Future Med Report Wrap-Up: Shiv Gaglani MD of Medgadget.com Reports
(ED NOTE: Thanks to Dan Kraft MD, Shiv Gaglani MD,, and Robin Farmanfarmaian et al. for the reporting and the conference)
FutureMed Day 1: ‘FutureMed’ Is Out, ‘Exponential Medicine’ Is In
by SHIV GAGLANI on Nov 4, 2013 • 11:07 am
We’re at FutureMed for the second time in 2013 and admittedly are feeling a touch of déjà vu. However, as Executive Director Dr. Daniel Kraft promised us a few weeks ago, there are enough changes to keep things fresh. This version – taking place at San Diego’s historic Hotel Del Coronado – is (exponentially) bigger and grander, and a welcome upgrade from the NASA Ames facility that is home to Singularity University.
The day began with one of Kraft’s characteristically rapid-fire and exciting overviews of the technologies that are changing medicine, ranging from 3D tissue printing to Google Glass applications in health care. Given that nine months have passed, there were a number of new examples including a sensor-laden diaper that sends Tweets to an augmented-reality car windshield that doubles as your behavioral health advisor by telling you to “turn right to the gym, instead of left to McDonald’s.”
Daniel Kraft was followed by Singularity University and X-Prize co-founder, Dr. Peter Diamandis, who gave an overview of SU’s various programs as well as the concept of exponential thinking. He repeated the “local and linear” and 6-Ds concept as well as the Kodak example that we heard at FutureMed earlier this year. Interestingly, he announced a rebranding of FutureMed and SU conferences as “Exponential Conferences”. Thus, FutureMed will be “Exponential Medicine” and they will also be launching two other conferences: “Exponential Finance” and “Exponential Manufacturing.”
At the end he took a few questions, and mentioned that a future X-Prize will be on the topic of learning. Specifically, the challenge will be to develop a software program that can help any child become both literate and familiar with coding.
Next up was Salim Ismail, the Global Ambassador and Founding Executive Director of Singularity University, who gave a talk about the increasing digitization of industries and subsequent disruption that follows. After Ismail was artificial intelligence expert, Dr. Neil Jacobstein, who expanded upon his talk from February with additional examples of how AI is impacting health care.
Jacobstein was followed by CEO of Singularity University Robert Nail, who made his career by founding a company that created automation equipment and robotics for cancer research and drug discovery. As with the other speakers he went through a series of examples of new robotic platforms that can directly or indirectly affect health care.
After a quick break, the session on exponential technologies resumed with a talk about 3D printing by Avi Reichental, CEO of 3D Systems. He began by discussing applications for aerospace and automotive engineering, and then transitioned into health care, providing the example of Invisalign which shipped 17.2 million custom 3D-printed dental braces last year. Reichental argued that the question is not if 3D printing will be incorporated in the home, but rather in which room people will first put 3D printers in.
The next speaker was Raymond McCauley, PhD, who gave another great presentation on the future of genomics, including the DIY bio movement. Before launching into the last session of the day, we were treated with an early evening performance from Irish singer, songwriter Eoin Harrington. A frequent participant of TED and TEDx events, Eoin ended his two-song set with a charge to the FutureMed attendees to participate in the FutureMed Crowd Sourced Song. Before the conference ends, we can expect Eoin back onstage to perform a song based on our creative input.
The following presentation was by Scanadu’s founder Walter de Brouwer, who promised they would be shipping the Scout, a device often compared to Star Trek’s medical tricorder, in March 2014 and offered a series of predictions for the next two decades, such as:
- 2018 – The tricorder replaces the thermometer
- 2021 – Underwearables, meaning wearable tricorders, become implantables, digestibles, subdermals, injectables, and even tattooables
- 2024 – “The 4th Screen” is the human body, meaning that devices read us, music listens to us, movies watch us, and walls spy on us (for a fee)
- 2028 – The medical reverse Turing test is won
Dr. Eric Topol closed out the evening with his talk on the Creative Destruction of Medicine. In addition to making familiar points about smartphone-based medical devices and nanotechnology sensors within the body, he spent much of his talk on individualized genomic medicine “from pre-womb to tomb.” He posed the question of why couples don’t use the existing relatively inexpensive tests, e.g. GenePeeks and 23andMe, to plan ahead to see if they are carriers for recessive disorders. At the fetal stage, there are at least four companies that can do prenatal genomic testing which are highly accurate and can replace amniocentesis. Next, once the baby is born its DNA can be fully sequenced, which can help identify disorders like phenylketonuria much earlier than existing procedures are able to. He then delved into specific use cases, such as identifying mystery disorders with patient and family sequencing, infectious disease diagnosis, and cancer sequencing.
That wrapped up the first day of FutureMed sessions, and we’re looking forward to much more to come tomorrow!
FutureMed Day 2: Empowered Patients and Data-Driven Health Care
by SHIV GAGLANI on Nov 5, 2013 • 5:49 pm
The first full day at FutureMed began with a talk by famed futurist and Singularity University founder Ray Kurzweil. He video conferenced in from Boston to give his talk on creating a mind and repeated some of his insights into how the neocortex works, with multiple levels of pattern recognizers.
Daniel Kraft then returned to introduce the Chief Medical Information Officer at Kaiser Permanent, Dr. John Mattison, but preceded that with a retrospectively-hilarious Kaiser advertisement about the “Hospital of the Future” from the 1950s. While some of the innovations described in the video continue to be ideals, like integrated and coordinated healthcare teams, others such as allowing people to smoke “in comfort” while in the waiting room have clearly fallen out of fashion. Mattison then characteristically began his talk with a series of questions to understand the audience, after which he launched into a presentation filled with insights and predictions ranging from democratized health to the quantified self movement.
He was then followed by Stanford physician Christopher Longhurst, who gave a similar-though-updated presentation on his work on making electronic medical record systems more intelligent. He ended with the question:
How do we ensure that the healthcare system learns from every patient, at every visit, every time? That’s how we move from evidence-based medicine to practice-based evidence.
Following Longhurst was Dr. Tracy Gaudet, the Director of Patient Centered Care and Clinical Transformation at the VA. Her talk, “A pivotal transformation for health care,” discussed why we need to be more proactive and patient-centered as opposed to reactive and disease-centric.
She made the interesting observation that the first step of a patient encounter is to elicit the chief complaint – meaning that we expect to only see patients when something is wrong, as opposed to trying to be more proactive.
After a short break we resumed with session four on big data and artificial intelligence in health care. Tim O’Reilly raised a number of points about the future of medical innovation, such as exploring the possibilities of human-machine symbiosis (creating systems such as Google search that work better when more people use them), designing natural and seamless human-computer interfaces, and rethinking health care workflow and experience as companies like Uber have done by designing on-demand systems.
Next up was Dr. Marty Kohn, the Chief Medical Scientist at IBM Research, who expanded on hisFebruary talk about big data in health care by using the Watson computer as a case study. Last up was the Director of Stratefix, Ari Caroline, who made the argument that we need to transition from “data miners” to “lamplighters” – that is, people who are capable of finding the patterns in the data to answer the questions that will actually turn data into value.
Following lunch the delegates divided into separate rooms for workshops on topics such as the “Future of Healthcare-IT,” “3D Printing,” and “Biotechnology and DIY Bio.” These were great opportunities to do a deep dive on topics that were of particular interest, as well as to meet like-minded delegates in a smaller setting.
Session five began with an energetic talk by FutureMed producer Robin Farmanfarmaian, who gave a personal anecdote of her teenage years suffering from an autoimmune condition and not feeling like an empowered patient. She encouraged patients to be the “CEOs of their own health care teams” and ended with a few questions to be ruminated on:
- Will data-enabled patients stress or un-stress health care providers?
- What can be done to streamline the approval process so life-saving innovations actually make it to market?
- If you’re the CEO of your own health care team, how are you going to change your behavior today?
The next speaker was UCSD Professor Larry Smarr, “The Most Measured Man in the World,” who gave a brief overview andupdate on his impressive quantified self efforts. He began session six, which was focused on mobile, connected health & body computing and featured short talks and demos from CellScope, Sotera, Google Glass-based companies, and the Smartphone Physical. We were particularly intrigued by the presentations from Qualcomm’s VP Don Jones (as readers likely know, Qualcomm has been making large investments in health technologies) as well as the talk on the future of imaging.
Session seven on personalized medicine featured perhaps the most diverse set of speakers: an author and quantified self-advocate, David Ewing Duncan; a Harvard geneticist leading the Personal Genome Project, George Church; and an angel investor, Esther Dyson. Dyson, who is known for her activity in the health care space, focused her talk on a low-tech and community-building initiative which she started called the Health Intervention Coordinating Council, or HICCup. She describes it as a “self-appointed counseling service aimed at persuading local institutions to embrace a long-term perspective and launch a full-scale intervention in their communities.”
The last speaker of the day was UCSF physician and preventive medicine expert, Dr. Dean Ornish. This author first met Ornish at the February FutureMed and reflected on the apparent mismatch between the cutting edge, high-tech conference and the decidedly low-tech, lifestyle-oriented Ornish. The doctor gave a refreshing speech on the importance of focusing on preventative and integrative health, and while he lauded the conference’s role in promoting cutting-edge technologies he advised that we pause to ensure we aren’t missing the low-hanging fruit.
It was an excellent second day at FutureMed. Stay tuned for updates on the various start-ups and exhibitors at the conference as well
Editor’s note: Reporting contributed by Michael Batista, Ph.D. Candidate at Johns Hopkins University
FutureMed Day 3: From Google’s Science Fair Winner to Microsoft’s Top MD
by SHIV GAGLANI on Nov 6, 2013
Next up was Stanford’s Dr. Peter Fitzgerald who echoed his remarks from earlier this year by speaking optimistically about the “trillion dollar disruption” of health care. Next, we were treated to an engaging talk by University of Washington’s Dr. Richard Satava, a surgeon who helped develop the first surgical robot and virtual reality surgical simulators. The last talk was by Medgadget editor and co-founder of Omada Health, Sean Duffy, who gave an update on his rapidly growing preventative health tech company.
Session nine on the Future of Pharma featured two talks, one by the co-founder and president of Medidata Solutions, Glen de Vries, and the second by high school student and winner of the 2013 Google Science Fair, Eric Chen.
de Vries, who led a thoughtful workshop on patient engagement later in the day, presented an interesting yet simple equation for what he views as the future of pharma. Drugs provide a baseline therapeutic value (x), though we will increasingly need to add engaged therapeutic value (y), which can be delivered through effective lifestyle change. Thus the future of pharma is x + y.
Next up was seventeen-year Eric Chen who was missing school to present at FutureMed. He spoke about his research on identifying novel endonuclease inhibitor targets for treating influenza. His approach narrowed down 1-2 million potential targets to 237 candidates, six of which were without toxicity and may be productively explored as therapeutics.
His was the only talk we saw to receive a standing ovation, showing FutureMed’s support of future scientists.
The next session on the Future of Global Health also featured only two speakers: the recent CMO of GE’s Healthymagination, Dr. Lisa Kennedy, and the founding CEO of InSTEDD, Dr. Eric Rasmussen, who gave a great talk at FutureMed earlier this year. Kennedy’s talk focused on the future of affordability in global health care. She delved into the issues surrounding our distorted health care system, where costs are not transparent and patients are not engaged. Rasmussen’s talk turned our focus to the challenges of healthcare beyond the US with anecdotes from the Russian heat wave to the challenges of clean drinking water in India to the compound crises in Tajikistan.
Session eleven was on NeuroMedTech and began with a talk by Dr.Ajay Verma, the VP of translational neurology at Biogen Idec. He gave a fantastic overview of the tools we are using to measure the brain, ranging from MRI to EEG to SPECT, followed by the tools to manipulate the brain, such as optogenetics. He then spoke about some of the key challenges in neuroscience and how they are currently being addressed. First, he described the Holy Grail of neuroscience as the complete wiring diagram of the brain, which is being tackled by the Human Connectome Project. A second challenge he mentioned, described as the “Greatest Calamity Our Species Has Faced,” is the rise of neurodegenerative diseases. An interesting class of clinical trials to address this is known as RTM, or Reverse Translational Medicine, in which drugs are developed from the biologics of healthy elderly people who have, for example, antibodies to amyloid, among other molecules.
Next up was Ariel Garten, the founder and CEO of Interaxon which produces a consumer-focused EEG headband called Muse. She demonstrated the product on-stage and opened the minds (pun intended) of the attendees to the consumerization of neuro-technologies like hers.
There are a number of such headbands, ranging from Emotiv to Neurosky to Zeo to Melon to Interaxon, and their potential for medical and consumer use is only now starting to be realized.
The second-to-last session of the day began with Dan Kraft, who gave a talk on regenerative medicine and stem cells. As always he gave a great, fast-paced overview of these fields and touched upon everything from organ printing to cancer stem cells. He cut through the hype and made sure to present evidence supporting the promise of stem cell therapies for blood disorders, heart failure, and even tracheal transplants.
Following Dr. Kraft was Dr. Robert Hariri, the CEO of Celgene Cellular Therapeutics, who delved into the next frontier and a new opportunity for biotechnology: stem cells. After a review of the basic science of stem cells, he focused on how Celgene transforms stem cells into a commercially successful, clinical deliverable. Celgene focuses on the application of placental stem cells applied to a range of systemic and local injectable programs to treat autoimmune diseases such as Crohn’s, multiple sclerosis, and rheumatoid arthritis, as well as stroke.
The last session was on the Future of Clinical Practice. First up was Dr. Dan Riskin, the CEO of Health Fidelity which aims to apply machine learning to health care. He gave an interesting animated presentation describing his path into bioinformatics and a vision for how Big Data can be applied to the clinical workflow.
For example, he predicted the end of randomized controlled trials in the coming decades since they are too expensive and don’t reflect uncommon conditions.
The final speaker was Dr. Bill Crounse, the senior director for Microsoft World Wide Health, who gave an engaging talk that began with his personal anecdotes starting a telemedicine company pre-2000 and being two decades too early. He believes the timing is right now and gave a few examples including Kinect for telemonitoring and Mobisante’s smartphone-ultrasound (which has its roots in Microsoft). His final point was “Don’t be afraid of the alligators,” meaning, don’t let fear of the unknown stop you from trying to accomplish something, especially in health care.
Another day, another series of thoughtful talks at FutureMed!
Editor’s note: Reporting contributed by Michael Batista, Ph.D. Candidate at Johns Hopkins University
FutureMed Day 4: The End of the Beginning
by MICHAEL BATISTA on Nov 8, 2013
The culmination of FutureMed began with a thought-provoking session on “re-inventions and reframings.” The first speaker of the day was Lucien Engelen, Director of the Radbound Reshape & Innovation Center and Curator of multiple TEDx events. His discussion reiterated a consistent theme of the week: improving patient engagement. Englen prompted us to imagine an ecosystem where all medical devices and health data are centralized into one system incorporating both patient and clinician-facing components.
Next up was Dr. Jack Kreindler, Founder and CMO of Jointly Health and self-styled “Imperial Physician.” Kreindler’s highly animated presentation included a clip from the main Star Wars theme song, a convincing argument that Darth Vader was a paragon of exponential medicine, and a reenactment of how Kreindler learned to shoot lightning from his hands like a Sith lord from none other than “Emperor Palpatine” himself, Ian McDiarmid. Entertaining antics aside, Kreindler elaborated on the value of high speed data for applications including remote patient monitoring and analytics to proactively detect deteriorating health states before they being to detract from quality of life. The energetic talk concluded by touching on how Jointly Health, in collaboration with Qualcomm Life, harnesses big data and analytics to make “information actionable.”
The final speaker of the session was geo-medicine expert Bill Davenhall, Senior Health Adviser at Esri. According to Davenhall, information on where patients have previously and currently live is just as important as standard health metrics to include in patient health records. Factors such as toxic runoff, mercury concentration, and ozone levels all exhibit geographic variability and are important for doctor consideration during diagnosis and treatment selection. Davenhall presented data showing that geographic location can even affect the prescription a patient can expect to receive for a given medical condition. Moving towards increased patient awareness of geographic health factors, Esri’s own My Place History iOS and PC app allows patients to upload the last twenty places they lived within the US. The app compares the patient’s geographic history to publicly available government databases, including the Toxic Release Inventory of the US EPA, to create a “personal place history.”
Following a quick break, session fifteen began with Glen Tullman, Managing Partner of 7wire Ventures and co-founder of Zest Health. Tullman motivated the session by discussing the progression of health information systems that have ultimately given rise to our current model of electronic health records (EHRs). A key takeaway was the necessity and value of pivots. Tullman elaborated using his experience as former CEO of Allscripts Healthcare Solutions, describing how Allscripts is evolving from a data aggregator to a tool that can suggest alternatives for treatment and management and provide real-time, integrated information. Recent pivots toward this goal include Allcripts’ collaboration with Humedica to focus on analytics, and acquisitions of dbMotion and JarDogsto improve engagement of patients and providers.
Veteran disruptors Laurence Ainouz, Head of Innovation and Foresight at Teva Pharmaceuticals, John Mattison, and Dan Kraft then joined Tullman onstage for a short panel session on lessons learned.
While Ainouz discussed disruption in pharmaceuticals, Mattison weighed in with a warning to innovators against prematurely lining up a business case and revenue model before focusing on the customer. His advice: solve problems, make life better for people, and provide value.
After a short break, the final keynote speaker of the conference, James Heyworth, took the stage. Heyworth is the founder and former CEO of the ALS Therapy Development Institute (ALS TDI), a non-profit biotechnology organization driven to developing treatments for amyotrophic lateral sclerosis (ALS). The first half of Heyworth’s talk focused on his emotional motivation for ALS TDI, which began when his younger brother Stephen was diagnosed with ALS. Heyworth’s investigation into the options available for managing his brother’s disease revealed a disturbing fact: as much as 80% of ALS research outcomes could not be replicated, making much of the support for ALS clinical trials statistically unsubstantiated.
Heyworth raised the question of how we can move forward when there are faults in the data at the heart of our assumptions. The fact that ALS, considered one of the best-researched medical conditions, might have no real supportable data drove Heyworth to establish ALS TDI in 1999 with the aim to champion a new model of disease research based outside of academia and for-profit organizations. Heyworth’s story was captured by author Jonathan Weiner in His Brother’s Keeper and by the PBS documentary So Much So Fast. Heywood’s discussion also touched on his work as co-founder of PatientsLikeMe, an online resource for disease-specific medical information. The tool allows patients to track their diseases and share this information with others dealing with the same conditions. PatientsLikeMe disrupts the current system of clinical trials with patient-driven databases that provide insight into the efficacy of specific treatments.
FutureMed 2013 ended on a high note with a performance by this year’s resident singer, songwriter Eoin Harrington. Over the course of the conference, Harrington crowdsourced material from conference attendees resulting in the catchy FutureMed 2013 theme song, “3D Me Baby.”
Overall, FutureMed 2013 (Part 2) turned out to be an “exponentially” excellent experience. The venue-upgrade and high density of thought provoking, disruptive innovators combined to deliver a polished, well-run event. As we depart from sunny San Diego, we are reminded of a quote from earlier today by Glen Tullman, “This is the future of healthcare, this is the end of the beginning.” This week, FutureMed has been an incubator of ideas and collaborations. We look forward to seeing how attendees use this catalyst as an inspiration to become the next wave of innovators in healthcare and medicine.
Look out for announcements regarding SU’s new series of “Exponential” conferences beginning next year.