After Day 2 we could not wait to get back to Singularity University for Day 3 of FutureMed. Unfortunately, the traffic in the valley wasn’t sympathetic so we missed the first speaker of the day, author David Ewing Duncan, but fortunately were able to catch the second speaker, Chief Science Officer of Genomera, Raymond McCauley. 
McCauley gave an eye-opening overview to the current state of genomics. He made a series of predictions, including a wild one that the cost of sequencing our genome will be 1 penny by 2020. As we discussed on Day 1, exponential growth (“the law of accelerating returns”) is characterized by demonetization and democratization. McCauley spoke of both and introduced the concept of “garage, DIY biotechnology,” that Medgadget has covered before, with innovations such as the Open PCR. He posed the question, “How do you react to a future in which tools previously restricted to dozens of labs are now in the hands of thousands and eventually millions of people?,” and gave the example of “BioCurious” which is an educational and maker space for biotech.
The next speaker, Andrew Hessel, echoed this shift we’re seeing towards DIY biotech by providing examples such as the iGEM competition (where one student team designed caffeine-infused beer, which depending on where you’re coming from either sounds like the best idea you’ve heard, or the worst). On a larger scale, however, he pointed out that there is competition in the space and it’s not necessarily in the form of garage entrepreneurs. The Beijing Genomics Institute (BGI), he said, moved to the manufacturing area of Shenzen and basically brought manufacturing techniques to genomics. Its one massive building does more sequencing than all the labs in the US combined. There are thousands of cubicles with low-paid ($400/month) bioinformaticians chugging away to make sense of the data. That’s scary to the US, but hopefully a good thing for the planet if it accelerates our understanding of our code. Hessel concluded with the observation that biology is to the 21st century what information technology was to the 20th, and he shared the following memorable analogy in reference to how we can “hack” our genomes:
If cells are like cell phones and if genomes are like operating systems, viruses are the apps.
Next up was UCSF professor Elissa Epel, who gave an intriguing talk on telomeres and aging. Research shows that negative lifestyle behaviors and conditions (i.e. smoking, obesity, trauma, stress sensitivity) lead to measurably shorter telomeres. It’s now possible to measure someone’s telomere length through a blood test (TeloTest) and there are plans for a large exploratory study that aims to map the population statistics of telomere length: perhaps in the not-too-distant future your telomere length will be compared to population averages for your age group, just as we do with height and other measurements. Better still would be improved accessibility and lower cost of TeloTest so that one’s values can be compared to the baseline (better to compare A and A than it is to compare A and B).
Epel was followed by professor Atul Butte, who runs a prolific lab at Stanford and whom we first heard speak at TEDMED 2012. He wrapped up the personalized medicine session with an energetic and entertaining talk about the immense possibilities of how we do biotech research.
As with his TEDMED talk he discussed how the “data explosion” may be obviating the scientific method: instead of designing experiments to collect data, many scientists can now simply analyze the vast amounts of existing data since journals and funding sources have made it a requirement for labs to post their data in central repositories. Butte quipped:
A 15-year old kid can go online and use PubMed to find over 30,000 microarray samples of breast cancer as easily as they can go to iTunes to download a song.
Together with the emergence of labs-for-hire that contract out experiments, this data accessibility is enabling and accelerating research. Butte contends, seriously, that “the next Genentech may start in your garage!” As we develop a better understanding of how our genomes predispose us to certain diseases, Butte argues that the future of genetics is in the environment – that the “environment is the new prescription pad and people will ask the question, ‘What can I do to compensate for my genome?'” But to get there we need better insights on the data we have, which Butte believes is the rate-limiting step because graduate students are taught to collect their own data and not trust outside sources. To this, an audience member posed the question about how future physicians should be trained differently and Butte responded that they will certainly need new skills and tools, but we should also remember that current physicians will require better continuing medical education (CME) to keep up to date on this exponential growth that will soon make its way from the bench (or keyboard) to the bedside.
The final speaker of the morning was Biogen Idec’s VP of translational neurology, Ajay Verma. Verma provided a great overview of neurodegenerative disease and potential molecular, cellular, and device-based therapies. An interesting take-away was that researchers are looking at centenarians and other healthy elderly and cloning their B cells which produce antibodies against molecules associated with neurodegeneration (e.g. amyloid/tau tangles, Lewy bodies) as potential neuroimmune therapy for others who may develop these diseases.
Following a lunch break with more time for demos, Intuitive Surgical’s Director of Medical Research, Catherine Mohr, took the stage. The title of her talk was “How should we build robots for the future of medicine?” She began by providing an overview of the history and current state of surgical robots, including the statistic that there are at least 25 companies actively developing these tools. She then flashed a picture of rusted knives and scalpels that were used in surgeries in Pompeii, and lamented that the field of surgery actually had not changed that much in thousands of years. 
Even robotic technology as advanced as the da Vinci system will not significantly help a patient diagnosed with stage 4 lung cancer. Better would be the ability to detect and prevent the formation of these tumors; with this statement she flashed a picture of a dog’s nose on the screen because some dogs are actually able to “smell” cancer biomarkers that we may not have even identified. We appreciated Mohr’s insights and honesty because, as Harvard Business School’s Clay Christensen writes in The Innovator’s Dilemma, it’s important for leading companies to be their own disruptors. Mohr ended with a hat tip to FutureMed:
The disruptions from surgery are not going to come from surgery, but from outside. When you’re thinking about exponentiality, you need to be able to imagine that your field will be disrupted by your neighbor. One of the most exciting things about FutureMed is that we get to see what the person next to us is doing.
Next up was Peter Fitzgerald, the Director of the Center for Cardiovascular Technology at Stanford. There are not many people with as impressive credentials in terms of developing and commercializing medical devices. He provided his thoughts on the “trillion dollar disruption” coming in healthcare, defined by (1) patient-centric care, not provider-based, (2) consumer engagement, and (3) the science of prevention. He urged the participants to “not only be focused on the US” because there are many other countries vying for that top spot in biotechnology, which almost certainly guarantees economic success in the 21st century. Wrapping up the session on the future of the intervention was our very own Medgadget editor and co-founder of Omada Health, Sean Duffy, who demoed their newly released “Prevent” program.
After another break for demos, we returned to hear DARPA’s Jay Schnitzer talk about cool medical innovations being funded by or developed at his agency. These include a novel wound stasis system (WSS), the ability to detect impending sickness days before symptoms appear, and a new imaging technique called quantum orbital resonance spectroscopy. He ended with the prophetic statement:
The global leader in biomedical research in the 21st century will be the global economic leader.
The final session featured talks by two health design gurus, Massive Health’s (now Jawbone’s) Aza Raskin and IDEO’s David Webster. Practicing what they preach, they both gave aesthetically beautiful presentations. Raskin focused on how design could be used to address behavior change such as eating less and losing weight. He provided examples from his own work at Massive, such as “The Eatery” experiment that was akin to Instagram-meets-myFitnessPal. Webster’s talk featured dozens of examples of how design was leveraged in interesting ways to change how people perceive and interact with the world around them. Many of these involved health and wellness applications as well as medical technologies, such as SNP-based music creation, homes for wounded veterans, and public health campaigns such as bedsider.org.
Patent attorney Nick Soloway was the final speaker of Day 3. Though legal stuff is not as exciting as 3D printing and surgical robots, Soloway did a good job of getting the audience interested in important issues related to their intellectual property. One of the main take-aways: “File early, file often.” The last event of Day 3 was the so-called “Unconference,” through which participants themselves were able to give 15-minute speeches about their experiences and interests. Most of these became pitches about their own start-ups, some of which were pretty intriguing. The major benefit was it allowed participants to learn from each other and, as Catherine Mohr said, imagine how our fields may be disrupted by our neighbors.
We also got a chance to ask Dr. Daniel Kraft, Executive Director of FutureMed, to talk about the conference itself (hat tip to Dr. Shawna Pandya of SingularityU for excellent videography):
Flashbacks: FutureMed Day 1: The 6 “Ds” of Exponential Growth; FutureMed Day 2: Data, Data, and more Data