Day 3 of Exponential Medicine began with none other than Dr. Daniel Kraft moderating the morning keynote with Vinod Khosla, renowned investor and Founder of Khosla Ventures, who talked about how the practice of medicine has evolved to follow a set of rules based largely on historical precedent rather than practicing the best possible medicine. He believes the practice of medicine needs to become the science of medicine. To that end, Vinod predicted that data science will do more for medicine within the next 10 to 20 years than all the biological sciences combined. He also thinks that in that timeframe we will see five times fewer errors, five times lower cost of care, five times less work per doctor, five times faster clinical interactions, and five times the number of opportunities for clinicians to take part in research. From that outlook, the clear trend is a reduction in the reliance on the doctor for most healthcare needs. Instead, as Vinod has commented in other talks, patients will become the CEOs of their own health. During a short Q&A, Vinod responded to a question regarding the volatility of startups in healthcare. His message to startups was that a 1% chance of failure is okay if you have a 10% chance of changing the world.
Daniel remained on stage as the first speaker of the morning session on ‘Regenerative and Rejuvenative Medicine’. Daniel spoke about progress in the development of synthetic organs and tissues. Already we’re seeing applications of implanted trachea and bladders which are becoming ever more individualized by using the patient’s own cells as the source material and tailoring the geometry of implants to the patient anatomy. Daniel also touched on opportunities in stem cells which the following speakers expanded.
Daniel ended by introducing our next speaker, Dr. Alan Russell, Director of the Disruptive Health Technology Institute at Carnegie Mellon University and the CIO and Executive VP for the Allegheny Health Network. Alan spoke about the work being done to replace inflammation with regeneration. In utero humans have a natural regenerative response to injury. Unfortunately, that ability is lost around the third trimester and replaced with an inflammatory response. Alan believes mesenchymal stem cells provide an opportunity to allow humans to regain natural regeneration responses. Current challenges that still face the use of MSCs include which specific cells to use, how to get them, how to get them to stay, and how to get them to act correctly at the right time. Additionally, while MSCs have almost always proven to be safe and result in a functional improvement, rarely do scientists understand why.
Dr. Robert Hariri, Chairman, Founder, and CSO of Celgene Cellular Therapeutics and a FutureMed staple, took the stage to posit: if 100 becomes the new 60, will it be worth it? It’s not just a matter of living longer, but living longer while feeling capable and competitive. Robert continued Alan’s discussion of stem cells by claiming that aging is a stem cell problem. He believes in the concept of recharging the regenerative engine. Robert’s company has done a great job learning how to collect, process, and preserve stem cells that can provide a resource well into the life of a donor. These stem cells can be used to replace organs and regain tissue functionality. Looking forward, Robert claimed the future use of stem cell work would benefit from a new model describing functional similarities to computers. Programming the biological software of stem cells is already happening and will be a real target to address the challenge of aging.
The session was closed by Dr. Aubrey de Grey, a biomedical gerontologist and CSO of the SENS Foundation. Aubrey has long been theorizing about aging and believes that the problem begins with the the mindset that there is a difference between diseases and aging. He claims that there is an arbitrary distinction between conditions that negatively affect health, to which we give specific names, such as Alzheimer’s disease, and conditions that affect the body as we age but which many consider natural. From a clinical perspective, Aubrey believes two main challenges exist. First, due to this mindset, current interventions often fail because they are designed to be used when the patient has already reached their later life at which point existing damage has already occurred. Second, the human metabolism is extremely complex and it is unreasonable to expect that it can be easily manipulated to eliminate a few negative effects while maintaining all the other positive aspects. Over the years, Aubrey has developed a rubric of damage types he believes exhaustively encapsulates all the areas that need to be tackled in tandem to effectively address aging: cell loss, division-obsessed cells, death-resistant cells, mitochondrial mutations, intracellular junk, extracellular junk, and extracellular matrix stiffening.
Next up was another speaker in the ‘Patients Included’ series, ePatient Dave deBronkart, a stage IV kidney cancer survivor who is now one of the world’s leading advocates for patient engagement. Dave gave a hilarious account of one of his first experiences as an engaged patient participating in a marijuana study at Boston City Hospital (now Massachusetts General Hospital). Just like in his original TED talk, Dave is still a proponent of letting patients help the advancement of medicine through efforts like the Society for Participatory Medicine of which he is a Co-Founder and Co-Chairman. To be clear, to Dave, patient involvement goes beyond simply being good data collectors and making personal data available to having an active voice in deciding where efforts in healthcare are placed and what gets studied.
After a quick break in the Innovation Lab, Daniel introduced Dr. Evan Snyder to begin a session on the Future of Neuromedicine. Evan is a Professor and Program Director of Stem Cells and Regenerative Medicine at the Sanford-Burnham Medical Research Institute. Evan painted a picture of approaching neurological disease and disability based on prediction, prevention and intervention, protection, restoration, and replacement. In the future, he believes medicine will become more intelligent about what stem cells can do naturally. One of the primary take-aways of Evan’s talk was the fact that despite progress in the development of stem cell treatments, the biggest challenge facing neuromedicine is that there is still a lack of understanding about what needs to be fixed biologically. Similar to Alan’s earlier comment, Evan claims that the best therapy with the most reliable stem cells are useless unless what they are targeting and what they are trying to fix is completely clear. Currently, some treatments work but a continued lack of understanding of why they work will limit progress.
Next we heard from Ariel Garten, CEO and Co-Founder of InteraXon, whose company develops tools to capture brain signals and creates brain-controlled technologies. The company’s current product Muse, is a brain sensing headband that captures EEG in a consumer-accessible form. Muse gives the user real-time feedback on their brain activity to increase cognitive activity and reduce stress, both of which can be tracked over time to see changes and, ideally, improvement. Thousands of individuals are already using Muse to decrease anxiety and improve sleep. With this excellent consumer start, Ariel and her company are looking forward to what their technology can do clinically to help patients. With so many high fidelity EEG signals being collected by Muse, Ariel closed by touching on the opportunity to leverage this neurological big data mine.
We then heard from Dr. Philip Low, CEO and Founder of NeuroVigil. whose company developed the iBrain which is the first portable brain monitor ever built. NeuroVigil’s products have been used for clinical research for over five years to provide functional capabilities to individuals suffering from debilitating diseases such as ALS, including Stephen Hawking and Augie Nieto. Expanding on the iBrain, Philip announced that NeuroVigil now has the world’s smallest noninvasive brain monitor (about the size of a Listerine packet). The company is now working with NASA to send their technology to the International Space Station to conduct the first space-based clinical study of brain signals.
The session was closed by Dr. Christopher deCharms, CEO and Founder of Omneuron. Chris began with a personal account of his own experience with pain and the challenges in communicating and individually managing pain. Chris’ company has developed an app to address both of these issues. Currently, patients use a simple 1-10 scale to convey the severity of pain. As a replacement to this ineffective system, Chris and his team have developed aN auditory analog where the patient chooses a decibel level that corresponds to their level of pain to safely convey the severity of the pain to others. To address the challenge of pain management, the app helps individuals understand the sequence of brain postures that allow an individual to control their pain. The platform also crowdsources experiences to share strategies among individuals dealing with similar types of pain.
Before lunch was the annual photo shoot where all attendees receiveD a pair of Exponential Medicine scrubs and assembleD for a picture of the whole conference. After lunch, attendees took part in any of eighteen different workshops including a discussion with Senior Director of Microsoft Worldwide Health, Dr. Bill Crounse, a session on Google Glass, and a review of the state of the art in military medicine presented by Navy Seal medics.
The afternoon saw attendees return to the main stage for a session on ‘ReShaping Healthcare’ by Data DeSiloing with Lucien Engelen and Jeroen Tas. Lucien is the Head of the Regional Emergency Medicine Network at the Radboud University Nijmegen Medical Centre in the Netherlands. Lucien pointed out the missing factors in discussions around medical innovations: users and patients. While we often think of doctors when we think of clinicians, in reality it is often a nurse who uses new medical devices. Poignantly, the Exponential Medicine crowd only has a handful of practicing nurses in attendance. Similarly, the input of the patient, who might not always be the most technically savvy individual, is critical. Lucien suggested that healthcare companies large and small make a new position, the CLO, or Chief Listening Officer, whose only role is to speak with and listen to what the target user and patient thinks. Lucien transitioned to Jeroen with a video introducing Philip’s eCareCoordinator and eCareCompanion. Jeroen discussed the application of Philips’ new system currently being implemented at Lucien’s institution. The platform takes advantage of mobile collected data, analytics, and big data to create a system that both providers and health insurance companies can use to deliver value-based care. Already Philips is using their products to address COPD in the Netherlands and are looking to expand geographically and to other diseases.
The next session was kicked off by Dr. Jordan Shlain, primary care physician, entrepreneur, and health policy thought leader. Jordan clearly outlined the incentives in care from the point of view of patients and providers. Patients want to minimize the impact of illness, trust their medical team, have convenient communication, feel support, and experience a sense of control. Doctors want to practice medicine easily, receive actionable information, and use payment models that make sense. Jordan believes these wants can be achieved through a continuously learning clinical operating system and a learning best practices engine. With this in mind Jordan developed HealthLoop. HealtLoop is a platform to connect doctors and patients with timely and actionable information, improving patient satisfaction and driving better outcomes. Jordan gave a brief demo of how the platform is already providing real benefit to patients and providers.
Back again this year we next heard from Dr. Maulik Majmudar, MGH cardiologist and CMO and Founder of Quanttus, Inc. Maulik spoke to the new Healthcare Transformation Lab at MGH whose mission is to improve the experience and value of patient care through collaborations. Part of this intiative is the recent award of 6 grants to incubate and support innovations that can positively impact healthcare.
Dr. Jack Kreindler returned to the stage for the third time this week drawing on his love of Star Wars to make some entertaining correlations between Darth Vader the maintenance of multiple chronic diseases. Jack echoed much of the material discussed earlier this week regarding Sentrian’s work combining machine learning with patient data to generate a new intelligence that does not exist today.
Dr. Christian Assad gave a broad presentation touching on trends of AI, mobile technology, and the value of gamification. Christian encouraged everyone to take advantage of the valuable connections formed at Exponential Medicine. Like Jack, Christian is a great example of an individual who took the energy of this event to heart and made the connections needed to drive foward an idea that ultimately became Curely, a company in this year’s Innovation Lab providing a telehealth marketplace for patients to get answers about their medical questions directly from doctors.
Before the afternoon break, Nigel Auckland, the Bionic Arm Man, gave another ‘Patients Included’ talk on his experiences coping with upper arm limb loss. Nigel touched on how his journey began as an emotional struggle dealing with a changing physical condition that, through technology, has become an outlet for hope for himself and others suffering with limb loss. His message: “life changing doesn’t have to be life ending.” Nigel closed with an amazing demonstration of the different types of grips and functions of his multiarticulating artificial arm built on reading myoelectric signals from his remaining limb.
After another break in the Innovation Lab, we heard from Paul Stamets, proponent of the science of medical mushrooms and ecology. Paul touched on many of the points from his now famous TED Talk, including how many individuals, including his mother, have reversed life-threatening diseases through the consumption of mushrooms. He also presented some very exciting insights into the interrelated behaviors of trees, bears, fungi, and honey bees. Specifically, he revealed new findings showing that bees interact with specific types of mushrooms for the antiviral benefit they confer to their hives. Expanding on these insights, Paul believes all organisms, including humans, can benefit from mycelial organisms.
The keynote of the evening, speaking on the ‘Future of Pharma’ was Dr. Jeremy M. Levin, Chairman of Ovid Therapeutics, Inc and of Health:Augmented and former CEO and President of Teva Pharmaceutical Industries Ltd. A common thread throughout Jeremy’s talk was the need for collaboration between technology, clinicians, patients, and pharmaceutical companies. More specifically, Jeremy pointed to the fact that mobile health, big data, and other innovation being discussed at this year’s Exponential Medicine are still largely anathema to pharmaceutical organizations. There are many reasons for this divide. For pharma, innovation takes place on 9 to 15 year time scales, not months. The people themselves are less entrepreneurial since most do not stay with their companies long enough to see drugs they work on make it to market. Pharma company structures are large and linear while innovative startups are small and often lack any semblance of structure. But despite all this, Jeremy believes these companies are not that different and that a fundamental change has occurred that will spur pharma to partner with new technologies. He believes such a trend is not only possible but imperative and that those who take what may seem like a risk will ultimately be the most successful.
Putting the focus back on startups, we heard about the work being done by Miroculus, a previous SU team disrupting cancer detection. Miroculus uses 3D printing, smartphones, and low-cost screening tools to detect microRNAs from blood samples that can serve as indicators of deadly metastatic cancer.
Following Miroculus, the evening closed with the MEDy (Medical Entrepreneurship and Disruption) Awards, given to the winners of the startup pitch competition held during the workshop sessions over the last two days. The awards were presented by Sandra Miller, Director of the SU Labs. Award categories and winners this year were:
One to Watch: NeuroRecovery Technologies, Inc
Most Disruptive: CaptureProof
Outstanding Pitch: FirstID
Previous days’ coverage: Exponential Medicine Day 1: Preparing to Reinvent Health & Medicine…; Exponential Medicine Day 2: Big Data Everywhere…