After another morning of healthy activities, Day 3 of Exponential Medicine 2015 started strong with a session on the microbiome led by Trustee of the XPRIZE Foundation, Lee Stein, and Paul Roben, Associate Vice Chancellor for Innovation & Technology at UCSD. Lee gave a personal account of his son’s experience with Lyme disease. Lyme disease is treated with a cocktail of antibiotics that, while addressing the condition, had the costly result of completely destroying the patient’s gut microbiome, the collection of all the microorganisms that live in conjunction with the human body. The challenge, therefore, as in cases like Lee’s son, is how to reconstitute the gut microbiome after a antibiotic-heavy procedure. Paul then explained how the microbiome affects the central regulatory processes in the human body such as digestion, the immune system, and the nervous system. The culmination of the presentation was an announcement from UCSD Chancellor Pradeep Khosla of the Microbiome Initiative, a campus-wide effort to advance microbiome research through the intersection of many of UCSD’s existing research programs.
The day’s second session brought a line up of six speakers to discuss the future of the brain and neuromedicine. First up to set the stage was Dr. Divya Chander, an anesthesiologist and neuroscientist from Stanford University School of Medicine. Continuing many of the themes of last night‘s keynote by Dr. Leigh Hochberg, Divya discussed her work using non-invasive EEG capture to monitor the consciousness of her patients in real-time. The ability to visualize consciousness through these signals could eventually be used by anesthesiologists to manage the unconscious state during an operation in a new, patient-specific manner. Divya closed with her work on a new wearable technology that the patient would wear from end-to-end in a hospital visit to track sleep during the stay, monitor anesthesia during the operation, and track stress as the patient prepares to manage their health back at home before discharge.
Next, we heard from two startup executives from the brain science sector, Ariel Garton, Founder and CEO of Interaxon, creator of the Muse, and Dr. Jamie Tyler, Founder and CSO of Thync. Ariel told the story of Muse technology and reported on some recent successes where regular use of the Muse resulted in a 43% decrease in hospitalizations and clinical utilization in a population of 17,000 patients. Another study at Baycrest found that “musing” for 10 minutes per day, 6 days a week caused an improvement of the functioning of the somatic systems, increase in calm, and better cognition in stressful situations. Jamie began with a technical discussion on the research work that ultimately led to the creation of Thync’s technology. Thync utilizes transcranial focused ultrasound to modulate brain activity. By modulating the cranial nerves, Thync can deactivate the sympathetic nervous system to reduce stress. The high resolution and specificity of the focused ultrasound signal apparently shatters that of transcranial magnetic stimulation.
In an inspiring talk of a patient turned entrepreneur, we heard from Derek Herrera, a paralyzed spinal cord veteran who is now the CEO of Spinal Singularity Inc. The company’s focus is developing technology to solve the challenges of patients with spinal cord injury and disease. Their first product, the Connected Catheter, is designed to alert patients, who no longer have bladder sensation, when their bladder is full and provide an easy voiding process that removes the need for the patient to insert a catheter for drainage. In addition to receiving a number of accolades, like the Johnson & Johnson JLabs award, the company recently completed a successful Indiegogo campaign and will be moving into clinical trials next year.
Up next we heard from Dr. Arshya Vahabzadeh, Innovation Officer at the Massachusetts General Hospital Psychiatry Academy and the Director of Digital Health for Brain Power, and Dr. Cori Lathan, CEO of AnthoTronix, Inc. Arshya spoke about how big data will play an important role in shaping the future of psychiatry. At Brain Power, a wearable smart glass technology is being developed for patients with autism. Also seeking to solve challenges in mental health, Cori’s company was charged by the U.S. government to create mobile medical apps to solve the challenges of deployed men and women including combat fatigue, stress, depression, PTSD, and concussions from blast injuries. The solution was DANA, an FDA-cleared mobile medical app for cognitive assessment in the field. With the success of DANA, the company looked for other areas to apply their technology and found an opportunity to address dementia in the 66 million caregivers who provide care to someone who is ill, disabled or aged. These caregivers are the second victims of long-term chronic care. The company has now launched a healthy brain study for caregivers to use the technology behind DANA to measure their brain health with the goal of curbing the 1/3 of deaths caused in this population by dementia.
Dr. Jordan Amadio, Co-Founder of NeuroLaunch and a physician in neurosurgery at Emory University, spoke about a new accelerator program. NeuroLaunch is “the world’s first neuroscience startup accelerator,” providing funding ($20k-$100k), education (90-day curriculum), mentors, and partners. As with most accelerators, NeuroLaunch culminates in a Demo Day event for the companies to show off their work and drive traction. NeuroLaunch’s goal is to provide neuroscience-specific startups a differentiated accelerator experience through a vertical focus and rapid validation.
To close this marathon session we heard from Will Henshaw, Founder and CEO of Focus@Will. Focus@Will, besides having one of the best startup names at the event, allows users to listen to music that creates an “on-demand flow state” for higher focus and productivity. Will shared some of his team’s findings when it comes to listening to music while trying to be productive. First, don’t listen to music you like, it can distract you if you’re paying attention to it over your work. Second, don’t listen to music with vocals, as this can also be distracting if you’re thinking about the words. Third, the most easily distracting types of music are also some of the most popular: classic rock, jazz, and hip-hop. Finally, don’t listen to music too loud, it’s not for entertainment, it’s to help you focus.
Attendees took a short break and explored the Innovation Lab before returning for Session 11, Crossing Disciplines. Dr. Eric Rasmussen, CEO of Infinitum Humanitarian Systems, and Jose Gomez, Director of the MIT Little Devices Lab both spoke about technology in underserved and developing countries. Eric, a previous FutureMed speaker, opened the session by promoting the message of disaster preparedness through data preparedness. One example where big data plays a role is in the fragmentation of resources at a disaster site. Using big data and mapping technology, disaster response teams can better focus relief resources where they are needed most. Jose spoke about the concept of medical black boxes and how, in developing countries, 90% of these medical black boxes are likely to fail within six months of arrival. He also showed one of the technologies developed at the Little Devices Lab, a diagnostic that quickly tests for Ebola, Dengue, and Yellow Fever in 10 minutes using silver nanoparticles.
Dr. Manish Kothari, Vice President of SRI Ventures, returned the discussion to robotics and SRI’s work in this sector. While considering robotic suits for military personnel, a question Manish had to ask was whether to make Iron Man or Spider Man. Iron Man can do more but takes time to deploy, while Spider Man does less but is less intrusive to the user. SRI settled on the latter and is now developing the DARPA-funded Warrior Web, a wearable suit designed to decrease the metabolic cost of walking with loads. Development of the suit required the creation of new electronic materials such as electro laminates that can impart force while having a quick conformation change response. Besides the battlefield, other applications of the Warrior Web include muscular dystrophy, rehab, and maybe even getting people with spinal cord injuries back on their feet again.
For the final session before lunch, we heard from Komathi Stem, Strategic Innovation Leader at Genentech, and Milind Kamkoller, Global Head of Next-Gen Analytics. Komathi spoke about her work with Genentech applying design thinking to uncover new solutions to the clinical trial recruitment challenge. Genentech’s solution was a de-centralized clinical trial (DCT) model that unlocked access by shifting the nodes in the network. In this model, patients are identified first and then mobilized to participate, in effect bringing the trials to the patients. As an example, in a typical n-120 rare disease trial, 67 sites in up to 11 countries might be identified with the hope that each site can enroll one patient a year for two years. Using a DCT metasite, patients were enrolled and began participation 20x faster with the use of fewer participating institutions all within the United States. Another poignant takeaway from Komathi’s talk was the point that regulatory reasons are often the excuse given why changes aren’t being made. However, the landscape in medicine is changing and pharmaceutical companies are beginning to realize this opportunity to apply new tools to solve old challenges. Closing up the session ahead of lunch, Milind spoke about the exponential shift from data science to behavioral science.
After lunch another series of breakout sessions included topics such as democratizing drugs and devices, understanding and working with the NHS, and another set of 10 pitches for the MEDy awards. Following this second round of breakout sessions, Donald Jones, Chief Digital Officer at the Scripps Translational Science Institute, addressed what has become a growing national concern that there will not be enough primary care providers (PCP) in the coming years, with the statistic that the number of nurse practitioners and physician assistants has doubled in recent years. Donald believes the death of the PCP is being quietly addressed by this shift to a new class of provider at the primary care level. These new resources combined with what he calls the “interlopers,” urgent care, retail clinics, telemedicine services, and others, will serve half of all primary care needs by 2018-2019. Patients are playing a big role in this trend as they begin to dictate how they access healthcare with a priority on convenience and price.
Scott Summit, Founder and CTO of Bespoke Innovations, and Eythor Bender, CEO of Unyq, concluded Session 13 by discussing the work at their respective companies, each of which specializes in personalized artificial appendages. Both showed examples of their products used for the treatment of physical ailments such as fractures and scoliosis. Scott emphasized how his company is bringing fashion into their design and customization process because “in 3D printing, complexity is free.” Eythor spoke about how after tackling scoliosis, Unyq began working with veterans and diabetics. One of the veterans using Unyq technology came to the stage to speak about his personal experiences and the return of dignity that well-designed, patient-centric prostheses can provide. Both companies offer a mobile application to support the customization and design of their technologies.
Session 14, Regenerative Medicine & Longevity, was kicked off by none other than our moderator, Dr. Daniel Kraft. Daniel likely covered about twice as much material as any other speaker in a talk that began with a stem cell tutorial and branched into the numerous ongoing works and applications of stem cells and regenerative medicine, such as incorporating stem cells with a donor’s cells into a decellularized trachea to grow a new, functioning biological structure. Daniel concluded with his belief that, while regenerative medicine has received a lot of hype in recent years, we are finally entering a period where real-world applications to help real patients can be realized.
Two representatives from Human Longevity, Inc (HLI), Chief Information Officer Dr. Yaron Turpaz, and Chief Medical Officer Dr. Brad Perkins, next spoke about HLI’s impressive work in human genomics. HLI, founded in 2013 by Dr. J. Craig Venter and Dr. Robert Hariri, is working to generate a comprehensive database of human genotypes and phenotypes to address aging-related diseases. Currently, HLI is collaborating with pharmaceutical companies and early adopters who agree that every patient in a clinical trial should have their genome sequenced and evaluated as part of the trial. They’ve also begun working with insurers like Discovery Ltd in South Africa and the United Kingdom to offer sequencing to members as part of a program to incentivize healthy living. Part of HLI’s effort includes seeing patients in the Health Nucleus, the first clinical center to include advanced genomics and other omic measures as part of the patient evaluation process. HLI’s long-term three phase plan includes: (I) establishing feasibility and risk profiles, (II) developing new care models, and (III) realizing health impact. They are currently in Phase I.
Transitioning right into Session 15, Unmentionables, Patient, and Doctor Included, Alexandra Drane, Founder and Chief Visionary Officer of Eliza Corporation, hearkened back to Dr. Alex Jadad’s concept that the definition of health is skewed. Alexandra’s approach is to consider life as part of the equation. Looking at data from patients evaluated against a vulnerability index, patients identified as “highly vulnerable” were 2.6x as likely to struggle with diabetes, 5x as likely to experience behavioral health issues, and cost the healthcare system 5x more than other patients. Multiple studies have found that work, financial, and relationship stresses have a significant, quantifiable impact on patient health and longevity. For example, individuals caring for aging parents have a 2x higher risk for having a chronic disease. In order to design solutions that take these factors into account, Alexandra points to empathy.
Next, we heard from Stephen Keating. While Steven is a postdoctoral fellow from the MIT Media Lab, he spoke to the audience as a patient. Within the last year, Steven underwent a dangerous awake brain surgery to remove a brain tumor in his frontal lobe. While the surgery was a success, Steven’s experience before, during, and after the procedure opened his eyes to the fact that patients sometimes end up having the least amount of access to their information. The limitations he experienced came from interoperability standards, liabilities, and policies. For example, after the procedure was completed, Steven donated a piece of his tumor to be genetically sequenced. While his doctor and nurse had access to the results, Steven was not given the ability to view his own genomic information. A concerning policy example Steve also mentioned is an exception in the Common Rule which allows studies to avoid IRB approval if they ensure patients will not get their data back after the study. The exact opposite should be the case, he said. While a “hospital share button” doesn’t exist today, one positive note on the horizon is that Meaningful Use Part 3 identifies the need for EMR APIs.
Dr. Steven Eisenberg, Co-Founder and Chief Medical Officer of Workup, closed the session with a message of bringing compassion and presence to every patient relationship. Steven accurately summarized the message of this session with the quote, “illness starts with I, wellness starts with we.”
Before the final session of the day, the winners of the MEDy (Medical Entrepreneurship and Disruption) awards were announced. The awards are given to four companies participating in a small pitch event which took place during the breakout sessions. The winners of this years MEDy awards were:
- Outstanding Pitch: Sense.ly
- One to Watch: Beyond Verbal
- Convergence: X2Ai
- Most Disruptive: Universal Diagnostics
Stay tuned for more details about the companies from the Healthcare Innovation Hub, including those above, following Medgadget’s event coverage of Exponential Medicine 2015.
To wrap up the second full day of the conference was a powerhouse duo of keynotes by Dr. Dean Ornish, Founder and Director of the Preventive Medicine Research Institute and clinical professor at UCSF, and Dr. Peter Diamandis, Executive Director of Singularity University and CEO of XPRIZE, among other titles. Dean spoke here two years ago about his surprisingly low-tech, lifestyle driven program to address heart failure and other medical conditions. The program is based on the tenants of eating a plant-based diet, receiving stress management resources, moving more, and most importantly, loving more. Dean presented more outcomes from his work showing that men with early stage prostate cancer can reduce, stop, and even reverse progression of their disease solely through lifestyle changes. In this population, Dean identified a number of positive biological changes including the down-regulation of 501 cancer-related genes, a 30% increase in the length of telomerase, a biomarker implicated in the progression of aging, and a suppression of VEGF, a tumor angiogenesis factor that normally requires expensive drugs to reduce. Looking at patients on the program with diabetes, Dean believes lifestyle changes are better at preventing and reversing type II diabetes than drugs. Recognizing the criticism that some see the fourth tenant of his program as “soft,” Dean emphasized the point that the impact of love in his patients lives from their care team, family, and friends did play an important role in the betterment of their health and wellbeing. Corroborating these results, Dean pointed to the EPIC-Potsdam study (European Prospective Investigation Into Cancer and Nutrition), that showed that walking more, eating a reasonable diet, and maintaining a healthy weight prevented 93% of diabetes, 81% of heart attacks, 50% of strokes, and 36% of all cancers.
Expanding the scope of the discussion, Dean gave examples of how one part of this lifestyle program, food choices, directly influences other major global challenges such as the energy crisis and global warming. For example, given that a 1/3 pound burger represents over 4,000 gallons of water that went into its production, simply not eating a burger does more for the environment than taking a shorter shower. He also commented on how he believes the globalization of illness is a result of changing lifestyles around the world, many of which are starting to mimic the unhealthy, unsustainable lifestyle of western culture.
After Dean’s commentary, Peter Diamandis, the evening’s second keynote, joined Daniel on stage to share some of his thoughts on the status and trajectory of exponential technologies and take some questions from the audience. This editor also had the chance to briefly sit down with Peter to capture more of his thoughts off the stage. When asked about the objectives of Exponential Medicine, Peter described the event as a way for those within healthcare to keep pace with what is going on across the broad range of innovative work that is being done in medicine. Here, he explained, is where some of the greatest minds in medicine come to set their expectations and hit the reset button for their trajectories. As we’ve heard before, Peter continues to advocate for the concept of making each individual the CEO of their own health. To get there, Peter believes that we will reach the point within the next five years where computations about ourselves and our environment will be constantly running in the background to look at meaningful correlations that become valuable to the individual. In terms of an example of how conventional healthcare businesses are responding to changes in technology, Peter pointed to the collaboration between HLI, of which Peter is a Co-Founder and Vice Chairman, and Discovery Ltd, an insurance company. Traditionally, insurance companies look at a patient’s health and family history and charge a rate. Now, Discovery Ltd. is partnering with HLI to offer a flat rate to patients, independent of their medical condition and history, as long as they allow for a complete genome sequencing. Finally, when asked about the success of the XPRIZE competition winners after the competition, Peter explained that there is no structured programatic support beyond the program but continued general support is available. For many of the companies, the next step is identifying the correct market fit outside the strictures of the competition.
And with that, the third day is a wrap. Today was a testament to the density of excellent content this conference brings to bear. Stay tuned for one more day of coverage as we wrap up Exponential Medicine 2015.