LifeLines

NAE Grand Challenges

2008-03-07T09:01:00.000-08:00

The National Academy of Engineering has announced 14 'grand challenges' for engineering in the 21st century. While they range from making solar and fusion energy possible to advancing personalized learning and making cyberspace secure, four of the fourteen are directly related to biology and health: manage the nitrogen cycle, advance health informatics, engineer better medicines and reverse engineer the brain.

Per the extensive website: "In each of these broad realms of human concern - sustainability, health, vulnerability, and joy of living - specific grand challenges await engineering solutions. The world's cadre of engineers will seek ways to put knowledge into practice to meet these grand challenges. Applying rules of reason, the findings of science, the aesthetics of art, and the spark of creative imagination, engineers will continue the tradition of forging a better future."

Good stuff - makes engineering sound like an exciting future - share it with young people you know who want to make a difference in the world!

2006-03-29T07:20:00.000-08:00

From our friends at Research!America, we have an update on the Specter/Harkin amendment, which proposes to add $7B of additional funding for healthcare and education to the president's budget. The amendement passed the Senate 73-27 earlier this month. It is now moving to the House of Representatives, championed by Representative Mike Castle (R) of Delaware. When all the dust settles around the federal government's discussion of health information technology, improving the healthcare delivery system, lowering costs, improving quality - yadda, yadda, yadda - it will be about the resources we are willing to invest as a country to fix things. Here's a chance to affect the allocation of those resources!

2006-03-16T05:58:00.000-08:00

Technology for Aging

A while ago I posted on the idea that there were good market opportunities in addressing technologies to support aging. Here's a clip that I saw on BoingBoing today of yet another Japanese robotic effort in this area. Link

And also, an interesting new report from the US Census Bureau titled: "65+ in the United States". Loaded with thought-provoking statistics and data on aging and longevity in the US. For anyone who can extrapolate, it creates a somewhat unsettling picture of what life will be like in 20 years.

2006-03-05T11:36:00.000-08:00

After last week's HealthGrid conference, I found myself thinking about new ways to use the grid for healthcare and lifesciences. Reading Boingboing this weekend, I found this interesting idea from Ralph Koster's website - for those who are into online gaming:

"Picture an MMORPG just like the ones today, but everywhere you see combat, replace it with healing. A six-man encounter would be a surgical operation that required teamwork. Soloing would be a brilliant doctor doing drive-by diagnostics. Raids would be massive experimental treatments.

Rather than spawning mobs, spawn ill people. Instead of weapons, have medicines. Instead of managing aggro, manage fever. Instead of armors, we have disinfectants.
Quests would include tasks to find and gather new plants for pharmaceuticals, and bespoke missions to fix the sanitation in a remote village. Puzzles might involve finding the standing water where the mosquitoes are breeding.

You can level up by building up immunity to the most common diseases. Your abilities are new forms of intervention and diagnosis; some classes might use homeopathic medicine, others might be trained in a Western mode. And death? Well, that would be a case of fighting off the infection youself, and failing.

You could go pretty psychedelic and “virtual” on the visuals, if you chose, with plenty of full-screen particle effects to keep the “fight” interesting. You could even, if you wanted to betray the Hippocratic Oath, have Dr vs Dr combat biowarfare."

Wonder when the new 'Mortal Kombat H5N1' will debut?!! Here's the link.

2006-03-03T14:38:00.000-08:00

Last two days I've been in the wilds of Frederick, MD attending a meeting on "HealthGrid: Grid Technologies for Biomedicine", sponsored by the US Army Medical Research and Materiel Command's Telemedicine and Advanced Technology Research Center - better know to its friends as USAMRMC-TATRC. I kid you not. And they say IBM has too many undecipherable acronyms!!

In any case, it was a really interesting meeting because it brought together a lot of folks who know a great deal about high performance computing and grids with a lot of folks who know a great deal about biology and medicine. I was struck by a number of thoughts:

First, there are a lot of interesting projects going on out there, which can be prototypes for a world of seamless access to resources, information and expertise. Some interesting projects included: very cool visualization and anatomical data ("The Visible Human Project") discussed by Michael Ackerman from the National Library of Medicine; Parvati Dev from Stanford spoke about bringing people from entertainment and the arts into creating virtual environments that enhanced 'human-human interactions' in medicine; Dr. Jim Wilson from TATRC and Georgetown University talked about grids and networks to develop situational awareness for epidemiological monitoring and tracking for diseases like avian flu as well as biodefense.

Second, there are huge challenges ahead of us. Ken Buetow from the National Cancer Institute and his colleague Peter Covitz spoke on the Cancer Biomedical Informatics Grid (CaBIG). This effort is a monumental task to organize both the data and applications that are useful to cancer researchers in a common, standardized architecture. On top of that, they are attempting to drive more standards so that data that are collected at all the cancer centers can be shared among them as a valuable research resource - something we simply can't do today. Our science culture - both public and private - is one that does not encourage sharing, at least not prior to publication in a peer-reviewed journal. The Genome Project was cited many times as the right way to create a mandate to share prior to publication, and your funding depends on that. Most people agreed that was the way to do it, but the GP had a strong central control and this grid world operates in a much more self-assembling (or not) way. So how do you agree on standards?

Our good friend Lee Hood spoke about his vision of the future of medicine, as the '4P's' - predictive, preventive, personalized and participatory. Lee's views are always bold, and I love how he challenges an audience with ideas that are 'out there' - like how the world will be different when we all can get our full genome sequenced for under $1000. Or how doctors will have a diagnostic test that makes a few thousand proteomic measurements on a patient blood sample a couple times a year that will enable them to detect and treat incipient disease including all types of cancers. The very cool thing is that he and his colleagues at the Institute for Systems Biology are inventing these technologies even as we speak.

2006-01-16T14:12:00.000-08:00

Yin and Yang

OK, it is 4am in China and I am pretty jet-lagged. Sleepy at 3 in the afternoon, and wide awake at 3 in the am. What better than to blog?

I had a really interesting side conversation yesterday with Mr. Ren Dequen, who is former head of the Chinese FDA – actually to call it a ‘conversation’ is not exactly right, as he speaks only a little English and I virtually no Chinese. He is a leading expert in traditional Chinese medicine (or TCM), which of course includes numerous and complex herbal remedies. These remedies (and the diagnostics used to prescribe them) are based on thousands of years of tradition, but only recently have western scientific methods been used to attempt to characterize them. This poses a very interesting dichotomy between East and West. On the one hand a school of medicine that treats the patient holistically, uses complex naturopathic remedies that are ill-understood but heuristically validated, and uses diagnostics that seem sometimes more like magic than science to the western mind. This meets a regulatory environment that is linear and reductionist, based on the Scientific Method, and which demands statistically validated experimental results to demonstrate efficacy and can mostly only deal with one molecule at a time. How on earth, I wondered, do you bring Chinese herbal medicines through a system like that?

Most Chinese medicines derived from herbs are complex mixtures of organic compounds and it is generally believed that the efficacy is not in any single ingredient but rather in the right proportions of the right compounds. There is only one drug that has become fairly widely accepted in Western medicine that came from TCM – that is an anti-malarial (actually one of the first new drugs for malaria in a long time) called artemisinin. In this instance, a single compound was isolated from the plant artemesia annua, purified and taken through western-style clinical trials to demonstrate efficacy. Artemisinin was researched and proven efficacious by Chinese scientists, and since has been used to create new drugs by companies like Novartis. Interestingly, it is now being mixed with other single-compound anti-malarials to create potent combination therapies. Its a very exciting example of something very new, very effective that can come from traditional medical knowledge like TCM.

But if it is the case that most TCM medicines are plant-based and depend on the right mixture of compounds, then new techniques are needed to ensure that the mixtures are correct and defining ‘purity’ is a nighmare. Mr. Ren indicated that the Chinese FDA is currently using HPLC fingerprints to attempt to characterize Chinese medicines and then bring them through western-style clinical trials. As long as the mixture is 90% or better similar to the accepted ‘fingerprint’, it is deemed to have sufficient quality to be used as a drug. I believe our FDA is also working on methods to look at safety and efficacy in naturopathic remedies, but I have to believe this is not very high on their list! Here's an interesting proposal for changes to the US regulatory system that might be used to address regulation of traditional medicines, including Chinese, Indian and others. I wonder if we don’t need just such a total re-thinking of the regulatory environment for therapeutic approaches like this, not just a force-fit of thousands of years of experience into the small, constrained box of modern pharmaceutical regulation.

2006-01-16T13:40:00.000-08:00

China Lifesciences Partnering Meeting

I am back in China this week, participating in the China Lifesciences Partnering meeting sponsored by Burrill and Company. Today’s meeting was hosted by CapitalBio, a small but very fast-growing biotechnology company in Beijing. They are located in a brand new lifesciences industrial park in Changping District on the northwest outskirts of the city. CapitolBio is a company to watch – they have very interesting technology (microarrays, readers and other lab instrumentation), are branching out into new areas aggressively (including clinical information systems and other software), and they are mastering the art of partnering and building relationships. They’ve gotten a lot of visibility recently in the western press and have attracted a lot of investment attention as well. No wonder – they have grown their revenues about 300% for the last two years, and have a trajectory that takes them to an IPO on the NASDAQ by 2008, according to their CEO, Mr. Cheng Jing (following Chinese convention of family name first).

The conference itself included both speakers from western companies like myself, Bill Haseltine, and Ron Cape as well as panelists from Chinese organizations such as Wei Huacheng (Chairman of the Beijing Pharmaceutical Group) and Ren Dequen (former head of the Chinese FDA). Many large global pharma companies were sponsors and/or attendees, including Eli Lilly, Amgen, Roche and Baxter.

Big global pharma companies seem to be focused on China mostly for developing capability in areas like chemical manufacturing of intermediates, pre-clinical toxicology testing, pilot manufacturing for clinical trials and other pharmaceutical services. There is little focus on the local Chinese market for pharmaceuticals, as this is still very small and China is struggling with healthcare insurance and reimbursement for the majority of its people (more on this later). So right now the primary focus for international partnering is on developing reliable sources that use ‘good laboratory practice’ (GLP) and ‘good manufacturing practice’ (GMP) and can deliver materials and study results that will be compliant with both Chinese and US FDA standards. Companies like WuXi Pharma Tech (more on them later) and Bridge Pharmaceuticals are organized around this value proposition. Clearly these are going to be very important partners for global pharmas (and biotechs). I expect that over time these companies and many others are going to move up the value chain to capture more of the value-add of R&D and bringing their own drugs to market. If China can solve some of her healthcare access and insurance problems, these companies will be well-positioned to be leaders in a Chinese pharmaceutical market that will rapidly expand. (But that’s a big ‘if’!)

Disclaimer: I own no financial interest in any of the above-mentioned companies.

2006-01-07T09:38:00.000-08:00

Happy New Year! OK, I've made several resolutions this year, and one of them is to blog more regularly, which I know I haven't been good at. Of course, the other one is the one you all made too, which is to watch my diet and exercise regularly and hopefully lose a little weight! So its a perfect topic for this blog, because although new years resolutions have a way of fading from memory by the second week of January, I think the trend in healthcare toward wellness management is one that's here with us for awhile.

We've all been reading about the rising cost of healthcare and what its doing to the bottom lines of companies like GM and others. But whether its an employer or an individual or the federal government that is picking up the tab for our healthcare, its incredibly costly and payors are going to be aggressively looking for ways to cut costs. How do you do that without rationing care and reducing the access of people who need it most?

Let's agree on this - keeping people healthy and well is generally less expensive than treating them once they are sick. Large employers are starting to pick up on this and incorporating in their benefits plans more focus on diet, exercise and smoking cessation. I'm a major technology fan, as most of you know, but we don't need genomic medicine to tell us that we could cure a lot of cancer right now by getting people to stop smoking.

There are interesting companies out there working on the emerging 'wellness' market. Some, like Matria are coming at this from a more traditional business in disease management. By monitoring patients with chronic diseases - like diabetes and congestive heart failure - Matria can help those individuals manage their disease and stay in control. Keeping them out of the hospital is not only better for the patient, but also saves their employer or insurer big money. Its a little harder to measure the return on investment for a similar approach to wellness, but its got to be enormous, because it starts even earlier - before a patient has chronic disease. Last April, Matria acquired Miavita, a company that Mike Milken helped found, which focuses on web-based solutions to help healthy people stay well.

Pharmaceutical companies are not unmindful of the wellness opportunity. While on the one hand, therapies to treat disease are becoming more and more targeted to narrower sets of patients, drugs that help more broadly promote wellness may be the blockbusters of the future - because we will all take them to keep from getting sick. I suppose you could think about the statins as an example of that category - we take them pre-symptomatically to prevent the development of heart disease, based on a diagnostic test (cholesterol level) result. Its likely that obesity will be the next big market for wellness blockbuster drugs.

The relatively wild west world of 'nutraceuticals' has been promoting wellness for a long time. My friend and advisor Steve Burrill has raised a fund to invest in companies in this space, and has . Steve would point out that the current market for nutraceuticals is $150B, which is almost half that for prescription drugs and is ALL paid out of pocket. Foods like Benecol, a margerine that lowers cholesterol by adding a natural plant sterol called sitostanol to the spread, have made it to the mainstream supermarket shelves.

So happy new year - and think about your own personal wellness this year. I'll take a moment to share some of my personal favorite wellness tips with you:

Great diet book, if you are a data-driven person like me: "The Business Plan for the Body" by Jim Karas. Good common sense and helpful advice to change your habits. And formulas!

Self assessment, web-based tool that tells you how 'old' you are (healthwise) compared to your chronological age. Makes you stop and think, and helps you create a good plan for action on the things you can do something about. http://www.realage.com/

Pilates - ok, you have to do cardio too, but strength training and flexibility are often neglected, especially by Type A personalities like me. I've become religious about my weekly Pilates class, which is a gentle way to strengthen your core muscles, including your back if you have back problems. As always, consult your doctor before embarking on new fitness routines - especially if you have health issues.

OK, time to get moving! Wishing you a healthy new year!

(Disclaimer: I own no stock or financial interest in any of the companies mentioned above. I just think they are interesting!)

Sage Technologies

2005-09-06T08:05:00.000-07:00

Sage Technologies

Let’s face it, we’re getting old. In fact, a lot of us are getting older and older every minute. And not exactly loving it! The demographics are compelling. According to the US Administration on Aging, by 2030, 20% of Americans will be over the age of 65, compared with around 12% today. And its not just the US - both developed and developing nations around the world will have to cope with aging populations. The UN Report on World Population Aging 1950-2050, says that the aging of the world's population during the coming years is unprecedented in human history and will have profound economic and social consequences.

Barring large-scale population destruction through war or disease, these consequences are not speculative, they are inevitable. Looking on the bright side, there should be some entrepreneurial opportunities in this!

Look at the buying behaviors and expectations of this customer set. We are demanding, informed consumers. We have high expectations for our lives and have been hard-charging achievers for a long time. We have a sense of style and fashion. We value ‘youth’ – which means to us, activity, energy, beauty, and the freedom to do things we choose. We have embraced technology in our business lives and our personal lives, and our technologies have become a status symbol for us. We are not going to put up with dowdy things for ‘old people’. We hate the word ‘senior’. We are going to want clever, practical, attractive products that help us age gracefully, in the manner we think we deserve.

Wow – sounds like a terrific marketing opportunity to me!! And since I’m in the technology industry, I’m thinking about products and services that are technology based to meet the needs of this emerging market. I even thought of a name for a company – should you want to start one. I call it ‘Sage Technologies’ – sage having the double meaning of ‘wisdom that comes with age’ and ‘a nice smelling herb that is comforting’ (I like that subliminal suggestion of something nice!).

I first got started thinking about this after reading this article in the NY Times, about how Sanyo is building washing machines for people, to assist caregivers in nursing homes. This story makes a lot of important points – caregiving for the elderly is a lot of work, and there are going to be fewer young people to do it. Privacy and respect are important, and it’s hard to achieve those with current methods. Nice things that are stress-free and comforting can bring pleasure and joy into a life where mobility and activity are otherwise curtailed, and can help prevent depression. Once you start thinking about it, there are lots of ways technology can be employed much more cleverly to support aging.

There is very cool stuff happening in physical augmentation of the body – for example, robotic ‘muscles’ built into a suit or other clothing, that you can put on to help you stand up and/or walk. At University of Tskuba in Japan, professor Yoshiyuki Sankai is working on 'hybrid assistive limbs' (HALs) that can be built into 'rehabilitation robots' for the elderly (shown in the photo). Loss of mobility is a key factor in the downward spiral of the very elderly - but I can imagine a day when lots of us are running around in suits that look like this.

Robotics in general is a hot topic in devices for the aging, and commercial products are starting to enter the market. Of course, they are very expensive now, and not even close to affordable for the general public, but we know how that goes, especially once a market develops! Not everyone likes the idea that you have a camera that watches you all the time to make sure you haven’t fallen or that you’re taking your medicine or eating properly. I think that would offend most people’s sense of privacy and autonomy. But a robot that is ‘friendly’ and companionable, that keeps an eye on you – well, that might not be so bad! Mitsubishi Heavy Industries will introduce this month a robot intended for home use called 'Wakamaru' that can recognize and respond to words and people's faces, and can help with tasks like keeping track of medications and appointments. In fact, some studies have shown that elderly people find robotic companions comforting and they help prevent depression. Hmmm!

Macular degeneration is the leading cause of blindness in the elderly. Several companies are working on new drugs for AMD, but there is also interesting work on implantable optical sensors for prosthetics, that use the intact optic nerve, which is not damaged in AMD, to send signals to the brain. This work may take some time to come into common use, but I'm hoping it might be ready within the next 20 years or so, when I start to need it!

The one I’m really looking forward to is memory augmentation. This is an off-the-wall idea I came up with 15 years ago at IBM Research. Dave and Mark laughed at me when I told them about it. I haven’t seen anything remotely close to commercial on this topic, but it's got to come. I’m looking for a small implantable device that can be placed subcutaneously behind my ear, that can receive my thoughts that I wish to store and save, and play them back for me when I ‘think’ a command. I could keep memories, shopping lists, names of people (actually, it would be really cool if it could store visual images of peoples faces and link them to a database of their names – I could use that NOW!). You get the idea. Lo and behold, Pattie Maes, Bradley Rhodes and colleagues at the MIT Media Lab are working on things like this - they call these 'remembrance agents' and right now they unfortunately look something like this. Can't quite see this look on your basic blue-haired grandma!

I never thought I’d see the day when you actually could start to envision all these technologies becoming even close to real – but I’m starting to think it could happen in my lifetime.

Which is a good thing, because I’m going to need them!! And so are you.

2005-08-17T05:22:00.000-07:00

We all have this vision of an electronic personal health record which:

begins from the day we are born,
automatically collects all our medical and health data,
gives us tools for managing not only our health finances but our health and well-being,
is accessible to us no matter where we are,
serves as a common repository for our physicians and caregivers, so we can stop schlepping papers and films from doctor to doctor!

Nice vision, but what's it going to take to make it a reality? I find it interesting that in the financial services area, these kinds of tools exist (okay, maybe not from birth) and have helped to create standards and change within the industry due to consumer demand for their institutions to connect to their personal tools. Think Quicken - for healthcare!

I'm starting to see a number of ways this could become reality in the next few years. One way I do NOT think this will happen is smart cards. There's a lot of talk about a smart card that holds all your records. Not going to happen, is my prediction. Smart cards might hold a little information, but more likely will only be used for secure access, and even that will be less important when biometric authentication (fingerprint) becomes more widely available.

Instead, I think it's going to be all about the back-end, unifying the sources where the data sit already. Think about a typical cancer patient. They have a primary care physician, an oncologist, a surgeon, a radiologist, a hospital, and probably a host of other caregivers where the necessary information for treating the individual resides. They need patient-centered (not institution-centered!) tools and records that can help them more effectively manage their disease. They need to be able to treat all their records as though they were in one common repository. They need a way to authorize a new physician or caregiver to access records in that repository, at the touch of a button.

It's not just a technology problem. In fact, it's not a technology problem at all. The bigger question is not the technology, but who's going to drive it and who's going to pay for it? My bet is on payors and employers. They are the ones who stand to benefit most from giving patients better tools to manage their own health and keep themselves out of the hospital. Payors could also use this as a way to disseminate health information as well as a tool to create patient satisfaction and retain patients in their plans. Look at what Empire Blue Cross Blue Shield of New York is doing in this regard. Also, note who is providing the application: WebMD. I think this is an example of what all plans will be doing in a couple of years. Employers, too. Lots of other examples out there, starting to happen - check out this great list of links at Informatics Review.

The challenge is going to be: what happens to all this integration when I change plans or change jobs? The personal record only becomes useful if it is truly portable, and for that we need standards and interoperability. More on this later.

2005-08-15T12:42:00.000-07:00

Last week I had the most amazing visit to the University of Pittsburgh, visiting with faculty from the Center for the Neural Basis for Cognition (CNBC). Professor Peter Strick, who is co-director of the center was kind enough to give me a wonderful and engaging tutorial about the breadth of experimentation that is happening and then I saw some fantastic work by Professors Andy Schwartz and Seong-Gi Kim.

Andy is working with monkeys to study areas of the brain that govern motion of the arm. Working in a particular region where there are large numbers of neurons associated with arm movement, Andy has been able to show that each neuron has a directionality associated with it - in other words, specific neurons can be identified with up-down arm movement, and others with side-to-side arm movement. The neurons fire about 100 msec before the movement actually occurs, so by tracking the firing of the specific neurons and knowing their directionality, Andy and his team can predict where the monkey will move his arm based on observation of the neuron firing pattern.

So what? Next step, was to train the monkey to perform a repetitive motion - in this case, to draw a circle with his arm, tracking a virtual reality 'pointer'. As the monkey moves his arm, Andy collects data from the neurons, and feeds it to a robot arm in the next room. Guess what the robot arm is doing? Drawing a circle, just the same as the monkey. Very cool!

So you are probably guessing where this goes next. Now we connect the monkey to the robot directly, and strap his arm to the arm of the chair so he can't move it. Then we put a piece of food in front of the monkey. Naturally, he thinks about moving his arm to get the food. But of course, he can't because he's strapped down. No problem. We feed the neural signals from the monkey's brain to the robot arm, and the monkey directs the robot to get the piece of food and put it in his mouth. Using only his brain to direct the machine. Incredible!

Other work is going on in Yoky Matsuoka's Neurobotics lab at CMU to create fully articulated robotic 'fingers'. Wow!

Andy says this technology could be used in humans in only 5 years. In fact, many organizations, both universities and companies, are beginning to implement human trials in brain-computer interfaces.

Seong-Gi's work is equally exciting, using functional MRI to study network structures in the brain and associate them with functions. And Peter is an icon in the study of networks in the brain, using neurotropic viruses (like rabies) to identify connections between neurons.

I think work like this is going to make incredible progress in the next 10 years - of course the first applications will be in prosthetics for the disabled. But I can envision ways that we all might use technology like this to create a closer, more natural interface between humans and machines of all kinds (including computers). This is going to be amazing!