of us who are sighted,
  293. how about having
    the assisted-living contact lens?
  294. Bluetooth, Wi-Fi available --
    beams back images to your eye.
  295. (Laughter)
  296. Now, if you have trouble
    maintaining your diet,
  297. it might help to have some extra imagery
  298. to remind you how many calories
    are going to be coming at you.
  299. How about enabling the pathologist
    to use their cell phone
  300. to see at a microscopic level
  301. and to lumber that data back to the cloud
    and make better diagnostics?
  302. In fact, the whole era
    of laboratory medicine
  303. is completely changing.
  304. We can now leverage microfluidics,
  305. like this chip made
    by Steve Quake at Stanford.
  306. Microfluidics can replace
    an entire lab of technicians;
  307. put it on a chip, enable thousands
    of tests at the point of care,
  308. anywhere in the world.
  309. This will really leverage technology
    to the rural and the underserved
  310. and enable what used to be thousand-dollar
    tests to be done for pennies,
  311. and at the point of care.
  312. If we go down the small
    pathway a little bit further,
  313. we're entering the era of nanomedicine,
  314. the ability to make devices super-small,
  315. to the point where we can
    design red blood cells
  316. or microrobots that monitor
    our blood system or immune system,
  317. or even those that might clear out
    the clots from our arteries.
  318. Now how about exponentially cheaper?
  319. Not something we usually think
    about in the era of medicine,
  320. but hard disks used to be 3,400 dollars
    for 10 megabytes -- exponentially cheaper.
  321. In genomics now, the genome
    cost about a billion dollars
  322. about 10 years ago,
    when the first one came out.
  323. We're now approaching essentially
    a $1,000 genome, probably next year.
  324. And in two years, a $100 genome.
  325. What will we do with $100 genomes?
  326. Soon we'll have millions
    of these tests available.
  327. Then it gets interesting, when we start
    to crowd-source that information,
  328. and enter the era
    of true personalized medicine:
  329. the right drug for the right person
    at the right time,
  330. instead of what we're doing now,
    which is the same drug for everybody,
  331. blockbuster drug medications,
    which don't work for the individual.
  332. Many different companies are working
    on leveraging these approaches.
  333. I'll show you a simple example,
    from 23andMe again.
  334. My data indicates
    I've got about average risk
  335. for developing macular degeneration,
    a kind of blindness.
  336. But if I take that same data,
    upload it to deCODEme,
  337. I can look at my risk for type 2 diabetes;
    I'm at almost twice the risk.
  338. I might want to watch how much dessert
    I have at lunch, for example.
  339. It might change my behavior.
  340. Leveraging my knowledge
    of my pharmacogenomics:
  341. how my genes modulate,
    what my drugs do and what doses I need
  342. will become increasingly important,
  343. and once in the hands
    of individuals and patients,
  344. will make better drug dosing
    and selection available.
  345. So again, it's not just genes,
    it's multiple details --
  346. our habits, our environmental exposures.
  347. When was the last time your doctor
    asked where you've lived?
  348. Geomedicine: where you live,
    what you've been exposed to,
  349. can dramatically affect your health.
  350. We can capture that information.
  351. Genomics, proteomics, the environment --
  352. all this data streaming at us
    individually and as physicians:
  353. How do we manage it?
  354. We're now entering the era
    of systems medicine, systems biology,
  355. where we can start to integrate
    all this information.
  356. And by looking at the patterns,
    for example, in our blood,
  357. of 10,000 biomarkers in a single test,
  358. we can look at patterns and detect disease
    at a much earlier stage.
  359. This is called by Lee Hood,
    the father of the field, P4 Medicine.
  360. We'll be predictive and know
    what you're likely to have.
  361. We can be preventative;
    that prevention can be personalized.
  362. More importantly,
    it'll be increasingly participatory.
  363. Through websites like PatientsLikeMe
  364. or managing your data on Microsoft
    HealthVault or Google Health,
  365. leveraging this together
    in participatory ways
  366. will be increasingly important.
  367. I'll finish up with exponentially better.
  368. We'd like to get therapies
    better and more effective.
  369. Today we treat high blood pressure
    mostly with pills.
  370. What if we take a new device,
  371. knock out the nerve vessels
    that help mediate blood pressure,
  372. and in a single therapy,
    basically cure hypertension?
  373. This is a new device
    doing essentially that.
  374. It should be on the market
    in a year or two.
  375. How about more targeted
    therapies for cancer?
  376. I'm an oncologist and know that most
    of what we give is essentially poison.
  377. We learned at Stanford and other places
    that we can discover cancer stem cells,
  378. the ones that seem to be really
    responsible for disease relapse.
  379. So if you think of cancer as a weed,
  380. we often can whack the weed away
    and it seems to shrink,
  381. but it often comes back.
  382. So we're attacking the wrong target.
  383. The cancer stem cells remain,
  384. and the tumor can return
    months or years later.
  385. We're now learning to identify
    the cancer stem cells
  386. and identify those as targets
    and go for the long-term cure.
  387. We're entering the era
    of personalized oncology,
  388. the ability to leverage
    all of this data together,
  389. analyze the tumor
  390. and come up with a real, specific cocktail
    for the individual patient.
  391. I'll close with regenerative medicine.
  392. I've studied a lot about stem cells.
  393. Embryonic stem cells
    are particularly powerful.
  394. We have adult stem cells
    throughout our body;
  395. we use those in bone marrow
  396. Geron, last year, started the first trial
    using human embryonic stem cells
  397. to treat spinal cord injuries.
  398. Still a phase I trial, but evolving.
  399. We've been using adult stem cells
    in clinical trials for about 15 years
  400. to approach a whole range of topics,
    particularly cardiovascular disease.
  401. If we take our own bone marrow cells
    and treat a patient with a heart attack,
  402. we can see much improved
    heart function and better survival
  403. using our own bone marrow derived cells
    after a heart attack.
  404. As mentioned earlier,
  405. I invented a device
    called the MarrowMiner,
  406. a much less invasive way
    for harvesting bone marrow.
  407. It's now been FDA approved;
    hopefully on the market in the next year.
  408. Hopefully you can appreciate the device
  409. going through the patient's body removing
    bone marrow, not with 200 punctures,
  410. but with a single puncture,
    under local anesthesia.
  411. Where is stem-cell therapy going?
  412. If you think about it,
  413. every cell in your body has the same DNA
    you had when you were an embryo.
  414. We can now reprogram your skin cells
  415. to actually act like a pluripotent
    embryonic stem cell
  416. and utilize those, potentially, to treat
    multiple organs in the same patient,
  417. making personalized stem cell lines.
  418. I think there'll be a new era
    of your own stem cell banking
  419. to have in the freezer your own cardiac
    cells, myocytes and neural cells
  420. to use them in the future,
    should you need them.
  421. We're integrating this now
    with a whole era of cellular engineering,
  422. and integrating exponential technologies
    for essentially 3D organ printing,
  423. replacing the ink with cells,
  424. and essentially building
    and reconstructing a 3D organ.
  425. That's where things are heading.
  426. Still very early days,
  427. but I think, as integration
    of exponential technologies,
  428. this is the example.
  429. So in closing, as you think
    about technology trends
  430. and how to impact health and medicine,
  431. we're entering an era of miniaturization,
  432. decentralization and personalization.
  433. And by pulling these things together -
  434. we heard at the beginning
    of this event about the why -
  435. if we start to think about
    how to understand and leverage them,
  436. we're going to empower the patient,
    enable the doctor, enhance wellness
  437. and begin to cure the well
    before they get sick.
  438. Because I know as a doctor, if someone
    comes to me with stage I disease,
  439. I'm thrilled; we can often cure them.
  440. But often it's too late,
  441. and it's stage III or IV
    cancer, for example.
  442. So by leveraging
    these technologies together,
  443. I think we'll enter a new era
    that I like to call stage 0 medicine.
  444. And as a cancer doctor,
    I'm looking forward to being out of a job.
  445. Thanks very much.
  446. (Applause)
  447. Host: Thank you. Thank you.
  448. (Applause)
  449. Take a bow, take a bow.
  450. Daniel Kraft, ladies and gentleman.