We’ve just wrapped up day three and FutureMed is quickly joining the club of highest quality conferences we’ve attended. It’s long, intense, feels a bit like a medical bootcamp, but we’re getting the sense that participants are digesting an incredible amount of information, making friends, and getting both a deep and broad picture of how the landscape of medicine is changing immensely. Kudos to Daniel Kraft and the FutureMed team for making the event happen – we’re all thrilled and honored to participate.
The program kicked off today with Todd Brinton from Stanford’s biodesign program. If you haven’t heard of Stanford Biodesign, they’re one of the leading centers in the world for the design and creation of medical technologies. 
Led by Paul Yock and Tom Krumel, they were one of the first places to include interdisciplinary collaboration and a methodological need-finding approach to innovation in medical technologies. Todd pointed out that too often people try to jam technologies into a need instead of building technologies to fit a need. Stanford Biodesign has a twelve-month fellowship program where they send participants on a mission to find needs in medicine (for the first half of the fellowship) and then invent and implement solutions that fit these needs (in the second half). The school recently put out an exceptional textbook called Biodesign: The Process of Innovating Medical Technologies (we’ve covered it) that’s a must read for those looking to innovate medical devices.
Next up was a panel by Allan May and Geetha Rao, who have worn both investor and entrepreneur hats in medical technology and gave a state of affairs of the medtech venture space, as well as provoked the audience with some thoughts and hypotheses as to where things are going. Allan noted that the overall pool of medtech venture money has recently fallen from $32B to $12B and companies like Intuitive Surgical, which were able to get large capital injections years ago, would never be able to start today. 
Not to say that’s a trend that’ll last forever (like all things, VC is cyclical), but there’s a movement away from large, capital intensive investments, while the only companies that are pursuing these sorts of advances right now are the big gorillas like Medtronic and Abbot. He and Geetha did note that though VC in medtech is on the decline, angel capital is still abundant, and in fact, likely mirrors VC in size (though hard data around this is notoriously hard to capture). Geetha and Allan proceeded to talk about the new value propositions that are peeking investor interest and are leading to large exits. These companies are increasingly producing innovations that reduce costs, approach problems in unique, more costs effective ways, and provide clear and immediate monetary value.
Tim O’Reilly, infamous founder of O’Reilly media gave a talk next on what he calls the “global consciousness.” As a society, we’re building and aggregating knowledge and services that are reflections of large bodies of people rather than individuals – systems that get better the more people use them. Pooled together, this global brain is creating great challenges and opportunities. Information is increasingly available in real time and innovations are increasingly coming from “hackers,” people who leverage open data creatively. These people, in a way, are the world’s (and your companies) R&D department.
Continuing with the thread of global consciousness, UCSD professor and social scientist James Fowler, spoke of his work analyzing social networks. He and Nicholas Christakis have made a splash recently with their book Connected: The Surprising Power of Our Social Networks and How They Shapes Our Lives, which highlights the influence our friends and connections have on even physical traits of ours, such as obesity. James imagines using this knowledge to help target treatments and map the epidemiology of disease. Unexpected relationships will change the way we approach problems. For example, even though men are more likely to drink heavily, this behavior is not principally dictated and influenced by their male friends, but rather their female friends.
So, if as a society we want to curb binge drinking among males, we should craft interventions to address the females. James is also directly involved in massaging Facebook data in a soon-to-be-published randomized controlled trial of social network influence.
Changing tracks a bit, next up we had a five-person panel of pharmaceutical executives talking about the upcoming “Pharmageddon”, and exploring why the pharmaceutical industry as a whole is suffering from pipeline drought and what’s next on the horizon. Some themes emerged in the discussion: the failure rate of pharmaceutical R&D is too high, we’re guessing too much and these guesses are becoming increasingly difficult; there’s a ways to go in basic biological understanding that gives pharma a platform to focus R&D; trials are increasingly difficult and expensive to conduct; and there’s a chance the industry as a whole has simply reached an asymptote and will be shaken up over the next ten years and branch into biotherapeutics, engage in aggressive partnerships with non-pharma medical companies and begin to sell outcomes rather than medications.
After lunch, David Webster, the global lead of IDEO’s Health & Wellness practice joined FutureMed along with IDEO’s Lionel Mohri to deliver a workshop about how the design and innovation firm IDEO helps clients craft products and services that match human needs. They briefly introduced IDEO’s work in health (including Bayer’s USB glucometer) and launched into a workshop to bring us through a compact version of IDEO’s innovation process.
They split people up into small teams and had them go through a rapid-fire design challenge: how might we improve the physical and mental well-being of our workforce?
They dumped a set of materials on stage and pushed us through the IDEO process of empathizing with the user, synthesizing the observations, brainstorming, and prototyping designs. At the end of the session, we shared our concepts through our drawings and physical prototypes.
After IDEO we had a brief talk by Ash Damle, CEO of MedGle. They’re building what they call a collaborative clinical decision making tool for both patients and clinicians. They’re trying to glue together symptoms, demographics, and other inputs to help doctors and patients with differentials and with finding the right information.
After Ash was a sensational talk by Robert Hariri, CEO of Celgene Cellular Therapeutics, an innovator in translating stem cell therapies to patients. They’re using placental derived stem cells as a platform for their therapies for a number of reasons, and are already seeing spectacular results. 
An early application is in Crohn’s disease, a poorly understood immunological gastrointestinal condition that has historically had very few high quality treatment options. Robert’s team has had remarkable clinical trial results using their placental cell platform PDA-001 (all cells are procured through donation) to treat the disease.
He showed us before and after endoscopies of Crohn’s patients and the results were startling – almost a compete remission of the disease. Celgene is currently applying this platform to broad spectrum of human disease such as multiple sclerosis.
Robert proceeded to blow us away even further with their work in organ and tissue engineering. They’re decellularizing organs and using their stem cell technologies to repopulate the left over non-cellular structures (think scaffolding) with new tissue. Celgene completed this successfully by creating a beating mouse heart and are moving into pigs. They’re hoping for a day in which humans could be transplanted with pig hearts, but with the pig cells removed and replaced with human cells.
Lastly, Celgene is using the structural framework of placentas to create sheet collagen that can be used in wound repair. They’re creating patches that are currently being tested in burns and the results are absolutely stunning. They showed pictures of a patient who had extensive burns with one segment of the burn treated with the current standard and the other with their collagen patches, and after a few months to allow the patient’s own skin cells to populate the collagen scaffolding, you couldn’t even tell the difference between the patient’s non-burned skin and their new skin. Further, the moment you put the collagen patch on the skin a patient’s pain is decreased dramatically – a huge victory in it of itself – simply astonishing.
The afternoon consisted of a visit to the Autodesk office and gallery in San Francisco, where they’ve got a smattering of examples of how their computer tools are used to build nearly every type of object from micro-mechanical devices to complete buildings. The office felt more like a chic design firm than a CAD company, and it’s clear that as computers have become the modern day hammer, Autodesk’s tools have immensely impacted humanity at all levels.
At the end of our visit, a speaker from Autodesk gave us a peek into their move into medicine. As biology is becoming increasingly manipulatable, they’re building CAD tools for bioscientists to sculpt and simulate small molecules, DNA, proteins, the works. An early example of what will be capable in the years ahead was from their partnership with the Wyss Institute to create tools that help scientists build DNA Origami, a new field in nano-biology that uses inert DNA and it’s natural properties to create complicated nano-structures. He showed a soon to be published picture of a DNA cargo box that can be triggered to release a payload by a molecular stimulus. For a number of reasons DNA might become exceptionally powerful in nano materials science.
Before we left Autodesk we also had an onsite lecture by Mike West, who floored us with his work reprogramming stem cells. At some point in the differentiation of a cell it goes from being able to replicate forever into anything, to being a certain type of tissue with a defined lifespan. Mike, a luminary in stem cell research has already used stem cells for the first time in history to create cartilage-producing cell lines for orthopedic repair. This alone is a tremendous innovation, but to go from here to a world where we can use our own stem cells to repair our own tissue, we need to go even further, as therapeutic somatic cells like muscle tissue created from stem cells that aren’t autologous (from your own body) would cause immunological problems.
Early stem cell work focused on using embryonic cells for the reason that they could be programmed and manipulated into certain cell types that might be therapeutic. But what if we could turn back the clock and go from say, a skin cell, which has already been given it’s instructional fate, re-boot it, and turn it back into a cell that’s more or less brand new and can become anything? A cell from your liver, for example, could be rebooted and turned into a muscle cell for your heart. Well, Mike & team have done this, reversing somatic cells into induced pluripotent stem cells (iPS). It’s truly spectacular work and leads to a future where you might be able to use a sample of your skin cells to repair your kidney.
After Autodesk, FutureMed organized some social time in San Francisco, which your editor skipped to grab some much needed sleep. Today we’ve got more on regenerative medicine, neuromedicine, and an offsite to go play with Intuitive Surgical’s daVinci robot.
