Eric Topol: The wireless future of medicine

50,330 views ・ 2010-02-23

TED


Please double-click on the English subtitles below to play the video.

00:15
Does anybody know when the stethoscope was invented?
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Any guesses? 1816.
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And what I can say is, in 2016,
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doctors aren't going to be walking around with stethoscopes.
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There's a whole lot better technology coming,
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and that's part of the change in medicine.
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What has changed our society
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has been wireless devices.
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But the future are digital medical wireless devices, OK?
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So, let me give you some examples of this
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to kind of make this much more concrete.
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This is the first one. This is an electrocardiogram.
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And, as a cardiologist, to think that you could see in real time
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a patient, an individual, anywhere in the world
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on your smartphone,
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watching your rhythm -- that's incredible,
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and it's with us today.
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But that's just the beginning.
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You check your email while you're sitting here.
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In the future you're going to be checking all your vital signs,
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all your vital signs: your heart rhythm,
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your blood pressure, your oxygen, your temperature, etc.
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This is already available today.
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This is AirStrip Technologies.
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It's now wired -- or I should say, wireless --
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by taking the aggregate of these signals
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in the hospital, in the intensive care unit,
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and putting it on a smartphone for physicians.
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If you're an expectant parent,
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what about the ability to monitor, continuously,
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fetal heart rate, or intrauterine contractions,
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and not having to worry so much that things are
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fine as the pregnancy,
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and moving over into the time of delivery?
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And then as we go further,
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today we have continuous glucose sensors.
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Right now, they are under the skin,
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but in the future, they won't have to be implanted.
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And of course, the desired range -- trying to keep glucose
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between 75 and less than 200,
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checking it every five minutes in a continuous glucose sensor --
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you'll see how that can impact diabetes.
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And what about sleep?
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We're going to zoom in on that a little bit.
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We're supposed to spend a third of our life in sleep.
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What if, on your phone,
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which will be available in the next few weeks,
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you had every minute of your sleep displayed?
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And this is, of course, as you can see, the awake is the orange.
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The REM sleep, rapid eye movement,
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dream state, is in light green;
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and light is gray, light sleep;
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and deep sleep, the best restorative sleep,
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is that dark green.
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How about counting every calorie?
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And this is ability, in real time, to actually take
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measurements of caloric intake
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as well as expenditure, through a Band-Aid.
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Now, what I've talked about are physiologic metrics.
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But what I want to get to, the next frontier,
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very quickly, and why the stethoscope
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is on its way out,
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is because we can transcend listening to the valve sounds,
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and the breath sounds, because now,
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introduced by G.E. is a handheld ultra-sound.
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Why is this important? Because this is so much more sensitive.
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Here is an example of an abdominal ultrasound,
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and also a cardiac echo, which can be sent wireless,
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and then there's an example of fetal monitoring on your smartphone.
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So, we're not just talking about physiologic metrics --
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the key measurements of vital signs,
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and all those things in physiology -- but also all the imaging
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that one could look at in your smartphone.
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Now, this is an example of another obsolete technology,
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soon to be buried: the Holter Monitor.
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Twenty-four hour recording, lots of wires.
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This is now a little tiny patch.
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You can put it on for two weeks
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and send it in the mail.
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Now, how does this work? Well,
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there is these smart Band-Aids or these sensors
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that one would put on, on a shoe or on the wrist.
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And this sends a signal
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and it creates a body area network to a gateway.
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Gateway could be a smartphone or it could be a dedicated gateway,
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as today many of these things are dedicated gateways,
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because they are not so well integrated.
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That signal goes to the web, the cloud,
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and then it can be processed and sent anywhere:
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to a caregiver, to a physician,
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back to the patient, etc.
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So, that's basically very simplistic technology
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of how this works.
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Now, I have this device on.
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I didn't want to take my shirt off to show you, but I can tell you it's on.
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This is a device that not only measures cardiac rhythm,
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as you saw already,
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but it also goes well beyond that.
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This is me now. And you can see the ECG.
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Below that's the actual heart rate and the trend;
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to the right of that is a bioconductant.
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That's the fluid status,
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fluid status, that's really important
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if you're monitoring somebody with heart failure.
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And below that's temperature,
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and respiration, and oxygen,
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and then the position activity.
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So, this is really striking, because this device
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measures seven things
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that are very much vital signs
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for monitoring someone with heart failure. OK?
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And why is this important? Well,
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this is the most expensive bed.
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What if we could reduce the need for hospital beds?
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Well, we can. First of all, heart failure
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is the number one reason
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for hospital admissions and readmissions in this country.
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The cost of heart failure is 37 billion dollars a year,
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which is 80 percent related to hospitalization.
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And in the course of 30 days after a hospital stay
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for a Medicare greater than 65 years or older,
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is -- 27 percent are readmitted in 30 days,
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and by six months, over 56 percent are readmitted.
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So, can we improve that? Well the idea is
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we take this device that I'm wearing,
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and we put it on 600 patients with heart failure,
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randomly assigned, versus 600 patients
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who don't have active monitoring,
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and see whether we can reduce heart failure readmissions,
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and that's exciting. And we'll start that trial,
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and you'll hear more about how we're going to do that,
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but that's a type of wireless device trial
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that could change medicine in the years ahead.
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Why now? Why has this all of a sudden become
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a reality, an exciting direction in the future of medicine?
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What we have is, in a way, a perfect positive storm.
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This sets up consumer-driven healthcare.
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That's where this is all starting.
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Let me just give you specifics about why this is
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a big movement if you're not aware of it:
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1.2 million Americans
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have gotten a Nike shoe, which is a body-area network
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that connects the shoe, the sole of the shoe to the iPhone, or an iPod.
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And this Wired Magazine cover article
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really captured a lot of this; it talked a lot about the Nike shoe
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and how quickly that's been adopted to monitor exercise physiology
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and energy expenditure.
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Here are some things, the principles
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that are guiding principles to keep in mind:
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"A data-driven health revolution
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promises to make us all
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better, faster, and stronger. Living by numbers."
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And this one, which is really telling,
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this was from July, this cover article:
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"The personal metrics movement goes way beyond
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diet and exercise. It's about tracking every facet
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of life, from sleep to mood to pain,
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24/7/365."
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Well, I tried this device.
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A lot of you have gotten that Phillips Direct Life.
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I didn't have one of those,
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but I got the Fitbit.
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That looks like this.
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It's like a wireless accelerometer, pedometer.
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And I want to just give you the results of that testing,
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because I wanted to understand about the consumer movement.
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I hope the, by the way, the Phillips Direct Life works better --
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I hope so.
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But this monitors food, it monitors activity and tracks weight.
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However you have to put in most of this stuff.
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The only thing it really tracks by itself is activity,
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and even then, it's not complete.
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So, you exercise and it picks up the exercise.
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You put in your height and weight, it calculates BMI,
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and of course it tells you how many calories you're expending
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from the exercise, and how many you took in,
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if you go in and enter all the foods.
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But it really wants you to enter all your activity.
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And so I went to this,
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and of course I was gratified that it picked up
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the 42 minutes of exercise, elliptical exercise I did,
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but then it wants more information.
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So, it says, "You want to log sexual activity.
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How long did you do it for?"
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(Laughter)
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And it says, "How hard was it?"
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(Laughter)
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Furthermore it says, "Start time."
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Now, this doesn't appear -- this just doesn't work,
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I mean, this just doesn't work.
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So, now I want to move to sleep.
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Who would ever have thought you could have your own EEG
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at your home, tagged to a very nice alarm clock, by the way?
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This is the headband that goes with this alarm clock.
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It monitors your brainwaves continuously, when you're sleeping.
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So, I did this thing for seven days
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getting ready for TEDMed.
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This is an important part of our life, one-third you're supposed to be sleeping.
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Of course how many here
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have any problems with sleeping?
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It's usually 90 percent. So, you tell me you sleep better than expected.
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09:07
Okay, well this was a week of
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my life in sleeping,
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and you get a Z.Q. score. Instead of an I.Q. score,
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you get a Z.Q. score when you wake up.
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You say, "Oh, OK." And a Z.Q. score
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is adjusted to age,
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and you want to get as high as you possibly can.
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So this is the moment-by-moment,
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or minute-by-minute sleep.
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And you see that Z.Q. there was 80-odd.
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And the wake time is in orange.
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And this can be a problem, as I learned.
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Because it not only helps you with quantifying
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your sleep,
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but also tells others you're awake.
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So, when my wife came in and she
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could tell you're awake.
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"Eric, I want to talk. I want to talk."
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And I'm trying to play possum.
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This thing is very, very impressive.
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OK. So, that's the first night.
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And this one is now 67,
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and that's not a good score.
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And this tells you, of course, how much you had in REM sleep,
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in deep sleep, and all this sort of thing.
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This was really fascinating because
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this gave that quantitation
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about all the different phases of sleep.
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So, it also then tells you how you do compared to your age group.
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It's like a managed competition of sleep.
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And really interesting stuff.
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Look at this thing and say, "Well, I didn't think I was a very good sleeper,
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but actually I did better than average in 50 to 60 year olds." OK?
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And the key thing was, what I didn't know,
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was that I was a really good dreamer.
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OK. Now let's move from sleep to diseases.
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Eighty percent of Americans have chronic disease,
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or 80 percent of age greater than 65 have
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two or more chronic disease,
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140 million Americans
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have one or more chronic disease,
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and 80 percent of our 1.5, whatever, trillion
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expenditures are related to chronic disease.
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Now, diabetes is one of the big ones.
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Almost 24 million people have diabetes.
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And here is the latest map. It was published
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just a little more than a week ago in the New York Times,
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and it isn't looking good.
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That is, for men, 29 percent
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in the country over 60 have Type II diabetes,
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and women, although it's less, it's terribly high.
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But of course we have a way to measure that now
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on a continuous basis,
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with a sensor that detects blood glucose,
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and it's important because we could detect
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hyperglycemia that otherwise wouldn't be known,
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and also hypoglycemia.
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And you can see the red dots, in this particular patient's case,
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were finger sticks, which would have missed both ends.
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But by continuous monitoring,
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it captures all that vital information.
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The future of this though,
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is being able to move this to a Band-Aid type phenomenon,
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and that's not so far away.
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So, let me just give you, very quickly,
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10 top targets for wireless medicine.
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All these things are possible --
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some of them are very close,
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or already, as you heard,
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are available today, in some way or form.
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Alzheimer's disease:
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there's five million people affected, and you can check
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vital signs, activity, balance.
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Asthma: large number, we could detect things like
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pollen count, air quality, respiratory rate. Breast cancer,
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I'll show you an example of that real quickly.
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Chronic obstructive pulmonary disease.
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Depression, there's a great approach to that in mood disorders.
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Diabetes I've just mentioned. Heart failure we already talked about. Hypertension:
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74 million people could have continuous blood-pressure monitoring
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to come up with much better management and prevention.
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And obesity we already talked about, the ways to get to that.
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And sleep disorders.
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This is effective around the world. The access to smartphones
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and cell phones today is extraordinary.
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And this article from The Economist summed it up beautifully
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about the opportunities in health across the developing world:
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"Mobile phones made a bigger difference to the lives of more people,
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more quickly, than any previous technology."
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And that's before we got going on the m-health world.
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Aging: The problem is enormous,
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300,000 broken hips per year;
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but the solutions are extraordinary,
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and they include so many different things.
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One of the ones I just wanted to mention:
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The iShoe is another example of a sensor that
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improves proprioception among the elderly
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to prevent falling.
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One of many different techniques using wireless sensors.
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So, we can change medicine across the continuum of care,
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across the ages from premies or unborn children
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to seniors; the pharmaceutical arena changes;
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the full spectrum of disease -- I hope I've given you a sense of that --
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across the globe.
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There are two things that can really accelerate this whole process.
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One of them -- we're very fortunate -- is to develop a dedicated institute
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and that's work that started with the work that Scripps with Qualcomm ...
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and then the great fortune of meeting up with Gary and Mary West,
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to get behind this wireless health institute.
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San Diego is an extraordinary place for this.
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There's over 650 wireless companies,
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100 of which or more are working in wireless health.
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It's the number one source of commerce, and interestingly
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it dovetails beautifully with over 500 life science companies.
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The wireless institute,
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the West Wireless Health Institute,
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is really the outgrowth of two extraordinary people
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who are here this evening:
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Gary and Mary West. And I'd like to give it up for them for getting behind this.
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(Applause)
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Their fantastic philanthropic investment made this possible,
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and this is really a nonprofit education center
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which is just about to open. It looks like this,
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this whole building dedicated.
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And what it's trying to do is accelerate this era:
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to take unmet medical needs, to work and innovate --
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and we just appointed the chief engineer, Mehran Mehregany,
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it was announced on Monday --
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then to move up with development,
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clinical trial validation and then changing medical practice,
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the most challenging thing of all,
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requiring attention to reimbursement, healthcare policy, healthcare economics.
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The other big thing, besides having this fantastic
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institute to catalyze this process
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is guidance,
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and that's of course relying on the fact that medicine goes digital.
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If we understand biology from genomics and omics
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and wireless through physiologic phenotyping, that's big.
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Because what it does is allow a convergence like we've never had before.
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Over 80 major diseases have been cracked at the genomic level,
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but this is quite extraordinary: More has been learned about
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the underpinnings of disease in the last two and a half years
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than in the history of man.
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And when you put that together with, for example,
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now an app for the iPhone with your genotype
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to guide drug therapy ...
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but, the future -- we can now tell who's going to get Type II diabetes
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from all the common variants,
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and that's going to get filled in more
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with low-frequency variants in the future.
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We can tell who's going to get breast cancer
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from the various genes.
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We can also know who's likely to get atrial fibrillation.
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And finally, another example: sudden cardiac death.
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Each of these has a sensor.
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We can give glucose a sensor for diabetes to prevent it.
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We can prevent, or have the earliest detection possible,
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for breast cancer with an ultrasound device
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given to the patient.
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An iPatch, iRhythm, for atrial fibrillation.
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And vital-signs monitoring to prevent sudden cardiac death.
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We lose 700,000 people a year in the U.S. from sudden cardiac death.
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So, I hope I've convinced you of this,
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of the impact on hospital clinic resources is profound
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and then the impact on diseases is equally impressive
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across all these different diseases and more.
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It's really taking individualized medicine to a new height
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and it's hyper-innovative,
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and I think it represents the black swan of medicine.
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Thanks for your attention.
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(Applause)
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About this website

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