Wired health: living by numbers – a review of the event

Wired magazine, longtime evangelist for all-things-tech, has played a growing role in serving up health-tech content over the past several years, especially through the work of Thomas Goetz. This month, Wired featured an informative section on living by numbers — the theme of a new Wired conference held 15-16 October 2012 in New York City.

This feels like the week of digital health on the east coast of the U.S.: several major meetings have convened that highlight the role of technology — especially, the Internet, mobile platforms, and Big Data — on health. Among the meetings were the NYeC Digital Health conference, Digital Pharma East (in Philadelphia), and Living by Numbers, sponsored by Wired magazine and The Robert Wood Johnson Foundation. Some health conference goers attending these meetings were bound for NYC airports to attend another relevant meeting, StrataRx, the O’Reilly conference on digital health, held in San Francisco this week, as well.

I greatly appreciated being invited to this meeting, which gathered a mix of east and west coast developers, providers (esp. among east coast academic medical centers), suppliers (pharma and biotech), government, and technology worlds. The full day of the conference started with big-picture futures and visions for health on Big Data, genomics and personalized medicine, and went into more down to earth, “now-ist” research and products, such as health robots and practice programs to “pre-manage” post-traumatic stress.

Craig Venter, the genomics pioneer, talked about building a so-called biological teleporter, focusing on research on Mars. Venter is sure he will find DNA on that planet. He’s also sure that, 12 years after we’ve found the genome, we’re just getting started on sorting out how to practically apply it to health and medicine applications. He admitted that genomics is “a field of probabilities ripe for actuaries,” and that such probabilities need to get tighter in order to be more useful when delivering personalized medicine. Of particular interest to me, a health economist who believes that vaccines are one of our most important and cost-effective tools for public health, was Venter’s description of being able to have a vaccine, in his words, “built and tested in a matter of hours, well before the World Health Organization” comes to a consensus statement in the field. Venter paints a future where, once the vaccine is developed, it can be sent around the world digitally, downloaded and administered in local health markets.

Particularly exciting to me was the interview with Dr. Eric Topol, of Scripps Health and author of The Creative Destruction of Medicine, must-reading for anyone working on health and health care. He asked “who” should be responsible for personalized medicine, noting that the AMA says it should go through genetic counselors – but as there are only 3,000 of them on the market, and only 10% of doctors generally embrace the concept, the drive for personalized medicine must come from consumers ourselves. Topol asserted that while this should be “fully democratized,” government is “working against this theme.” Today, only a few medical centers are using the data available to push toward personalized medicine. “Only in Taiwan do you need a genotype to get an Rx filled for Tegretol,” a drug that can have an extreme adverse effect resulting in the deadly Stephen Johnson syndrome. Topol is working to get data-driven, evidence-based processes incorporated into medicine for the masses. But he notes, “the empowered patient movement has not taken root yet.”

One of the most colorful moments of the day saw Topol using a health sensor device coupled with an iPhone and taking his own EKG. This isn’t yet approved by the FDA for physicians to use on human patients; veterinarians are already using the device. But Topol admitted that he’s not used a traditional stethoscope since 2010, opting for this tool that provides him with far greater and more useful patient data in the same time he’d use the old school stethosocope. While Mt. Sinai, he said, is giving students digital scanners on the first day of medical school, Topol observed that medical school curricula are very slow to change requiring a “reboot” (his word) of medical education.

Dr. Alan Greeneof the pediatric health info website DrGreene.com and Chief Medical Officer of Scanadu (with the tagline, “sending your smartphone to medical school”) sought to debunk the long-time “myth” that a normal human temperature is 98.6. While complimentary of Dr. Wunderlich’s 19th century research on human temperature citing that fever could in fact be characterized as a data point, Dr. Greene argued that temperature — and many other human clinical data measures like cholesterol and blood glucose — are actually wave forms and continuities, not single points in time. He demonstrated Scanadu’s Scout device which is Bluetooth enabled and takes many measures. Dr. Greene said we shouldn’t just live by “the numbers;” we should live by calculus and know our personal health ecologies.

Note: Wunderlich’s thermometer was a foot long and took a temperature. Scout is about 1″x1″ and measures numerous metrics over many points in time.

Intouch Health demonstrated their RPVita robot. THINK: the Jetson’s Rosie the Robot meets a health cart-cum-video camera. All RPVita needs is bandwidth, and “she” can become a key member of the health care team, enabling doctors to be in 2 places at once for remote presence health care. This new version of RP needs no joystick like the first version did: once the robot is programmed with the health site’s locations, she can roam the hospital halls and reach its programmed destination.

Sue Siegel, the CEO of GE’s Healthymagination
, talked about the company’s program to enable better health for more people – and in particular, its own employees, through the firm’s Health Ahead benefits program. GE spends $1 billion (yes, with a “b”) in health costs each year on its 300,000 employees. If you think about the cost of health and what it did to the auto industry, then GE is just as concerned about bending its own corporate health cost curve. So moving GE’s workers toward healthier personal decisions is part of the objective. Health Ahead allows different tools for employee base to access, from programs for smoking cessation, exercise and health coaching, as well as re-thinking what food in the company cafeteria should look like. “It’s hard to find a brownie at GE,” Siegel noted. Furthermore, GE has launched a Healthymagination investment fund and has made several investments already including one in an Israeli company, Check Cap, that does, as Siegel put it, “colonoscopies without the cleansing.” It’s an imaging capsule for colorectal-cancer screening. This could fit nicely with GE’s diagnostic imaging portfolio. Why is GE engaging in this pursuit? Among many reasons, Siegel said, is to “bring GE scale to help startups get to scale faster.”

Gigi Hirsch, Executive Director of MIT’s Center for Biomedical Innovation, brought a strong (and very welcomed by me) patient perspective to the proceedings. Her goal: to get new, better and more affordable drugs to patients faster. She described the large pharma-health ecosystem of patients, providers, prescribers, FDA/regulators, and the pharma and life sciences  industry. In the current model, each of these stakeholders acts as independent agents. There is little awareness between them, Hirsch has observed, with poor information sharing across this (loose) network of players.

Google’s presentation on “Inside the Kitchen” was a fascinating surprise, scheduled just before lunch. Instead of wonky techies, we listened to two human resource pro’s from Google, Jennifer Kurkoski and Brian Welle, who discussed Google’s 34,000 employees in 40 countries working in 70 offices and asked the question, “what if working at Google added 2 years to your life?” The answer, in part, these speakers said, was….food. Google, as a company perk for workers, offers an incredible array of food for free. “Food is everywhere at Google,” they told us, with free meals for all  employees.  In the Mountain View locale, workers can graze in any of 24 cafes. Google takes the opportunity to provide information and artful nudges toward healthy choices, although different from GE, Google does provide M&Ms (for example) — but they’re located not front and center in the cafe but in a more remote place in less than accessible containers. “In HR,” she said, “we are architects of choice.”

It was a real pleasure to witness Andy Grove from Intel visiting us via Skype. The latest issue of Wired features an outraged plea from Grove arguing for greater price transparency in health care. Grove is no stranger to understanding antitrust in business, and he’s concerned about growing consolidation among health insurance plans and the potential impact on concentrated market power when it comes to price setting in local markets for health insurance. “Where does the motivation for price transparency come from?” Goetz asked. Grove didn’t miss a beat: “From you and I getting sufficiently pissed.”

Speaking of battle, Rhonda Cornum, a career General, lived through the first Gulf War and was a POW. She came through that emotionally unscathed, she said, and is now working to building a stronger soldier through the comprehensive soldier fitness initiative – building up both psychological and physical strength. Her program is about resilience training, so that people can proactively prevent post-traumatic stress. “The time to train for a race is not after you have done it,” she advised. In this context, she discussed Diener’s floushing scale developed at the University of Pennsylvania. Cornum believes we should get to young people on this issue so we cannot only build a stronger soldier, but a stronger human.

Nicholas Christakis of Harvard was on the stage to talk about the impact of social networks in health. Starting professional life as a hospice doctor, Christakis often cared for people who were cared for by their social networks of friends and family. He noticed the widowhood syndrome: that often when one spouse died, the survivor quickly succumbed to illness and, eventually, death. This led him to his breakthrough work with James Fowler on connections  in health. In their study of 32 years’ worth of data from the Framingham study database, they found that many health behaviors and conditions, such as obesity, smoking, and drinking, are viral in nature — socially viral, that is. On the other hand, positive health habits are also viral, presenting opportunities for “paying it (good deeds and modeling) forward.”


Health Populi’s Hot Points:
 The Wired/RWJF meeting was brilliantly executed: sessions were finished on-time, a difficult feat when herding such intellectual and clever cats. The event was video streamed so interested observers could participate from afar, and the WiFi worked perfectly for us tweeters. Follow the hashtag #wiredhealth to reconstruct some realtime comments and observations. There were hundreds of them.
The challenge is clear: how to democratize health innovation, empower patients-people-consumers-caregivers, and bring a greater sense of health ecosystem to currently siloed players who aren’t aligned for the benefit of patients. The problem isn’t really about the  technology much — it’s more about regulation and politics, physician buy-in, and most importantly — patient/consumer engagement and sustaining long-term healthy behaviors. Dr. Topol expects a consumer revolution; the slope of that curve is hard to predict for now.

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