Exponential Medicine 2019 Summaries
Trends out of Day 3
A year has led to much deeper understanding of the microbiome and actual correlation of the data with disease expression.
Modulating angiogenesis (blood vessel formation) was mentioned in a number of the presentations. Will this be a research fad? or does it hold the answer to treatment of a number of conditions? Time will tell.
The food as nutrition movement presented far more research based findings than I have seen before. I used to think this space was complete quackery, but it may turn into a scientifically interesting space to watch.
The benefits of exponential technologies to have a significant impact in terms of being able to scale healthcare delivery to low resource areas around the world is a significant step forward in the conversation of ‘medical-technology’. In prior years, the conversation was far more centred around the use of medical technology at high resources areas.
Fungi research continues to have powerful findings.
Neuromedicine At The Frontier
“Our understanding of the brain and mind is accelerating. This session will explore the cutting edge, from consciousness, to preventing and treating neuro pathologies.”
Divya Chander MD PhD, Chair for Neuroscience, Singularity University
Santiago Ramón y Cajal was frist person to take idea of brain mapping seriously. Drew photos of neutrons.
We continue to try to map the brain’s connections.
One of the early targets of such research is the ability to be able to create a ‘bionic eye’ for those with vision loss.
There is also potential to synthesize speech from brain way activity for those who are unable to articulate their mouth.
Deeper human-machine interfaces has potential to dramatically transform the lives of those with paralysis and other physical disabilities.
16.2. Alzheimers’s Prevention & Treatment
Rudolph Tanzi PhD, Professor of Neurology, Harvard Medical School. Co-Director Center for Brain Health at Massachusetts General Hospital. @RudyTanzi
Contextual integration: some people ‘feel’ the ground shaking when they watch this video. Their body knows what it should expect based on the visual input
In Alzheimer's disease one theory is that there is loss of contextual integration. E.g. I smell rotten food, I shouldn’t eat that. Over time this is lost.
In order to halt Alzheimer’s we need to stop neuro-inflammation. Problem is drugs to effectively do this have failed.
Once one has full 'dementia’ they have had years of accumulation of plaques and tangles from neuroinflammation.
Our diagnosis of Alzheimer’s disease is coming too late. “We do not diagnose Alzheimer’s Disease until the brain has degenerated to the point of dysfunction.” “Imagine if we did the same with cancer, diabetes, and heart disease!”
Research into use of eye tracking headsets as a surrogate marker of neuro-inflammation.
16.3 Brain, Oxygen, and Recovery
Shai Efrati MD, Director of The Sagol Center for Hyperbaric Medicine and Research. Tel Aviv University
The wound on the foot, and the wound in the brain are similar. If we control inflammation on the foot, it can heal. In a similar way, if we could control the inflammation in the brain - perhaps it could heal too.
Oxygen is a limiting factor for brain activity.
- The brian uses 20% of the oxygen in the body.
- The brain always uses up 100% of the oxygen that is delivered to it.
- Oxygen get redistributed through the brain to the activity of interest.
The hyperbaric chamber can be used to study people performing single and dual tasks. This study looked at healthy participants who were asked to perform a single or dual task at normobaric (regular oxygen) conditions, compared against hyperbaric (extra oxygen) conditions. There was a improvement in task performance with the extra oxygen.
We know this limitation of brain activity, by our inability to do complex multi-tasking
- What is the trigger for the body to sense hypoxia? It is the rapid decrease in oxygen change that is the trigger.
A hyperbaric environment enables oxygen to reach areas of the brain through oxygen tissue diffusions, that may be blocked by delivery from occluded vessels.
THESIS: it is possible to stimulate angiogenesis in the brain? To help heal the brain from stroke.
Which patients should receive this therapy? Can map this using MRI imaging. Is there a wound that may be amendable to therapy in the area of deficit.
“Our buisness is wound care”
Guru Banavar, CTO, Viome @banavar
Viome: about 100,00 customers
THESIS: Gene expression, not genetics, is a major player in chronic disease.
E.g. when you have Chron’s disease there are periods where you are healthy and periods with illness. Is this a result of altering expression of your genes. Because your genetics aren’t changing between flares.
Can we check the expression of your genes from your blood?
What can we do today with this testing?
- Can predict within 8 years your age.
- Can we model how your body will respond to different foods.
- Their model can predict glucose response to foods much better than the traditional method of ‘calorie counting’ that those with diabetes do,
- Several very clear markers of irritable bowel syndrome.
Can find a signature for oral cancer in the gut microbiome.
16.5 Mental Health
Kristian Ranta, CEO & Founder Meru Health @ihqkristian
Showing superior long term outcomes. (Though not testing RCTs yet).
The Future Of Clinical Care: AnyTime, AnyWare, AnyBody.
“Who does what, when and where? New tools for preparation and practice to upskilling and collaboration. The blending of in-person and virtual care, avatars, to AI enabled decision support is reshaping how and where healthcare happens.”
Jennifer Radin, Healthcare Chief Innovation Officer & Future of Work Leader, Deloitte Consulting
Shafi Ahmed MD, Professor of Surgery Barts Medical School. @ShafiAhmed5
The image below was hands free manipulation of 3D images on the television via used of Hololens. Quite smooth and accurate from what I could tell.
Colon polyp identified via machine vision on colonoscopy. A few years ago this concept was just something for the future. This October 2019, Medtronic released a colonoscopy technology that places visual markers in real-time on pre-cancerous lesions.
Use of AR to expand first responder’s capabilities
Danny Thomsett Digital Humans, CEO, UneeQ @DannyTomsett
“Digital Humans” ability to scale to provide better experiences.
Unique human creation process based on the needed user.
Common issue that holds patients back from being honest in medical care is judgment. Therefore they are willing to share more with the digital human than with
Marie Johnson, Centre for Digital Business @mariehjohnson
Important that design includes people with disability.
In the UK, 60% of the population has grade 5 reading ability. Whereas most documentation in the UK is produced at a grade 10 level.
Digital cardiac coach
Look for common patterns of healthcare conversations, to build digital humans around this.
Clinton Phillips, Founder & CEO, Medici @ClintGPhillips
10 million members to date
benefits of virtual
- Less wait
- Better digital intake
- Language is no longer a basis
- Better long term education via digital
- Collaboration easier to bring in other specialise
- Engagement in digital world can begin before the patient gets sick
- Geography is not an issue in the digital world
- Outcomes are better when patients have regular interactions with their doctors
- Satisfaction of patients on average for in clinic visits is rated 1 star, whereas for a virtual experience across multiple platforms it is 4.5 stars
Julia Hu, CEO/Founder Lark Healthcare @JuliaHuCEO
The world’s largest AI healthcare provider, treating nearly 2 million patients with
Why did she start Lark? She had a misdiagnosed disease for 12 years. Wanted to understand better how to scale healthcare.
THESIS: Care protocols via conversational chat. Coach you in the moment.
Goal - short five minute conversations, in the moment, when people need help.
Will coach you based on what you are doing in the moment.
Their AI system, is the equivalent of 14,833 “nurses added” to healthcare.
Ardy Arianpour, CEO Seqster
The personalized health record.
Ted Goldstein PhD, C hief A.I. Officer, Anthem Inc. @tedgoldstein
Kira Radinsky PhD, Co-founder, Diagnostic Robotics @KiraRadinsky
THESIS: use of AI to triage medical issues that can be dealt with outside the emergency room
Creation of a knowledge graph from patient record and data.
The medical record is incomplete sometimes, because of the variation between what the patients report, and what is documented.
- When patients report “constant pain” it is only documented as “constant pain” 20% of the time.
- 21% of patients reported paid radiates to the left side. Doctors write this 5% of time
The top result isn’t always correct, but they frequently surface an answer to the top three
Example 1 of system
Example 2 of system. This time the answer after investigation was the second proposed answer.
They are finding the system generally effective when applied to different data sets with different populations.
Value of this system is its ability to deliver care at scale.
Rajeev Ronanki, SVP and Chief Digital Officer, Anthem @RajeevRonanki
Nutrition, Health And Food Of The Future
“Let Food be Thy Medicine” (Hippocrates). The science of nutrition is rapidly evolving, as are new forms of FoodTech. What are the implications for the environment, to prevention to treatment of disease.
William Li MD, Founder, Angiogenesis Foundation @drwilliamli
Advancements in nutrition sciences:
Angiogenesis as a root of a number of conditions
The “biological potency” of a number of common medications and cancer drugs.
The same graph above, but with inclusion of dietary foods “food as medicine” compounds.
About a cup of soy.
Flavorome looks to connect the biologic effect of multiple foods together into common categories.
Planetary, Global & Public Health
From climate change to pandemic disease, novel approaches are needed to address these grand challenges and to apply technologies that democratize and improve healthcare at a global level.
Moira Gunn, Tech Nation @biotechnation
Michelle A. Williams, SM, SD, Dean, Harvard T.H. Chan School of Public Health @HarvardChanDean
- Concept of “Planetary Health”
Paul Auerbach MD. Emeritus Professor. Stanford, Dept of Emergency Medicine. Founder, Wilderness Medical Society. Author of Enviromedics @PaulAuerbachMD
- Our first response systems can’t respond to multiple environmental disasters at the same time
Stephen Hunt MD PhD, Professor, University of Pennsylvania @md_rogue
The Things That Kill Us: #ThisIsOurLane
Clinicians and patients are increasingly becoming activists at the social and policy level on matters of public health addressing a range of issues including gun violence, vaccination rates and clinician well-being and burnout. Hear from those on the frontlines of hashtags making a difference.
Megan Ranney, MD MPH, Brown University Associate Professor of Emergency Medicine, Health Services, Policy & Practice. Chief Research Officer of American Foundation for Firearm Injury Reduction in Medicine @meganranney
This was a very good talk on the issue of firearm injuries. I think both non-gun owners, and gun-owners will find Dr Ranney’s approach here quite reasonable.
In short: the major focus of the talk is on the fas that 2/3 of gun-related deaths are suicide. Therefore, there are a number of ways that public health interventions (such as locking up firearms during periods of vulnerability) can help save lives.
Although there are a lot of gun deaths in the USA. Most guns don’t cause deaths.
Firearm deaths have not decreased in the USA
There is almost a direct correlation between improved outcomes, and research funding.
In terms of gun violence, this area is underfunded, and perhaps that is also why there are too many deaths in the area, and without decline in the last few decades.
Those at risk of depression, suicide, inter partner and interpersonal violence are highest risk.
In periods of depression, locking up guns can help save lives.
Mapping of facilities where gun owners can store their guns so that they are out of the house.
Helps reduce deaths from impulsive behaviour during a depressive period.
Kristina Saffran. Co-founder and CEO, Project HEAL
Eating disorder research:
Lori Boyle, BSN, MS, APRN. Nurses Who Vaccinate @KristinaSaffran
Stephen Eisenberg, DO. Oncologist & Co-founder cCARE.com: CPR for the Doctors Heart @drseisenberg
Don’t become an heartless robot going through the actions when providing healthcare.
The Things That Save Us: Mushrooms, Mycology & Medicine
A keynote from the world’s leading mycologist and medical researcher on the role of fungi in environmental and human health.
Paul Stamets, Founder, Fungi Perfecti @PaulStamets
The largest organisms in the world is fungi mycelium.
MEDy (M.edical E.ntrepreneurship & D.isruption) Startup Awards
Selected winners share their innovative startups
Let me know if anything looks incorrect. I’ve tried to summarize the presentations accurately, but haven’t had chance to externally verify what presenters claimed to be true.
Exponential Medicine 2019 Summaries