Yesterday at FutureMed we finished another exceptional 14 hours of medicine, complete with regenerative biology, cutting edge neuroscience, a trip to go play with da Vinci surgical robots and a paranoia-inducing talk on how the future of synthetic biology will present tremendous challenges and opportunities for the world ahead.
The day started with FutureMed chair Daniel Kraft giving us a summary of the happenings in regenerative medicine and how the field has traveled on Gartner’s hype curve, and is now beginning to produce some large advances. Yesterday we covered two examples of how the field is maturing through the work of luminaries Robert Hariri and Mike West, who are both taking different but complementary approaches to stem cell therapies. Daniel, a pioneering stem cell researcher himself, noted that bone marrow is a rich source of adult stem cells. His work using these cells for regenerative medicine led him to the creation of a harvesting device called the MarrowMiner, which, using a flexible catheter, harvests bone marrow through one hole instead of many, and delivers 10x the number of stem cells. It’s a wonderful tool both in efficiency as well as patient experience (minimal discomfort) relative to the previous methods. MarrowMiner 2, an iteration off the first device, is entering commercialization soon and it’s sure to make both stem cell acquisition and bone marrow donation a better process.
Peter Altman from BioCardia took the stage next. He first discussed the insight that medication delivery is shifting from systemic (whole body either through pill or vein) to targeted (through local injection or molecular targeting). Local delivery of a medication is nothing new. In fact, pacemakers have long had a steroid on the tip of the pacing lead to reduce the extent of fibrosis over the tip. Yet, the concept is starting to pick up more steam as therapies such as stem cell based regeneration of cardiac tissue are being used more broadly. His company has a unique delivery technology for the heart called Helix that is essentially a spiral needle that an interventional cardiologist can use to directly inject into the muscle of the heart. This was previously quite difficult because jabbing a straight needle into the wall of a beating heart is quite difficult thanks to, well, the fact that the heart is beating. By creating a helical needle, BioCardia is enabling physicians to get around this since it can be screwed into the wall of the heart prior to injection.
The next block of FutureMed centered on patient engagement. Lucien Engelen, from the Radboud REshape & Innovation Center in the Netherlands, shared his opinion that largely due to advances in computing systems medicine is finally at a place where it can really listen to the needs of the patient to become more patient centered. He thinks we’ve not, as a field, done even close to an adequate job building the tools and systems for patients to understand their own health, interact with the complicated medical system, and share advice with each other. To this aim, he and his team have launched a few projects, one being a crowd sourced mapping of automatic external defibrillators, and the other a new video conferencing system that makes engaging with a patient over video not only easier and more secure, but more customized to medicine, including features such as the ability to record a conversation with your doctor for later playback.
Echoing similar sentiments, next up we had Dave deBronkart, also known as e-Patient Dave, who told his remarkable story of how he went from working in software to being a patient advocate and a representative of the “patient of the future.” Receiving an X-ray for a possible shoulder injury, Dave and his doctor discovered a large cancer metastasis in his lung. Further exploration showed that the cancer originated in his kidney and had spread to other organs even beyond the lung. Dave had in large part accepted his mortality but kept exploring his options. In a twist of fate, Dave found a kidney cancer patient community that pointed him to a new therapy IL-2. This ended up saving his life. Dave, rightfully asked why the best possible information didn’t exist in traditional channels and wondered how many patients were missing things that their doctors could not possible keep up on. From that moment on he became an advocate for the development of better patient-focused health policies, systems, and tools, and has developed an avid Twitter following as @epatientdave.
Dave noted that even relinquishing control of the medical record into the hands of the patient can have an impact and that current efforts like Microsoft Health Vault and Google Health aren’t cutting it in terms of porting health data into a place and format where it’s useful for the patient. He highlighted a recent effort by the VA to allow patients to download their data in raw form. At first this made the hospital network extremely uncomfortable. Questions popped up such as what patients would do with their data and if it was irresponsible to allow the download of data in raw form without a user interface. Thankfully, the VA decided to stomach their concerns and create a big blue button that provided an easy raw download. The effort has been incredibly popular and hundreds of thousands of patients have gotten hold of their medical data.
After Dave, Christopher DeCharms from Omneuron kicked off the neuroscience track of FutureMed. Some recent developments in neuroscience have shaken up the field. For example, his company is helping back pain patients by putting them under real-time fMRI, exploring which areas of the brain light up in response to pain, and teaching the patients to control that area (see Nature News). In other areas he notes developments in deep brain stimulation, allowing for both the dramatic improvement of motor disorders as well as the ability to use electrodes to control brain and computer interfaces. He also cited an amazing study out of Japan where scientists showed patients certain contrast patterns such as a plus sign or the letter ‘n’ and using fMRI, reconstructed these patterns simply from the brain data.
Philip Low was up next, neuroscience’s latest darling and founder of NeuroVigil, a company that, according to Philip, just landed one of the highest pre-money seed valuations in history. Before getting into his own technology he did a brief survey of advances in neuroscience. First, he spoke about optogenetics, the fast advancing technique in neuroscience of using light to switch neurons on and off. At a high level, the firing of neurons depends on a precise orchestra of ions flowing in and out of channels in the walls of the neurons. A new type of ion channel that can be opened through light stimulation was discovered and this enabled the field of optogenetics. By inserting a gene for this new type of channel, scientists are able to disrupt the normal firing of a neuron by shining light on it in the brain. Since researchers are able to precisely target which types of neural cells are given this gene (through viral vectors), they’re able to shut off exactly what type of neurons they’re interested in studying. Quite literally, by shining light at the brain, you’re able to shut off any part of the brain you’d like.
The research has dramatic clinical and research potential. Philip also talked about new efforts to categorize and organize neurons by studying their synaptic organization. He showed a 3D model of a dendritic tree, which represented one of the most advanced recent efforts to tease out the structure and organization of individual neurons in order to better learn how they work together.
Philip then dove into his own revolutionary work. First, he was able to use complex mathematics to get the same quality EEG data from one lead that previously required dozens of them. Then he used that data to discover a brand new sleep stage that turned out to be hidden inside of REM sleep. Following up further, he was able to identify that this stage is actually genetically directed (identical twins have the same patterns), and finally, he realized that an incredible amount of clinically valuable data exists in frequency ranges previously ignored by sleep scientists. He noted that this work has immediate clinical application because sleep disorders are powerfully correlated with mental illness and neuropathological disorders such as Alzheimer’s. In fact, in Alzhemier’s patients, sleep disorders are often the first reason they are admitted to the hospital. His technologies, able to detect incredibly subtle variations and abnormalities in brain activity during sleep, might soon be able to diagnose Alzhemier’s and mental illnesses like depression and schizophrenia. To this aim his company NeuroVigil is building the largest collection of brain EEG data on earth, and as more data gets added, analysis becomes even more powerful. As NeuroVigil runs clinical trials for its diagnostic potential, it’s immediately useful as a worn-at-home replacement for sleep studies and a monitor for adverse neurological events during medication clinical trials. We’ve interviewed Philip before and it’s wonderful to watch how quickly this dazzling technology is rumbling the foundations of neurosciences. Kudos Philip.
After lunch we had Ryan Howard, CEO of Practice Fusion, give us a tour of how his company’s completely free, cloud based, electronic health record system fits into what he called the current “industrial revolutions for EHRs.” We’ve covered Practice Fusion extensively on Medgadget and they’re really starting to take off. Their target market is not inpatient hospitals, but rather private practice medical centers that would benefit from EHR but might not be able to afford the slew of equipment and software licenses that accompany running a non-cloud based traditional EHR. Even today they’ve got the biggest collection of health record data (by patients) in the US, topping even the VA and Kaiser. They’re also trying to catalyze innovation in the developer community and recently launched a challenge called Analyze This! in which they took a dataset representing the medical records of 15,000 patients, made it anonymous following HIPPA standards, and released it to the developer community for hacking. This has already resulted in innovative applications such as QuaMe, which allows a patient to compare his or her own medical data with others of similar demographic and medical characteristics. The data is available here for those who want to join in on the fun.
Changing topics, up next was Raymond McCauley, CSO of Genomera, a recently launched company that’s building a platform for people to conduct, what amounts to, their own clinical studies. Individuals on the platform can sign up for or create a particular study of interest and then build, using the company’s API measurement instruments that serve as data inputs to the trial. These instruments might either consist of simple text field entries or more behaviorally based interactive tests. In addition to discussing Genomera, Raymond highlighted some trends in genetics that include the ongoing speedy reduction in the price of sequencing and how it’s leading to research centers like the Beijing Genomics Institute (BGI), which are tying to sequence a vast array of life forms.
After Raymond was a provocative talk by Andrew Hessel about the state of synthetic biology. He began by noting that at a high level DNA has become a programming language. In order for this analogy to work, we’d need to master reading, comprehension, and writing of DNA, and we’re just entering a time when all of these elements are coming together. It’s cheaper than ever to sequence (read) DNA, we’ve got a growing comprehension of function, and the synthesis (writing) of DNA is now available even to the hobbyist. There are software tools to design DNA and printers that can print it. Events like MIT’s iGEM (International Genetically Engineered Machine), a genetic engineering contest aimed at undergraduates, are catalyzing scientific enthusiasm among the new programmers of biology, students who will soon become adept at sculpting genes for purposes of their own.
In the world of synthetic biology, yeast will be the new platform and new strains of organisms will be crafted using building blocks of code. We’ll likely see start-up biotech companies tomorrow that look like today’s software companies, and that will produce equally incredible innovations ranging from oil eating bacteria to drug synthesis.
It seems clear that this level of gene programming is almost certainly to yield new organisms and life forms previously unknown to man. In the next 100 years we’ll in all likelihood, literally build a new world – it’s a strange and paranoia-inducing reality. Outside of ethical concerns, there’s real potential, as the devices to create DNA become increasingly distributed, or “desktop,” for individuals to maliciously craft viruses and other pathogens. Given how inexpensive this technology will be, and that there are few if any material constraints on synthesizing DNA, this will be more or less unstoppable. Though Andrew shares these concerns, he’s optimistic and thinks the ways to address this is through transparency, open-source platforms, and careful checks and balances like using watermarked printing or implementing security standards for all DNA printers.
Next we travelled over to Intuitive Surgical to learn more about and play with their da Vinci robots. Catherine Mohr, director of medical research for Intuitive, told us a bit about the company and their devices. We’ve covered da Vinci extensively on Medgadget so we’ll refrain from too much detail, but some new insights we gained from Catherine were that the foundational intention behind Intuitive Surgical was to take fields that were not using minimally invasive surgery and enable them to become so using their robot. In other words, if a certain specialty was only doing 15% of their surgeries laparoscopically, their goal was to bring that to 100%. Also, interesting enough, though Intuitive is known for prostatectomies, their first intended use case was actually in cardiology. Them landing on urology was more or less accidental – surgeons just found the tools most useful. Catherine says that they “took aim at the heart and ended up hitting the crotch.”
After the overview of the technology, we were ushered over to the da Vinci showroom to play with their robots. They had six machines set up for us and with no training, they let us sit down and figure out how to work them. It was, shall we say, intuitive. Once you’ve got your fingers in the little Velcro holders, it’s immediately possible to manipulate the clips, grab objects (in this case little rubber bands), and use both of your new stable and precise robot hands effortlessly.
After Intuitive we went back to NASA Ames where we had a banquet complete with wine, music, a magic show, and a graduation ceremony in which all participants got Singularity University FutureMed diplomas. Tomorrow is the last day of FutureMed and it’ll be a partial day, ending after lunch, with talks covering global health and the hospital of the future.