Transcriber: Chryssa R. Takahashi Reviewer: Sodam Yang
(Greek): Good afternoon. Ιt's amazing to be here, in Athens,
the home of Asclepius, the Greek God of Healing,
and in Greece, where so much of modern medicine
has been derived from Hippocrates and others, Galen and beyond.
And the formation and the foundation of modern medicine has been formed here
and it's really informed the rest of the world
and it can form the future of health care as well.
But before we look into the future we often take a bit of back to the future look
and I had the chance to return to my roots, to Massachusetts General Hospital,
where I did my medical training, for its 200th anniversary.
That's very old in the United States, very very young here.
And had a reunion of the doctors I trained with,
and I found myself after one of the receptions
at one of the most famous spots of health care history.
This is called the Etherdome, the spot where in 1846,
this lucky patient was the very first patient to get general anesthesia with the surgery.
And if you go to the Etherdome today
it's frozen in time from 1846, nothing has changed.
And it's a very historic spot, I wandered about 4 minutes down the hall
to the ward where I spent my first month as a brand new doctor.
And I found also in over 15 years, that was frozen in time.
Some of the same alarms were beeping,
some of the same nurses, some of the same patients.
The only difference was that the young doctor was pushing around
a cart with an old computer and printing out the electronic record
and putting in the chart and I thought,
even at a great institution, like Massachussets General Hospital,
medicine is still practiced like has been done for hundreds or sometimes thousand of years,
still stucked in silos, in departments,
in old definitions of how health care has been organized, with waiting rooms.
And we are in the new age now, new age of technology,
we can define medicine beyond just body parts and specialties,
in new and powerful ways, with connected health,
with digital health, with the empowered patient.
And we need to change our definition, instead of how we practice medicine today
with most of our dollars on sick care, we can change our definition
to spending more of our focus on healthcare
and using technology to enable ourselves to be more empowered.
We can also change where health care happens,
traditionally in the hospital, in the clinic,
but increasingly the pressures on the cost
are taking health care out of the hospital to our homes
and even onto our own bodies.
Now in the 10 years or so, since I came back to Stanford
for fellowships in hematology and oncology,
a lot of technology has exploded.
It's a very exciting age and it gives us the opportunity to do brave new things.
Many technologies are moving at an exponential rate,
doubling in their power and performance.
The smartphones in your pockets have more than a billion times
the price and speed and performance of the best supercomputers in the 1970's.
And this Moore's law of IT and technology
is happening not just in computers, it's happening in many fields.
And it's when those technologies come together and they converge
and the opportunity to rethink many elements of our society,
including that of health and medicine.
We thought we've reimagined many things in the last decade,
how we read books, how we take photos.
Many companies have been disrupted like Kodak,
and other companies like BlackBerry have almost disappeared,
because technology can be disruptive and it can be disruptive in health care.
One element that is getting disrupted is the use of personal genomics.
The price of sequencing your own human genome
has dropped from a billion dollars, it's dropped to twice the rate of Moore's law
to about one or two thousand dollars today.
You can have your genome on a disk.
The challenge is when a patience comes to me with their genome on a hard drive,
we still don't know yet what to do with that. There's a lot of opportunities to learn
and converge that information and it's beyond just genomics.
It is our proteome, it's the data from our blood, our environmental data,
imaging the bugs in our gut, our microbiome,
all those information come together,
and as Hippocrates said, early proponent of personalized medicine,
if you can get every individual the right amount of nourishment and excercise,
not too little, not too much, we have found the safest way to health
and the safest way to medicine is to truly individualize that.
We are able to individualize care now with high speed computing,
so we can do incredible imagery,
so a surgeon can appreciate the anatomy of a specific patient.
We are able to see inside the brain now,
not only to appreciate the anatomy at high resolution,
but increasingly the connectome, and mapping the brain,
and understanding psychiatric diseases
and treating those in better ways.
We are using high speed computing to disrupt and change old procedures,
like an angiogram,
to look at the heart can now be done with a 30-second CT scan.
We can scan the heart, send it to the cloud, analyze the blood vessel,
and determine, does that patient need a stent or a bypass surgery,
where it used to take an operating room, and a catheter, and lots of radiation,
and now it can be done computationally.
And we can determine, does that patient need a stent or other therapy?
So we are disrupting cardiology. Soon we won't have echo cardiograms.
We'll do a ten minute cardiac MRI
and analyze the function and structure of the heart
on a tablet, a smartpad or your phone, anywhere on the planet.
So, with faster technology and smaller technology,
we're clearly changing the way we practice health care.
The smartphones in your pocket have become health care tools.
And it's only been three years since the iPad came out.
That's become a disruptive force in changing the way we practice medicine.
Tablets, in fact the cheapest tablets today are only 35 dollars.
Imagine the impact of giving away a 35$ tablet
in education and healthcare and beyond.
And we can use these mobile technologies to also give us dashboards into our data.
If you are a diabetic patient, you can record your blood trigger directly onto your phone.
Get a dashboard of your numbers, understand what that means
and do a better job yourself and as your clinical team of treating your diabetes.
And simple apps, again, can give us those feedback loops.
And soon, instead of always giving a drug or a vaccine,
we'll prescribe an app.
There'll be an app for pregnancy, an app for surgery.
They can really help tune and personalize your therapy.
We are in the age of gamification.
Making patients more engaged on top of their own therapy,
using gaming technologies like Microsoft Kinect to make things like physical therapy
easier, and more fun.
We are in the age now of digital mess and all this faster computing is digitizing our data.
And with digital information now, we can again leverage our mobile platforms
to take pictures of our skin lesions, analyze those,
diagnose eye disease.
The case of my smartphone here can measure my EKG and send it anywhere on the planet.
We are in the age that is called the quantified self.
And as Hippocrates said, "Walking is man's best medicine."
Now, wearing new devices -- I am wearing three of them, one, two, three --
I can track my walking, I can track my steps.
And there is whole new generation of low-cost consumer technology
including connected blood pressure cuffs.
You know, blood pressure, one in three Europeans has high blood pressure.
Now we can control that and measure it and have feedback loops.
Simple technologies, like connected blood pressure cuffs
and quantified health can make a huge difference.
There are now tattoos that can measure your vital signs.
And dashboards of our own body.
I am actually wearing a small patch, a two dollar disposable patch,
you can switch to my vital signs.
You'll actually be able to see it transmit through my phone, my vitals.
And if I show you how I run through the stage,
you can switch over and you'll see my live EKG through my phone.
Here we go, here's my EKG.
OK, only 132 beats per minute, my stress level's only 100 percent. No problem.
(Laughter) (Applause)
And if I run around, and if I fall down
it can call Emergency, or call my mom.
So this sort of technology is getting powerful
and is disposable and will help us control and treat diseases in smarter ways.
So new tools are coming to physicians and patients.
Digital tools to make better physical exams, for a nurse or for a patient at home.
We are using the power of low cost laboratories.
A single drop of blood now, can give us incredible levels of measurement
that were never possible before,
with very-very low cost.
We can even print out some of our laboratory tests.
So the idea of a digital check up, anywhere on the planet,
whether it's a rural island off the coast of Greece, or rural India,
combined with telemedicine, being able to interract with a physician,
or anybody else through your smart tablets
is really changing the way we practice health care.
And enabling us to have better health care for the older generation.
They don't have to come to the hospital all the time, and to the lab.
Now, it's not one technology, it's the layering of these technologies,
the internet of things.
Even our new pacemakers have IP addresses that can be connected.
The can also be hacked by the way, so there's a dark side.
So, we need to understand how to put these together in smart ways,
and not be overwhelmed.
You know, our brains haven't had an upgrade in millions of years
but our technology keeps getting upgraded.
And so it's very easy, as patients, as doctors,
as healthcare systems, to be overwhelmed by data.
So how do we make sense of this?
As Hippocrates also said, "Life is short, the art is long."
We could be reading every paper in my field, I could never keep up.
So the new field of artificial intelligence is going to dramatically change
how we practice medicine.
And I like to call not AI but IA, Intelligence Augmentation
because it's going to help augment us.
Hippocrates also said, "Science is the father of knowledge."
Now we have so much science and knowledge.
How do we integrate that together?
Some doctors are threatened by this.
Even Socrates thought that reading and writing was not a good idea.
But if we embrace some of these technologies
we can dramatically improve healthcare.
Because there is so much inefficiency, we waste 30 percent of our healthcare dollars
and we're not often smart about what we do.
There's lot of medical errors.
So, by using the integration of sensors, big data, artificial intelligence,
your car. You know more about the health of your new car than you do.
There's hundreds of sensors in new cars.
You care about when your own check engine light goes on.
And systems like OnStar for your car,
could eventually become the OnStars for your body.
and integrate all this information in smart and powerful ways.
Might be some Star Trek fans here?
The tricorders are no longer science fiction.
There's now, what used to be a hundred thousand dollar ultrasound,
it can fit in my pocket, right?
And there's even an Xprize.
You met Peter Diamantis here last year, the founder of the Xprize.
There's now a new Xprize I helped design, to make a medical tricorder.
To be at home for patients and consumers, to use, to do a better job than physicians.
And many companies are developing these.
And one company that I helped get started called Scanadu,
has developed a technology.
Hold it to your forehead, it pulls up all your vital signs.
Talks to your phone. Communicates with your health care team.
This is a view of where this might be in the next couple of years
as we put all this technology together. Take a look.
(Music)
(Video): Technology has given us an unprecedented window into the human body.
But on a day-to-day basis we are still in the dark about our own health.
We are changing that.
What if instead of fearing the worst when you notice something out of the ordinary,
you could identify the condition yourself.
Getting the right diagnosis would save you worry.
And an unnecessary doctor's visit.
Instead of hearing about a viral outbreak on the news,
imagine you got an alert,
that was tailored to your family's needs.
It would also give you advice about what to do next.
What if you had a way to identify what was wrong right away.
A way to get all of the information you need,
to understand the situation.
(Music)
And in serious cases, you would know when and where to seek help.
(Music)
We're building a way for people to check their bodies,
as often as they check their e-mail.
It's all possible. And it's only the beginning.
Now that's not science fiction.
These technologies have been built.
They'll be on sale next year.
In fact, this company crowd-sourced the funding of their next clinical trial.
So we can now have an era of connected health care.
Where we can share our information and make sense of it.
The social network is very important to our health.
And it's not our genetics that are most important for our health.
In fact it's our social networks, it's our behavior.
And as Hippocrates also said, "It's far more important
to know the person the disease has, than the disease that the person has."
So understanding the social construct can enable me to influence you
to behave better and have better habits.
If you can look in the mirror in the morning and see healthy you, right?
Or what happens if you have too many baklava, right?
You can change how you may be wiring your behavior.
I can now download an app and see my self today and one thousand baklava later.
It changes my thinking, right?
Or if I'm trying to influence a patient to stop smoking.
What they might look like in twenty years, if they keep smoking.
Or if they spend too much time on Facebook for example, right?
(Laughter)
We can use technologies, including telepresence,
new ways of using robotics to interact as clinicians.
New ways of having low cost telepresence robots to visit our friends and family.
and interact both in medicine and beyond.
We are using robotics to enable the disabled.
There's a lot of innovation going on with robotics.
In fact I was a judge last week at the Google Science Fair,
and Harry, a young student, 17-year-old, here from Greece
has developed a robotic exoskeleton to help his grandmother.
(Applause)
And robotics is enabling the severely disabled,
those who have completely paralyzed
to connect their brains to a robotic limp.
So we have an incredible ability now,
to change the way the disabled interact with the environment.
We're seeing robotics that are now wearable, wearable exoskeletons.
So someone who is paralyzed, for example,
can put on a wearable exoskeleton and climb a mountain.
And it's going beyond that. We really want to cure spinal cord injury.
And the next generation of regenerative medicine can enable that.
Shinya Yamanaka there, won the Nobel prize last year
for developing induced pluripotent cells that you can turn your own skin cells
into any cell in your body.
So the opportunity to have extreme remedies and build a fountain of youth
and converge technologies, like 3D printing.
I am actually wearing a 3D printed belt.
You'll hear from the next speaker more about 3D printing.
But 3D printing can be applied to health care
from neurosurgery to next generation prosthetics to orthopedics
to even being able to scan my own self and have a little version of mini-me, right?
It's cute, but what if I have cancer and I have lost part of my face.
We can make a prosthetic, or combine that with bionics.
So incredible potential, to eventually 3D print the organs of the future,
from simple ones that we do today, to complex ones in the future like our hearts.
Now, I've been diving into this world as the head of a medicine track
at a new institution called Singularity University, based in the heart of Silicon Valley.
And our mission is to cross fertilize technologies
and to say how can we take exponential technologies,
put them together to solve global problems, like even global health.
And a student from Greece, Andreas, formed a company, called MatterNet,
at Singularity University, to use drones to deliver drugs and vaccines.
A better way of delivering medicines in parts of the world with poor transportation.
Other students build gloves for telemedicine.
I've formed a program at Singularity University called FutureMed.
We bring together doctors and researchers and scientists from all sorts of fields
to rethink and reinvent medicine in new and powerful ways.
And I hope some of you can join us at FutureMed this November.
Just go to FutureMed2020.com where we rethink the future of health care.
So, many new people come into health care.
You don't need to be a doctor or a roboticist to go into health care today.
Any field can impact health care.
In fact, even Google is now approaching longevity
and a new company to think about longevity and health care.
And we're bringing new folks with beginner's mind.
Even designers. Design thinking is important.
Like, I'm flying back tomorrow to California.
I need new technologies, you know...
Oh, by the way, you can do smart things with your furniture
to help older folks get up and have a smart design in our environments.
And even our walking canes.
We need smart design thinking.
If I'm flying, I don't want to put wings on my car.
I need a 747, and a 747 doesn't fly by itself, it needs a whole system, right?
So we can take lessons actually from aviation and other fields
to apply to health care.
I've been a pilot for 20 years, since college,
and I've had the opportunity to fly in fighter jets as a flight surgeon,
in the International guard.
And there's lessons to take from aviation, from the fighter pilot world,
from the military, that apply to health care.
Like checklists. We use checklists to make flying safer.
We use checklists to make the operating room safer.
So checklists have been applied and dramatically improved outcomes in that regard,
and we amplify checklists and personalize those.
The idea of simulations, simulations have made flying safer.
Now we can simulate procedures
and do training for surgeons and nurses and medical students.
And we, instead of see one, do one, teach one,
we see one, and simulate it and get it right.
And we get to practice it, not on our grandmothers,
we practice it in the simulation lab.
We're using the world of a new cockpit,
that we have now digitized.
We can see our world in new ways
and make the data information actionable.
Even Lockheed Martin is helping create the new intensive care units at Johns Hopkins.
We, in the fighter pilot world, use heads up display.
We need other information in bad weather,
that might remind us when to hit a mountain.
It'll give us a cue, a sound.
We can sometimes use it, different information if we are in a dogfight.
We use feedback loops in our cars now.
We might soon have a GPS for our own health care,
that says, "Daniel, go to the right to the gym, not to the left to the McDonalds."
Right? It helps guide us, right?
We want just the right amount of information, not too much information also.
We're seeing the world in new ways.
The blind now have visual prosthetics to help them see.
And we are also as sighted people seeing the world differently.
We have new technologies being developed, like an assisted living contact lens,
so we can see the world maybe through our contacts.
It might have some interesting implications.
You might be wearing your assisted living contact lenses
and be out on a date and you need a little bit of help,
so you bring up the Wingman app.
(Laughter)
So, some interesting implications. (Laughter)
Do we need to wait for those? No, today we are in the era of eyewear.
Google Glass is here. Google Glass is going to be transformative I think,
in many fields, including health care.
As a doctor I can see my patients vital signs.
As a patient I can understand my medicines
and be more on track with things.
We might see our food in different ways.
And another Greek saying "Everything in excess is opposed to nature."
What if you're having a little bit of excess, you might have a clue.
You know, from your visual cue.
As you might have another clue.
(Beeps)
(Voice): Pull up, pull up.
From the fighter pilot world.
(Beeps) (Voice): Pull up, pull up.
Finally, we have the idea that there's radar.
What if we could see other patients like ours,
or other patients like mine, and share that information.
When you drive now and use Google Maps, you use a little privacy,
but you can crowd-source that information together and share it.
Now you can build a map of Rome, build a map of Rome in a day
and see what's the right route to work,
what's the fastest way to get there,
how do you avoid the traffic jams.
What if we could do that in health care,
and share our information in new and powerful ways.
So in conclusion, medicine, traditionally has been very much blind, very empiric.
Now we have new technologies, new sensors, new data being shared.
We can get information about our individual neighborhoods
and from our individual social networks, and maybe even decide,
you know, who to shake hands with each day, based on that information.
So, we can use other ways of thinking and dashboards, and contextual systems medicine
to change the way we do things, and design thinking.
All these elements can come together to re-invent health care.
And changes from a world that's been traditionally very episodic and reactive,
you have a chest pain and a lump, the problem,
and you get seen two days later, or after the event.
To changing health care to being continuous and pro-active
and leading us to a much healthier society at lower cost.
And I would encourage all of you to get engaged in your own health.
You don't just need to be blood donors or organ donors,
you can also be data donors and change the face of health and medicine.
So, I think with lessons from the past, from Hippocrates and others,
we can have a brave new world of health care.
In many ways, like my Google Glass, the future is already here,
it's just not evenly distributed yet.
And it's up to you, not just to imagine that future but to go out there and create it.
So, with that, I'll say thank you. (In Greek): Thank you.
(Applause)