Transcript
Hello, and welcome to Get Yourself Optimized! I’m your host, Stephan Spencer, and today, I have the distinct pleasure of inviting Dr. Daniel Kraft on to the show. Dr. Kraft is a Stanford and Harvard-trained physician, scientist, and inventor. He’s an entrepreneur innovator. He’s the faculty chair for medicine and neuroscience at Singularity University, which is an amazing organization that’s really thinking about the future and helping us build a compelling future that is sustainable and works for us humans. He’s also the faculty chair for medicine. He’s also the founder and chair of the Exponential Medicine Annual Conference.
With over 20 years of experience in clinical practice, biomedical research, and healthcare innovation, Dr. Kraft is a true innovator. He’s founded a couple of companies, including IntelliMedicine, which is focused on enabling connected, data-driven, and integrated personalized medicine. He is the inventor of MarrowMiner, an FDA approved device for minimally invasive harvesting of bone marrow, and he founded RegenMed Systems, which is a company developing technologies to enable adult stem cell-based regenerative therapies. He’s definitely doing cutting-edge stuff. He’s been awarded the Aspen Institute Healthcare Innovator Fellow, and he’s an advisor to multiple companies including the X Prize Foundation. Welcome, Daniel! It’s great to have you on the show!
Great to be here. Thanks for having me!
If you think about the future of healthcare, we’re much more not in the healthcare system, but more of a “sick-care” system.
Let’s start with just kind of generally speaking, what is the future of health and medicine looking like for us humans? Are we just going to become batteries for our robot overlords like in The Matrix or we’re going to live for forever? What does the future hold for us, humans?
Well, I’ll start maybe with the help in medicine side and leave a sort of super longevity and robot overlords for a little bit later in the conversation, but if you think about the future of healthcare, and you sort of look at where we are today in the US and around the world, we’re much more not in the healthcare system, but more of a “sick-care” system. We’re in a setting where we get sort of very intermittent and sporadic data that might be your weight, your blood pressure, your blood sugars, and getting that to your clinician or healthcare team in this broken feedback loop, and so, therefore, we’re quite reactive.
We wait for the disease to happen-the heart attack, the stroke, the lump to be discovered in an advanced stage-and I think part of that re-imagination and future of health and medicine broadly is to, with a lot of the new tools and technologies that are already here to use as a smart way to be much more continuous with our information and data, make that actionable to you as an individual and to your healthcare team, and then to be much more proactive, to pick up and prevent diseases early, or as I like to call it, “stage Zero,” as opposed to stage three or stage four. I think that healthy medicine crosses a whole spectrum-from prevention to diagnostics to therapy to clinical trials-and I think it’s a really exciting time to start to reboot and reimagine pieces of that.
Right. Let’s dig into each of those-through the interview here and the clinical trials and diagnostics-let’s actually start with the health and prevention and kind of wellness side of thingWhat are some of the things that we need to think about today for planning for our longevity and optimal health? What sort of technologies and modalities should we look forward to in the future that we would be incorporating into our wellness regimen?
Sure. Well, I think it’s a really interesting exciting era and a real tipping point on the health of prevention and wellness side because we’ve just, especially for the optimized geeks out there like you and me, we can now start to capture on a minute-by-minute basis elements of our health and our behaviors, and it’s really our daily and monthly and sort of regular behaviors that drive most of our long term diseases. Whether it’s smoking or stress or poor sleep or diet, that leads to 80% of our health care conditions and the vast majority of a cause. If you think about it, we’re only what? Seven or eight years into the smartphone era, which brings us a zero of sort of mobile-connected health, and now, maybe what? Six years into the year of wearables like Fitbit and others, which can give us very basic insights into things like our steps and core elements of our sleep, but where I think it’s moving now is to be able to quantify a whole array of elements in much more granular detail from our actual heart rate, which is our smartwatches can do today to our heart rate variability, which might relate to stress, to the quality of our voice, which can be picked up on our smartphones, which can relate to our emotional status, to the quality of our breath.
Whether it’s blood alcohol levels or things that might contribute to bad breath or be indications of disease so, we can start to, now, quantify all sorts of things. The challenge is, there’s a lot of geeks out there that might make spreadsheets and track these things. The trick is to make this information useful and gain insights and actionable elements from that so that you can start to tune something like your sleep, which has huge implications into our risk of neurodegenerative disorders and risk for cancer and depression-ways to gain insights into our mental health. Companies like Ginger.io are using the smartphone as a platform to measure things from your movement, to your steps, to your texting, to who you’re calling and when. I think if we start to connect the dots on all these new little pieces of quantification, we’ll start to integrate them in smart ways. I kind of like to call it an “on-star” for your body-kind of like we have in our modern cars, which have hundreds of sensors of which you don’t care about any one sensor, you kind of care about your check engine light goes on. As we move to more proactive preventive health and medicine, we’ll start to use these as individuals and in conjunction with our healthcare teams to keep us on a on a more optimized precision prevention regimen.
As we move to more proactive preventive health and medicine, we’ll start to use these as individuals and in conjunction with our healthcare teams to keep us on a on a more optimized precision prevention regimen.
Mm-hmm. I like that analogy of the check engine light. A lot of people are kind of, especially geeks who are into the quantified self-movement and just tracking everything that can be tracked, but really, it’s not about the tracking, it’s about taking actionable insights out of whatever you’re tracking and improving your health longevity. The fact you’re tracking the number of steps you’re taking or your heart rate throughout the day doesn’t really do anything unless you make some behavior changes, right?
It’s a lot of data, potentially. You don’t want to watch your heart rate trends throughout the whole day. Even your cardiologist wouldn’t know what to do with that. I have a little patch I can wear that can live stream my full-on EKG, my position, my temperature, and my steps. The trick, I think, is how to take this in a big data and make it small actionable information both for modulating behaviors like sleep and exercise all the way to giving an early warning that you’re heading towards a cardiovascular event like a stroke or heart attack. A small example might be, I have a new little sensor on my mattress to track sleep. It actually tracks motion, heart rate, and respiratory rate, and it gives you pretty good idea of how long you’re deep sleep and otherwise. It will show me every day, “Wow, your resting heart rate the last two days was up five points from normal,” and that might not mean much if it’s just a couple random days, but let’s say over a few months, that software starts to look at that and go, “Hey, your heart rate is up to 10 points for normal.
Maybe something’s going on a cardiovascular status.” I think we can look at it individually, but more and more the artificial intelligence and the algorithms built into this will start to learn what your normal baseline is and when are changes relevant. I like to call it “predict-olitics.” Similar to a good intensive care unit doctor in a very complex intensive care unit, the patient has all sorts of data coming at them, and someone’s going to say, “Septic,” we’ll start to have a heart rate creep up, a temperature spike, the blood pressure may start to drop when it gets farther along, and really, you want to take those things up early before they get into full septic mode and take a blood culture and start on antibiotic I think we’ll, hopefully, see some of the same analogies come to our homes into our own bodies and be connected to our healthcare system so we can tune those behaviors and its preventative measures as we go along.
Right. Right now, there are a whole bunch of different devices that track different things like for example, Zeo, which they no longer make, but it’s a great device for tracking deep sleep, light sleep, REM sleep, and etcetera when you wear this headband, and then it syncs with your phone with an app via Bluetooth that just tracks your sleep, reports on it, tells you how many minutes deep sleep, for example, you’ve got, which is a really important metric-more important than the total amount of sleep you had for the night, to know you have this amount of deep sleep and for it to know that through tracking your brain waves rather than just movement of your mattress or like a Fitbit tracking movement of your wrist, which is an indicator of how much deep sleep you’re getting, but it’s not quite as accurate so, there’s the Zeo.
I have the Healbe GoBe health tracker, which is kind of like a big Fitbit that you wear around your wrist. It not only tracks your heart rate and so forth, but it also tracks your intake of protein, carbs and fats, which is pretty cool, and within 85% accuracy, which is about equivalent to the accuracy if you just track your own intake of calories just pen and paper, or using an app where you just input the items that you’ve eaten throughout the day. There’s a lot of stuff to keep track of, devices and things, or maybe there’s going to be a universal kind of health tricorder where it tracks all of these things in one device.
Well, we’re sort of moving to that sort of integration. I mean, take something now like HealthKit on my iPhone or Google’s coming out with a version as well and Samsung. We can start to flow the data from multiple devices whether it’s your scale, your glucometer, your blood pressure device if you need that, maybe how long you’re brushing your teeth with, it connects to the toothbrushes. A lot of the value in this information is to connect the dots and not just have it in sort of raw spreadsheets. You mentioned two thingsleep and diet, both of which are impacted by your base genetics by other factors from your BMI and percentage body fat to exercise and other elements. I think where we can go this, in terms of let’s say hacking your sleep to get better REM sleep, for example, and maybe need less time, we’ll be increasingly using things like brain computer interface like the Zeo, one of the early ones now off the market. Maybe supplanted by things like the Muse, which can also be used to optimize mindfulness or meditation, which can help sleep and stress.
Yup.
Or take diet, which again is so variable. You look at any bookshelf, there are hundreds of books. Some say eat more fat, some say eat less, some say do high carb or low carb-there are so many variations there. I don’t think any of us has the need for the same diet. If you can start to integrate your base genetics, which you can get from things like 23andMe or your full genome, which I just ordered from a company called Veritas for less than a thousand dollars, or your microbiome, which you can get for $80 or so from companies like uBiome. You can start to integrate that with your digital health data and what kind of meals you’re on to, potentially, really optimize something as critical as diet, which can be used to lose weight or to optimize health and performance.
There are studies showing that even a few minutes of meditation once or twice a day have a lot of long and short term benefits.
Mm-hmm. Right. You mentioned the Muse. I actually have a device. I haven’t really gotten into it yet. Do you use it?
Yeah. I’m actually full-disclosure advisor of the company. I use it to sort of help by my mindfulness and help improve it. It provides a pretty simple feedback loop-hearing different sounds as your mind gets more active or calmer. There are many, many studies showing that even a few minutes of meditation once or twice a day have a lot of long and short term benefits. This is the kind of thing that, as a physician, I could prescribe to a patient who has anxiety or depression as opposed to giving them a benzodiazepine, for example. Kind of this idea of prescribing a digiceutical whether that’s an app to help prevent Type II diabetes or optimize your stress and addressing anxiety issues. I think we’ll see these sorts of things be used in increasingly less consumer ways, but be integrated in with true healthcare, and moving from quantified self to quantified health where the data from your health kit on your phone integrated through multiple devices, for example, can populate your EMR or your electronic medical records so your clinician can see that in a useful and not overwhelming way.
Right. What are the implications in terms of health insurance, life insurance, and so forth if you’re feeding all this data to the insurance companies, it’s going in your health records, and they kind of treat you unfairly, let’s just put it that way. Like I applied for disability insurance and then they pored through my medical records looking for things that they could carve out as preexisting conditions or whatever just because they don’t want to cover all those things. What are the implications? They are sharing all of this data with the health company, health insurance, and all that.
Yeah. I mean, there are dark sides and bright sides. The bright side is, if you can get leverage over yourself or of your employees or others to be proactive and to do things that will be a long-term benefit for their health, and you can reward them by giving them lower insurance premiums, for example, that’s great. I mean, let’s take the car driver model. If you’re a horrible driver and has lots of accidents that points on your record, companies like Progressive car insurance will put a little mini black box in your car and track your driving. If you show that you’re not stopping and speeding too often and you’re maintaining the speed limit, they’ll lower your premium rates to a more reasonable level. That’s starting to come into different sort of health plans. If you show that you’re doing your 10,000 steps a day and you’ve gone and joined a gym and started doing yoga and you quit smoking, you might benefit from lower premiums versus someone who, let’s say, has a chronic disease and doesn’t take care of it and has a frequent flyer comes back to the emergency room costs the system millions of dollars.
We can use these, hopefully, to do smart incentives and to align them for both healthcare systems and individuals. The danger is, what happens to healthcare and data privacy? Who owns that information from your smartphone? Could a health insurer use everything from your base genetics otherwise, to change your rates? Can employers use this in a discriminatory fashion? There are laws on the books like GINA or Genetic Information Non-Discrimination Act that should prevent an employer from looking at your base genetics and going, “Wow, you have a risk of getting heart disease or Alzheimer’s, I’m not going to hire you,” when you’re 40 because there’s a higher risk of that 20 years from now. Lots of ethics and policy things that sometimes moving much more slowly than the exponential pace of low-cost sequencing for one example. I think we need to be smart about it. I don’t think we should get paralyzed and not use this information, but you should be pretty clear about where that data goes, who owns it, and how it can be leveraged for good and to bad.
Yeah. For sure. So, back to neuro feedback and using a device. I guess it would be superior to use just a pure app for meditation like Headspace, correct?
Well, Headspace is terrific. I know the founder. He was in our faculty from Exponential Medicine. They’re complimentary. I think an app showing the power of distributing a platform for mindfulness like Headspace is a great example of democratizing an ancient tool really, which is mindfulness, that is benefiting lots and lots of folks. My mother-in-law swears by Headspace. She was excited that I knew Andy, and she does 30 minutes a day. I met many other folks who do some form of mindfulness that has significantly changed their lives. When you can appafy it and just say, “Take 10. Do 10 minutes a day, and that’s it,” it feels approachable and doable. It doesn’t make you feel woo-woo or tied to some spirituality. It’s just a way to calm your brain. There are applications within that to address things like sleep, stress, and athletic performance should you choose to go in that pathway. A good example sort of blending East and West. It’s pretty amazing that in the smartphone era, which isn’t even a decade old, you can look to create an application and distribute it to millions of people and potentially garner a lot of revenue if you do that in a smart way that can be very positively impacting.
It’s an exciting time to reinvent and rematch in healthcare using exponential-type technologies from mobile to sensors to quantified self.
At Singularity University, where I chair the medicine side of the program, we ask our participants to think about how you could leverage some of these exponential technologies whether it’s digital health, mobile health, connecting data, wearables, low-cost genomics, sensors, and 3D printing to address plan challenges and everything from poverty, education, environment, and healthcare. It’s been pretty exciting to see how many innovators are coming to health and medicine who are not traditional physicians or pharma people or device or nurses, but have technology insights and are applying them to healthcare realm. One example is, a pretty famous rock star who is with the Londonbeat. He came to one of our programs, and he was interested in neuroscience-that music can affect your ability to focus and your sort of cognitive state. He started a program called focus@will because his name is Will Henshall. It’s a great little app on your mobile phone or your computer when you’re working to play music that helps your brain to focus. Those are examples that are coming from outside of health or medicine applying skills there. Many of the folks working at Apple, Google, Facebook, and other sort of big tech companies are now bringing their talents to the health medical field so, it’s an exciting time to reinvent and rematch in healthcare using exponential-type technologies from mobile to sensors to quantified self that, hopefully, when they blend together giving us real leverage across the spectrum.
Right. Yeah, there are amazing apps out there. You mentioned that there’s an app even for helping prevent Type II diabetes. What app were you referring to?
One of the sort of poster children for sort of digital health is a company called Omada Health, which has taken sort of old school proven methods to take folks who are pre-diabetic-they’ll be a little overweigh and their immunoglobulin in a certain range. They’re pre-diabetic, they’re very likely to convert to being Type II diabetes patients with medication and higher cardiovascular and other medical issues. If you take these folks, as it was shown in Harvard study, and put them in a social network group, you give them a way to track their steps in a scale, and you do that sort of real life, you bring them into a room every week, you could pretty dramatically turn them around and use that social support as well as the data to give them leverage and to lose weight and change their diets and move from being pre-diabetic to basically normal. Now, Omada sort of appleied that in their first program called, Prevent, with great success. As an example, again, of being proactive, identifying folks at risk and using some of these smart connected tools to engage them to meaningfully change their trajectory and instead of becoming expensive, sick diabetics staying healthier for longer.
Mm-hmm. Any other apps that you would recommend? Any apps, for example, that you use on a daily basis for health?
If you look at the same step data and the same form every day, it may not keep you going, but as smart platforms and systems can learn, you can be look at your sleep and your activity.
I think one of the challenges with healthcare apps is-I’ve had a TED Talk where they call it, “There’s an app for this,” in health and medicine. There’s over 60,000 or more-when you count them-health and medical-related apps. Some of them are very specific to certain diseases like diabetes or managing hypertension or heart disease, remembering to take your pill. Others are for general wellness and diet. The challenge is, a lot of them are sort of one-size-fits-all. The opportunity, I think, in the future is to move to apps to user interface that matches you, Stephan, or Daniel, and my carrots, and my sticks, and can keep me engaged and changed over time. If you look at the same step data and the same form every day, it may not keep you going, but as smart platforms and systems can learn, you can be some sort of digital coaches to look at your sleep and your activity.
One of my favorites, actually, is one that I use called, Lark, and it’s a bit of an AI chat bot for health and nutrition. It tracks your steps through your phone. You need to wear anything. It tracks your sleep from when you put your phone down at night and pick it up in the morning. They can track your diet if you want to know that information. They give you this kind of almost like the Her movie kind of interactive agent that encourages you and looks at your data and say, “Hey, you’re doing great yesterday. Compared to normal, you’re 2,000 steps above where you normally are at this time of the day,” or “Last night, wow, you only got six hours. It happens sometimes. We get to bed early tonight.”
I think we’ll see this sort of AI coaches start to manage health and wellness, but manage chronic disease like diabetes or emphysema. There are already companies that have real coaches that connect through your smartphone-kind of like tele-medicine for health coaching. I think all those when you blend them together and you tune that again to the individual and their mindset can be most impactful so, there is not any one go-to, one has plenty of wearables that track basic elements. Sometimes, it’s just the fact that you’re wearing one that reminds you to take the stairs or to stand up and stop smoking that can really engage folks into changing their behavior over the long term.
Mm-hmm, yup. What about devices you use on a daily basis? Do you have a Wii Fit that you use?
Yeah, a couple of things-I’ve got my trusty Apple watch as an early adopter, and frankly, I don’t use most of the functionality on I, but I like how it syncs with my Healthkit data. I can track the heart rate. I have a Withings wristwatch, which looks like a regular watch, it’s an analog-type looking watch, but it also tracks steps and sleep and connects through WiFi through Bluetooth and can give me additional functionality. I have a kinetic scale that also tracks percentage body fat and muscle mass and, again, these things-to stepping on the scale and I’m of a normal weight and I get a normal BMI, but it keeps me a little more mindful about not overdoing it. If I’ve been on a big trip and I know I’ve added some up a pound or two, it tweaks my behavior just enough, I think, to kind of come down a pound or two over the next week and stay in a good range.
Again, what you might use as tools in the future are going to start to dissolve into our clothes, into our cars, our homes, the WiFi in our homes as M.I.T published last year. It can be used to detect the vital signs of up to 10 people in the same room at the same time so, in many cases, you don’t need to wear anything. Again, this is going to create a lot of data. We haven’t had this information over long periods of time to know what to do with it. Companies like Google or now Google Health verily are doing a baseline project to start making sense of thousands of people and what their data is. We’re seeing medical tricorders being developed so you can have ways of tracking much more detailed data like your temperature, your heart rate, and your oxygen saturation, integrate that and make sense of it. I think over time, by, hopefully, even crowdsourcing and open-sourcing some of this information, we’ll be smarter about keeping ourselves in a good path or if we have disease or problem, we can triage it and address it in a much more timely fashion than we do today when folks end up at an emergency room too late or too early.
Right. One thing that seems pretty universal amongst us, humans-especially Americans-is stress. What would be some of your recommendations for stress reduction-whether they’re old-school stuff like Yoga or some of the latest technologies? What would you recommend for stress reduction?
Stress-you measure in different ways. Sometimes, stress is very adaptive. You need a little bit of extra stress at times you get through a project or a deadline, and then, often, before people collapse and get the cold comes on. I think the trick is to sort of learn to manage it in smart ways that empower you and it doesn’t become overwhelming. Of course, things like yoga and basic mindfulness practices can dramatically impact that or doing things in the workplace like taking walking meetings. Sitting is the new smoking, get up, and take a walking meeting. That can be helpful for interactivity with your colleagues as well as reduce stress. I’ve even seen groups now. Even large companies are adapting mindfulness training and even do some of those exercises before a meeting to get people more in sync and less sort of amplified to communicate in smarter ways. There are now ways to track heart rate variability, which is one marker of stress. Now, the challenge is you would often see one number. You’re at 80% stressed now or 20%. How can you start to integrate that?
Imagine of having a bit of a-you’re empty or full light on your smart watch that gives you an indication of where your stress is over the day and how you might want to do elements of recovery when it’s doing a taking a nap in the afternoon, which has been shown to be very good for your health, but not often approved in many employer settings. There are ways that you can be, again, proactive about it. Recognizing that you’ve been on a big trip, you have jet lag, or you’re bound to have jet lag so tuning your sleep in your activity before that or taking smart breaks, drinking more water, taking a walk to the water cooler as opposed to cracking open a Diet Coke, all those things can, in an additive way, add up. We do have new ways of measuring that through our smart devices. Our smartphones and the cameras on our computers and laptops can pick up heart rate and heart rate variability potentially and facial expressions and the voice.
Less sleep means more stress over the day.
There’s a great app from a company called, Moodies. It listens to your voice. It can track your emotional stress level or that of your friends and family. I think the ability to integrate and, potentially, take signals, it can help coach you as well from real coaches or smart algorithms to be more on top of your stress element. Sleep is another good piece of that as well. Less sleep means more stress over the day. All those can lead to more chronic challenges like heart disease and, potentially, long-term risk for neurologic function.
Right, and I’m just thinking about other devices that I have that are really geeky devices that get me feedback on my stress level. For example, the Spire, which is a mindfulness and breathing tracker. You wear it and it detects whether you’re breathing deeply and reminds you to take deeper breaths if you kind of get too shallow. The Lumo Lift, which measures your posture and can give you reminders to straighten your back if you’re slouching. There are some great tools with apps out there and-
Yeah, we’re moving from just wearables, which sort of are passively tracking us, to this idea of “trainables,” whether it’s a Lumo Back or a company of posture to give you a little buzz in your back. UPRIGHT is another device that does that. It gives you a buzz on your back, and you can wear that little trainable for about a week or two weeks, and it’s going to retrain your physiology to maintain that posture so you don’t need to always be wearing that device. Lower back pain is a very common complaint in primary care clinics and leads to disability so, again, using that in smart ways to be your digital mother and say, “Sit up straight,” can be trainable. Then, inside- we’re moving to devices you can implant underneath your skin. There are versions now that you can wear on your skin that all can contract various spinal slides from full-on EKG’s to blood sugar.
I think in the next 10 years, we’ll start to see folks implanting things that can measure blood sugar, potassium, and other chemistries, which might give you useful information depending if you’re a patient with renal failure-like, potassium might be relevant or renal function number or diabetic. From simple wearables to inside-ables to trainables-there’s a whole spectrum of technologies being applied to measure almost any element of our physiology. Again, the trick is how to make that data useful and actionable, not just overwhelming, and hopefully, how do we connect it, cross feed it, and donate it in terms of crowdsourcing the information. Similar to things like when we drive with Google Maps or Waze, most of us wouldn’t imagine driving without a little digital map now in our cars or in our smartphone. We actually give up a little privacy or speed and location, but from that we can build a map of the traffic and you get information back. It will suggest you to reroute on a different highway given the traffic situation. We can crowdsource data from wearable devices like that and beyond. I think we can have that same sort of used case across many elements of health and medicine from prevention to diagnostics to therapy.
Mm-hmm, right. Inside-ables-do you have any that you have implanted?
Not personally. It’s sort of in the early stage. I mean, barely. Google Health is famously developing a contact lens, which is a bit of an insideable that will track blood sugar and enable a patient to adjust diet or insulin, for example, or other medications. There’s some basic ones you can implant through your skin. I think that as this technology gets smaller and less intrusive and the battery life extends-I mean, pacemakers. They’re an insideable. There are pacemakers for the heart around for decades, but now, they’re getting smaller, they’re being more connected, the data can flow, they need less technical skills to implant their sort of electroceuticals for the brain that can help folks with Parkinson’s and other tremor disorders. There are pacemakers that can affect epilepsy. Pacemakers for the G.I. system that can address an inflammatory bowel disease or bladder issues so, we’re going to start to blend these sort of insideables, not just to measure elements, and there are, in some medical implants today, small devices will transmit, for example, blood pressure, MEMS devices. We’ll start to see these things both in measuring and applying therapy inside our bodies as well.
So, MEMS devices-can you explain that?
Sort of microelectronics. I think folks who are familiar with cardiac catheters or implants, let’s say, for an aortic valve might be replaced or a portion of a blood vessel, there are now companies sort of implanting in those little sensors that can track blood pressure in real time, for example, which might be then be used to adjust the pacemakers rate or to indicate what blood pressure medications might be best used by the patient. That’s one example. As sensors get smaller, some of them can be swallowed. They’re now pills that can be swallowed and can replace an upper endoscopy with a big scope-cannot be done with the little camera on a swallowable pill. We’re going to see microrobots inside our bodies not just moving forward G.I. tract, but maybe through our vascular systems, and as we get more into the air nanotechnology, some of these might be literally down at the molecular level. We already have molecular nanobots. They’re called viruses essentially. We’re modifying those now to deliver genes or to be used to deliver chemotherapy, for example. A lot of these worlds are blending and sometimes, hype-involved with them, but we’re kind of getting there-sometimes, faster than we might think.
We’re going to see microrobots inside our bodies not just moving forward G.I. tract, but maybe through our vascular systems, and as we get more into the air nanotechnology, some of these might be literally down at the molecular level. Share on XHmm. Speaking of chemotherapy, I’m just curious what your take on traditional chemotherapy is? There is a lot of negative sentiment about chemotherapy and radiation as treatment for cancer.
Sure. I trained as a pediatric hemotologist/oncologist cancer doctor and also, with a focus on bone marrow transplantation. If you think about the old school cancer therapy, which is most of where we are still today, we’re taking like a weed whacker out, and we’re trying to whack the tumor in a very non-specific way, which is why a lot of the toxic side effects of many of our traditional chemotherapy drugs are so significant-whether it’s hair loss or G.I. systems or a risk for other organs. What we were moving ideally is this world of precision oncology where every tumor will be sequenced, sometimes, multiple times. We’re going to understand the molecular pathways in markers that can be addressed with targeted drugs, whether it’s for a particular mutation receptor or for a molecular pathway that’s apparent.
There are many new exciting drugs coming in the market that function in the realm of immunotherapy to amplify the patient’s own immune system to attack cancer. We’re really entering this new era of, hopefully, much more targeted precise oncology. Even you take something like lung cancer might all be thousand lung cancer patients today might be treated roughly the same, we already understand that each of those has a very different molecular pathway with different markers and, potentially, a whole different cocktail of drugs can be applied to personalize the therapy. We’re seeing companies like IBM Watson apply artificial intelligence to working up the pathology from some of these patients and suggesting what might be the best combination of drugs. We’re going to see repeated sequencing to two in the therapies and looking at circulating DNA in the patient, not a tissue biopsy but a blood biopsy, and will, hopefully, then develop faster and more specific therapies.
The idea of gene therapy is coming to real reality with things like CRISPR to be able to insert new genes and replace them for treating cancer or for genetic diseases.
The idea of gene therapy is coming to real reality with things like CRISPR to be able to insert new genes and replace them for treating cancer or for genetic diseases like sickle-cell where replacing one bad gene can simply cure that patient. I think it’s an exciting era. Part of it is not about the technology. I was just participating in The White House Cancer Moonshot Summit in Washington DC led up by Vice President Joe Biden, and a lot of the initiatives there aren’t just about the pure technology, but how do you share the data for clinical trials or basic biological research between academics and pharma companies and healthcare systems? How do you get patients into clinical trials when they qualify, when only less than 5% of patients today with cancer can start a clinical trial today? In pediatrics, my field, almost every kid is in a trial. That’s how we’ve taken survivorship for basic leukemia from less than 20% to over 80-90% today. It’s aligning the incentives to share data to make clinical trials smarter, to be even smarter about the patent system, and in the regulatory FDA routes to get some of these therapies to patients who need them.
Yeah, and CRISPR has been in the news a lot as a huge innovation. Could you give a little description to our listeners about how Crispr works-whether it is in use currently with humans and at their genes?
Sure. Super briefly, CRISPR/Cas9 is a system that was discovered only four-five years ago. First, in bacteria, and then it moved to mammalian cells that enables you to have a really like a very specific cut and paste for a gene. It has elements of gene therapy for a while, but often they can insert a gene pretty randomly into a cell, which can times can have bad side effects. What’s exciting about CRISPR systems is, you can identify a particular region and, let’s say, let’s take the example and get a sickle-cell disease since when a patient has one base pair in the DNA that codes for their hemoglobin, which is switched from, let’s say, a C to a G, and so that patient will, under certain conditions are red cells will sickle, especially when they’re sick or have oxygen stress, which leads to lots of other complications.
Now, you can take out the bone marrow stem cells from a sickle-cell patient and take some of the blood from the stem cells replaced with this CRISPR system or there are a few others like Zinc Finger to switch out the bad gene with a new one, and then re-transplant those patients and reboot their blood an immune system. You can cure those patients with that genetic disorder. That is an approach, which has already been in clinical trials with some other gene therapy approaches, which I think will get there with CRISPR. We’re seeing some of the first clinical trials for cancer just approved using CRISPR to knock in certain genes so that T-cells can go after a particular tumor target so, there’s a wide variety of both basic science applications, and it’s starting to move into the human clinical trial realm.
I think is going to be exciting era and also ethical dilemmas because we can now start to screen embryos and, potentially, do gene therapy at the pre-implantation stage of an embryo so, you want blue eyes versus brown, or six-feet of height versus five. Those can potentially be tuned and what we do with that is going to be challenging and brings up all sorts of other issues. I recommend your listeners go watch the movie Gattaca, which is now 20 years old almost, that brings up a lot of the issues about both genetics and manipulating genetics in the future.
Yeah, it’s a great movie. Right. We kind of jumped a little bit here from more diagnostics and biofeedback to treatments for different diseases. Let’s just kind of go back to the diagnostics, finish up any kind of discussion around that, and then we’ll jump into other kinds of therapies, but what sort of tests would you recommend-you mentioned earlier that you got your whole genome sequenced. First, you did 23andMe, I guess, and then you did the whole sequencing with Veritas Genomics. I’m having my full sequencing done with Simplified Genetics. I’m going to have the founder of Simplified Genetics on as a guest on the podcast. What’s the difference between this analysis of the genome versus full-sequencing for our listeners, and what would they do with that data? What’s the value?
The challenge is, if you have your genome, and you come to me, and I’m your physician, the challenge is, what do I do with your genetic information? How do I make sense of it? I think there’s a variety of levels. Number one, we can get, even with your 23andMe data, some basic risk ratification like you have a potentially higher risk for Type II diabetes or cardiovascular disease based on studies over large populations. That might mean, I might tune your prevention regimen differently than I might someone with different risks. We can look at your genes on snips and on platforms like 23andM for your pharmacogenetics.
What drugs might work or not work on you and what don’t? They might want to choose a different medicine in the different dose based on your genetics and how you likely metabolize that in the risk of having things like muscle myopathies as a side effect. Drugs like aspirin, I may choose to not prescribe to you because they’re not going to work for you based on your pharmacogenetics. Many examples there. The trick is, even if we have that genetic information, it needs to be integrated into my workflow as your doctor so that I can see that when I’m going to prescribe you, which is, “Hey, Dr. Kraft, check out this pharmacogenetics. You might want to choose this dose and this drug.” That’s some of the low-laying fruit there.
Right now, it doesn’t often connect to the clinical side, but I think, increasingly, particularly as we get to low-cost sequencing. We’re at $1,000 to do it essentially. Let’s say in five years, it’s going to be $100-less than the price of an X-ray. Once millions and millions of people are sequenced, we’re going to start to connect the dots between the diseases and the information in the genomes. Even today, they applied machine-learning to the genomes of thousands of Type II diabetics, they can find three different subsets that respond differently to therapy and diet. I think we can really reshape medicine in this genomic era. The trick is to get it integrated and made useful, not just reams of genetic data.
Mm-hmm. Any other test that you would recommend for our listeners?
Start looking at your microbiome in your gut, in your skin, and elsewhere.
I think it’s an interesting time to start looking at your microbiome in your gut, in your skin, and elsewhere. It plays a significant role in everything from obesity to inflammatory bowel disease, maybe even psychiatric disorders uBiome, which span out from another Singularity University students, allows you to test that for less than a hundred dollars and to crowdsource and donate that data. We’re seeing companies start to develop therapeutics for the microbiome, for treating things like severe infections, which kill thousands of patients in intensive care units every year to maybe optimizing for prevention. That’s an early adopter-type thing. You can start to actually get information and help share it. Other test folks might do-it really depends on you and your lifestyle and your risk factors. Hopefully, you can be engaged with the smart clinician to say, “We want to look at your vitamin D levels and maybe your genetic information,” because that may be one of the few areas of taking a supplement that might be helpful for folks who don’t metabolize it well and even if they do get enough sun. The trick, again, is to integrate information and not have it be made useful, and that depends on the individual.
Yeah. You mentioned-specifically, uBiome-I used that company and got my microbiome looked at. I didn’t do all. I think there are five sites that you can check your microbiome with, and I just did one site-just basically send your poop in a tube. I didn’t really get any actionable insights out of the report once I got the data back. I don’t know if maybe I’m just not seeing-I don’t know. I don’t know what to do with it whereas, with 23andMe, I could at least see, “Okay, you have an elevated risk for this disease or lower risk for this other disease.” That’s at least something I can do something with. I couldn’t really see what to do with the uBiome data.
Right. I think where it’s going to head is, you’ll see how does your microbiome from your gut compare to others or how has it changed in you over time. Let’s say, you had a course of antibiotics, and they shift dramatically, and then slowly recover or move into a different direction, and depending if you’re having some sort of G.I. symptoms or other elements, it may become more and more useful so, now you know baseline and may be you repeat that every few months, you might learn what your base microbiome is and if you end up in trouble or you have a microbiome that is setting you up for particular issues, it may become useful. Again, as more and more folks get this done and we tie that in correlate it to particular conditions, it’s going to be more useful. Still early days, but I think pretty exciting given all the connections we’re learning about microbiome and health and disease.
Mm-hmm, yup. Very good. So, let’s jump to more clinical stuff. What would be a potential alternative therapy for somebody who has kidney failure? They’re hooked up to a dialysis machine-is there an alternative now or in the near term with all the new technology?
Well, being on dialysis is usually the end result of having a lot of other things going on like diabetes, giving you bad faster status, and renal failure or renal cancer, but once you’re in a state of renal failure, kidneys don’t work. Ideally, in the regenerative medicine realm, we could give some sort of factor, which will help regenerate your kidneys inside your body. That’s one approach to regenerative medicine. Number two, the sort of solution today is often to get a renal transplant, but there’s a shortage of organ donors. Many cases where we have organs that are donated by organ donor that can’t be used because they may be from an older patient who has issues, I was just at a lab in Toronto, and now, X-VIVO, taking an organ out of a patient and able to perfuse it, and sometimes, fix any problems it has or optimize it or treat it and then and transplant it after 12 hours outside of the body or so into a needy recipient so, we’ll see.
I hope we’ll have better ways of keeping organs fresh and happy when they’re being transported or to optimize them so they can be used when they may not otherwise. We’re seeing the advent of-there’s, obviously, now home dialysis. What used to require coming to a clinic, there are now home dialysis machines that are getting more and more complex and user-friendly. There are even wearable dialysis sort of boxes. I’ve heard of one company that’s trying to create, literally, a sort of mechanical kidney that can be sort of worn or even implanted. At the more distant rounds, we want to be able to position 3D print a personalized organ that matches yourself from your own stem cells, for example. The idea that you can now take a due stem cell developed from your skin or blood and turn that into the building blocks of a kidney and, potentially, serve 3D printout is exciting and micro kidneys and livers have sort of been printed and are being used for drug discovery today at kind of pre-clinical trials, but what I think that is probably the most interesting combination of two fields is taking things like CRISPR and pig organs.
There’s been an interest for several decades now in using organs from animals to transplant to humans.
There’s been an interest for several decades now in using organs from, let’s say, pigs to transplant to humans because there are some strains of pig organs that have the same size as humans. The problem is, the immune markers on pig cells will have a human immune system reject it right away so, folks who are using CRISPR and other approaches to sort of knock out the pig genes and knock in human genes for human immune marker so, you can literally transplant a pig heart or kidney or liver to a human patient who may desperately need it. That I think is going to come far sooner than 3D printing a full-on organ. It’s already in trials in some of primate models.
Wow. So, these 3D printers are using your own stem cells-do we need to think about banking our stem cells? For example, you get your wisdom teeth extracted and there’s an opportunity to bank the stem cells from those wisdom teeth, do you take it? Do just figure that the technology is going to advance so quickly that you’ll be able to extract stem cells very easily from your fat cells or whatever?
In terms of banking your own stem cells, you have different forms. You have bone marrow stem cells, which you can harvest with a needle or the technology I invented called the Marrow Miner that can enable you to do that in a less invasive way. That can be used particularly for saving a matched sibling or someone who, let’s say, has a cancer and needs a bone marrow transplant. You can bank and collect cells from your fat-type stem cells if you have a child born, it’s a good time to collect cord blood, which again is used mostly in the sort of bone marrow transplant realm, but you can already now send in a little bit of skin or blood to a company that will take your normal cells and transform into your own induced pluripotent stem cell line.
You can literally take a skin cell and have it, in special culture conditions, turn into the equivalent of your own embryonic stem cell line when differentiated can turn into, let’s say, beating heart cells. You can literally have a tube of your own beating heart cells in the lab. The trick is, that’s not useful clinically yet. We can’t yet inject those into your heart, for example, to treat you after a heart attack, but I do think they’ll be an industry where you’ll bank your stem cells, maybe pay extra to have them differentiate into heart patches and liver cells and neural cells that can then be used in a clinical setting should you need them because if you need those cells acutely, you’re not going to have them because today it still takes at the very least a couple of weeks to develop those, but we can use adult stem cells right away from your bone marrow, for example, which is being explored in treating everything from heart attacks and heart failure, to perform vascular disease, to stroke, and to being used in orthopedics.
Hmm. Interesting. What other therapies are worth noting that we didn’t discuss earlier like telemedicine for example?
Well, telemedicine, I think, one thing to address is-what’s the practice in medicine and healthcare will look like in the future? Today, it’s call up on the phone, potentially get a receptionist, or make an appointment, or you might use things like Zocdoc to make an appointment, which are much more user-friendly. Then, you go to your doctor, you see them for 12 minutes on average for your average primary care visit, and they ask a few questions, and maybe write you a prescription. The future, I think, is going to blend in with telehealth.
The future is going to blend in with telehealth.
If I’m your physician, I may be from your wearable data, your internet of things data from your home, be able to download and understand what’s your history been like over the last months or years. If you have hypertension, I might send you home with a connected blood pressure cuff or one that’s eventually going to be built into your wrist watch to help understand what your blood pressure is, how to adjust your medications, and then you need to come in and take three hours off of work to sit the waiting room for an hour and see me in 12 minutes? No, I could do the equivalent of a Skype-type call for some of that interactivity. It does not replace all visits, but can certainly augment and make health care much more accessible, particularly, for folks in remote regions or housebound so, I think we’ll see a smart blending of telehealth.
When you have much more than just a thermometer at home, you have a medical tricorder-tech device or another company I’m involved with called 19 Labs is developing a sort of smart home health center, kind of like a first aid kit with screen on it and drawers and know where your medications are, for example. You can be coached through diagnostics and therapy at home, which will, again, save time, money, and get care in a smarter and more proactive way so, that’s part of healthcare. The things that we can do at home are advancing. The pressures in the hospital system are to never admit you in the first place or to send you home very early after a surgery or an infection or otherwise. We can do more and more with smart IV pumps and sensors at home so folks can be in a nicer environment than the hospital or prevent you from going there in the first place.
What about the use of drones like maybe for delivering pharmaceuticals in-?
Sure!
-remote regions, etcetera.
One of the big challenges, particularly, in the developing world like the rainy season or even in the West after earthquake or disaster is, getting medical supplies. Whether it’s a diagnostic-catered drugs or blood, and drones-actually, it was five years ago, one of our Singularity University student teams was the first to propose the idea of using drones to deliver anything. It was a foreign concept because the drones could only carry a small amount and couldn’t go very far, but they are on the exponential path, cheaper, more powerful, farther traveling, and this company called Matternet has pioneered the idea that we can deliver drugs, vaccines, and other medical supplies through drones. In fact, through a whole network with software overlay so, whether you’re in Africa or in California, you may be getting a drop off of your prescription or a medical kit if you crash your car to a remote region. We’re seeing drones being used potentially for search and rescue and for public health. We’ll eventually even see drone ambulances. The Israelis and others are working on drone ambulances that can take you up and take you to care. Lots of obligations in that space, including delivering maybe a different when you might be a location that needs one so, lots of convergence. Drones are one piece of that.
Amazing! Speaking of global health and remote villages in Africa and so forth, what do you see happening over in the near-term with regards to diseases that are not really considered important by the pharmaceutical industry because there’s just not enough revenue in it like any worm disease was a disease that didn’t have a lot of profit potential, and that was one that President Jimmy Carter targeted to eradicate in Africa because it just wasn’t getting dealt with. What do you see interesting in terms of advances and direction of things in third world countries and so forth?
New innovations are going to happen outside of the US where there are big unmet needs.
Well, the developing world is quickly becoming online. The poorest of the planet all have SMS phones. Soon, they’re all going to have an equivalent of a smartphones or $10 smartphones being sold at Walmart even today so, there’s a tremendous opportunity to leverage some of these technologies to democratize healthcare. These are massive markets, which are sort of untapped. Guinea-worm maybe treated with five cents-a-day therapy so, there are lots of low-hanging fruit. Just giving a health worker in a rural village in India, for example, a smart tablet and maybe a few mobile diagnostic devices and all the scope, a mobile portable ultrasound digital pathology type equipment, you can do a huge array of both diagnostics and therapy with less skilled folks and even enable in the relatively illiterate individual in a rural location to understand their health and whether it’s for maternal fetal, a childbirth, where a lot of women die in childbirth and kids at young ages-a lot of health can be done there with just applying smart information and connectivity and maybe with drones, in other ways, getting the drugs and therapies to folks when they need them. We can democratize healthcare. In some cases, new innovations are going to happen outside of the US where there are big unmet needs are in the lobbies and some of the regulatory restrictions, which slow down innovation, and then they’ll sort of bounce back to the US.
Mm-hmm. Yes. One last question here-where do you see the hospice being evolved or improved with technology? Because I mean, it’s just an area that’s not really thought about a lot by wellness and health geeks, but eventually, at the end of life, you want to be comfortable. What are some technologies or advances there?
It’s a great question. I mean, end-of-life care is so critical. We spend a good percentage of our healthcare budget on that last month of life, and many folks don’t want to die in intensive care unit. It’s getting everything done possible often without much real impact. I think there’s a lot of great tools and mindsets we can apply there. Number one is, sort of just awareness. You can now, literally, use your smartphone or maybe even your Facebook profile to say, “Here’s my wishes for end-of-life care should I not be able to communicate. Do I want to be resuscitated or not? Do I want to be made comfortable?” Using smart software and apps, every time someone checks into the hospital or the clinic, you can ask those questions because many times we can’t do everything because we don’t have any knowledge of what that individual would want and their family members may not either.
Secondly, we can provide a lot of, again, sort of hospital-based technologies into the home environment where there are IV pumps and smart sensors to keep folks comfortable, to provide them pain relief, provide them tools like, we didn’t talk about augmented reality. Virtual reality can take folks on interesting trips and reduce their anxiety or pain. We’ve seen interesting approaches, taking what used to be sort of the psychedelic-route from magic mushroom. These are fascinating work taking folks at end-of-life hospice and putting them on a single trip, and it changes their anxiety levels go way down in these sort of almost mystical experiences. In their last months of life, they are much more calm and less anxious and connected.
I think there’s a tremendous multidisciplinary approach to both raise awareness and the tools to enable family members, caregivers, and the patients themselves at end of life. Mohammed addressed longevity in this interview. I think most of us are not just interested in living up to 120 or longer, we want health span-100 to be the new 60. At the last part of our lives, we want to, hopefully, use technology to make it comfortable, not extended just for the sake of extension, and so I think we’re seeing technologies come into play and do services. There’s Uber for healthcare coming to provide you a doctor in your home. There are platforms like Honor, which can provide home health aides-kind of like an Uber-type service to connect providers and folks who need them in their home so aging in place. Those tools all can be smartly-connected across the healthcare continuum.
Eat your veggies, get your sleep, and get your basic exercises. All those elements are much more preventative in terms of risk for cancer, heart disease, depression, and Parkinson’s.
Right. Yeah, we didn’t cover longevity and anti-aging. We’ll have to have you back another time, I think. Is there one thing that you would point out as an interesting technology or something that help people can do to increase their chances of living past 100?
Well, eat your veggies, get your sleep, and get your basic exercises. All those elements are much more preventative in terms of risk for cancer, heart disease, depression, and Parkinson’s than waiting for it to occur and waiting for some magic or evolved therapy. Hopefully, if you live another 10-20 years, we’ll see a lot of amazing advances from genetics to nanomedicine to regenerative medicine that can help those of us who get to these ages live and thrive longer. All the stakes in exponential mindset so, I run a company called Exponential Medicine. It will be this October 8th-11th at the Hotel Don Coronado. We’ll cross everything from longevity to prevention to dynastic, to mental health, and it takes this exponential mindset.
We talked about how quickly the smartphone has taken over and the applications and wearables. That sort of pace of change is coming across many fields and the opportunity in the future of healthcare is to think exponentially. What can a smartphone do in three or four years? What kind of memory is going to be there? What AI or big data machine? How do you plan and integrate some of those technologies into healthcare in smart ways that engage the physician, the patient, the pair, and society, and not to be thinking in our sort of sick-care model of intermittent and reactive model that we have today? That’s, I think, the real potential is for many folks to come into play, and that will, hopefully, affect our individual health and longevity as well as that of our planet and our friends and family.
Very good. Any other conferences and trainings? Singularity University has a ten-day-long program you can-?
Yes, so Exponential Medicine at www.exponentialmedicine.com, will be this October 8th-11th. It’s not focused on just regenerative medicine, but how we can re-imagine health and medicine across the spectrum. We have everything from musicians to patients to pharma to device to investors. The Singularity University has a whole wealth of programs. Some are short five-six-day executive programs for folks like yourself to come in and get your brain rewired in what’s happening in AI, robotics, 3D printing, space, policy laws, things in beyond, and how you can disrupt yourself or help disrupt other industries.
We’re having a big summit-The Global Summit, and it will be at the end of the summer in San Francisco, and we also have beyond Exponential Medicine-Exponential Finance, what’s the future of investing, block chain, AI investing agents, and a new one called Exponential Manufacturing. What’s the future of how we’re going to design and build everything from widget to buildings and planets so, I encourage people to go to www.singularityu.org and look at what might match their interests, both on individual and corporate level as well.
Perfect! I’m guessing you’re not taking on new patients, but if you are, how would somebody reach out to you if they wanted to work with you on an individual basis?
You can find me on Twitter, @Daniel_Kraft, or hit me up on LinkedIn, and that’s a good way to find me and communicate. I love to help mix up with smart folks who are looking at big challenges and big problems because there are many across healthcare, and it requires the combination of folks who have a medical background and technology background with folks from all sorts of different fields to think smartly and reinvent elements of health prevention, diagnostics, therapy and discovery.
Wonderful! All right, well, thank you so much, Daniel! This was just a-my brain is exploding with so much information. Really innovative! I’m amazed with the amount of knowledge, experience, and forward-thinking innovation that you have so, thank you again.
Well, thanks! You’re already doing this, but for your listeners as well. The future is already here. Sometimes, it’s coming faster than you might expect. The famous quote is not to predict the future, but go and create it so, o a lot of these things you can start trying today and educate your healthcare team, your physicians, friends, and family that you could use a little device to track your sleep or track your blood pressure or track taking your medications and not to wait for the future to arrive. There are a lot of things that you can do today. It’s an exciting year!
Yeah, and you could save somebody’s life if you propose some sort of device that gives them a heads-up that something is wrong and they go get it checked out, and they get early treatment. You could save somebody’s life.
Absolutely! It’s just short story. There’s a device that you can buy on Amazon that will be a live core EKG case. Put on your smartphone, track your own EKG, and then if someone collapses at a cocktail party, it’s useful to figure out if they have a heartbeat or not, or what kind, or to screen folks as well. Just one small example of digital mobile connected diagnostics coming that you can use and show off your EKG and those of your friends and family just on your smartphone.
Amazing! Wow! Until next time, this is your host, Stephan Spencer, signing off.
