Daniel Kraft:
Thank you, Will. Thank you, all of you, for coming. This is going to be an incredible four days, chock full with, hopefully, new ideas, inspiration, and ways to rethink and re-imagine and catalyze the future of health care.
So first of all, how many is this your first Exponential Medicine? Wow. How many, first Singularity University event? Wow, so a lot of newbies here, some veterans. And I think we're all here to look at what's possible as we move into the future of health and medicine.
And, of course, all around us, technologies are moving quickly. And it's no one technology moving exponentially. It's at their convergence point that we often have the opportunity to hopefully bring health care forward. We're still often stuck in sort of the third industrial age, while many fields are beyond that. And I think one of our missions is to move health care really and medicine globally across the spectrum into the future.
And, again, health care's a broad element, from keeping ourselves healthy, not just lifespan but health span; the future of diagnostics, picking up disease early rather than late; therapy, more tuned, more precise, more personalized, less toxic; global health, how we can democratize health care; even discovery, how particularly amongst those in the room and online, we can start to connect the dots and speed up new innovations or bring them to patients and the global market. So lots of potential, lots to cover. And in these 30 minutes, I'm going to try and cover all of these, get a taste of what's coming over the next four days, and get your sort of spooled up exponentially.
So a lot of us still live in silos of health care. I'm an oncologist. We practice oncology. The cardiologist is in cardiology-- all the ologies, right? Big companies-- pharma to biotech-- all often still live in old silos. We especially at Exponential Medicine like to break open those silos, not just think based on body parts and subspecialties because we're now in this digital age, this connected age, this exponential age where we have the opportunity to reframe from sick care, where we spend most of our time, to true health care.
Now, what do I mean by sick care? Well, in our sick care world, most of us, and our patients, and our friends and family, we get intermittent pieces of data, blood pressure check every month or year, an EKG if you're lucky. If you have diabetes or high blood pressure, maybe you're faxing or PDF-ing your data to your doctor, whether they want to see it or not, fax machines still being a primary mode of communication.
Hopefully, most of our patients are outside of the clinical setting for 99.999% of the time. How do we capture that information? So with this intermittent data, we're often-- and scattered data, still on paper records, electronic records that don't talk to each other-- we end up with a very reactive system. We wait for the patient to present with a heart attack, or the stroke, or in the cancer field, to come to the clinic with stage 3 or stage 4 disease.
And I think globally part of what we want to help happen and catalyze here at Exponential Medicine is to move to much more continuous health care and be much more proactive, not waiting for disease to happen, but to catch it early or prevent it in the first place. So tremendous potential there, and even going beyond where we are really with imprecision medicine, where many of even the blockbuster drugs only work for a small percentage of the population, to really move the needle to where these really work effectively.
And we're not just, again, treating disease. But we're working to optimize our health and wellness. So here, many of you are going to get the chance to do yoga and meditation and runs and get into your flow state. So we want to optimize, not just react to sick care.
But we are still here in 2017. We're still waiting 67 minutes on average for a 12-minute primary care visit or anywhere you might be in the world. We have a chance to hopefully rethink the process of medicine, including for the overworked residents and docs who are spending more time typing medical records than often face time with their patients. So as you've heard about the triple aim-- better outcomes, lower cost, better care-- I want to advocate also for that quadruple aim-- making the health care experience better for clinicians, nurses, pharmacists-- all of us-- so burnout doesn't become a continual issue as we go forward.
So the theme here in Exponential Medicine is a bit technology. But it's not just technology. Of course, to move things forward, we have to align the incentives. And in health, no matter where you are in the world-- I think we have, like, 36 or more countries represented here-- we're often not practicing evidence-based medicine but reimbursement-based medicine. We're on the right side of that equation, getting paid to do more drugs, more procedures, more biopsies.
We're starting to shift the curve to the left, with value-based care, rewarding prevention, paying for the drug, app, the device, a service when it works. And so that's a big change. That shifts things. But together with technology, that can really start to move the needle and bring health care from the hospital, to the home, to on our phone, to onto and inside our own bodies.
So it means where health care happens will no longer be in the traditional four walls. It could be your corner pharmacy, which is battling it out to be a primary care provider. And you can compare one pharmacy to another, one hospital to another.
There's Yelp for doctors. There are ways to look at individual surgeons and individual hospitals and their complication rates for certain surgeries. So the empowered consumer often has a lot more power and knowledge at their fingertips.
So we're here in 2017. The world's changing, sometimes not as fast as we might expect. But 2017, right? There's a Bill Gates quote. We tend to overestimate what will happen in a year and underestimate what will happen in a decade.
So this got me thinking. I wrote a piece for Wired magazine about health care in 2017. Where were we just 10 years ago-- 2007?
This is the cover of Forbes. "Nokia, 1 Billion Customers-- Can Anyone Catch the Cell Phone King?" That was 10 years ago.
10 years ago-- 2007, of course-- the amazing first Apple iPhone 1 came out 10 years ago this month. Twitter launched just 10 years ago at South by Southwest. Facebook came out of universities. Airbnb was still a mattress company. That was just 10 years ago. Think how quickly the world has moved in that last decade.
This was 30 years ago. Remember that on the beach, just walking on the cell phone? Amazing, right? That was only for the super rich.
Now, of course, these have become democratized. Who's ordered their iPhone X? Does anyone have one here?
Anyone have one? Someone please do show-and-tell later, OK? We'll have iPhone Xs here.
And these are, of course, really becoming medical devices. They're connecting our patients, our nurses, our friends, our family, our communities in really impactful ways. And since I live up in Silicon Valley, down the street from Apple, I have a sneak peek at what the next iPhone-- really, the next iPhone 11/12-- is going to look like. So don't tweet that out.
But clearly, we're in the medicalized world now, where so much technology can fit on these exponential devices, to the point where Google just bought a company where you can use your regular smartphone to pick up hemoglobin and pick up pulmonary functions. So we're living in this exponential age. And just to remind you what that feels like, our brains are wired literally. 30 linear steps, I'll be across the ballroom. But if I took 30 exponential steps-- 2, 4, 8, 16, 32, 64-- by the 30th step, I'm actually at a billion. That would be 26 times around the planet. That's the power of exponentials. It's kind of hard for [INAUDIBLE] to get that. But it's happening all around us.
You've seen it with our memory. It used to be 5 megabytes for $12,000. It's pennies. We've seen it in our digital cameras, which have dissolved into almost everything. And now not just 1,000-fold better but more.
It's coming to the Human Genome Project, where if we had the linear mindset, it would've taken 700 years to sequence the genome. But riding the exponential wave, we did it in 13 years. And now the cost of sequencing is dropping at twice the rate of Moore's law, from a million dollars a few years ago to $1,000 and likely $100 pretty soon.
So you'll get the chance to meet Peter Diamandis later this week. He often talks the six Ds of disruption, from digitization to demonization. My favorite one, however, is the D of deceptive-- deception. It's deceptive how sometimes these things can happen so quickly and surprise us.
So let's take a look back to 1984-- some of you remember 1984-- and what it took to connect a computer to the outside world. This is thanks to the BBC and our friend Jane. So sound up.
[VIDEO PLAYBACK]
- With the assistance of the outside broadcast unit, we will be linking from the database studio to their home. Pat Green and Julian, welcome to "Database."
- Hello, Jane.
- Hello, Jane.
- Now, Julian, I see you have your computer linked to the telephone line. Can you tell us how you did that?
- Yes, well, it's very simple, really. The telephone is connected to the telephone network with a British Telecom plug. And I simply remove the telephone jack from the Telecom socket and plug it into this box here, the modem. I then take another wire from the modem and plug it in where the telephone was. I can then switch on the modem. And we're ready to go.
The computer's asking me if I wanted to log on. And it's now telling me to phone up the main [INAUDIBLE] computer, which I will now do.
[DIALING]
- It's a very simple connection to make.
- Extremely simple.
[END PLAYBACK]
Daniel Kraft:
How many people remember 1984? And so the younger folks, that's a rotary phone. That's how we used to dial. That's a little technology.
But, well, that was 1984. 16 years later, we had the iMac. Now that fits on your smartphone. Now that fits on your smartwatch. And, of course, our smartwatches are becoming medical devices as well.
And we now have computers with the size of a grain of rice that have the connectivity and memory of my Apple Watch. And, of course, those are becoming connected, not just the internet of things but the internet of medical things. And it's from everything from the hospital to our connected homes.
Down the street is Qualcomm. They're launching in a couple years 5G-- not 4G. 5G won't be 10 times faster but 100 times faster than our current network. So the speed of connecting this information is getting powerful.
And it's bringing us this world of connected health, mobile health, digital health. Those are all buzzwords. I think we'll soon just call it health. We don't call it digital banking, digital movies. But it does give us the ability to connect the dots between all sorts of elements of information and hopefully move the needle.
Now just prescribing a Fitbit doesn't mean someone's going to lose weight. We're seeing folks at my [INAUDIBLE] base of Stanford, studying these-- UCSF and others. We have to study these elements and speed them up. But it's a new ability to connect the world.
And it's not any one technology. It's not just Moore's law on our smartphones. It's many fields moving quickly that we're going to talk about today, from 3D printing, and AI, and robotics, and nanotech, and genomics, all coming together and converging.
So part of our theme for exponential medicine is to think convergently and exponentially, and how we can use these exponentials to address grand challenges in the world-- our personal challenges, those of our friends, our families, our hospitals, from rising costs, aging population. We'll have a great talk about the age wave tomorrow. Access to care-- a shortage of doctors and nurses in many parts of the US, let alone the rest of the world. And no matter what happens to Obamacare, or-- god forbid-- Trumpcare, or Putin care-- whatever we get-- we need to think about how we give access and democratize health care.
We've got lots of data coming at us. But exponential data doesn't make us smarter. How do we make that actionable information at the point of care? Unfragment it, so we're not using fax machines or repeating tests.
And then another big challenge-- some of you are here from the payer world. How do we reward new innovations? How do we pay for the next app or device or digiceutical or digital layer as we move forward? And then how do our friends in the regulatory bodies-- the FDA, which we'll have back here again this year-- how do they get out of the linear mindset and speed up regulatory and reinvent that?
So if we spend potentially less of our dollar, we can spend it on more important things, like education and infrastructure. So tons of potential there. And just a snapshot. I met a pediatric psychologist here earlier today. Huge shortage, let's say, of subspecialists in many parts of the country-- hundreds of miles to find a child psychiatrist.
So we need to do better, including on social determinants and disparities. Low-income folks have six times the rate of adult onset type 2 diabetes. And depending on zip code, even in the same city, you can have a 20-year difference in lifespan, let alone across the world. So tremendous opportunities to move the needle and to re-imagine health care.
So everyone's favorite example used to be Uberization of re-imagination. It's still a good example. Uber couldn't have existed 10 years ago. They didn't invent the smartphone, GPS, online maps.
They connected the dots and have been disruptive to the taxi world. It's been a threat, right? If you go to London, there are strikes. They now lost their license. They're disrupting the taxi world.
But disruption's even coming to that world. Self-driving Ubers are coming. Uber's disrupting themselves by developing those and piloting them right now in Pittsburgh. I was down the street from one last year.
And we'll have John Brownstein from Boston Children's bring the Uberization of health care. Press a button on your app, and a doctor or nurse comes and gives you a flu shot. You'll hear more from John about how we can connect those dots in smart ways.
So we can start to bring back the house call. We can press a button on our app, and a doctor comes to you. Not sure what kind of doctor, but you get a doctor.
And they can rate you. You can rate them, so that element's there. John and others have built the circulation platform, Lyft and others-- to help patients come and access care. So we can connect these dots in interesting and powerful ways.
Zipdrug delivering drugs-- so pharmacy-- the pharma world. Many of you are from the pharma world? Is pharmageddon coming?
Should it still be the case where most of the clinical trials in late stage often fail? We're spending over $2 billion for a clinical trial, or to get a drug to market. So big changes are coming there. And our friends in the pharmacy-- you all know about Amazon coming to the mix. What's that going to do to the world when they can deliver drugs by drone to your doorstep?
Or the payer world, right? How do we make the interface for understanding your insurance in smarter ways? And we've been seeing CVS may be buying Aetna. So changes are coming to that world. Disruption is coming.
And the classic example from Peter Diamandis is digital photography, right, changing. Kodak wasn't thinking exponentially. They didn't want to cut into their film sales 20 years ago.
What happened? They were bankrupt five years ago. And Instagram was sold for a billion dollars from 12 kids down the street from me in Palo Alto.
So they had their Kodak moment, right? That's an example of not thinking exponentially. So all of us, we need to get our heads out of the sand and think about how we move these things forward. And the summary for all of this is you want to Uber yourself before you get Kodaked 'cause that's the takeaway.
All right, so as Will mentioned, I've been really lucky to be on the founding faculty at Singularity University since it started back in 2009. It's been an incredible experience to be at the convergence of all these technologies and help folks think about, where do we take these to address health and medicine?
In our programs at Singularity U, about half of the new companies that have spun out of our summer programs are focused on health care. Many come from people outside of medicine. A lot of people here are not traditional health care folks. And that beginner's mind that can bring a lot of innovation.
And this is an amazing community. The way we can blend it together for four days really catalyzes some new thinking. We started small back in 2011, with about 100 folks for the first three years. And now we've grown.
And really grateful that you're all here. And we're so big now we'll even have a drone taking a picture of our famous scrub shot on the beach. So for those of you online, check out ExponentialMedicine.com. A lot of the talks and other resources from the past several years are there.
And part of that new thinking was synthesized by Tony Young, who was with us the last few years-- head of innovation for NHS. Had this quote up last year. "The difficulty lies not in the new ideas but in escaping from old ones, which ramify, for those brought up as most of us have been, into every corner of our minds." An old quote from John Maynard Keynes but I think part of what we need to keep in mind as we move forward.
All right, so let's quickly look at where some things are today, many of which we'll dive deeply into our next sessions over the next four days. Part of it is how do we think about changing outcomes? Partly through behavior.
We know genetics are important. But it's our behaviors that drive most of our downstream costs. So we're just in the early era of being able to track our behaviors, right?
Fitbit only launched in 2009. Who's wearing a Fitbit right now or something like it? I've got five versions on right now. Who's got one in their drawer and hasn't charged it for a while? That's the rest of the room, right?
These sensors are evolving, right, to sensors you can even put in your pill and track your medications. We can now measure almost any element of behavior and physiology with this new world of wearables, which we can use outpatient or inpatient, from consumers to patients. Companies that got knocked out of the phone business, like Nokia, are coming in strong into digital health and connected medical devices. Philips, which we'll meet their number two tomorrow, is really moving into the space in smart ways.
So in summary, with all these new sensors, we're moving from a world of the data geeks, which are many of us, and quantified self to quantified health. We can start to track almost every element of our behaviors, again, in health. So we can measure, pick up, diagnose, and manage our therapies with these as well. We're seeing big health care systems start to pay for these sorts of devices to connect the dots.
So just a quick thing of things that have just come out in the last year-- your phone can now diagnose heart disease. You can have a blood pressure cuff built into your watchband. You have glucometers that talk to your smartphone or can be built into your watch by itself. And some of those are becoming bloodless. So the year of digital tattoos is rapidly emerging.
We're not just wearables on our wrist but on our feet, so we can measure everything from gait and beyond. We're going from wearables to insideables. Them The idea that these are shrinking, and our friends at Google are Verily Health are now partnering with big pharma to bring contact lenses to market. Those are trials now for measuring blood sugar.
We met here last year the folks from Profusa-- sensors underneath the skin that are already CE marked that can pick up blood oxygenation, and potassium, and blood sugar and transmit that anywhere the patient may be. Starts with the military but moves to the patient world. We're going beyond insideables to the trainable world, right? We often don't have good posture in our smartphone world today. And posture is really important.
Last year, some of you met Upright. They were here with this little sensor that you could put on your back about an hour a day for about a week. And it retrains your posture. It's your digital mother to remind you to sit up straight.
My mom's actually here. She can remind me to sit up straight. But this can do it as well. And they won one of the many awards last year, and they just launched in Apple store. So some of those things got catalyzed here.
We're going to shockables, if you need more invitation. Hearables, our music devices that play music, are often able now to track steps and sleep and give you AI feedback. Ringables-- I'm wearing a ring out of Finland called the Oura Ring that tracks sleep.
We joke about SU, Sleepless University. But sleep is so important across the health care continuum and underappreciated. But we can measure that now. Apple bought Beddit a few months ago. So big players coming into the sleep space.
Breath is something that can be a biomarker, not just for the quality of your breath, if you're going on a date, but maybe a nanonose to pick up cancer. So we'll be talking about cancer diagnostics and new ways to detect. Even sweat can be a biomarker for a patient with heart disease. Or if you're running a marathon, be used as a biomarker to optimize your hydration.
For folks with diabetes, you want to track the feet of a diabetic patient-- sockables. Smogables in many parts of the world are getting important. We can crowdsource data from the weather.
Food-- of course, the most important drug-- you can now quantify your food, pick up does it have gluten, or peanuts, or beyond, or how many calories might it have? And on the drinking side, if you need this wearable, you have other issues. But real-time blood-alcohol detection.
Bottom line-- these are going to dissolve into our environments and be part of managing every part of prevention diagnostics and therapy, even particular diseases, with a shakeable for managing a Parkinson's patient. Or you can figure this one out. Lots of data there.
Even if, let's say, if a patient's had a hip surgery or a knee surgery and have a risk for a fall, they might want to wear a-- boom-- airbag on their belt. A protectable. Might be useful. And new ways to treat pain without drugs-- so lots of things coming.
None of us want to wear 50 devices, have 10 apps on our phone. We need to integrate these. We need to synthesize this to empower each of us and our patients to be participatory, owning their data.
Lucien Engelen coined the term "patients included." And here's my data. Really important that we own our data, can share it, and crowdsource it in powerful ways.
So we're really into an era-- an era now-- where the Facebooks, the Googles, the Apples are all getting into health care. And that can change incentives, right? If you're able to hit a certain number of steps, you get a free Apple Watch.
If you're able to hit other elements, you get $4 a day. So we can start to tune these to individual people, and their behaviors, and their culture, and their language. So new opportunities for businesses, as people will always hack the system, but ways to move forward there.
And even Apple may be buying clinics. We'll have Chrissy Farr here from CNBC, reported on this a couple weeks ago. Who are these new players that may be not just-- might be quite disruptive as they move forward.
So we can now track the health of the pregnant mother. When the baby's born-- this used to be a joke-- the connected diaper. But now, no kidding, Tweet Pee exists. You can figure that one out.
As a pediatrician, I might be able to send a child home from the PICU or NICU a couple days early and sensor them at home. That's my son, Leo, who you'll meet here later, who's now about 3. But when he was younger, he wore that for a while. I didn't need that to tell me he's waking up every two hours. But that could be useful.
Connected binkies for temperature, tracking milk-- all these elements. But what is a parent, a pediatrician, a health care system to do with all that data? How do we connect the dots and make it useful?
Mental health-- another really important area. We've gotten better in curing and treating other diseases. Sadly, suicide rates are up. But now even Instagram filters can predict depression in some populations. Or voice-- we'll hear from Beyond Verbal, a way to detect emotion and other biomarkers from voice. And they have an app which can do that in real time.
We can now do interesting things like-- send you home with a digital psychologist that can watch you, listen to your tone of voice, your eye gaze. And for folks who don't have access to regular psychological follow-up, be quite effective.
[VIDEO PLAYBACK]
- What advice would you have given yourself 10 or 20 years ago?
[END PLAYBACK]
Daniel Kraft:
So bottom line, these are already here. And the Googles and others-- Tom Insel left NIMH, went to Google, developed online screenings-- when you search for depression, you might get a screening-- and developing biomarkers that your smartphones will pick up. There are new ways to blend virtuality reality and drugs to treat really reticent diseases like PTSD. And old drugs, from psilocybin to party drugs like MDMA, are now being applied and going through the FDA in really powerful ways to address our big mental health challenges across the world.
So bottom line in this quantified health era-- we can now start to track almost anything. Wi-Fi alone can pick up vital signs. So soon, whether we like it or not, we'll be exuding our digital health exhaust. It's going to get captured 24/7.
How do we use that? So what if the data isn't accessible, if you have to keep charging devices, if it doesn't flow to your clinician, if it's not actionable, if we don't align the incentives so that clinicians and patients and others use these technologies, if it doesn't align with a workflow so that poor overwhelmed doctor doesn't have to do 18 clicks to order an aspirin in many electronic medical records systems. So we want smarter ways to integrate this.
At my home base of Stanford, I can connect my Apple Watch and phone data into my EMR. And my doctor can send me a note and track my data. He doesn't want to look at my Fitbit data. He doesn't even know how to make sense of it.
We've never had some of this data. So Verily is now partnering with Duke, and Stanford are doing this, I think, 10,000-patient baseline trial-- what's normal digital exhaust, let alone changes that occur when folks are moving to disease?-- using devices, apps genomics and integrating all these new exponentials in a convergent way. So hopefully we'll end up with a form where we can almost have a FICO score for our health, understanding what the integration of this is, not just our vital signs in weight but our sexual health, our social connectivity. If you're socially isolated, that's as dangerous as a pack a day of smoking.
Hopefully, we can integrate this data to make it easy to understand. Like our modern cars have a Check Engine light, integrating hundreds of sensors. What about each of us and our patients having a Check Engine light for their body? And the software layers on top, not the commoditized sensors, are going to be the valuable elements there.
We're starting to see that happen. This is a new company out of Michigan. They can build this dashboard. You don't need to be a ICU doctor or anesthesiologist to tell that patient has an issue with their airway or their heart and provide you easy ways to upskill folks who don't have necessarily years of physiology experience.
Out of Stanford just this year-- I've always used the Check Engine light term-- Dr. Snyder and team wired him up. He found that he had type 2 diabetes early. Also detected his own Lyme disease a month before he might have been detected.
So we're going to move to this Check Engine world and maybe learn lessons from the cars-- the Teslas of the world, the hive mind. They improved the maps for all the Teslas moving down the road. So I think if we crowdsource this era and leverage this data, we can really optimize health and medicine in nice ways.
Now having data alone is not enough. We're not often honest with ourselves with our data. Digital coaching is a new emergence, where you can talk to a real coach through your smartphone or beyond or virtual chat bots that might know you and help through diagnosis of it, reminding that you're low on sleep.
Many of you are jet-lagged. So be careful. They can remind you and coach you. Soon these will be coaching chronic disease, not just health and sleep.
Our robots are coming. You'll meet Catalia Health in our Innovation Lab, with a robot that can help medical adherence for older folks. And, of course, our connected homes-- our Google Homes and our Amazon Alexas-- are becoming health care devices.
They can remind you how much insulin to take or to do a med refill. Or hey, Google, make a doctor's appointment. Or, Alexa, help. I've fallen, and I can't get up.
And we're seeing many folks build amazing apps on top of this. Many of you are already doing that. So new ways to connect using voice can bring access and information and democratize it.
That coach may show up in the mirror in the morning, giving you your score. What if you didn't see you of today in the mirror. What if you saw-- maybe you saw you of today. Looks good. [INAUDIBLE]
What if it was you of tomorrow, right? And you're doing your exercise, your workout-- virtually see you of tomorrow. Or if you keep having doughnuts for breakfast, you of tomorrow. Yeah, me now, me 1,000 doughnuts later.
Or if you have a patient who smokes, you could show them on their own face before smoking, after smoking, or the effects of too much Facebook time, right? This is, of course, the new world of augmented reality, something that's blending. We'll have a great session on AR and VR here coming up. Really going to impact health care in really interesting ways, from letting a nursing mother get coaching on breastfeeding, to kids with autism to understand emotions and gamify it, for surgeons to see data in real time.
In fact, we had the first Google Glass come to our Exponential Medicine 2013. And several of the members-- now faculty here-- were the first to get their hands on it and brought it into the operating room and beyond. Microsoft is here with HoloLens. It has a lot of applications in medical education and beyond.
So we're going to see new ways to blend data. If you're a surgeon, you may see the back of your patient in interesting ways. You may be able to do a much more precise surgery that's safer and more guided. And I think there's lots of opportunity we're going to see. And we'll have a lot of interesting demos of that later.
Of course, medical education-- the surgeon today studies for an exam today like this or for a particular patient. But imagine this being your world of training. This comes from Osso VR. They were here last year-- young company out of the Bay Area.
So you can start to gamify whether it's training for an orthopedic procedure or with different kits. So we're going to see whole new ways to amplify medical education using AR and VR in empowering ways. We'll hear from Meta later about augmented reality. And of course, a live demo-- this is always a dangerous thing. We could start to do blended reality.
This is the amazing Shawna Butler, who will be with us a lot this week. Let's see if this works. Stand back. Always dangerous to do a live demo.
Oh, boy, turn this way. Turn this way. Turn this way. Back up.
Oh, Wow Well, this is what it will look like on the screen. Sorry about that. Let's go back to my slides. We'll try later.
Basically, see through the patient and educate them about their heart and their lungs. It's great for kids. My son Leo now knows his basic anatomy by using this sort of technology.
I love the world of flying. I was a flight surgeon in the Air National Guard. We used blended reality in the fighter pilot world to see what's going on. We'd get warnings from our virtual environment, too--
[ALARM]
Daniel Kraft:
--if you're about to hit a mountain. But imagine the future of behavior change. See breakfast one way, then another way and get another clue, right?
[ALARM]
Daniel Kraft:
VR is exploding. You can even do it on your Google Cardboard. But now it's being used for therapy for things like burns-- and we'll hear a lot more of that from Brendan Spiegel-- or for to diagnose folks with dementias and beyond.
Or it's going to be used maybe to bring folks in hospice to places they can't access. Or, as out of Stanford this year, a virtual heart, so a new way to learn anatomy. If you've got a patient with tetralogy flow, you can understand that anatomy.
You can walk inside that heart. It's going to change all the ways we learn, not just in health care but many ways and beyond. And you're going to get to experience many of that in our Innovation Lab.
And of course, the amazing Shafi Ahmed is here, who did some of the first VR surgery. I was in London with him a year and a half ago. He did the first VR, virtual surgery-- 5,000 people watching his surgery in real time. And he's going to update us with some of the new work he's doing in some pretty amazing realms coming up. So watch out for that on Wednesday.
So what about 'omics? We're going to be talking a lot about genomics tomorrow morning. Sequencing, of course, getting very cheap and available. $100 genome pretty much this year.
What do you do with that data, right? I can look at even my 23andMe data and see my risk of chronic kidney disease or my response to drugs-- pharmacogenomics. When is that going to translate to the clinicians' dashboard?
Helix just launched, from Illumina out of San Diego, an app store for your genome, where you can look at your athletic ability, for example, or maybe what wines you might drink based on your smell and taste genes, right-- another application. We had Joel Dudley here two years ago. Talked about the ability to subset diabetes into three subjects based on crowdsourcing genomics. So new ways we're going to understand disease.
And, of course, we're going beyond the genome. We're going to learn a lot more about the microbiome tomorrow-- how you can get your own microbiome done, how it's playing a role in everything from obesity to inflammatory bowel disease to Parkinson's to doing fecal transplants for folks with C. diff or beyond. We're seeing the ability to use this in really amazing ways.
Maybe we're going to get probiotic fecal transplants from really athletic folks in the future and use that to tune our diets. How do we optimize our diets using all of this new data so it's not one-size-fits-all fad diets moving forward? And Viome will be here talking a bit about that, even delivering food to you based on your genomics and other information.
Old-school stuff we can do-- we have swami here. You'll get a chance to do yoga and meditation. We can look at the impacts of these technologies on our brains with brain computer interfaces like the Interaxon Muse, which you'll get a chance to try in the lab. You might prescribe this for a patient with anxiety or depression and get a dashboard of your patients and how they're doing.
In fact, they just came out with, and I just got the new version like this. Let's see. I'll wear it, and we can see how stressed out I am, right?
We won't do a live demo with this one. But this is a glasses with brain computer interface built in. So we'll see new ways to use these for treating diseases like ADHD and train for focus, or whole new ways that we're going to use video games moving forward for both optimizing our brains and treating challenges.
And, of course, on the far end, at my alma mater, Brown University, brain computer interfaces are getting really amazing for the quadriplegic. We'll hear more from Divya Chander. And even Elon Musk this year is getting into the brain computer interface space.
Diagnostics-- we want to pick up disease early rather than late. We don't want to wait for dementias to occur. What if we could use ways of picking it up 10 or 15 years early and then apply elements like statins for the brain that might prevent and reverse plaques?
Two weeks ago, I was down at Human Longevity Inc.-- some of you got to visit it, and will a chance later this week-- where I had an amazing amount. I had a one-hour scan. And within an hour of being scanned, I had an amazing view of my heart, my ejection fraction data all calculated automatically.
I could look at my brain health in pretty incredible ways. Really amazing data-- nice to know my hippocampus is at 96th percentile. Maybe that's a good thing. Or how much lean body mass I have. Imagine having that data for not thousands of dollars but hundreds and getting that every couple of years.
Diagnostics is getting digitized. We have an amazing set of tools now that we can digitize from our Apple Watches now that can pick up atrial fibrillation and other disease. This is a tweet from last week or so.
"Never thought a stupid little wrist computer I bought two years ago would save my life. Saw my heart rate go up. Ended up being a pulmonary embolism."
Right? And he saw that his resting heart rate was, like 180, which is not normal. Brought himself to the ER. Maybe in the future your watch will call you an Uber or Lyft.
But imagine that Check Engine light on your wrist or simple elements, like doing an ear exam through an otoscope. Is your doctor or pediatrician going to get paid for doing that exam? Lots of challenges. Lots of diagnostics coming.
Lots of new ways to make sense of that data using AI. We'll hear from Neil Jacobstein next. Are we going to replace the dermatologist? Can we scan the face of a child with facial dysmorphia and figure out what genetic disorder they have?
We're going to see the way to look at the back of our eyeball in powerful ways. And Google and others are already applying this lens to understand progression of disease. We'll see already pathology-- Google Deep Learning-- pathology with machine learning can do better than a pathologist with unlimited time. Not many pathologists have unlimited time. ,
Tomorrow, you'll hear from the co-founder of Zebra about applying AI in the imaging world. And, of course, in the cardiology world, we can do a lot just with our simple smartphones today and sensors, which are moving from the back of our phone onto our wristwatch and beyond, that will help us diagnose disease and manage it, like atrial fibrillation, and sometimes replace the much more expensive versions going forward. So lots happening, of course, in diagnostics. We'll play more with that in the next couple of days. And, again, diagnostics blending with artificial intelligence is going to make a big difference.
So convergence again being the theme, Peter Diamandis started the X Prize. I got to help design the Tricorder X Prize. It was just one about six months ago. We had 300 companies enter the competition doing really smart ways to collect data from devices in your pocket that might be basically an intensive care unit sensor in your pocket.
We have new ways to do smart urinalysis using your smartphone and blending information in to send that data to your doctor, to the CDC, to the NSA-- whoever else wants the information. Again, lots of data. We need to start connecting the dots.
The winner of that, of course, was an ER doctor. He was also an engineer. And his family won the Tricorder X Prize.
We'll have one of the finalists here with us. There I am with Basil and Dean a couple weeks ago. And you'll hear more about a Cancer X Prize that myself and some Deloitte colleagues are getting off the ground.
So last two minutes-- connecting the dots. We need to make all this come together. Of course, it's overwhelming information. It's beyond what our brains can do.
I think it goes beyond AI but to IA, Intelligence Augmentation. We're going to start crowdsourcing that to help our AI and IA become smarter and not to replace the doctor or the nurse but hopefully enhance that smart human connection that we really need. It's not either/or. And I think we want to recognize that piece.
All right, finally, therapy-- gene editing is coming. CRISPR is moving quickly. We'll hear more about CRISPR and gene therapy to the point where we're starting to see in clinical trials to cure diseases like sickle cell, or maybe be used for HIV with CRISPR gene therapy. To the point where it's trying to modify embryos-- so a whole brave new world or babe new world is coming out, potentially, with lots of ethical challenges, particularly as we can do things with artificial wombs and genomics in really interesting ways. Old movies like Gattaca, a 20-year-old movie, can inform where that might be heading.
For those in the pharma world, how do we deliver drugs and work on adherence? RFIDs in pills that can track when you take it, all the way to electroceuticals that are replacing drugs and devices. Sleep apnea treated with electroceuticals, not a CPAP mask.
A device for contraception that has a remote control. What if someone hacks your remote control? Honey, where's the remote? Or what if someone hacks your pacemaker? All the issues with privacy-- not just individual data but all hospital systems getting hacked-- so we need new technologies like blockchain we'll hear more about, that could be applied to solve that grand challenge.
Prescribing apps this year-- this whole world-- we'll have whole sessions on the new world of what's the clinical practice and the future of prescribing digiceuticals for pre-diabetes. Where diabetes is heading now, with connected insulin pumps and glucometers. We'll hear from the CEO and co-founder of Bigfoot Biomedical, the checkup of the future with Jordan Shlain and Leslie Saxon-- new ways that we're going to interface with our clinicians, some of them using VR and AR, that will be quite surprising.
Your doctor, Leslie Saxon-- now she turned into her own avatar-- may show up on your own app as a way of interfacing with clinical care going forward. So lots of things happening. Lots of virtual care is coming, not in the future-- even in 2018.
And because there's so much happening in this space, I keep getting asked what to prescribe, what to use. We're going to be launching soon a platform called Digital.Health as a new .health Domain So sign up at Digital.Health. We'd love your help building that out as we go forward.
Of course I've run out of time. You know, I'm exponential. We'll hear more about robotics, how sometimes even new solutions aren't always adopted.
Robot anesthesiologists were not a hit amongst anesthesiologists. So those got killed. So remember-- aligning incentives.
We're now seeing robots come in all sorts of ways-- to help the disabled, wearable robotics, exoskeletons. This woman's paralyzed from the waist down. She's wearing a exoskeleton with 3D printed parts. We're going to hear later today from Dara about where 3D printing is going, from printing your casts, to digitizing your data, to personalizing hip and knee implants, to customizing prosthetics, to scoliosis braces, to even one of our Singularity new companies that printed and flew the first 3D printer to the space station and just this last year printed the first medical devices in space-- so ways of democratizing that.
I don't think we're going to be 3D printing organs in the next year or two. But there'll be the ability now to print small organs, as Organovo is doing down the street in San Diego, to do organs on a chip, to study disease. And I think well beyond we 3D print organs will be genetically modifying with CRISPR humanized pigs.
So we'll get organ transplants from humanized pigs. May not be kosher, but you'll take it. And that is moving very quickly.
George Church-- he was here two years ago-- thinks this will be in trials the next three to five years. So lots happening in that space.
I'm going to skip through user interface. Just making the point that we could all innovate. MakerNurse and the MakerHealth new movement will be in the breakout room in a talk later. We can all start to think about not just MacGyvering but solving the solutions.
Applying design lessons from the world, from aviation, like checklists and simulators to health care, because, of course, you can now simulate everything. And I mean everything can be simulated. So new ways to train as we move forward.
So I'm going to finish up with global impact. We want to democratize health care. 3 billion people are coming online. Everyone who has an SMS phone will soon have a smartphone. Project Loon and others are bringing internet to billions of people in the next few years.
Drones are delivering drugs, devices, and blood products already to 1,000 clinics in Africa. We'll see some drone technology here this week. All these ways are going to democratize and bring health care in new realms, whether it's your defibrillator or your ambulance.
So where this takes us is discovery, right? Technology and widgets are all great. How do we pull this together to reinvent clinical trials, whether it's for a device, a drug, an app?
How do we crowdsource our data? How do we become data donors, not just-- well, you can download a clinical trial or build your own clinical trial in new ways. The Stanford-- my heart trial signed up as many people in the Framingham trial in about a week for fractions of the cost.
So I think we'll move, in 10 years or less hopefully, to a world like with health care being as unimaginable as driving without Google Maps or Waze. Today we drive with Google Maps and Waze. We couldn't imagine that we'd give some private data, but we'd get the map of the traffic back.
I think we can have that mindset in health care going forward and become data donors, not just organ donors. Take our own medical selfies, as our friend Steven Keating did a couple years ago. Coined the term "medical selfie," that we can all maybe share our data-- have a Medical Share button. He 3D printed his own tumor and now has coined this element and trying to democratize the ability to share this information.
So, again, let's all think convergently. There's no one exponential technology. Let's not think about where we are in 2017 but skate to where the puck's going to be in 2027 or 2020. It's moving much quicker than you might expect.
We have the whole ability to really move from our today's sick care to a real future of health care, crossing all these spectrums that we'll dive into this week. It's not always just disruption. It can still be innovation.
And I think if we have that mindset here at Exponential Medicine this week and beyond, we can move from sick care-- intermittent, episodic, and reactive-- to a true era of continuous and proactive and participatory health care, not just take linear steps but exponential ones. And we in this room and beyond have the real opportunity not to predict the future but really go out there and catalyze it and build it this week.
Down the street is the Salk Institute. I love this quote. "Hope lies in dreams, in imagination, and in the courage of those who dare to make dreams into reality."
That's what we want to catalyze this week. So thanks for coming out and playing full out. Let's go be exponential. Thanks.
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