Day two of FutureMed was just about as dense (8am – 10pm) as day one, with the morning dedicated to the future of personalized medicine, the afternoon to a visit to Kaiser’s Garfield Innovation Center, and then the post-dinner lectures on integrative medicine. On the whole it was a wonderfully inspiring day full of mind-blowing medical advances.
Ben Rosner, the medical director of Archimedes, Inc. introduced the personal medicine track with an overview of the need to personalize medical guidelines to the particular patient and the role that inputs from the “omics” (genomics, proteomics, etc) will play in medicine’s transformation from bucket recommendations to mathematically validated personalized recommendations. Personalized medicine, he noted, got a lot of hype 10 years ago and has still yet to pan out, but his talk and the talks following made it clear that the concept of personalized medicine is at an inflection point of clinical utility and is already shaking up cancer treatment, with other arenas to follow.
Next up we heard from David Ewing Duncan, author and journalist behind the Experimental Man Project, who has subjected himself to just about as many personalized medicine tests as humanly possible and, through doing so, discovered the limitations in the field as well as some of the promises. This is a man who probably knows more about his innards than anyone else on the planet.
Ted Goldstein, Apple computer scientist turned UC Santa Cruz bioinformatician, stepped on stage next to describe his efforts in decoding and making sense of cancer genomes. He and the UCSC team have developed an open cancer genomics browser to help catalyze research in this space. His talk, along with others, left us with the sense that using genomics to provide personalized treatment of cancers is simply exploding. Given that each tumor has diverse, ever-changing, and increasingly actionable genetic profiles, it seems clear that in years ahead clinicians will sequence all tumors and develop customized treatment plan for the specifics of the found genetic mutations. It’s going to flip cancer treatment on it’s head – it’ll matter much less if the cancer is a “lung,” “breast,” or “liver” cancer and much more if it’s an “KIF3A,” “MDM2,” or “MELK” cancer.
Next up was Nader Pourmand, another UC Santa Cruz innovator who gave an absolutely whirlwind talk about his work with nanopipettes. He and his team are currently using 50nm pipettes to interact with, monitor, and manipulate single cells. Their first order of business is injection. They’re able to precisely inject small molecules, RNA, you name it, into a single cell. This allows direct, real time, perturbation of cellular status in a way not previously possible. Not only that, they’re able to observe the activity in cells by attaching DNA aptamers to the end of their pipette tips. For those unfamiliar, DNA aptamers are little strands of DNA that researchers can, more or less, make to be sticky to a molecule / protein of their choice (think antibodies but more selectively binding). Because the binding of a target compound to an aptamer is detectible as an electrical signal in the pipette, and because an increased concentration of target molecules means more binding events, Nader and team are able to determine the real-time concentration of, more or less, whatever they’d like inside a cell. It’s a fascinating tool.
After Nader was another fascinating talk by Eric Schadt, chief scientific officer at Pacific Biosciences. Eric was recently profiled in the NYTimes and Esquire, and there’s good reason for it. Firstly, he and the folks at Pacific Biosciences have developed an incredibly fast sequencing technology by rigging the proteins that synthesize DNA (DNA polymerases) in a way that allows for direct observation of specially tagged nucleotides as they’re incorporated into a growing DNA strand. By observing this, they’re able to sequence DNA in a way that’s as fast as nature is able to build it – extremely fast – and with minimal prep and no amplification needed (PCR). This technology scales so well that it might allow a sort of molecular-epidemiology, where the sewage of an entire city is rapidly analyzed to look for the DNA of various pathogens, etc. In the recent cholera outbreak in Haiti, he and his team were able to sequence the bug, determine useful information about it, and publish in NEJM, all in 4 weeks.
But the sequencing technology is step one… it’s how Eric and team are using the output of this sequencing where things get really interesting. Eric is taking a network approach to genomics rather than looking at specific genes one at a time. With mathematics that are far beyond your editor’s understanding, he’s building what amounts to social nodes of genes and looking at patterns of how they interact. This is leading him to some interesting conclusions about how genomics might be used clinically. There might, for instance, be an entire node of 1,000 genes that relate directly to certain pathology and, in order to treat that pathology, we might have to intervene in the whole node. This work goes completely against the traditional, “every gene is important, alone” approach and is already starting to yield some fascinating results in areas such as the genetic contributors for type II diabetes.
Esther Dyson, entrepreneur and investor, and Carol McCall, health economist, came up next to talk largely about behavior change as it applies to health care. After discussing a number of approaches, including gamification, incentives, etc., Esther made an extremely apt comment that next year she’d like to see some HR benefit folks in the audience of FutureMed. There’s a large push in the employer benefits world to engage with employee health in new ways. Companies larger than 300 people are generally self-insured, and so they’re paying mostly out of pocket for their health care costs. New solutions and systems to engage employees with their health are popping up, and employers are becoming increasingly interested in trying novel solutions. Carol gave a relatively optimistic view of reimbursement for wellness programs by noting that “there are ways for these things to pay for themselves.”
The next to talks, by Peter Alperin and Randy Scott, told of their companies active efforts to commercialize some of the oft discussed personalized medicine advances.
Peter, from Archimedes, a company whose tagline is “moving medicine through mathematics” spoke next about their personal risk assessment tool called IndiGO. Their software creates individualized guidelines for care according to a person’s characteristics, risk factors, and current treatments. Their vision is to plug this into an informative, graphical user interface and get it in front of physicians at the point of treatment.
Randy, from Genomic Health, spent his time talking principally about two things: the shift from therapeutics to diagnostics, and his company’s moves in commercializing Oncotype Dx, a genetic test for breast cancer that is dramatically changing the standards of care. He noted that 2% of medical spending is currently in diagnostics, and that the paradigm of finding companion diagnostics to match therapeutics will likely flip to finding companion therapeutics to match diagnostics. His company’s test, Oncotype Dx, gives a single number score that helps clinicians decide if chemotherapy is efficacious for breast cancer patients. The test, according to Randy, was harder to market than develop, but it’s clear benefit and use case is catching on: it’s now used in about 50% of early stage ER+ cancer cases. In large part due to his test, there’s been a 30% decline in chemotherapy use in these types of cancers.
After the morning of talks, we then boarded a bus to head over to the Kaiser Permanente Garfield Innovation center for an afternoon lecture and tour. Only four years old, the center is a playground for physicians, nurses, and patients to innovate process improvements, space improvements, and think deeply about how new systems and technologies can better care. They’ve mocked up their various patient rooms in full, and have tested out a slew of innovations ranging from innovative room layouts, the types of tiles used in the bathrooms, to Doppler based breathing monitors.
Kaiser folks talked a little bit about the innovation processes at Kaiser and walked us through their various environments to show some of the technologies they’re testing. For example, at one point during the tour they summoned a hospital transport robot called the Aethon that politely asked folks to move out of the way until it reached its destination.
In the labor and delivery room, they’ve got lights embedded into the ceiling that can be angled and adjusted automatically through a wand. They’ve also mocked up a full digital operating room and are experimenting with Microsoft Kinect hacks that allow surgeons to explore radiology data without breaking the sterile field. They’re also working with new, boom based systems to hold equipment and reduce the number of cables in the OR.
We got the feeling after leaving the Garfield center that there’s virtually no technology they haven’t tried and they’re working hard to think broadly about how these new gadgets and process innovations fit into the lives of the clinical staff and patients.
After the tour of Garfield, we had a miniature break and then immediately jumped into dinner followed by talks from Dean Ornish, head of the Preventive Medicine Research Institute and Woody Merrell, the director of the Integrative Medicine center at Beth Israel, the nation’s largest and most comprehensive.
Dean spoke of the incredible, proven benefit of lifestyle intervention on human health and his efforts over the last 30 years to bring these sorts of interventions to patients. In a victory that took 17 long years of fighting, Medicare recently approved payment for his program last January. He thinks that the message of the clinical and cost saving benefits of these programs is finally hitting clinicians, payers, and politicians, and he’s is hoping that we’ll see a huge shift toward greater support of these interventions in the health care community.
Woody closed the night with a look into integrative medicine, defined broadly as the fusion between Western medicine and alternative traditions. He’s a long time advocate for such approaches and is convinced that things like acupuncture and Reiki will and should be applied more broadly in today’s healthcare. The birth of his center at Beth Israel was part catalyzed by the realization that patients are themselves turning to these therapies in large numbers and they need to be incorporated into treatment regimens for patients that find them helpful.
The night finished at 10pm. Tomorrow we kick things off at 8:30am with entrepreneurship & innovation, the future of pharma, a workshop from IDEO, and a visit to Autodesk in San Francisco. Stay with us for three more days of exclusive Futuremed coverage…