FutureMed Takeaway Points: Day 3, February 8, 2012
Personalized Medicine, Patient Perspective, Future of Interventions, Virtual Reality
Personalized Medicine and Health
David Ewing Duncan - introduction to personalized medicine and health
-Many of our treatments don’t work well today; we need to customize/individualize them
-Experimental Man Project resulted in 500GB of data. How will we use and interrupt this?
-Genetics can forecast disease risk based on weight gain, statin use, etc and motivate patients
-One example is “Envirogenomics”: how genetics impact environmental toxins (new startup EcoEos)
-Neuromarketing may use fMRI to see what works best on brain
-Science needs validation, integration, creativity in clinic and policies, cost too high
Raymond McCauley - Genomera
-Microarrays and sequencing growing: In ~two years genome will cost less than x-ray approach and approach ‘free’ by 2020
-Genome wide association study (GWAS) better and allow for comparing healthy with unhealthy patients; also will allow us to track copy number, DNA methylation, epigenetics, and transcription (e.g. cancer cells have differences in methylation, transcriptomics studies mRNA to see how concentration differs in tissues)
-Informatics is the bottleneck
Genia Chip – integrated circuits for molecular analysis
-Microarrays are template shotgun approach. The future is to broadly sequence…
-Sequencing can be done electrically – Nanopore based sequencing that pull sample through transmembrane pores while passing current across. Current varies with sequence.
-Integrated on chip: Developers can create apps on the sequencing chip. Software creates lipid bilayer and inserts proteins and processes DNA (can rewind DNA) in minutes
Cost: Chip under $100/test and reader under $1000
Andreas Sunquist - DNANexus
-DNA sequencing at scale will pose infrastructure problems:
-1) Data storage problem 2) Infrastructure. How do we transfer this data? Better to move analysis code to data 3) Data security and Who can access it
-DNA sequencing is ‘expert dominated’ lacking amateur accessible and inter-operability
-DNA nexus is a “Genomic Operating System:” a common environment for tools, community driven which will help new businesses grow in medical records, family trees, drug design, simulation of treatments run on particular genomes,
Randy Scott – Founder & Chairman of Genomic Health: Genomics in Cancer
-When will genetics be part of clinical guidelines? How can this info empower the patient?
-Standard diagnosis of most cancers is dated – still based on H&E stains and by pathologist’s visual interpretation of slides.
-We can now use genetics to increase efficacy of chemotherapy.
-OncotypeDx improves use of chemo in breast cancer by determining aggressiveness of cancer through its molecular fingerprint
-Moores law is about doubling computer power… Metcalfes law: Connecting genomes gives us power to do more clinical trials – utility increases with square of number of users
-Law of finite genomes. Each gene we learn about increases rate of discovery. Finite problem around personalized medicine
-Accelerating technologies are being leveraged for the integration of data and clinical trials to realize true personalized medicine
Patient Perspective Panel Discussion
Robin Farmanfarmaian, Executive Producer, FutureMed
-Poor connectivity and lack of patient involvement in care leads to poor outcomes
-Patients need to be allowed to be part of the healthcare team as decision makers in their own health
-Your “Peers in Health” are a great resource of information
Sean Ahrens, CEO of Chronology – Patient Revolution
-Future will have more chronic illnesses, but less time with a doctor: Patients live life…but physician only sees for a very small time – its like ‘looking through keyhole’.
-We are in a patient revolution – motivating patients and using social media.
Patients do experiment and can track their progress e.g. experimental use of intestinal worms in Rx Crohns
-Chronology allows patients to share experiments and experiences with others; social network to track self treatments and to aggregate data to see what works
Rebecca Woodcock, CakeHealth - Financial Aspects of Health
-20% of ones income goes to health care, this has resulted in significant debt
-CakeHealth helps keep track of insurance plans, deductibles, etc
Yael Cohen, Fuck Cancer
-90% of cancer is curable if caught in stage 1; Fuck Cancer focuses on empowering Gen Y;
-Change paradigm to finding cancer… not waiting for it… using humor and edginess.
-A a call to action for GenY to encourage their parents to do timely screening and early detection
Future of Interventions
Kevin Stone MD – Orthopedic Surgeon & Founder of the Stone Clinic.
-Biologics trump Bionics
-Prevention of joint damage key – Examples: Decrease obesity with sugar tax, Microsoft Kinect exercise based coaching, & appropriate supplements
-Need better implants and techniques:
- Collagen meniscus implants or using scaffold to help regrow tissue using patient’s crushed cells placed on articular surface
- Use 3D CT scans to optimally align implants using robotics to minimize wear
- Future Ortho involves examples like: printing a personalized scaffold of hip, covering with patients stem cells then implanting
Richard Satava MD - Future of Intervention
-We need to change the scientific method by adding simulation in before experimentation. -Simulation can provide outcomes not envisioned to help drive disruptive technologies.
-Simulating humans is important, but we lack patient models. New EMRs include full body scan data with physiological or genetic data overlaid.
-Can do surgery with no one in the room: Life Support for Trauma and Transport (LSTAT) – Portable life support and trauma bays, Penelope - robotic scrub nurse with vision and voice recognition, Da Vinci – robotic surgery
-As fighter pilots replaced with robots so will surgeons. Need to train in this area: squad of microrobots that can do surgery.
Dave Albert - AliveCor
-Current in a mobile health revolution
-Patients will pay < $100 for devices to improve our health; Simplicity is key
-Many challenges to ECGs outside of medical settings, AliveCor uses an iPhone case for 1 lead ECG and transmit to your doctor
-Positive findings in USC Body Computing initial clinical trial….
Fabien Beckers & John Axerio on the Future of Imaging: Morpheus Medical
-We can now perform image processing in real-time to learn about structure and function
-We can apply gaming technology and 3D rendering for image reconstruction on the web/cloud : E.g. Functional imaging of breathing in OSA, CT angio to assess benefit of stent placement, new rapid cardiac imaging provides information on pressure and flow, fluid dynamics around plaques
Don Jones - Qualcomm Life
-To reduce health care costs and facilitate development of technologies Qualcomm developed the 2net platform, FDA approved cloud or hub that any device can feed into for consumer or business use
-What sells new products is what saves physician time and effort, the “Gotta have it element”, including passive collection of data followed by active coaching, social engagement, and being your own ‘Personal Health CEO’
-Kids spend 1.25 hrs per day as avatars through video games
-Online… beauty is free
-Cognitive research using Virtual Reality (VR) demonstrates that attractive and tall avatars increase confidence both inside and outside of VR
-Can apply VR to change behaviours e.g. Promote exercise by watching your avatar lose weight while you exercise, gain weight by eating unhealthy, save more money by seeing an old version of yourself
-Chronic Pain management is possible using VR of a peaceful place (decrease pain by 75%)
Peter Diamandis MD Founder and Chairman of the XPrize - Revolution through competition
-What drives breakthroughs is being uncomfortable: Fear, curiosity, wealth creation, significance or human drive for more
-Prizes can be a huge incentive – highly leveraged (10-40x), efficient because you only pay the winner, sparks a new industry, encourages nontraditional solutions
-Innovation is a state of mind. Need willingness to fail (early and often) and audacious vision
-Creating an innovative culture with the 555 plan. Teams of 5 with 5 weeks and 5k to make 5 ideas, thus forcing people to go big and fail fast