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)