TEDMED 2009 – Day 2

We had a long and eventful second day at TEDMED, filled with plenty of laughs, thought provoking technology, spitting into vials for 23andMe, embarrassing ourselves in front of med tech celebrities, and even a conversation with Aubrey de Grey over a clam bake dinner on the beach. Yesterday sessions featured twenty two speakers, far too many to write up, but we’ll highlight a few that we feel stood out from the rest, those that showed something new or especially interesting.
The conference opened with the second appearance of songwriter Jill Sobule. She’s quite talented and today’s song was a bit more upbeat than yesterday’s, about the apocalypse, and was a great lead in to John Abele, co-founder of Boston Scientific. Everyone expected John to talk about catheters, stents, or something else from his world, but instead he threw a curve ball and discussed the concept of collaboration. It seems that research into how people best collaborate is a deep personal interest of John’s, and he even bought a conference center called the King Bridge Center to better investigate his ideas on collaboration. He thinks medicine is lacking in the sort of productive collaboration that helps other fields quickly advance and be optimally productive. Through his talk he discussed a few ideas surrounding collaboration, but the kicker was his insight into the idea of surgical collaboration, where an audience of medical professionals sit in an auditorium with real time high definition operative data, and they all participate in a procedure by giving advice on what the surgeon should do next. This is actually already happening. He showed a video of a vascular surgery event of sorts in which at least one hundred leading vascular surgeons were all participating in the surgery. The doctor actually performing the procedure was collecting advice on what to do next and getting real time consensus data via real time polls. This, no doubt, made the procedure last longer, but most of the doctors in attendance said they thought they learned from it and that it produced a better result for the patient. A poll even indicated that they trusted their established consensus more than something they would read in a peer reviewed journal.
Soon after John, David Agus, professor of medicine at the University of Southern California and founder of Oncology.com and Navigenics spoke of his views on cancer. He would like to see a paradigm shift in the thinking of cancer as a tissue defined disease to a molecular marker defined disease. Rather than calling a disease breast cancer, for instance, we should eventually know the molecular gene mutations that caused the disease and be able to identify the cancer as HER2 cancer, etc. This hyper specific focus on the molecular basis of medicine should help refocus our thinking of the disease into a more curative direction. He also requested that researchers examine other ways to attack cancer besides targeting the diseased cells themselves. Citing a highly successful trial with zoledronic acid (a drug that improves bone growth), he noted that sometimes when you “change the soil” (make the bone more healthy), “the seed can’t grow” (the cancer cannot thrive).
After a quick break in the coffee room, which, by the way had a 103″ flat screen TV broadcasting the talks as they went along, we heard from Alexander Tsiaras, artist, scientist, and founder of The Visual MD. The idea behind VisualMD is to be the Google Earth for medical imagery. News organizations, for instance, might use the images from VisualMD to explain health concepts to their audiences just as how now they use Google Earth to convey geographic information. His goal is to make all of the data free and available and to serve as a resource for individuals, as well as doctors explaining health matters to their patients. Their images are beautiful 3D reconstructions of organs that the user can spin around, interact with, annotate, and even create their own slide shows for easy email to others.
Also before lunch was the science of aging pair up with Aubrey de Grey, CSO of the SENS Foundation, and David Sinclair, professor at Harvard Medical School. If you’ve not heard of these gentlemen before, both view aging as a disease but both are approaching aging in very different ways. Aubrey spoke first and has a more futuristic view of aging. His mantra is that aging is metabolism caused cellular damage that leads to organism pathology, and the human body, just like cars, can be made to run longer with adequate maintenance and repair. He views age related problems as belonging to seven types and in order to tackle aging, all seven cellular and molecular problems need to be cured. Aubrey also coined the idea of a Longevity Escape Velocity (LEV), which is the point of life span where progress in aging science is occurring faster than the degradation of the body itself. He believes that if someone is able to live to 150 years old, then by that point the progress in the ability to keep them alive will be faster than their rate of death, thus they will live into their 1000s. Still focused on the same target, but shooting from a different angle was David Sinclair, who focuses his research on a set of proteins called sirtuins. Multiple studies have shown that when an animal (it has been done in many specifies, including primates) undergoes caloric restriction (fed about 75% of what would be considered normal for that animal), they live about 30% longer. David has some great data to show that this is due to a cellular starvation response that is healthy for the cells and is activated by sirtuins proteins. He founded a company off this idea called Sirtris™ Pharmaceuticals which was quickly snapped up by Glaxo Smith Kline for $720 million dollars. Yes, you read that correctly, a $720 million dollar buy out for a company that so far has no proven drugs. Clearly GKS is betting big on this technology. The early uses of Sirtuins would be for diabetes, but might carry the side effects of less cancer, stronger bones and muscles, a longer life, and a few other wonderful things.
Eric Dishman, the director of Intel’s Digital Health group spoke next about the power of in-home care. His central insight is that medicine needs to leave what he calls the mainframe model and move to a personal computer model, where care is delivered in the home if at all possible. He noted several ideas that might have clinical significance in gerontology. The first was simply engineering a smarter monitoring phone, that over time would track the responsiveness of the elderly person answering calls to determine how quickly they recognized the person calling in an attempt to detect any early signs of dementia. They would also be able to monitor the person’s tremors to check for trends in motor deficiencies. Along these lines of elderly monitoring, Eric showed a prototype system that can be installed in a patient’s home that might delay the necessity for them to move to a nursing home. Through a network of sensors and an high quality pedometer, an elderly person can be monitored to make sure they are able to take care of themselves in their house, are physically stable while walking, and are not injured or in need of help. These sorts of innovations let those who might be at risk of going to a nursing home live in their own home longer and safer.
After a lunch on the lawn of the Hotel Del Coronado, we heard from Greg Lucier, CEO of Life Technologies, the company that makes a slew of biological technologies, but of more recent relevance, DNA sequencers. He talked about how quickly DNA sequencing technology has grown and scaled, with the first genome being sequenced in 2000 for a cost of $3 billion. Now full human genome sequencing can be done for $10,000 in 10 days. This technology has advanced even quicker than Moore’s Law (seen in cpu speed increases), and has far outpaced how the data is used clinically. With all of the genetic information that will soon flood the field of medicine, Greg advised the creation of a specialty of medicine akin to a genetic doctor, or someone who would help interpret genetic test results for clinical action. The technological advance of DNA sequencing, to Greg, parallels the introduction of more advanced radiological techniques which spawned the creation of a dedicated branch of medicine.
Keeping with the DNA sequencing trend, we then heard from Anne Wojcicki, founder of 23andMe. She spoke of her frustration with patients not being able to take an active stance in their medical care as the impetus for founding the company. We’ve covered 23andMe many times before so we’ll hold off on most of the smaller details, but the two big announcements she made at TEDMED were that 23andMe now has 30,000 genomes in their library (likely one of the larger collections in the world) and that the company is introducing a relative finder that looks for people who might be your cousins (from 2nd to more distant) based on your genetic profile. But by and large our favorite thing about 23andMe being at the conference was that we got to spit in tubes and get our DNA sequenced for free. It took us imaging a quality cut of steak to work up the requisite saliva, but we did so, sealed it off, and it will be sent for processing.
In the last session of the conference, Philip Low, the founder and CEO of Neurovigil told us about his mathematical techniques for processing EEG readings. EEGs pick up electrical activity in the brain and Philip figured out a miraculous way of processing them that not only showed a brand new stage of sleep (a subset of REM) but also might, in combination with a large database of EEGs, be able to clinically diagnose neurological pathologies such as schizophrenia or depression. It’s still in the early stage, but his preliminary data looks remarkably promising.
The last of talk of the day was David Pogue, from the New York Times, who gave an entertaining review of all of his favorite medical iPhone apps on the topic of “will your iPhone save your life?”. We’ve covered many of the ones he’s talked about, but for all of you medical students out there, take a look at Anatomy Lab, which lets you virtually dissect a cadaver on your iPhone. It looks like a slick application.
That’s it for day two. We’re looking forward to be fascinated by today’s sessions. The report is coming up tomorrow…