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