WEBVTT 00:00:00.738 --> 00:00:02.952 I have a tendency to assume the worst, 00:00:03.757 --> 00:00:06.620 and once in a while, this habit plays tricks on me. 00:00:06.644 --> 00:00:09.925 For example, if I feel unexpected pain in my body 00:00:09.949 --> 00:00:13.456 that I have not experienced before and that I cannot attribute, 00:00:13.480 --> 00:00:18.000 then all of a sudden, my mind might turn a tense back into heart disease 00:00:18.024 --> 00:00:20.920 or calf muscle pain into deep vein thrombosis. 00:00:21.699 --> 00:00:25.217 But so far, I haven't been diagnosed with any deadly or incurable disease. 00:00:25.241 --> 00:00:27.653 Sometimes things just hurt for no clear reason. NOTE Paragraph 00:00:29.098 --> 00:00:31.318 But not everyone is as lucky as me. 00:00:31.970 --> 00:00:35.215 Every year, more than 50 million people die worldwide. 00:00:36.287 --> 00:00:39.820 Especially in high-income economies like ours, 00:00:39.844 --> 00:00:44.599 a large fraction of deaths is caused by slowly progressing diseases: 00:00:44.623 --> 00:00:48.931 heart disease, chronic lung disease, cancer, Alzheimer's, diabetes, 00:00:48.955 --> 00:00:50.325 just to name a few. NOTE Paragraph 00:00:51.300 --> 00:00:55.804 Now, humanity has made tremendous progress in diagnosing and treating many of these. 00:00:56.859 --> 00:01:00.060 But we are at a stage where further advancement in health 00:01:00.084 --> 00:01:03.374 cannot be achieved only by developing new treatments. 00:01:03.398 --> 00:01:05.798 And this becomes evident when we look at one aspect 00:01:05.822 --> 00:01:08.188 that many of these diseases have in common: 00:01:09.418 --> 00:01:12.246 the probability for successful treatment 00:01:12.270 --> 00:01:14.912 strongly depends on when treatment is started. 00:01:15.370 --> 00:01:18.814 But a disease is typically only detected once symptoms occur. 00:01:19.632 --> 00:01:24.025 The problem here is that, in fact, many diseases can remain asymptomatic, 00:01:24.049 --> 00:01:26.902 hence undetected, for a long period of time. 00:01:27.902 --> 00:01:31.803 Because of this, there is a persisting need for new ways 00:01:31.827 --> 00:01:33.775 of detecting disease at early stage, 00:01:33.799 --> 00:01:35.937 way before any symptoms occur. 00:01:37.135 --> 00:01:39.411 In health care, this is called screening. NOTE Paragraph 00:01:39.435 --> 00:01:42.600 And as defined by the World Health Organization, 00:01:42.624 --> 00:01:48.282 screening is "the presumptive identification of unrecognized disease 00:01:48.306 --> 00:01:50.867 in an apparently healthy person, 00:01:50.891 --> 00:01:54.680 by means of tests ... that can be applied rapidly and easily ..." 00:01:55.429 --> 00:01:57.618 That's a long definition, so let me repeat it: 00:01:58.237 --> 00:02:01.722 identification of unrecognized disease 00:02:01.746 --> 00:02:04.230 in an apparently healthy person 00:02:04.254 --> 00:02:08.268 by means of tests that can be applied both rapidly and easily. 00:02:08.292 --> 00:02:11.671 And I want to put special emphasis on the words "rapidly" and "easily" 00:02:11.695 --> 00:02:13.945 because many of the existing screening methods 00:02:13.969 --> 00:02:15.628 are exactly the opposite. 00:02:16.189 --> 00:02:18.888 And those of you who have undergone colonoscopy 00:02:18.912 --> 00:02:22.111 as part of a screening program for colorectal cancer 00:02:22.135 --> 00:02:23.482 will know what I mean. NOTE Paragraph 00:02:25.209 --> 00:02:28.285 Obviously, there's a variety of medical tools available 00:02:28.309 --> 00:02:29.838 to perform screening tests. 00:02:30.298 --> 00:02:33.984 This ranges from imaging techniques such as radiography 00:02:34.008 --> 00:02:36.138 or magnetic resonance imaging 00:02:36.162 --> 00:02:38.166 to the analysis of blood or tissue. 00:02:38.190 --> 00:02:40.106 We have all had such tests. 00:02:41.344 --> 00:02:44.917 But there's one medium that for long has been overlooked: 00:02:45.674 --> 00:02:48.416 a medium that is easily accessible, 00:02:48.440 --> 00:02:50.461 basically nondepletable, 00:02:50.485 --> 00:02:53.732 and it holds tremendous promise for medical analysis. 00:02:54.994 --> 00:02:56.522 And that is our breath. NOTE Paragraph 00:02:58.514 --> 00:03:01.895 Human breath is essentially composed of five components: 00:03:02.649 --> 00:03:09.325 nitrogen, oxygen, carbon dioxide, water and argon. 00:03:09.349 --> 00:03:12.748 But besides these five, there are hundreds of other components 00:03:12.772 --> 00:03:15.155 that are present in very low quantity. 00:03:15.179 --> 00:03:17.732 These are called volatile organic compounds, 00:03:17.756 --> 00:03:20.089 and we release hundreds, even thousands of them 00:03:20.113 --> 00:03:21.872 every time we exhale. 00:03:23.110 --> 00:03:26.479 The analysis of these volatile organic compounds in our breath 00:03:26.503 --> 00:03:28.204 is called breath analysis. 00:03:29.545 --> 00:03:33.309 In fact, I believe that many of you have already experienced breath analysis. 00:03:33.333 --> 00:03:36.934 Imagine: you're driving home late at night, 00:03:36.958 --> 00:03:39.656 when suddenly, there's a friendly police officer 00:03:39.680 --> 00:03:42.472 who asks you kindly but firmly 00:03:42.496 --> 00:03:45.899 to pull over and blow into a device like this one. 00:03:47.486 --> 00:03:50.709 This is an alcohol breath tester 00:03:50.733 --> 00:03:54.440 that is used to measure the ethanol concentration in your breath 00:03:54.464 --> 00:03:57.821 and determine whether driving in your condition is a clever idea. 00:03:58.509 --> 00:04:00.456 Now, I'd say my driving was pretty good, 00:04:00.480 --> 00:04:01.700 but let me check. NOTE Paragraph 00:04:02.788 --> 00:04:04.715 (Beep) NOTE Paragraph 00:04:08.445 --> 00:04:11.405 0.0, so nothing to worry about, all fine. NOTE Paragraph 00:04:11.429 --> 00:04:12.696 (Laughter) NOTE Paragraph 00:04:14.298 --> 00:04:16.959 Now imagine a device like this one, 00:04:16.983 --> 00:04:19.927 that does not only measure alcohol levels in your breath, 00:04:19.951 --> 00:04:23.767 but that detects diseases like the ones I've shown you 00:04:23.791 --> 00:04:25.507 and potentially many more. 00:04:26.868 --> 00:04:30.666 The concept of correlating the smell of a person's breath 00:04:30.690 --> 00:04:32.810 with certain medical conditions, 00:04:32.834 --> 00:04:35.254 in fact, dates back to Ancient Greece. 00:04:35.905 --> 00:04:40.876 But only recently, research efforts on breath analysis have skyrocketed, 00:04:40.900 --> 00:04:44.307 and what once was a dream is now becoming reality. 00:04:45.307 --> 00:04:48.321 And let me pull up this list again that I showed you earlier. 00:04:49.047 --> 00:04:51.813 For the majority of diseases listed here, 00:04:52.495 --> 00:04:54.688 there's substantial scientific evidence 00:04:54.712 --> 00:04:58.369 suggesting that the disease could be detected by breath analysis. NOTE Paragraph 00:04:59.917 --> 00:05:01.612 But how does it work, exactly? 00:05:02.421 --> 00:05:05.199 The essential part is a sensor device 00:05:05.223 --> 00:05:08.435 that detects the volatile organic compounds in our breath. 00:05:09.364 --> 00:05:12.294 Simply put: when exposed to a breath sample, 00:05:12.318 --> 00:05:15.002 the sensor outputs a complex signature 00:05:15.026 --> 00:05:19.006 that results from the mixture of volatile organic compounds that we exhale. 00:05:20.141 --> 00:05:24.457 Now, this signature represents a fingerprint of your metabolism, 00:05:24.481 --> 00:05:25.646 your microbiome 00:05:25.670 --> 00:05:29.273 and the biochemical processes that occur in your body. 00:05:29.980 --> 00:05:31.573 If you have a disease, 00:05:31.597 --> 00:05:33.884 your organism will change, 00:05:33.908 --> 00:05:36.868 and so will the composition of your exhaled breath. 00:05:37.479 --> 00:05:42.609 And then the only thing that is left to do is to correlate a certain signature 00:05:42.633 --> 00:05:45.739 with the presence or absence of certain medical conditions. NOTE Paragraph 00:05:47.921 --> 00:05:51.156 The technology promises several undeniable benefits. 00:05:51.719 --> 00:05:54.816 Firstly, the sensor can be miniaturized 00:05:54.840 --> 00:05:57.686 and integrated into small, handheld devices 00:05:57.710 --> 00:05:59.548 like this alcohol breath tester. 00:06:00.437 --> 00:06:03.450 This would allow the test to be used in many different settings 00:06:03.474 --> 00:06:05.248 and even at home, 00:06:05.272 --> 00:06:07.266 so that a visit at the doctor's office 00:06:07.290 --> 00:06:10.049 is not needed each time a test shall be performed. NOTE Paragraph 00:06:10.946 --> 00:06:14.326 Secondly, breath analysis is noninvasive 00:06:14.350 --> 00:06:17.997 and can be as simple as blowing into an alcohol breath tester. 00:06:18.900 --> 00:06:23.894 Such simplicity and ease of use would reduce patient burden 00:06:23.918 --> 00:06:27.361 and provide an incentive for broad adoption of the technology. NOTE Paragraph 00:06:27.973 --> 00:06:32.081 And thirdly, the technology is so flexible 00:06:32.105 --> 00:06:34.345 that the same device could be used 00:06:34.369 --> 00:06:37.509 to detect a broad range of medical conditions. 00:06:38.224 --> 00:06:42.909 Breath analysis could be used to screen for multiple diseases at the same time. 00:06:44.195 --> 00:06:47.526 Nowadays, each disease typically requires a different medical tool 00:06:47.550 --> 00:06:49.006 to perform a screening test. 00:06:49.561 --> 00:06:52.645 But this means you can only find what you're looking for. NOTE Paragraph 00:06:54.637 --> 00:06:58.496 With all of these features, breath analysis is predestined 00:06:58.520 --> 00:07:01.584 to deliver what many traditional screening tests are lacking. 00:07:02.671 --> 00:07:04.310 And most importantly, 00:07:04.334 --> 00:07:07.684 all of these features should eventually provide us 00:07:07.708 --> 00:07:10.214 with a platform for medical analysis 00:07:10.238 --> 00:07:13.943 that can operate at attractively low cost per test. 00:07:15.713 --> 00:07:18.963 On the contrary, existing medical tools 00:07:18.987 --> 00:07:21.373 often lead to rather high cost per test. 00:07:21.920 --> 00:07:24.198 Then, in order to keep costs down, 00:07:24.222 --> 00:07:26.832 the number of tests needs to be restricted, 00:07:27.562 --> 00:07:30.803 and this means (a) that the tests can only be performed 00:07:30.827 --> 00:07:35.511 on a narrow part of the population, for example, the high-risk population; 00:07:35.535 --> 00:07:40.690 and (b) that the number of tests per person needs to be kept at a minimum. 00:07:41.459 --> 00:07:43.303 But wouldn't it actually be beneficial 00:07:43.327 --> 00:07:46.287 if the test was performed on a larger group of people, 00:07:46.311 --> 00:07:50.559 and more often and over a longer period of time for each individual? 00:07:51.845 --> 00:07:55.706 Especially the latter would give access to something very valuable 00:07:55.730 --> 00:07:57.997 that is called longitudinal data. NOTE Paragraph 00:07:58.950 --> 00:08:03.052 Longitudinal data is a data set that tracks the same patient 00:08:03.076 --> 00:08:05.572 over the course of many months or years. 00:08:07.318 --> 00:08:12.368 Nowadays, medical decisions are often based on a limited data set, 00:08:12.392 --> 00:08:15.584 where only a glimpse of a patient's medical history 00:08:15.608 --> 00:08:17.662 is available for decision-making. 00:08:18.210 --> 00:08:20.509 In such a case, 00:08:20.533 --> 00:08:23.326 abnormalities are typically detected 00:08:23.350 --> 00:08:25.916 by comparing a patient's health profile 00:08:25.940 --> 00:08:29.212 to the average health profile of a reference population. 00:08:30.419 --> 00:08:34.337 Longitudinal data would open up a new dimension 00:08:34.361 --> 00:08:37.229 and allow abnormalities to be detected 00:08:37.253 --> 00:08:39.950 based on a patient's own medical history. 00:08:40.862 --> 00:08:43.685 This will pave the way for personalized treatment. NOTE Paragraph 00:08:44.741 --> 00:08:46.305 Sounds pretty great, right? 00:08:47.194 --> 00:08:50.169 Now you will certainly have a question that is something like, 00:08:50.193 --> 00:08:54.988 "If the technology is as great as he says, then why aren't we using it today?" 00:08:55.012 --> 00:08:57.490 And the only answer I can give you is: 00:08:57.514 --> 00:09:00.094 not everything is as easy as it sounds. 00:09:00.983 --> 00:09:04.470 There are technical challenges, for example. 00:09:04.494 --> 00:09:07.508 There's the need for extremely reliable sensors 00:09:07.532 --> 00:09:10.800 that can detect mixtures of volatile organic compounds 00:09:10.824 --> 00:09:12.917 with sufficient reproducibility. 00:09:13.629 --> 00:09:16.064 And another technical challenge is this: 00:09:16.088 --> 00:09:21.074 How do you sample a person's breath in a very defined manner 00:09:21.098 --> 00:09:23.446 so that the sampling process itself 00:09:23.470 --> 00:09:26.123 does not alter the result of the analysis? 00:09:27.187 --> 00:09:28.975 And there's the need for data. 00:09:29.556 --> 00:09:33.514 Breath analysis needs to be validated in clinical trials, 00:09:33.538 --> 00:09:36.030 and enough data needs to be collected 00:09:36.054 --> 00:09:40.296 so that individual conditions can be measured against baselines. 00:09:41.167 --> 00:09:43.640 Breath analysis can only succeed 00:09:43.664 --> 00:09:46.437 if a large enough data set can be generated 00:09:46.461 --> 00:09:48.811 and made available for broad use. NOTE Paragraph 00:09:51.050 --> 00:09:53.880 If breath analysis holds up to its promises, 00:09:54.745 --> 00:09:57.271 this is a technology that could truly aid us 00:09:57.295 --> 00:09:59.538 to transform our health care system -- 00:10:00.410 --> 00:10:03.564 transform it from a reactive system 00:10:03.588 --> 00:10:06.750 where treatment is triggered by symptoms of disease 00:10:06.774 --> 00:10:08.789 to a proactive system, 00:10:08.813 --> 00:10:12.027 where disease detection, diagnosis and treatment 00:10:12.051 --> 00:10:13.935 can happen at early stage, 00:10:13.959 --> 00:10:16.058 way before any symptoms occur. NOTE Paragraph 00:10:17.590 --> 00:10:20.976 Now this brings me to my last point, and it's a fundamental one. 00:10:21.537 --> 00:10:23.526 What exactly is a disease? 00:10:24.590 --> 00:10:28.625 Imagine that breath analysis can be commercialized as I describe it, 00:10:28.649 --> 00:10:31.255 and early detection becomes routine. 00:10:32.417 --> 00:10:34.721 A problem that remains is, in fact, a problem 00:10:34.745 --> 00:10:37.733 that any screening activity has to face 00:10:37.757 --> 00:10:39.578 because, for many diseases, 00:10:39.602 --> 00:10:43.426 it is often impossible to predict with sufficient certainty 00:10:43.450 --> 00:10:45.992 whether the disease would ever cause any symptoms 00:10:46.016 --> 00:10:48.138 or put a person's life at risk. 00:10:48.990 --> 00:10:51.549 This is called overdiagnosis, 00:10:51.573 --> 00:10:53.211 and it leads to a dilemma. 00:10:53.927 --> 00:10:56.011 If a disease is identified, 00:10:56.035 --> 00:10:58.079 you could decide not to treat it 00:10:58.103 --> 00:11:02.074 because there's a certain probability that you would never suffer from it. 00:11:02.955 --> 00:11:04.454 But how much would you suffer 00:11:04.478 --> 00:11:07.865 just from knowing that you have a potentially deadly disease? 00:11:07.889 --> 00:11:10.813 And wouldn't you actually regret that the disease was detected 00:11:10.823 --> 00:11:12.080 in the first place? NOTE Paragraph 00:11:13.281 --> 00:11:17.169 Your second option is to undergo early treatment 00:11:17.193 --> 00:11:18.843 with the hope for curing it. 00:11:19.485 --> 00:11:22.314 But often, this would not come without side effects. NOTE Paragraph 00:11:25.623 --> 00:11:27.727 To be precise: 00:11:27.751 --> 00:11:30.325 the bigger problem is not overdiagnosis, 00:11:30.349 --> 00:11:31.802 it's overtreatment, 00:11:31.826 --> 00:11:34.841 because not every disease has to be treated immediately 00:11:34.865 --> 00:11:36.925 just because a treatment is available. 00:11:39.441 --> 00:11:42.139 The increasing adoption of routine screening 00:11:42.163 --> 00:11:43.912 will raise the question: 00:11:45.082 --> 00:11:49.173 What do we call a disease that can rationalize treatment, 00:11:49.197 --> 00:11:53.785 and what is just an abnormality that should not be a source of concern? 00:11:55.404 --> 00:12:00.336 My hopes are that routine screening using breath analysis 00:12:00.360 --> 00:12:03.120 can provide enough data and insight 00:12:03.144 --> 00:12:07.690 so that at some point, we'll be able to break this dilemma 00:12:07.714 --> 00:12:10.144 and predict with sufficient certainty 00:12:10.168 --> 00:12:12.858 whether and when to treat at early stage. NOTE Paragraph 00:12:14.794 --> 00:12:19.513 Our breath and the mixture of volatile organic compounds that we exhale 00:12:19.537 --> 00:12:24.207 hold tremendous amounts of information on our physiological condition. 00:12:25.262 --> 00:12:28.602 With what we know today, we have only scratched the surface. 00:12:29.993 --> 00:12:34.234 As we collect more and more data and breath profiles across the population, 00:12:34.258 --> 00:12:38.790 including all varieties of gender, age, origin and lifestyle, 00:12:38.814 --> 00:12:41.147 the power of breath analysis should increase. 00:12:42.147 --> 00:12:47.725 And eventually, breath analysis should provide us with a powerful tool 00:12:47.749 --> 00:12:52.215 not only to proactively detect specific diseases 00:12:52.239 --> 00:12:55.888 but to predict and ultimately prevent them. 00:12:57.110 --> 00:12:59.728 And this should be enough motivation 00:12:59.752 --> 00:13:03.935 to embrace the opportunities and challenges 00:13:03.959 --> 00:13:06.420 that breath analysis can provide, 00:13:06.444 --> 00:13:09.846 even for people that are not part-time hypochondriacs like me. NOTE Paragraph 00:13:10.532 --> 00:13:11.689 Thank you. NOTE Paragraph 00:13:11.713 --> 00:13:15.730 (Applause)