The third day of TEDMED came and passed in a blur, with twenty three talks, the filming of some great video content for Medgadget, lunch outside on the lawn, and a few cups of coffee to keep us going. As with yesterday’s overview, we cannot cover all the talks so we’ll focus on a subset that stood out.
Another Jill Sobule original song kicked off the day, this time about a girl named Lucy who goes to the gym. She’s been doing TED conferences for many years now and has become in a way, a TED tradition. Her story based songs are quite fun and I’m looking forward to listening to more of her after the conference is over.
Jill’s songs led into the first talk of the day, a joint conversation of sorts between the spiritual Deepak Chropra and the scientific Dean Ornish. Richard Saul Wurman and Marc Hodosh, the two leaders of the conference, thought it’d be a good idea to let these two people, with relatively different ideas of medicine, meet head to head on stage. And it largely worked and made for insightful conversation. After establishing that their end goals of health, positive relationships, empathy, and community, were similar, the two of them talked about how they believe people should get there. Dean discussed the importance of a patient having a support community and gave a short presentation with content such as the fact that depression increases one’s risk of a slew of medical maladies. Deepak spoke of spirituality’s role in healing and gave his outline of how one should look at and treat his or her’s soul in order to treat the body. By far the best quote of the talk, however, goes to Deepak when he jokingly said that “Dean is a real doctor and I am a witch doctor” when asked about what makes the two of them different.
Keith Black, Chairman of the Department of Neurosurgery and Director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center, came on next to talk about his work on using the immune system to target cancer of the brain. He noted that cancer cells essentially cloak themselves from the immune system in order to hide their abnormal physiology and growth from the body’s natural defenses. To do so, cancer cells release a flood of immunosuppressant cytokines and the healthier a person’s immune system, the more likely they are to survive a brain cancer. In fact, age is the strongest predictor of surviving a glioblastoma. Why? Because younger people have healthier immune systems. He talked about his attempts to make the tumor cells more visible to the immune system by using dendritic cell vaccines based off samples excised from the patients’ cancers. Essentially they make a vaccine off tumor markers that hyper sensitizes the patients immune system to their cancer. In about 60% of patients given this vaccine, they were able to both activate the immune recognition of the tumor as well as activate the killer T cells to help fight the tumor. And interestingly, in the 40% of patients where this immune modification did not occur, there still seemed to be the effect of increased sensitivity to chemotherapy. Strong data in support of this research comes in the from of a direct correlation between the intensity of the patient’s immune response and their length of survival.
Right after Keith was Peter Diamandis, founder and chairman of the X-Prize Foundation. As most of you know, the idea behind the X-Prize is simple: offer a lot of money to spur private industry competition and innovation. So far this framework for innovation has worked remarkably well, with the Ansari X Prize for private space flight producing the Space Ship One, and the Archon X Prize for genomics likely months away from being awarded. In crafting their prizes, the foundation tries to find goals that will be achievable in between 3-8 years – any fewer than 3 and it’s too easy, and more than 8 and people loose interest. The big item of interest in his talk was the upcoming Healthcare X-Prize, set to be launched in the spring of 2010. The Healthcare X Prize awards first the creation of a suitable metric to determine the health of a community, because you can’t improve what you can’t measure, and then the creation of a healthcare system for a population of 10,000 people that most improves this wellness metric for the least amount of cost. A set of five 10,000 person large groups of people have been identified for participation in the prize. We can’t wait to see what might come out of this.
The next person to keep the morning excitement going was Kary Mullis, who won the Noble prize in chemistry for developing PCR. He discussed updates to his latest project (that was previously highlighted at TED; see video below) that involves taking randomly generated 30 base pair DNA oligonucleotide aptamers, or more simply, random lengths of DNA that have binding affinity to a variety of molecular substrates. The idea is that it is relatively easy to create a massive library of aptamers that bind to almost anything at a highly selective level. So, if you’ve got a microbe you want to kill, you figure out which unique surface proteins it’s got that you’d like to target and select an aptamer that binds to it. Then, you take this aptamer and attach it to something that the body has a strong innate immune response to. This combination means that the aptamer binds to the microbe but is attached to a giant flag that tells your immune system to come over and eat up whatever the aptamer is bound to. The technology has been proven to completely eliminate anthrax in animal models and we’re quite excited to see where it goes over the coming years. Here’s an overview of this technology from a previous TED conference:
After quite a content strong morning session, we had a one hour coffee break during which we interviewed a few companies and wandered around between snack tables. Soon after the break, we heard from Steve Cole, one of the men behind HopeLab, the company that makes a cancer fighting video game called Re-Mission to help pediatric patients contextualize and play a more active role in the fight against their disease. The idea is to give these patients the experience of taking charge in their fight against cancer and have them understand both visually and emotionally what the chemotherapeutic agents might be doing to their body so that they remain more optimistic, more compliant with their medications, and more engaged with their treatment.
After a few more talks we went off to the lawn of the hotel for lunch, during which time we talked to David Bolinsky, founder of XVIVO, an animation company that makes beautiful videos of molecular biology events. They had been showing David’s company’s videos after almost every talk and each time they completely captivated the audience. You can see our brief interview with him up on Medgaget, few posts below.
After lunch Colin Angle, the co-founder and CEO of iRobot gave a talk about his company and the sorts of robots they might build to help elderly people stay out of the nursing home longer. The staggering statistic he spoke of as impetus for his work was that 23% of people self-identify as informal care givers. That’s quite a lot of people whose lives are dramatically affected by the need to constantly care for a loved one. To illustrate his point, he used the example of his mother (including a life-size cardboard cutout) to talk about the sort of assistance she might someday need and how robotic technology might be able to help provide her with that and let her live in her home longer, grounded in the statistic that 3/4 of seniors would prefer to stay in their home rather than go to the nursing home. He attacked this problem from a few angles. The first was monitoring. He noted that one of the biggest reasons a son or daughter might choose to put their parent in a nursing home is simple worry, the constant concern that their parent is not OK and the pressing need to always keep in touch with them. iRobot might someday have a solution to this in the form of a household robot that provides a video feed and activity monitoring of the house and the people in it. This sort of always-on monitoring would help alleviate concerns from the parent’s side. He also noted that the inability to comply with complicated medication regimens is the number one reason that an elderly person ends up in a nursing home. iRobot is looking at how they might be able to take a more active stance in this problem by programming a robot to literally hand a person the right medication when the need it, allowing elderly people to just sit back and wait for the robot to offer up what pills they should take. Lastly, Colin noted that the point of the robot is to extend independent living, not replace it. An example of the type of robot that might someday be tweaked into a household version can be seen in the video below.
Next up was Rick Satava, the Senior Science Advisor at the US Army Medical Research Command. One of his major ideas was that as science progresses, the methodology needs to keep up as well. Double blind clinical trials are certainly a gold standard for much of medical progress, but he advocates for supplemental approaches such as simulations that will be valuable in their own way. He also said that he thinks we’re on the verge of the fourth wave of human technological revolution, the first being agricultural, the second being industrial, the third information technology, and the fourth, biointelligence, which he defines as a hybrid of IT and biology. Richard went on to present a flood of impressive medical technology, much of which we’ll cover in subsequent posts.
After Rick, Helena Foulkes, the Executive Vice President of CVS spoke about how dismally poor patient compliance is for medications, especially those to treat chronic conditions. More than half of patients who start taking “maintenance” medications stop taking them after a year. And over 70% of hospital readmissions are due to medication noncompliance. CVS is testing out a medication counseling program called First-fill that aims to address these problems using the pharmaceutical staff as more of a resource. So far they’ve seen that this program can improve refill rates by over 15%.
Last on the list we’re going to cover is Jamie Heywood, co-founder and chairman of the medical networking site PatientsLikeMe. He gave a riveting talk, both in content, presentation, and graphics, on how PatientsLIkeMe is not only providing a support network for patients with similar medical conditions, but is looking to be a hotbed of the aggregate mock clinical trials. The site collects structured data for multiple medical ailments and their associate symptoms, treatments, and responses for each patient. On the individual level this is valuable as a source of record and a way to seek out others who are undergoing similar treatments, but at aggregate this power really shines. Jamie used the example of ALS, which his brother died from, to show just how powerful something like PatientsLIkeMe can really be. A study in PNAS came out that demonstrated that lithium helped to slow the progression of ALS. The study, though, had multiple methodological problems, yet many ALS patients who used PatientsLIkeMe started taking lithium as a result of the study. Using PatientsLIkeMe data to compare those who didn’t take lithium to those who did (along with some advance mathematical transformations), they were able to demonstrate that lithium did not have an effect in their patient population. The results for an aggregate patient “trial” like this were vastly quicker than what current medical literature can produce. We’re definitely going to keep an eye on PatientsLIkeMe in the next few years.
From San Diego and the beautiful Hotel del Coronado, that’s it for day three. Stay tuned for the last wrap up of day four.