الخطوات التالية في مجال الصحة والطب إلى أين يمكن أن تقودنا التكنولوجيا دانيال كرافت TEDxBe

So, it's really interesting time for the present and the future of health care. And think part of the theme of this talk will be that the next steps are that all of us can play role in the future of of health and medicine. But, if we think about health care today, it's really actually more like sick care. We're more of like reacting to when we have disease. we're not really our systems are set up to treat the sick, not to really keep us healthy. And our care is mostly sort of reactive. We end up in system where we wait for the heart attack or the stroke or the cancer to be discovered. And the data that we get in the health care system is very intermittent. We wait for the occasional blood pressure check or lab value test or vital sign check or EKG. And that makes health care very expensive and discontinuous. In fact, the most cutting-edge technology for communicating most health care data today is still the fax machine. Most prescriptions are still written on paper and most of our records are turning electronic, but are still sort of siloed health care systems and electronic medical records and paper charts. So, the feedback loops of health are often sort of very broken and intermittent. And that's where things get expensive and that's what takes us time. We spend an hour waiting for the doctor for 10-minute visit. And as physician, you know, get rewarded for seeing more patients, not for doing better job with my patients. And when my patients come to see me, they don't often remember everything about their data or their condition. So, health care is intermittent and reactive. It needs to become continuous and proactive. And our health care systems are still kind of set back in the 1800s in the old silos and definitions and boxes that they've been placed in for for long, long time. And in this new age of connected health, genomics, digital, mobile, we can start to rethink health care outside of the spectrum where we spend most of our health care dollar, 80% or more on the sick care side of the equation. We can use our technology and our own initiative to move ourselves to the left side of the equation. Because if we don't do that, we're going to bankrupt our countries. Here in Germany, you're think number four on the list of the GDP. In the US, number one in on health care spending per capita. So, if we start to shift our thinking, shift our incentives from sort of reimbursement-based medicine to evidence-based medicine and start changing how we reward ourselves as individuals and as doctors, we can make big change. One change will be that, you know, no longer is the the doctor the god who tells you what to do as patient. You're going to be the new sort of CEO of your own health. The new drug is really the engaged and empowered patient who lives and owns their information and stays on top of it. And part of that is being enabled by this whole new fast-paced world of technology all around us. In 2005, that was the the last pope being inaugurated. There's the next pope in 2013. You can see the difference in the same scene. And that's largely been enabled by our our smart mobile technologies that are riding Moore's Law. You know, the computational power keeps doubling every 2 years or so and gets faster and cheaper. That's why our smartphones are really becoming medical devices. They have about billion times the price and speed and performance of the best supercomputers in the '70s. Your tablets are the equivalent of Cray supercomputer. And you need to start thinking in whatever field you're in, health care or otherwise, exponentially cuz as these technologies double, they get very disruptive. And it's no one technology. It's where they come together. It's where they converge. It's that's the point where reinvention can happen in health care and in many other fields. So, we're seeing this combination of technologies and each of you can start to use that in your own health care platforms and as we reinvent the next steps in health care. Because as we've seen with technologies like the iMac, it now fits on an iPhone and probably next week the announcement from Google will fit on your iWatch. And companies like Apple didn't really invent these technologies. They sort of reimagined how they could be used. Just like we're reimagining how we pay for things, how we read for books, how we read books has been now moved to Kindles. How we book our travel, how we get our movies all streaming to us. That's been very disruptive for certain other company country companies. Even here in the in the US and in Germany, companies like Uber, which is San Francisco-based company where come from, is valued at 18 billion dollars after 4 years. They didn't invent the mobile phone, they didn't invent GPS, online maps, online payments. They just layered it up together. And of course, that's disrupting the taxi industry to the point where think it's been outlawed here as of two year two days ago. So, sometimes progress needs the help of the regulatory bodies and forward thinking to move forward. So, what would the Uber Uberification of health care look like? Makes it more streamlined, easier to use. Actually, tweeted that out few months ago and so two companies came back saying, "We're building that. You press button and doctor comes to your house." So, this sort of disruption is starting to occur and it's partly through new thinking from folks who are not traditionally physicians or medical devices or in pharma. And in fact, if you're not thinking disruptively, our friends in pharma are experiencing in some cases things like Pharmageddon. Now, I'm physician. also happen to chair the medicine track at new institution based in the heart of Silicon Valley called Singularity University, where we look at the cross-pollination and pace of fast-moving technologies from medicine, biotech, robotics, artificial intelligence, 3D printing and beyond. And in our 10-week summer programs and our 1-week executive programs, we look to ask, "How can you use technology to impact the world in in powerful ways?" And many of those platforms have actually been in the medical realm. I've run conference specifically at Singularity University for 4 years called Exponential Medicine, where we take folks from every different field. We mix them up, we mash them up, and we ask, "Where can we reinvent? How can we take the next steps in reinventing health and medicine?" And encourage you to come join us in November. So, let's look now at some elements of technology and how that can in fact our our own health, our diagnostics, our therapeutics, and how we can all contribute to health care innovation. So, first of all, we all know we're supposed to, you know, exercise and eat right. We don't need to have our personalized genomes to let us know that. But, today the price and speed of sequencing and genome is dropping at twice the rate of Moore's Law to the point where it's only about thousand dollars today. And that gives us lot of opportunity to understand and do smart prevention for the diseases we might be prone to genetically. And it's not just genetics that's getting cheaper. There's proteomic data, environmental data, our microbiome that's in our in our GI tract. there are nano noses that can take listen to our breath and maybe detect cancer. But again, that's riding an exponential wave. All of us though can do our part to practice health care, not sick care. We can realize that moving appropriately, 30 minutes of exercise is the best drug that you can take part of. Getting enough sleep, all those things are really, really important. And if we practice them in simple ways and leverage technology, which we now have ubiquitously, we can make the most impact on our own health and of our community and our and our nation. Now, there's an explosion now of these sort of ex- exponential technologies we're wearing on our wrists. I'm wearing like six of them, right? How many here have have have some sort of Fitbit or wearable device? Yeah, few of you are, right? It can make difference when you can sort of see and understand your data. Something as simple as your steps or your sleep can be very impactful. And these technologies have exploded on the scene. You can go into an Apple Store now and find 20 or 30 on the shelf. There's 40,000 or more health-related apps in the Android and Apple Store. And they're not all terrific. But, if you use some of them, just pick one, it can really help you stay on top of things that are really important like your sleep, right? if you don't take care of your sleep health, that can really impact your health downstream. And these technologies have started sort of simple, this idea of quantified self, but they're moving to this era of quantified health. It can be toothbrush that tracks your kids when they brush their teeth or the scale that tweets your weight to your friends. it can be new technologies that can tell how much you're drinking and what you're drinking, whether that's legal or not or if you're legal or not to drive. All those things are are merging very quickly, becoming appified. Some can even measure how many calories you're eating or drinking. And don't look to the sensors of today. The sensors of tomorrow are going to start disappearing and layering different elements. Even Google's building new smartphone that has multiple integrated components. One might be glucometer if you're diabetic. One might help track your cardiac issues if you're heart patient. These new sensors will start to become embedded in our clothes, in our cars, the Internet of Things in our homes. They're even coming to our youngsters. this is the idea of smart diaper from Wired Magazine. But actually, it's now reality. There's TweetPee from Huggies. You can figure out what that does. I'll let you figure out what this one does, number two. You know, sometimes too much data. So, we can get all sorts of information even from our our youngest citizens including there's my 2-month-old contributing to the medical establishment. So, when we have this data and it starts to disappear and be integrated into wearable tattoos that can be given to us when we leave the hospital or the wearables essentially become insidables, tools that we'll start to swallow. This is an integrated i-pill that can replace an endoscopy to look at your GI tract. So, we're now going to be surrounded by lots and lots of big data, but the trick is to make that actionable information, personal information we can use. So, we're going to be layering analytics, predictalytics, the idea of what your car has today, check engine light that lets you know based on hundred or two hundred sensors that your BMW needs to go into the shop. We'll have those kind of mentalities coming into our health care systems to to to understand you and give you your own early warning light. Or if you hit the tree when you crash your car, it can call the emergency services. And services like Google Now will start to remind you, it's time to go to your run or to go have healthy breakfast as opposed to your normal run." And we'll get other reminders like looking in the future mirror. You'll see future you, view of tomorrow. Okay, you of tomorrow. You kind of work out. Really working out, you of tomorrow. Okay, you're doing P90X, you of tomorrow, right? What if you keeping having strudel for breakfast? Well, that's what happens, right? Now, you don't need to wait for the magic mirror, you can download apps today. Here's me now, here's me thousand strudels later, right? So, think think about it before have that extra strudel. love strudel, right? Or for those of you in Europe who smoke, right? What's going to happen to your skin if you're smoking? What if you could show someone what their skin's going to look like if they spend too much time on Facebook, all right? So, this idea of understanding our health before you smoke, after you smoke, can be really powerful levers to change your behavior. And we're seeing new technologies like Oculus Rift, which was just bought by Facebook for $3 billion, it's going to be powerful way to see our environment and train our brains. So, we want to optimize our brains in new ways, right? There's new ways to understand and read our brains, that's the the old Back to the Future way, but there's now an explosion of consumer devices that you can wear that can give you insights into your own brain waves. So, can wear this headset essentially and take look at my brain waves, can learn to focus if need to focus playing game for kids who have attention deficit disorder, that can be very useful. we can use this to train folks to meditate. Here's my brain signal when I'm actually calm for few minutes. we're seeing folks start to open source these technologies and hack them to use brain waves in new ways. And in fact, some groups at MGH and other places where trained are starting to create devices that will put energy into your brain to maybe make you smarter, have more focus, or treat Parkinson's or other disorders. So, it's really new world now just for diagnosis and health, but also for diagnosis. most of you when you go to the doctor, that's when you have access to certain diagnostic kits. Now, as physician, have digital doctor's bag. may have device can attach to my smartphone to look in child's ear for pediatric visit. Or again on our phones, we have whole new version of connected technologies like the smartphone case. can hold the case and it will give me my EKG directly. could screen the room here and pass this around and find folks who might have medical issues. And if you don't read EKGs, you can press button on the app and boom, your EKG result comes to you and your physician right away. So, it's really interesting world where we can start to get continuous data anyone on the planet. In fact, I'm wearing little patch. Maybe we can switch over to the live screen right now. I'm wearing little disposable patch right here. And if the AV folks can help out, there's my live data talking from this patch I'm wearing to my phone. you can see my EKG sort of my stress is only 99%. Thank you. if run around or if fall down, it knows my posture and it can tell and call my mother or emergency services if don't get up in time, all right? I'll switch back. And so, this is an example of big data coming to us. Who's going to understand this data? Who's going to analyze it? We'll need to use this in smart ways. Other ways to look at my heart. This is technology from Stanford where you can do 5-minute cardiac MRI, completely reconstruct the heart function, and this will replace the ultrasounder in few years. Or if you're patient that you're trying to that might have epilepsy or other neurological disorders, we can measure and predict when you're going to have epileptic episodes. Or if you're patient with advanced disease or complicated disease like multiple sclerosis, what if we have dashboard to look at the integration of signals and give you medicines before you have the MS flare-up. So, lots of ways to start integrating this data. We're going to need to put this together for the consumer, for you at home. I've been involved with an organization called the Prize for few years, and we've designed medical tricorder prize, like from Star Trek, the medical tricorder. And over 200 teams have entered this competition. One of them started at the first exponential medicine program, and they're already have developed handheld medical device for the home that you hold to your forehead, it gives your heart rate, temperature, oxygen saturation, respiratory rate, talks to your smartphone, which is connected to IBM Watson, and can help you as consumer and your medical team make better diagnoses. And that will maybe replace visit to the emergency room. Or we can use tools now to dip your urine and take picture of the urinalysis. So, dip the urine stick, take picture with the app, and boom, it gives you urinalysis immediately. Or if you might have influenza or swine flu, you can spit in tube and have that analysis done at home. So, new ways of doing connected diagnosis from home are going to enable all of us to hopefully be healthier and do smarter triage and lower costs. And what's really interesting about this company is that they raised most of the money for the clinical trial, 10,000 of these will ship next month, through online crowdsourcing. So, new ways to fund medical innovation are certainly coming as well. Back to the brain. How about diagnosing things that are very expensive and hard to treat like Alzheimer's? We can now put someone in scanner and using special technique determine if they're going to get Alzheimer's or other diseases about 10 years ahead of time. Maybe then we can be more proactive. Now, there's new blood-based tests that may be able to diagnose Alzheimer's 10 years early. Or even now, visual tests, an app and little sensor that looks at your eye motion can track eye eye movements and determine 10 years or 20 years early who's likely to get diseases like Alzheimer's. So, lots of new ways to think about diagnosis using these connected tools in new and powerful ways. Okay, hopefully we're healthy, hopefully we've done good diagnosis, but we're still going to need therapy. Where is therapy Where's technology taking health care therapeutics? Well, lot of the future of medical visits will be mediated by telemedicine. About six companies have launched in the last six months that are offering sort of online visits directly from your smartphone or tablet for less than 20 euros. And think good percentage, maybe 50% of doctor visits or other health care visits will be mediated by these apps. You can have apps that will help you make appointments. You can have In my case, had little lump on my neck, used dermatology app that connected to real dermatologist to help diagnose the little lump. Then made an appointment with plastic surgeon, and in one visit with two apps, had my little mole removed. So, boom, right? Lower cost and better experience. And in some cases, this is lowering costs. We're seeing evidence now that these apps will prevent heart patients who have difficult complicated disease from coming back and forth to the hospital. Or using therapeutics using artificial intelligence systems to maybe even do better job than your psychiatrist some sometimes, all right? We're blending therapeutic modalities. This idea now of ultrasound, which you use for diagnostics, can be blended with MRI. So, woman, for example, with uterine fibroid or tumors in their liver or their brain can have focused ultrasound to knock out these lesions, and that might be the focus of less invasive surgeries as we go forward. So, lots of ways that are happening in therapeutics. My field, I'm trained as oncologist, cancer doctor, is getting very exciting because now with lower cost genomics, we're going to start sequencing every single tumor using artificial analytics and other services to predict what drugs are specifically right for you. There are new classes of drugs like this one that was just approved this week that are leveraging the immune system and are much more targeted and less toxic. We're seeing new interventions that are like our pacemakers, but they're getting smaller and more powerful. they can be placed by less skilled doctors. We're seeing pacemakers not just for the heart, but for the brain, for the GI tract, and whole new set of modalities. Even some pacemakers are are implants that will modulate long-term birth control. You can turn it on and off with your app. Might be convenient. So, again, from wearables, externals to insidables. And part of therapeutics, like it or not, will be mediated by artificial intelligence and robotics. We're already seeing robotic anesthesiologists embedded with artificial intelligence. You can think about like the taxi drivers here who's who's not very happy about this, right? so, robotics is coming. We're seeing the era of wearable robotics. the woman on the left there is paralyzed from the waist down, she's wearing wearable exoskeleton with components of it that are 3D printed to actually match her anatomy. And 3D printing, by the way, is really exploding and really is starting to impact health care. If you're fracture, you're an orthopedic patient, you're going to have things that match your anatomy. If you need new hip or new joint, those might be printed exactly for you. have been scanned and I've been printed. Here's little mini me. carried my my pocket. Now, it's fun to have mini me, but what if God forbid had cancer on my face and could print component that matches and replaces that. So, new ways to think about these 3D printing realms as we move forward. And including new ways to educate and help the physician, whether they're in the operating room using technologies like Google Glass. One of the best use cases and most common apps that are being developed for these are in the world of of health care. So, the surgeon can see the vital signs or be in communication with senior surgeon or medical student. We're seeing new ways of education where physicians and nurses and and students and you can share your images and and help the whole process of medical discovery. So, speaking of discovery, we all can play role if we can crowdsource our our health and our information. In fact, just there was an earthquake in in near San Francisco about 2 weeks ago, and they could tell all the folks who were wearing this Jawbone device, they could tell who woke up based on how close they were to the earthquake. Pretty amazing, right? so, that was sort of crowdsourced information about sleep. What if we could start to crowdsource our genetic information? If you start to share your genetic information and volunteer it with smart privacy laws in place, that will be powerful. Or now, for 100 US dollars, you can have your microbiome sequenced, and you can share that data. Soon we'll be prescribing bacteria to replace our GI tract and do other things. And finally, just like when we fly, we can track all the airplanes. We can have dashboards of our data and share our information. Just like when we drive now with Google Maps or Waze, you share little bit of your privacy. This is map of Rome being built in day just from the Google Map data, right? What if you can then get some information back like the best route to school or to work, and you you crowdsource and share your information. And realize that we're all connected, we're all part of social network. It's our social networks that are often most important in our health care outcomes. We can mine our social network data with privacy in mind. We can then determine who to maybe shake hands with or not shake hands with that day. And we can all become not just organ and blood donors, but potentially data donors. So, in closing, think about all the technologies that are emerging. They're moving very, very quickly. The new innovators in healthcare aren't the traditional physicians anymore. They're new accelerators and incubators. visited one in here here in Berlin just yesterday. We can all have global impact just not just here in the West, but in the in developing world by leveraging mobile and health in new ways, by taking technologies like this $35 Android tablet, which could be used in health and education in powerful realms. We could take new technologies like drones from company from Singularity University called Matternet that's taking drones to deliver drugs and vaccines. And soon we're now seeing big players like the Amazons and the Googles get in this realm. So, even for real, there's company in San Francisco that's going to be delivering drugs from the pharmacy to you in San Francisco. Not sure what kind of drugs, but they'll be delivering them by drone. So, this is happening. So, remember, healthcare's shifting from one that's been episodic and reactive to an era that's more continuous and proactive. Technology is often here before we expect it. And the best way for us to take the next step and create the future of health and medicine is to go and create it ourselves. So, want all of you to be the next step in the future of health yourself and for the world. With that, I'll say danke. Thanks.