The Future of Medicine is … Here: TEDMED 2012

iMedicalApps.

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In just a few short years, the TEDMED conference has grown in size and prominence to become an annual highlight for health care visionaries and digerati. The list of speakers shows it to include some of the best and brightest in the nation and spans disciplines from engineering to medicine to informatics to chemistry.

As many readers already know, the TEDMED format follows that of the original TED conference series, consisting of 20-minute presentations followed by a brief on-stage Q&A by the conference moderator. There are no panels, breakout sessions or parallel tracks. By asking conference goers to apply to attend and pricing tickets in the thousands, an aura of exclusivity has grown around the meeting. But this same aura clearly adds an element of excitement, media buzz and even importance around the meeting. As one speaker reported, even his 9-year-old daughter was excited to learn her dad was speaking at TEDMED! Below are some highlights from iMedicalApps’ coverage of the final day of the conference.

Although TEDMED was originally founded in 1998, in its current incarnation it has only produced its signature conference since 2009. The inaugural show included a memorable demonstration of the power of mobile health technologies and personal genomics by Eric Topol, MD (iMedicalApps interview). Starting in 2012 and going forward, the conference has moved from San Diego to Washington, D.C., in order to be near the “heart of America’s national conversation on health and medicine.”

This year, TEDMED introduced two new concepts: simultaneous live HD streaming of the conference to numerous health related institutions and med schools internationally, and a Great Challenges program. In the latter, a panel of 50 leaders suggests one “great” challenge confronting each, which is voted upon by the TEDMED delegates. The top 20 vote getters are subsequently announced. According to the organizers:

“The mission of the Great Challenges Program is not to ‘solve’ America’s most confounding health and wellness problems. Instead, we seek to provide America and the world with a comprehensive view, incorporating thoughtful perspectives from every discipline and from all sectors of society.”

Leslie Saxon, MD, executive director and founder of USC Center for Body Computing and professor of Clinical Medicine at the Keck School of Medicine of USC

Many iMedicalApps readers already are familiar with the Saxon and the USC Center for Body Computing, which has taken an important role in investigating and promoting wireless health sensors. The conference has hosted an annual conference on body computing since 2007. Saxon’s presentation was memorable both for its bold idea as well as two great anecdotes that highlighted the promise of mobile health devices.

In one story, she recalled a recent event she hosted where participants were each provided the mobile iPhone ECG device AliveCor. This device exposes to small metal surfaces on an iPhone case and quickly displays on the phone screen an ECG tracing, which can subsequently be uploaded. Over the next couple of weeks, the participants continued to upload their tracings, hundreds of them, which Saxon would occasionally peruse from her home computer. One night, she turned on the display to see that a Nigerian gentleman, at that time sitting in Mumbai, India, had a tracing showing on active myocardial infarction. She contacted him by phone immediately. It turned out to be a silent MI — he had no idea!

She told another similar story of her weekly tennis game, that day with a 19-year-old tennis athlete. The night before, that teen had been out with friends and was likely still tired and dehydrated. Part way through the game, she slumped against the fence. Saxon quickly took out her iPhone and obtained a tracing showing the girl was in a rapid ventricular arrhythmia — I am guessing SVT — which the doctor was able to quickly reverse with a physical maneuver — likely carotid massage. This event gave her an insight into how otherwise healthy athletes sometimes suffer sudden death. By pushing themselves harder than other individuals, this typically non-life threatening arrhythmia can kill. But, without the ability to make the diagnosis in its actual context, this insight would have been elusive.

These moments led her to a bold idea. Why not collect the heart tracings of every human on the planet? She announced the launch of a website to do just that: everyheartbeat.org. It is a place to collect and share wireless health information. As she put it, there is a Wikipedia of medicine (“I know, every patient reads it to me”), but no Facebook of medicine. By collecting and analyzing these vast databases, we could learn much more about cardiac activity in the context of life.

“I imagine a world where people share their heart data like they share other social activity,” she said.

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And even though the dataset sounds massive, she said one year’s worth of data 365 Tb would still be less than the amount of data amassed by the filming of .

chair of the department of Genomic Medicine, and scientific director at the Institute of Applied Cancer Science, MD Anderson Cancer Center

Chin gave an understated but profound talk on how the construct and culture of academic science and medicine is not equipped to solve the challenges of drug discovery. She started by noting that there is an important disconnect between the rate of scientific discovery and the rate at which new drugs and treatments become available.

The concept of “personalized medicine” — tailoring treatment for one individual instead of a population — is very much in vogue. While the term is inconsistently used, she believes it is best defined as “practicing medicine with science.” However, the disruptive technology of rapid genetic sequencing underlying personalized medicine will increasingly lead us to dead ends since we only have a limited number of drugs “on the shelf.”

One obstacle she has noticed, starting from her days at the Dana Farber Cancer Institute at Harvard and as a biotech company founder, is that the academic researchers, the small biopharma companies and the large pharma companies are in silos and unable to communicate “without lawyers.” This means that experimental problems that necessarily crop up at each phase of the evolution to commercialization have to be solved in a vacuum.

She proposes a fundamental restructuring of the academic context, from one where credit only accrues to individuals publishing papers in prestigious journals to one where teams work together to create viable drugs and are rewarded according to their productivity.

Otherwise, from the researcher’s perspective, it ends at publication. They hand over the discovery of a new target or pathway to pharma.

“Once you hand the baton, you can’t help the next runner, you can only cheer from the sideline,” she said.

Can we get 8 billion heartbeats on speed dial?Can medical industry and medical research live happily ever after?Lynda Chin, MD,

Yet, we need the biology at every step of the pipeline. It is not enough to do only research in academia; it will be necessary to incorporate applied research. We need a new organizational construct in academia, recognizing the importance of applied scientists and engineers.

In academia, only the first author counts. This will not work when diverse skills are needed. The team has to be celebrated. It needs to be goal oriented, given a map. We have to manage resources, if it is not working, we should kill it. We have to change the culture of academia and recognize that publication is not the only thing that matters. We need to get the right people and give them the right rewards. We need products.

associate professor of Computational Biology, Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute

Franziska Michor,

When does 2+2 = life?

Michor came from an interesting background, with a mathematician father and caregiver mother. She loved that math contained a list of rules and logic but wanted to combine it with the humanitarian approach of her mother. Later, she thought that it was mind-boggling that mathematics was not applied to cancer as math permeates everything.

In math, rules are used to predict future activity. But the question was, what rules underly cancer? Her insight was that these rules come from evolution — specifically, from the progression from unicelluar to multicellular organisms. In this important step, selfish cells had to enter into “the covenant of multi-cellularity” to give up this selfish behavior and be part of a larger organism.

Therefore cancer is the breakdown of this covenant. In the human body, there are a trillion cell divisions daily and thousands of mutations. The immune system protects us from these mutations as does the process of cell differentiation and natural apoptosis. However, as more mutation occurs, the policing breaks down, which leads to cells that declare “me, me, me.”

We can describe the rates of mutation in a population of cells and calculate the chance that tumors will respond to treatment. These underlying mathematics describe the evolutionary dynamics of cells. Michor showed an example of lung cancer sensitive to a targeted therapy. However, the cells evolve resistance by changing their receptors. In this patient, after an initial response, the tumor starts to grow again two years later.

However, she asked, what if we had changed the initial dosing strategy to reduce the risk of resistance? What if we dosed every other day or every third day? To model the effects of these dosing strategies, we could not realistically run clinical trials for each one. However, if we can describe the evolutionary rules that lead to resistance, we can model them in seconds on a computer.

If the meteoric course of her career — obtaining a Harvard Ph.D. at age 22 and holding positions at Memorial Sloan Kettering and Dana Farber Cancer Institute — is any indication, we will no doubt be treating cancer with drugs as well as math in the future.

Conclusion

Some of the other highlights included Atul Butte, MD, an accomplished medical informaticist now at Stanford, who predicted that the wide availability of genetic data published freely on the web means that the scientific method may become obsolete. In the future, we will start with massive data stores and then look for a question to ask.

In his words: “data is frozen knowledge, you and I bring the heat and light to melt it.”

He also thinks the rapid dissemination of genetic experimental tools, such as available at assaydept.com, will lead to a future where garage tinkerers come up with new drugs.

Bud Frazier, MD, the chief of Cardiac Support at Texas Heart Institute and heart pump pioneer, gave an account of his insight that mimicking the natural beating function of the heart was the wrong way to make an artificial heart. He started by saying that early flight machines tried to replicate flapping wings and all failed until we came up with the idea of a propeller. Similarly, early artificial hearts had to beat 100,000/day — a rate at which man made materials could not sustain. Seeing an archimedes screw pump irrigation water led to the development of a compact and efficient blood pump that can completely replace a heart and amazingly resulting in perfectly functional people who do not have heart beats!

There were many other great speakers, and no doubt our readers will enjoy the videos once published on the TEDMED site. We look forward to the amazing TEDMED when it returns to Washington in 2013.