9:59:59.000,9:59:59.000
I have a tendency to assume the worst,

9:59:59.000,9:59:59.000
and once in a while,[br]this habit plays tricks on me.

9:59:59.000,9:59:59.000
For example, if I feel[br]unexpected pain in my body

9:59:59.000,9:59:59.000
that I have not experienced before[br]and that I cannot attribute,

9:59:59.000,9:59:59.000
then all of a sudden, my mind[br]my turn a tense back into heart disease

9:59:59.000,9:59:59.000
or calf muscle pain into ??.

9:59:59.000,9:59:59.000
But so far I haven't been diagnosed[br]with any deadly or incurable disease.

9:59:59.000,9:59:59.000
Sometimes things just hurt[br]for no clear reason.

9:59:59.000,9:59:59.000
But not everyone is as lucky as me.

9:59:59.000,9:59:59.000
Every year, more than[br]50 million people die worldwide.

9:59:59.000,9:59:59.000
Especially in high-income[br]economies like ours,

9:59:59.000,9:59:59.000
a large fraction of deaths[br]is caused by slowly progressing diseases:

9:59:59.000,9:59:59.000
heart disease, chronic lung disease,[br]cancer, Alzheimer's, diabetes,

9:59:59.000,9:59:59.000
just to name a few.

9:59:59.000,9:59:59.000
Now, humanity has made tremendous progress[br]in diagnosing and treating many of these,

9:59:59.000,9:59:59.000
but we are at stage[br]where further advancement in health

9:59:59.000,9:59:59.000
cannot be achieved only[br]by developing new treatments,

9:59:59.000,9:59:59.000
and this becomes evident[br]when we look at one aspect

9:59:59.000,9:59:59.000
that many of these[br]diseases have in common.

9:59:59.000,9:59:59.000
The probability for successful treatment

9:59:59.000,9:59:59.000
strongly depends on[br]when treatment is started,

9:59:59.000,9:59:59.000
but a disease is typically only detected[br]once symptoms occur,

9:59:59.000,9:59:59.000
and the problem here is that in fact[br]many disease can remain asymptomatic,

9:59:59.000,9:59:59.000
hence undetected,[br]for a long period of time.

9:59:59.000,9:59:59.000
Because of this, there is[br]a persisting need for new ways

9:59:59.000,9:59:59.000
of detecting disease at early stage,[br]way before any symptoms occur.

9:59:59.000,9:59:59.000
In health care, this is called screening,

9:59:59.000,9:59:59.000
and as defined by[br]the World Health Organization,

9:59:59.000,9:59:59.000
screening is the[br]presumptive identification

9:59:59.000,9:59:59.000
of unrecognized disease

9:59:59.000,9:59:59.000
in an apparently healthy person

9:59:59.000,9:59:59.000
by means of tests that can be applied[br]rapidly and easily.

9:59:59.000,9:59:59.000
That's a long definition,[br]so let me repeat it:

9:59:59.000,9:59:59.000
identification of unrecognized disease

9:59:59.000,9:59:59.000
in an apparently healthy person

9:59:59.000,9:59:59.000
by means of tests that can be applied[br]both rapidly and easily.

9:59:59.000,9:59:59.000
And I want to put special emphasis[br]on the words "rapidly" and "easily,"

9:59:59.000,9:59:59.000
because many of[br]the existing screening methods

9:59:59.000,9:59:59.000
are exactly the opposite.

9:59:59.000,9:59:59.000
And those of you who have gone colonoscopy

9:59:59.000,9:59:59.000
as part of a screening program[br]for colorectal cancer

9:59:59.000,9:59:59.000
will know what I mean.

9:59:59.000,9:59:59.000
Obviously, there's a variety[br]of medical tools available

9:59:59.000,9:59:59.000
to perform screening tests.

9:59:59.000,9:59:59.000
This ranges from imaging techniques

9:59:59.000,9:59:59.000
such as radiography[br]or magnetic resonance imaging

9:59:59.000,9:59:59.000
to the analysis of blood or tissue.

9:59:59.000,9:59:59.000
We have all had such tests.

9:59:59.000,9:59:59.000
But there's one medium[br]that for long has been overlooked,

9:59:59.000,9:59:59.000
a medium that is easily accessible,

9:59:59.000,9:59:59.000
basically non-depletable,

9:59:59.000,9:59:59.000
and it holds tremendous promise[br]for medical analysis,

9:59:59.000,9:59:59.000
and that is our breath.

9:59:59.000,9:59:59.000
Human breath is essentially[br]composed of five components:

9:59:59.000,9:59:59.000
nitrogen, oxygen,[br]carbon dioxide, water and argon,

9:59:59.000,9:59:59.000
but besides these five, there are[br]hundreds of other components

9:59:59.000,9:59:59.000
that are present in very low quantity.

9:59:59.000,9:59:59.000
These are called volatile[br]organic compounds,

9:59:59.000,9:59:59.000
and we release hundreds,[br]even thousands of them,

9:59:59.000,9:59:59.000
every time we exhale.

9:59:59.000,9:59:59.000
The analysis of these volatile[br]organic compounds in our breath

9:59:59.000,9:59:59.000
is called breath analysis.

9:59:59.000,9:59:59.000
In fact, I believe that many of you[br]have already experienced breath analysis.

9:59:59.000,9:59:59.000
Imagine, you're driving home late at night

9:59:59.000,9:59:59.000
when suddenly there's[br]a friendly police officer

9:59:59.000,9:59:59.000
who asks you kindly but firmly

9:59:59.000,9:59:59.000
to pull over and blow[br]into a device like this one.

9:59:59.000,9:59:59.000
This is an alcohol breath tester

9:59:59.000,9:59:59.000
that is used to measure[br]the ethanol concentration in your breath

9:59:59.000,9:59:59.000
and determine whether driving[br]in your condition is a clever idea.

9:59:59.000,9:59:59.000
Now I'd say my driving was pretty good,

9:59:59.000,9:59:59.000
but let me check.

9:59:59.000,9:59:59.000
(Beep)

9:59:59.000,9:59:59.000
0.0, so nothing to worry about, all fine.

9:59:59.000,9:59:59.000
Now, imagine a device like this one

9:59:59.000,9:59:59.000
that does not only measure[br]alcohol levels in your breath,

9:59:59.000,9:59:59.000
but that detects diseases

9:59:59.000,9:59:59.000
like the ones I've shown you[br]and potentially many more.

9:59:59.000,9:59:59.000
The concept of correlating[br]the smell of a person's breath

9:59:59.000,9:59:59.000
with certain medical conditions

9:59:59.000,9:59:59.000
in fact dates back to Ancient Greece,

9:59:59.000,9:59:59.000
but only recently, research efforts[br]on breath analysis have skyrocketed,

9:59:59.000,9:59:59.000
and what once was a dream[br]is now becoming reality.

9:59:59.000,9:59:59.000
And let me pull up this list again[br]that I showed you earlier.

9:59:59.000,9:59:59.000
For the majority of diseases listed here,

9:59:59.000,9:59:59.000
there's substantial scientific evidence[br]suggesting that the disease

9:59:59.000,9:59:59.000
could be detected by breath analysis.

9:59:59.000,9:59:59.000
But how does it work exactly?

9:59:59.000,9:59:59.000
The essential part is a sensor device

9:59:59.000,9:59:59.000
that detects the volatile[br]organic compounds in our breath.

9:59:59.000,9:59:59.000
Simply put, when exposed[br]to a breath sample,

9:59:59.000,9:59:59.000
the sensor outputs a complex signature

9:59:59.000,9:59:59.000
that results from the mixture of volatile[br]organic compounds that we exhale.

9:59:59.000,9:59:59.000
Now, this signature represents[br]a fingerprint of your metabolism,

9:59:59.000,9:59:59.000
your microbiome,

9:59:59.000,9:59:59.000
and the biochemical processes[br]that occur in your body.

9:59:59.000,9:59:59.000
If you have a disease,

9:59:59.000,9:59:59.000
your organisms will change,

9:59:59.000,9:59:59.000
and so will the composition[br]of your exhaled breath,

9:59:59.000,9:59:59.000
and then the only thing that is left to do

9:59:59.000,9:59:59.000
is to correlate a certain signature

9:59:59.000,9:59:59.000
with the presence or absence[br]of certain medical conditions.

9:59:59.000,9:59:59.000
The technology promises[br]several undeniable benefits.

9:59:59.000,9:59:59.000
Firstly, the sensor can be miniaturized

9:59:59.000,9:59:59.000
and integrated into small,[br]handheld devices

9:59:59.000,9:59:59.000
like this alcohol breath tester.

9:59:59.000,9:59:59.000
This would allow the test to be used[br]in many different settings

9:59:59.000,9:59:59.000
and even at home,

9:59:59.000,9:59:59.000
so that a visit at a doctor's office

9:59:59.000,9:59:59.000
is not needed each time[br]a test shall be performed.

9:59:59.000,9:59:59.000
Secondly, breath analysis is non-invasive

9:59:59.000,9:59:59.000
and can be as simple as blowing[br]into an alcohol breath tester.

9:59:59.000,9:59:59.000
Such simplicity and ease of use[br]would reduce patient burden

9:59:59.000,9:59:59.000
and provide an incentive[br]for broad adoption of the technology.

9:59:59.000,9:59:59.000
And thirdly, the technology is so flexible

9:59:59.000,9:59:59.000
that the same device could be used

9:59:59.000,9:59:59.000
to detect a broad range[br]of medical conditions.

9:59:59.000,9:59:59.000
Breath analysis could be used to screen[br]for multiple diseases at the same time.

9:59:59.000,9:59:59.000
Nowadays, each disease typically requires

9:59:59.000,9:59:59.000
a different medical tool[br]to perform a screening test,

9:59:59.000,9:59:59.000
but this means you can only find[br]what you're looking for.

9:59:59.000,9:59:59.000
With all of these features,[br]breath analysis is predestined

9:59:59.000,9:59:59.000
to deliver what many traditional[br]screening tests are lacking,

9:59:59.000,9:59:59.000
and most importantly,[br]all of these features

9:59:59.000,9:59:59.000
should eventually provide us[br]with a platform for medical analysis

9:59:59.000,9:59:59.000
that can operate at attractively[br]low cost per test.

9:59:59.000,9:59:59.000
On the contrary, existing medical tools

9:59:59.000,9:59:59.000
often lead to rather high cost per test.

9:59:59.000,9:59:59.000
Then, in order to keep costs down,

9:59:59.000,9:59:59.000
the number of tests[br]needs to be restricted,

9:59:59.000,9:59:59.000
and this means a) that the tests[br]can only be performed

9:59:59.000,9:59:59.000
on a narrow part of the population,[br]for example the high-risk population,

9:59:59.000,9:59:59.000
and b) that the number of tests per person[br]needs to be kept at a minimum.

9:59:59.000,9:59:59.000
But wouldn't it actually be beneficial

9:59:59.000,9:59:59.000
if the test was performed[br]on a larger group of people

9:59:59.000,9:59:59.000
and more often and over a longer period[br]of time for each individual?

9:59:59.000,9:59:59.000
Especially the latter would give access[br]to something very valuable

9:59:59.000,9:59:59.000
that is called longitudinal data.

9:59:59.000,9:59:59.000
Longitudinal data is a dataset[br]that tracks the same patient

9:59:59.000,9:59:59.000
over the course of many months or years.

9:59:59.000,9:59:59.000
Nowadays, medical decisions

9:59:59.000,9:59:59.000
are often based on a limited dataset

9:59:59.000,9:59:59.000
where over a glimpse[br]of a patient's medical history

9:59:59.000,9:59:59.000
is available for decision-making.

9:59:59.000,9:59:59.000
In such a case,

9:59:59.000,9:59:59.000
abnormalities are typically detected

9:59:59.000,9:59:59.000
by comparing a patient's health profile

9:59:59.000,9:59:59.000
to the average health profile[br]of a reference population.

9:59:59.000,9:59:59.000
Longitudinal data would[br]open up a new dimension

9:59:59.000,9:59:59.000
and allow abnormalities to be detected

9:59:59.000,9:59:59.000
based on a patient's own medical history.

9:59:59.000,9:59:59.000
This will pave the way[br]for personalized treatment.

9:59:59.000,9:59:59.000
Sounds pretty great, right?

9:59:59.000,9:59:59.000
Now you will certainly have a question

9:59:59.000,9:59:59.000
that is something like,

9:59:59.000,9:59:59.000
"If the technology is as great as he says,[br]then why aren't they using it today?"

9:59:59.000,9:59:59.000
And the only answer I can give you is,

9:59:59.000,9:59:59.000
not everything is as easy as it sounds.

9:59:59.000,9:59:59.000
There are technical challenges.

9:59:59.000,9:59:59.000
For example, there's the need[br]for extremely reliable sensors

9:59:59.000,9:59:59.000
that can detect mixtures[br]of volatile organic compounds

9:59:59.000,9:59:59.000
with sufficient reproducibility.

9:59:59.000,9:59:59.000
And another technical challenge is,

9:59:59.000,9:59:59.000
how do you sample a person's breath[br]in a very defined manner

9:59:59.000,9:59:59.000
so that the sampling process itself

9:59:59.000,9:59:59.000
does not alter the result of the analysis?

9:59:59.000,9:59:59.000
And there's the need for data.

9:59:59.000,9:59:59.000
Breath analysis needs[br]to be validated in clinical trials,

9:59:59.000,9:59:59.000
and enough data needs to be collected

9:59:59.000,9:59:59.000
so that individual conditions

9:59:59.000,9:59:59.000
can be measured against baselines.

9:59:59.000,9:59:59.000
Breath analysis can only succeed

9:59:59.000,9:59:59.000
if a large enough dataset can be generated

9:59:59.000,9:59:59.000
and made available for broad use.

9:59:59.000,9:59:59.000
If breath analysis[br]holds up to its promises,

9:59:59.000,9:59:59.000
this is a technology[br]that could truly aid us

9:59:59.000,9:59:59.000
to transform our health care system,

9:59:59.000,9:59:59.000
transform it from a reactive system

9:59:59.000,9:59:59.000
that treatment is triggered[br]by symptoms of disease

9:59:59.000,9:59:59.000
to a proactive system

9:59:59.000,9:59:59.000
where disease detection,[br]diagnosis and treatment

9:59:59.000,9:59:59.000
can happen at early stage,

9:59:59.000,9:59:59.000
way before any symptoms occur.

9:59:59.000,9:59:59.000
Now this brings me to my last point,[br]and it's a fundamental one.

9:59:59.000,9:59:59.000
What exactly is a disease?

9:59:59.000,9:59:59.000
Imagine that breath analysis[br]can be commercialized as I describe it

9:59:59.000,9:59:59.000
and early detection becomes routine.

9:59:59.000,9:59:59.000
A problem that remains

9:59:59.000,9:59:59.000
is in fact a problem that[br]any screening activity has to face,

9:59:59.000,9:59:59.000
because for many diseases,

9:59:59.000,9:59:59.000
it is often impossible to predict[br]with sufficient certainty

9:59:59.000,9:59:59.000
whether the disease[br]would ever cause any symptoms

9:59:59.000,9:59:59.000
or put a person's life at risk.

9:59:59.000,9:59:59.000
This is called overdiagnosis,

9:59:59.000,9:59:59.000
and it leads to a dilemma.

9:59:59.000,9:59:59.000
If a disease is identified,

9:59:59.000,9:59:59.000
you could decide not to treat it

9:59:59.000,9:59:59.000
because there's a certain probability[br]that you would never suffer from it.

9:59:59.000,9:59:59.000
But how much would you suffer

9:59:59.000,9:59:59.000
just from knowing that you have[br]a potentially deadly disease?

9:59:59.000,9:59:59.000
And wouldn't you actually regret that the[br]disease was detected in the first place?

9:59:59.000,9:59:59.000
Your second option[br]is to undergo early treatment

9:59:59.000,9:59:59.000
with the hope for curing it,

9:59:59.000,9:59:59.000
but often this would not[br]come without side effects.

9:59:59.000,9:59:59.000
To be precise,

9:59:59.000,9:59:59.000
the bigger problem is not overdiagnosis,

9:59:59.000,9:59:59.000
it's overtreatment,

9:59:59.000,9:59:59.000
because not every disease[br]has to be treated immediately

9:59:59.000,9:59:59.000
just because a treatment is available.

9:59:59.000,9:59:59.000
The increasing adoption[br]of routine screening

9:59:59.000,9:59:59.000
will raise the question:

9:59:59.000,9:59:59.000
what do we call a disease[br]that can rationalize treatment,

9:59:59.000,9:59:59.000
and what is just an abnormality[br]that should not be a source of concern?

9:59:59.000,9:59:59.000
My hopes are that routine screening[br]using breath analysis

9:59:59.000,9:59:59.000
can provide enough data and insight

9:59:59.000,9:59:59.000
so that at some point,[br]we'll be able to break this dilemma

9:59:59.000,9:59:59.000
and predict with sufficient certainty

9:59:59.000,9:59:59.000
whether and when to treat at early stage.

9:59:59.000,9:59:59.000
Our breath, and the mixture[br]of volatile organic compounds

9:59:59.000,9:59:59.000
that we exhale,

9:59:59.000,9:59:59.000
hold tremendous amounts of information[br]on our physiological condition.

9:59:59.000,9:59:59.000
With what we know today,[br]we have only scratched the surface.

9:59:59.000,9:59:59.000
As we collect more and more data[br]and breath profiles across the population,

9:59:59.000,9:59:59.000
including all varieties of gender,[br]age, origin and lifestyle,

9:59:59.000,9:59:59.000
the power of breath analysis[br]should increase,

9:59:59.000,9:59:59.000
and eventually breath analysis[br]should provide us with a powerful tool

9:59:59.000,9:59:59.000
not only to proactively detect[br]specific diseases

9:59:59.000,9:59:59.000
but to predict and[br]ultimately prevent them,

9:59:59.000,9:59:59.000
and this should be enough[br]motivation to embrace

9:59:59.000,9:59:59.000
the opportunities and challenges

9:59:59.000,9:59:59.000
that breath analysis can provide,

9:59:59.000,9:59:59.000
even for people that are not[br]part-time hypochondriacs like me.

9:59:59.000,9:59:59.000
Thank you.

9:59:59.000,9:59:59.000
(Applause)