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TEDMED Day 2 – Glow in the Dark Tumors that Blind Rats Can Now See

October 27th, 2011 Sean Duffy Exclusive

We’ve just wrapped up day two at TEDMED, retiring to our rooms after a beach clambake at the beautiful Hotel Del Coronado. After a bit of a slow start in the morning sessions, things picked up to make a great day of talks, filled with medical innovation, performances, and more. In addition to this summary of the day’s events, stay tuned for a set of interviews with companies from the TEDMED innovation showcase, among others.

Song-a-day writer Jonathan Mann (of iPhone Antenna Song notoriety) kicked-off today with a song introducing TEDMED and getting the audience ready for a rapid fire talk by Daniel Kraft, chair of Singularity University’s FutureMed (a spectacular program that we’ve also covered). For those of you who don’t know Daniel, you can think of him as medical trendspotter extraordinaire, and he took us on a tour of the advances in technology and health as he sees them from his purview at Singularity University. Most of the innovations he discussed we’ve covered on Medgadget, so we’ll hold off from going into too much detail (or check out his TED talk here), but notably Daniel spoke about how when he finished his training at Massachusetts General Hospital 15 years ago the hospital still functioned, from an delivery standpoint, in about the same way as it does today, with speciality silos, defined training hierarchy, etc.

After Daniel, Catherine Mohr from Intuitive Surgical gave a talk on the future of surgery. The key take away for those of you interested in Intuitive’s progress is that lung cancer surgery is one of the fastest growing procedures for their da Vinci robot. We didn’t get a perfectly clear opinion from Catherine on where surgery is headed, but she did hint that years from now the best surgery might not be surgery at all, but rather the prevention of the need for surgery.

Next up was Pacific Bioscience’s resident genius Eric Schadt. At FutureMed Eric blew us away and his talk at TEDMED was a shorter version of his talk there. In summary, as the world of sciences advances, we’re gaining an increased understanding at how the individual pieces function, like for example, an enzyme in a biochemical pathway, but we’re still in the early days of sorting through how the systems of these individual pieces work together inside the body. It is all too easy for us in the medical community to create a story that feels solid and linear – enzyme A acts on enzyme B, which leads to event C, etc – but the reality is that these pieces are intertwined into networks that are frankly, of a size that are incomprehensible without modeling. Eric and his team are working to understand how various networks operate and interact both on an individual level and a meta level through math. By building computer models of these networks, they can take a guess at exactly how, for example, up-regulating one protein might affect the system as a whole, and then use these guesses to make bets on which levers they should pull through medicine to get the desired effect in the biochemical network. It is a fascinating approach that we imagine we’ll be seeing a lot of in the years ahead by Eric and others to help craft both understanding of biological systems and therapies for defects.

The world of aging as it relates to DNA was on display next by Calvin Harley and Elissa Epel. Due to problems involved in replicating the very ends of DNA strands, your body essentially snips off a little piece every time a cell divides. These end regions of chromosomes are called telomeres, and their length correlates to the biological age of the cell. Once the telomeres are too short, the cell essentially calls it quits and the cell line dies, for good. There are ways to measure telomere length and Calvin provocatively noted that short telomere length may be the single best marker of our overall disease risk. His colleague Elissa also showed how chronic stress and its physiological effects has a measurable impact on the length of telomeres. Their lab was even able to show that people who’s minds wander more (a likely symptom of stress) have shorter telomere length.

The always engaging Peter Diamandis, chairman of the X-Prize Foundation and Co-Founder of Singularity University, was up next to talk about how the rise of technological power and accessibility (both in computing and biology) like never seen before is empowering a whole new class of innovators. Previously, when the equipment to, say, print in 3D was expensive, the derivative innovations from the technology were constrained to the prestigious folks lucky enough to have access to such tools. Now that these tools and equipment are getting cheaper, the number of individuals who are able to utilize them to invent dramatically grows and society benefits as a result. In many ways his model for the X-Prize foundation relies on this foundational belief – that given a focused, specific task along with the allure of a pot at the end of a rainbow, the global community can achieve amazing things. His foundation, for example, recently ran a contest for oil cleanup technologies. In less than six months the winning team quadrupled the absorption capability of existing best-in-industry tools.

After an hour-long break which your editors spent touring the innovation room, interviewing various technologists, and dosing up on coffee, we were led into the next session of talks, the most notable of which were Cheryl Pegus, Chief Medical Officer at Walgreens and designer and architect Michael Graves. Cheryl talked about the new role of the pharmacy to help manage care and provide health care services. Walgreens has 8,000 stores and they’re increasingly looking to use them for medical service delivery, of sorts. At the end of the talk someone asked why Walgreens didn’t have the equivalent of Apple’s genius bar, but for health, and Cheryl replied that they’re prototyping and expanding upon just that.

Following Cheryl, renowned architect and designer Michael Graves spoke about his quest to reinvent hospital architecture and furniture design. After a tragic infection left Michael paralyzed from the waste down in 2003, he quickly realized how horrible prototypical designs for hospital rooms and furniture really are. During his recovery at a rehab clinic, he found that he couldn’t reach the sink, the outlets, that the layout of the room didn’t make sense, and that the furniture tools such as in-room chairs and bedside tables weren’t even close to meeting the needs of their intended audience. He embarked on a quest to re-think hospital gear and started with both a beside table and chair. Take a look at the results here. His line of hospital furniture is (in his words) “selling like hotcakes,” so he thinks he’s done the job well. We agree.

Lunch was up next on the hotel’s lawn and we had a great conversation with a medical device CEO about his company’s growth and the struggles they are facing pushing their technology through the FDA. In what is clearly a sad state of affairs for our nation, a running theme from the medical technology entrepreneurs at TEDMED seems to be that their regulatory strategy is generally prompting them to get approval and sales first in the European market and then bringing the technologies to the US some years after.

Perhaps fitting after a lunchtime talk on the FDA, government officials Aneesh Chopra (CTO of the USA) and Farzad Mostashari (National Coordinator for Health IT) gave a presentation that felt more like a theatrical performance than a lecture. These two, along with Todd Park (CTO of HHS) are clearly moving the health innovation agenda forward, with meaningful use EHR adoption increasing dramatically, new models of payment and reimbursement being tested and approved, and opening health care data to both patients and innovators. Though our fragmented and largely fee-for-service health care system needs a gigantic makeover, you really get the sense that HHS is giving it their all and empowering others to help too. Now if they could only work on the FDA.

Legendary technologist Tim O’Reilly spoke next on a number of advances, but perhaps most insightful was his notion that any time a technology space is about to get interesting, the hackers show up… the people that tinker with the fundamentals simply for fun just as the early computer programmers were hobbyists.

Through his involvement in Maker Faire and events like it, he is witness a tremendous surge in health hackers, which is to him an increasing sign that the world of medicine is getting more interesting.

Bill Doyle from Novocure, a company we’ve followed for a long time here at Medgadget, followed Tim with a talk on his company’s novel cancer technology that stops cell duplication simply through electric fields. Every time a cell divides it builds what amounts to little strings (mitotic spindles) that tug on the chromosomes in order to pull them apart for duplication. The components that make up these strings happen to be slightly charged, which makes them prone to disruption by a specifically tuned electric field. Bill’s company is built off the discovery that if they put cells into these fields, they not only can’t divide, but upon trying commit cell suicide. Their first product for the aggressive brain cancer glioblastoma multiforme was recently given FDA approval. Patients using Novocure’s technology affix small, non-invasive patches to their head and wear them and the electric field generator 24×7, which of course sounds difficult but there are essentially no side effects to the device. It matched the effectiveness of chemotherapy in their trial for glioblastoma recurrence. They are targeting lung cancer next and will move on to other solid tumor cancers from there. It is a remarkable technology which, if it lives up to its promise, could significantly shift the treatment paradigm for certain cancers.

A short discussion between Lance Armstrong and David Agus proceeded the next break, with David asking Lance largely about his journey through testicular cancer and the story behind Livestrong. Lance had just gotten off of plane from Hawaii where he just finished up a triathlon.

After the break, we had an exceptionally interesting talk by surgeon Quyen Nguyen. She and her lab team have created a molecule that has the ability to selectively fluoresce tissues during surgery (including cancers), which essentially lights them up for the operating surgeon. They’ve taken a fluorescent molecule, attached it to another that’s particularly sticky to all tissues, and then linked that to yet another that prevents the stickiness of the first. They can customize the link between the sticky and non-sticky molecules so that when the compound hits a particular type of tissue, like a tumor, the enzymes in that tissue cut the link, allowing the molecule to latch on to the cell. When you shine a special light at this tissue, it glows. This has the potential to allow surgeons to more precisely remove cancerous lesions as well as better identify where exactly the cancer has spread. In a running theme of TEDMED, Quyen talked about the incredible regulatory difficulties her and her team are going to face in order to bring their technology to market.

Magician Eric Mead then gave us a small performance and then in what seemed to be substantially more magical, Sheila Nirenberg from Cornell’s biophysics group told us about her lab’s success allowing blind mice to essentially see again. In deteriorative vision disorders such as macular degeneration, the retina fails but still leaves the connector that sends the signal to the brain. Theoretically, if you could reproduce the signal being sent to the connector, the brain wouldn’t know much of a difference and the person would be able to see. Granted, there are tremendous difficulties in doing this, but Sheila’s lab has taken an amazing step in mice. She has used mathematics to model the natural encoding of the retina and has achieved wonderful results. Read more here. It is quite staggering.

The day closed with a talk by Diana Nyad, who, in an extraordinary test of human endurance, attempted to swim 103 miles from Cuba to Florida. On the way, however, she got stung by a Box Jellyfish, one of the most venomous creatures in the sea, and somehow swam through it with the help of epinephrine and steroid injections… that is until she got stung again the next day, stopping her attempt. Diana recounted the story of her dream and promised the audience that she’s not done – she’s going to try it again.

To finish off the night, we had a wonderful beach clambake where we met, among others, the founder of Kairos Labs, creator of habit-forming helper Livn.it. They’ve got a talented team of people working on how to use smart psychology and game dynamics to help people form better and lasting behaviors.

That’s all for today, we’ll see you tomorrow!

Sean Duffy

Sean is the Co-Founder and CEO of Omada Health, (http://omadahealth.com), a Silicon Valley startup that aims brings thoughtful and engaging products to disease prevention and health promotion. Prior to Omada Health, Sean was enrolled in Harvard’s joint MD/MBA program, and previously worked in IDEO’s Health & Wellness group driving innovative work for providers, health technology companies, and employers. Sean also spent two years at Google, served as an editor at Medgadget.com, and was recently named as one of the "40 Under 40" top medtech innovators by MDDI. He received his BS from Columbia University.

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