0:00:00.948,0:00:03.920
I have a tendency to assume the worst,

0:00:03.920,0:00:06.854
and once in a while,[br]this habit plays tricks on me.

0:00:06.854,0:00:09.988
For example, if I feel[br]unexpected pain in my body

0:00:09.988,0:00:13.340
that I have not experienced before[br]and that I cannot attribute,

0:00:13.340,0:00:18.234
then all of a sudden, my mind[br]my turn a tense back into heart disease

0:00:18.234,0:00:21.909
or calf muscle pain into ??.

0:00:21.909,0:00:25.406
But so far I haven't been diagnosed[br]with any deadly or incurable disease.

0:00:25.406,0:00:28.559
Sometimes things just hurt[br]for no clear reason.

0:00:28.559,0:00:32.180
But not everyone is as lucky as me.

0:00:32.180,0:00:36.497
Every year, more than[br]50 million people die worldwide.

0:00:36.497,0:00:40.054
Especially in high-income[br]economies like ours,

0:00:40.054,0:00:44.490
a large fraction of deaths[br]is caused by slowly progressing diseases:

0:00:44.490,0:00:49.165
heart disease, chronic lung disease,[br]cancer, Alzheimer's, diabetes,

0:00:49.165,0:00:51.510
just to name a few.

0:00:51.510,0:00:57.041
Now, humanity has made tremendous progress[br]in diagnosing and treating many of these,

0:00:57.041,0:01:00.294
but we are at stage[br]where further advancement in health

0:01:00.294,0:01:03.314
cannot be achieved only[br]by developing new treatments,

0:01:03.314,0:01:05.852
and this becomes evident[br]when we look at one aspect

0:01:05.852,0:01:09.388
that many of these[br]diseases have in common.

0:01:09.388,0:01:12.480
The probability for successful treatment

0:01:12.480,0:01:15.580
strongly depends on[br]when treatment is started,

0:01:15.580,0:01:19.654
but a disease is typically only detected[br]once symptoms occur,

0:01:19.654,0:01:24.259
and the problem here is that in fact[br]many disease can remain asymptomatic,

0:01:24.259,0:01:28.007
hence undetected,[br]for a long period of time.

0:01:28.237,0:01:34.011
Because of this, there is[br]a persisting need for new ways

0:01:34.011,0:01:37.325
of detecting disease at early stage,[br]way before any symptoms occur.

0:01:37.325,0:01:39.687
In health care, this is called screening,

0:01:39.687,0:01:42.947
and as defined by[br]the World Health Organization,

0:01:42.947,0:01:46.195
screening is the[br]presumptive identification

0:01:46.195,0:01:48.516
of unrecognized disease

0:01:48.516,0:01:51.212
in an apparently healthy person

0:01:51.212,0:01:55.724
by means of tests that can be applied[br]rapidly and easily.

0:01:55.724,0:01:58.412
That's a long definition,[br]so let me repeat it:

0:01:58.412,0:02:02.060
identification of unrecognized disease

0:02:02.060,0:02:04.614
in an apparently healthy person

0:02:04.614,0:02:09.036
by means of tests that can be applied[br]both rapidly and easily.

0:02:09.036,0:02:11.579
And I want to put special emphasis[br]on the words "rapidly" and "easily,"

0:02:11.579,0:02:14.221
because many of[br]the existing screening methods

0:02:14.221,0:02:16.399
are exactly the opposite.

0:02:16.399,0:02:19.027
And those of you who have gone colonoscopy

0:02:19.027,0:02:22.345
as part of a screening program[br]for colorectal cancer

0:02:22.345,0:02:24.504
will know what I mean.

0:02:25.442,0:02:28.519
Obviously, there's a variety[br]of medical tools available

0:02:28.519,0:02:30.534
to perform screening tests.

0:02:30.534,0:02:32.794
This ranges from imaging techniques

0:02:32.794,0:02:36.372
such as radiography[br]or magnetic resonance imaging

0:02:36.372,0:02:38.576
to the analysis of blood or tissue.

0:02:38.576,0:02:41.622
We have all had such tests.

0:02:41.622,0:02:45.884
But there's one medium[br]that for long has been overlooked,

0:02:45.884,0:02:48.650
a medium that is easily accessible,

0:02:48.650,0:02:50.766
basically non-depletable,

0:02:50.766,0:02:55.278
and it holds tremendous promise[br]for medical analysis,

0:02:55.278,0:02:58.773
and that is our breath.

0:02:58.969,0:03:02.599
Human breath is essentially[br]composed of five components:

0:03:02.599,0:03:09.598
nitrogen, oxygen,[br]carbon dioxide, water and argon,

0:03:09.598,0:03:13.060
but besides these five, there are[br]hundreds of other components

0:03:13.060,0:03:15.710
that are present in very low quantity.

0:03:15.710,0:03:18.050
These are called volatile[br]organic compounds,

0:03:18.050,0:03:20.224
and we release hundreds,[br]even thousands of them,

0:03:20.224,0:03:23.409
every time we exhale.

0:03:23.409,0:03:26.823
The analysis of these volatile[br]organic compounds in our breath

0:03:26.823,0:03:28.876
is called breath analysis.

0:03:28.876,0:03:33.461
In fact, I believe that many of you[br]have already experienced breath analysis.

0:03:33.461,0:03:37.168
Imagine, you're driving home late at night

0:03:37.168,0:03:39.990
when suddenly there's[br]a friendly police officer

0:03:39.990,0:03:42.440
who asks you kindly but firmly

0:03:42.440,0:03:46.404
to pull over and blow[br]into a device like this one.

0:03:47.759,0:03:51.057
This is an alcohol breath tester

0:03:51.057,0:03:54.773
that is used to measure[br]the ethanol concentration in your breath

0:03:54.773,0:03:58.752
and determine whether driving[br]in your condition is a clever idea.

0:03:58.752,0:04:01.680
Now I'd say my driving was pretty good,

0:04:01.680,0:04:03.191
but let me check.

0:04:03.372,0:04:05.299
(Beep)

0:04:08.655,0:04:12.043
0.0, so nothing to worry about, all fine.

0:04:14.646,0:04:17.193
Now, imagine a device like this one

0:04:17.193,0:04:20.161
that does not only measure[br]alcohol levels in your breath,

0:04:20.161,0:04:22.504
but that detects diseases

0:04:22.504,0:04:26.467
like the ones I've shown you[br]and potentially many more.

0:04:27.145,0:04:30.745
The concept of correlating[br]the smell of a person's breath

0:04:30.745,0:04:33.044
with certain medical conditions

0:04:33.044,0:04:36.148
in fact dates back to Ancient Greece,

0:04:36.148,0:04:41.110
but only recently, research efforts[br]on breath analysis have skyrocketed,

0:04:41.110,0:04:45.130
and what once was a dream[br]is now becoming reality.

0:04:45.130,0:04:48.497
And let me pull up this list again[br]that I showed you earlier.

0:04:49.257,0:04:52.762
For the majority of diseases listed here,

0:04:52.762,0:04:56.465
there's substantial scientific evidence[br]suggesting that the disease

0:04:56.465,0:05:00.174
could be detected by breath analysis.

0:05:00.174,0:05:02.336
But how does it work exactly?

0:05:02.336,0:05:05.433
The essential part is a sensor device

0:05:05.433,0:05:09.691
that detects the volatile[br]organic compounds in our breath.

0:05:09.691,0:05:12.655
Simply put, when exposed[br]to a breath sample,

0:05:12.655,0:05:15.531
the sensor outputs a complex signature

0:05:15.531,0:05:20.508
that results from the mixture of volatile[br]organic compounds that we exhale.

0:05:20.508,0:05:22.228
Now, this signature represents[br]a fingerprint of your metabolism,

0:05:22.228,0:05:25.776
your microbiome,

0:05:25.776,0:05:28.253
and the biochemical processes[br]that occur in your body.

0:05:28.253,0:05:31.926
If you have a disease,

0:05:31.926,0:05:34.292
your organisms will change,

0:05:34.292,0:05:37.867
and so will the composition[br]of your exhaled breath,

0:05:37.867,0:05:40.212
and then the only thing that is left to do

0:05:40.212,0:05:42.843
is to correlate a certain signature

0:05:42.843,0:05:46.762
with the presence or absence[br]of certain medical conditions.

0:05:47.978,0:05:52.002
The technology promises[br]several undeniable benefits.

0:05:52.002,0:05:55.177
Firstly, the sensor can be miniaturized

0:05:55.177,0:05:58.132
and integrated into small,[br]handheld devices

0:05:58.132,0:06:00.890
like this alcohol breath tester.

0:06:00.890,0:06:04.030
This would allow the test to be used[br]in many different settings

0:06:04.030,0:06:05.617
and even at home,

0:06:05.617,0:06:07.651
so that a visit at a doctor's office

0:06:07.651,0:06:11.320
is not needed each time[br]a test shall be performed.

0:06:11.320,0:06:14.692
Secondly, breath analysis is non-invasive

0:06:14.692,0:06:18.207
and can be as simple as blowing[br]into an alcohol breath tester.

0:06:19.110,0:06:23.495
Such simplicity and ease of use[br]would reduce patient burden

0:06:23.495,0:06:27.843
and provide an incentive[br]for broad adoption of the technology.

0:06:27.843,0:06:31.730
And thirdly, the technology is so flexible

0:06:31.730,0:06:35.436
that the same device could be used

0:06:35.436,0:06:38.164
to detect a broad range[br]of medical conditions.

0:06:38.164,0:06:44.088
Breath analysis could be used to screen[br]for multiple diseases at the same time.

0:06:44.406,0:06:48.760
Nowadays, each disease typically requires

0:06:48.760,0:06:49.930
a different medical tool[br]to perform a screening test,

0:06:49.930,0:06:54.058
but this means you can only find[br]what you're looking for.

0:06:54.058,0:06:57.058
With all of these features,[br]breath analysis is predestined

0:06:57.058,0:07:02.746
to deliver what many traditional[br]screening tests are lacking,

0:07:02.969,0:07:06.355
and most importantly,[br]all of these features

0:07:06.355,0:07:10.712
should eventually provide us[br]with a platform for medical analysis

0:07:10.712,0:07:16.071
that can operate at attractively[br]low cost per test.

0:07:16.071,0:07:19.284
On the contrary, existing medical tools

0:07:19.284,0:07:22.214
often lead to rather high cost per test.

0:07:22.214,0:07:24.535
Then, in order to keep costs down,

0:07:24.535,0:07:27.856
the number of tests[br]needs to be restricted,

0:07:27.856,0:07:30.714
and this means a) that the tests[br]can only be performed

0:07:30.714,0:07:35.855
on a narrow part of the population,[br]for example the high-risk population,

0:07:35.855,0:07:41.631
and b) that the number of tests per person[br]needs to be kept at a minimum.

0:07:41.857,0:07:43.828
But wouldn't it actually be beneficial

0:07:43.828,0:07:46.788
if the test was performed[br]on a larger group of people

0:07:46.788,0:07:51.934
and more often and over a longer period[br]of time for each individual?

0:07:51.934,0:07:56.025
Especially the latter would give access[br]to something very valuable

0:07:56.025,0:07:58.895
that is called longitudinal data.

0:07:58.895,0:08:03.232
Longitudinal data is a dataset[br]that tracks the same patient

0:08:03.232,0:08:07.617
over the course of many months or years.

0:08:07.617,0:08:10.316
Nowadays, medical decisions

0:08:10.316,0:08:12.682
are often based on a limited dataset

0:08:12.682,0:08:15.955
where over a glimpse[br]of a patient's medical history

0:08:15.955,0:08:18.701
is available for decision-making.

0:08:18.701,0:08:22.660
In such a case,

0:08:22.660,0:08:23.613
abnormalities are typically detected

0:08:23.613,0:08:27.812
by comparing a patient's health profile

0:08:27.812,0:08:30.774
to the average health profile[br]of a reference population.

0:08:30.774,0:08:34.571
Longitudinal data would[br]open up a new dimension

0:08:34.571,0:08:37.487
and allow abnormalities to be detected

0:08:37.487,0:08:41.105
based on a patient's own medical history.

0:08:41.105,0:08:45.068
This will pave the way[br]for personalized treatment.

0:08:45.068,0:08:47.084
Sounds pretty great, right?

0:08:47.084,0:08:49.216
Now you will certainly have a question

0:08:49.216,0:08:51.039
that is something like,

0:08:51.039,0:08:55.596
"If the technology is as great as he says,[br]then why aren't they using it today?"

0:08:55.596,0:08:57.799
And the only answer I can give you is,

0:08:57.799,0:09:01.247
not everything is as easy as it sounds.

0:09:01.247,0:09:03.456
There are technical challenges.

0:09:03.456,0:09:07.865
For example, there's the need[br]for extremely reliable sensors

0:09:07.865,0:09:11.075
that can detect mixtures[br]of volatile organic compounds

0:09:11.075,0:09:13.840
with sufficient reproducibility.

0:09:13.840,0:09:16.414
And another technical challenge is,

0:09:16.414,0:09:21.445
how do you sample a person's breath[br]in a very defined manner

0:09:21.445,0:09:23.680
so that the sampling process itself

0:09:23.680,0:09:27.440
does not alter the result of the analysis?

0:09:27.440,0:09:29.766
And there's the need for data.

0:09:29.766,0:09:33.748
Breath analysis needs[br]to be validated in clinical trials,

0:09:33.748,0:09:36.462
and enough data needs to be collected

0:09:36.462,0:09:41.516
so that individual conditions

0:09:41.516,0:09:44.504
can be measured against baselines.

0:09:44.504,0:09:46.430
Breath analysis can only succeed

0:09:46.430,0:09:47.113
if a large enough dataset can be generated

0:09:47.113,0:09:51.443
and made available for broad use.

0:09:51.443,0:09:55.047
If breath analysis[br]holds up to its promises,

0:09:55.047,0:09:57.505
this is a technology[br]that could truly aid us

0:09:57.505,0:10:00.059
to transform our health care system,

0:10:00.059,0:10:03.798
transform it from a reactive system

0:10:03.798,0:10:06.984
that treatment is triggered[br]by symptoms of disease

0:10:06.984,0:10:08.778
to a proactive system

0:10:08.778,0:10:12.373
where disease detection,[br]diagnosis and treatment

0:10:12.373,0:10:14.362
can happen at early stage,

0:10:14.362,0:10:17.901
way before any symptoms occur.

0:10:17.901,0:10:19.835
Now this brings me to my last point,[br]and it's a fundamental one.

0:10:19.835,0:10:24.631
What exactly is a disease?

0:10:24.631,0:10:28.920
Imagine that breath analysis[br]can be commercialized as I describe it

0:10:28.920,0:10:31.912
and early detection becomes routine.

0:10:32.627,0:10:34.225
A problem that remains

0:10:34.225,0:10:37.967
is in fact a problem that[br]any screening activity has to face,

0:10:37.967,0:10:39.922
because for many diseases,

0:10:39.922,0:10:43.748
it is often impossible to predict[br]with sufficient certainty

0:10:43.748,0:10:46.686
whether the disease[br]would ever cause any symptoms

0:10:46.686,0:10:49.200
or put a person's life at risk.

0:10:49.200,0:10:51.783
This is called overdiagnosis,

0:10:51.783,0:10:54.137
and it leads to a dilemma.

0:10:54.137,0:10:56.370
If a disease is identified,

0:10:56.370,0:10:58.313
you could decide not to treat it

0:10:58.313,0:11:02.943
because there's a certain probability[br]that you would never suffer from it.

0:11:02.943,0:11:04.688
But how much would you suffer

0:11:04.688,0:11:08.165
just from knowing that you have[br]a potentially deadly disease?

0:11:08.165,0:11:12.312
And wouldn't you actually regret that the[br]disease was detected in the first place?

0:11:13.604,0:11:17.403
Your second option[br]is to undergo early treatment

0:11:17.403,0:11:19.473
with the hope for curing it,

0:11:19.473,0:11:23.491
but often this would not[br]come without side effects.

0:11:24.225,0:11:27.961
To be precise,

0:11:27.961,0:11:30.941
the bigger problem is not overdiagnosis,

0:11:30.941,0:11:32.281
it's overtreatment,

0:11:32.281,0:11:35.407
because not every disease[br]has to be treated immediately

0:11:35.407,0:11:39.221
just because a treatment is available.

0:11:39.709,0:11:42.711
The increasing adoption[br]of routine screening

0:11:42.711,0:11:45.375
will raise the question:

0:11:45.375,0:11:49.407
what do we call a disease[br]that can rationalize treatment,

0:11:49.407,0:11:52.323
and what is just an abnormality[br]that should not be a source of concern?

0:11:52.323,0:11:59.600
My hopes are that routine screening[br]using breath analysis

0:11:59.600,0:12:03.056
can provide enough data and insight

0:12:03.056,0:12:07.994
so that at some point,[br]we'll be able to break this dilemma

0:12:07.994,0:12:10.895
and predict with sufficient certainty

0:12:10.895,0:12:15.216
whether and when to treat at early stage.

0:12:15.216,0:12:18.913
Our breath, and the mixture[br]of volatile organic compounds

0:12:18.913,0:12:20.143
that we exhale,

0:12:20.143,0:12:25.495
hold tremendous amounts of information[br]on our physiological condition.

0:12:25.655,0:12:30.203
With what we know today,[br]we have only scratched the surface.

0:12:30.203,0:12:34.523
As we collect more and more data[br]and breath profiles across the population,

0:12:34.523,0:12:39.111
including all varieties of gender,[br]age, origin and lifestyle,

0:12:39.111,0:12:42.407
the power of breath analysis[br]should increase,

0:12:42.407,0:12:48.023
and eventually breath analysis[br]should provide us with a powerful tool

0:12:48.023,0:12:52.449
not only to proactively detect[br]specific diseases

0:12:52.449,0:12:57.392
but to predict and[br]ultimately prevent them,

0:12:57.392,0:13:00.826
and this should be enough[br]motivation to embrace

0:13:00.826,0:13:03.992
the opportunities and challenges

0:13:03.992,0:13:06.654
that breath analysis can provide,

0:13:06.654,0:13:10.391
even for people that are not[br]part-time hypochondriacs like me.

0:13:10.391,0:13:12.740
Thank you.

0:13:12.740,0:13:16.757
(Applause)