The future of healthcare both small and big. It’s big data, machine learning, and massive amounts of data coming from tiny robust devices or phone apps of individuals. It’s individualized medicine – not only for patients who need care but for healthy individuals. The data will come from devices that will become ever more ubiquitous – stickers on skin, tattoos, clothing, contact lenses, and more. This conference, organized by Applysci, and held on Feb 7 and 8, 2017 at Stanford University, involved a slate of some of the most creative, ambitious, and successful people in the digital health industry. I was both mesmerized and inspired.
I decided to venture outside my comfort zone of fMRI and brain imaging conferences to get a glimpse of the future of wearable technology and digital health by attending this conference. The speakers were mostly academics who have started companies related to their particular area of expertise. Others were solidly in industry or government. Some were quite famous and others were just getting started. All were great communicators – many having night jobs as writers. My goal for being here was to see how these innovations could complement fMRI – or vise versa. Were there new directions to go, strategies to consider, or experiments to try? What were the neural correlates of expanding one’s “umwelt?” – a fascinating concept elegantly described by one of the speakers, David Engleman.
On a personal level, I just love this stuff. I feel that use of the right data can truly provide insight into so many aspects of an individual’s health, fitness, and overall well-being, and can be used for prediction and classification. There’s so much untapped data that can be measured and understood on an individual level.
Many talks were focussed on flexible, pliable, wearable, and implantable devices that can measure, among other things, hemodynamics, neuronal activity, sweat content, sweat rate, body heat, solar radiation, body motion, heart rate, heart rate variability, skin conductance, blood pressure, electrocardiogram measures, then communicate this to the user and the cloud – all for analysis, feedback, and diagnosis. Other talks were on the next generation of brain analysis and imaging techniques. Others focussed on brain computer interfaces to allow for wired and wireless prosthetic interfacing. Frankly, the talks at this conference were almost all stunning. The prevailing theme that ran through each talk could be summarized as: In five or so years, not much will happen, but in ten to fifteen years, brace yourselves. The world will change! Technophiles see this future as a huge leap forward – as information will be more accessible and usable – reducing the cost of healthcare and, in some contexts – bypassing clinicians altogether and increasing the well-being of a very large fraction of the population. Others may see a dystopia wrought with the inevitable ethical issues of who can use and control the data.
Below are abbreviated notes, highlights, and personal thoughts from each of the talks that I attended. I don’t talk about the speakers themselves as they are easily googled – and most are more or less famous. I focus simply on what the highlights were for me.
-Director of eWear
Dr. Bao started with a quote – “Future wearable tech must enhance users abilities” and listed a sequence of where the area is going:
- Enhanced wearables
- Smart clothing
- “Derma” clothing (i.e. artificial skin)
- Implanted sensors
She focused much of her talk on electronics for the skin where a flexible wrap could measure heart rate, blood oxygenation, heart rate variability, skin conductance, protein in sweat, pH of sweat, blood pressure, and more…
She demonstrated impressive properties of these materials – maintaining their electronic integrity when being stretched, twisted, and even punctured. These apply for conductive and semiconductive materials.
She talked about a startup PyrAmes that was developing an implanted device for measuring intracranial brain pressure.
She suggested that her collaboration with Karl Deisseroth may allow direct communication of mechanoreceptors to the brain via optogenetics.
Lastly, she addressed the issue of batteries. If they get too hot, the problems multiply if they are implanted. She discussed work on safer batteries that can sense temperature and then shut down – rather than cause damage.
-President of Bell Labs and CTO of Nokia
Dr. Weldon gave a visionary talk on the future of digital fabric and focussed on the point that we are entering the era of “automation of everything” which will be considered another major transformation of economy and society. He started with the classic Maslow’s hierarchy of needs and added to it – at the pinnacle was “time.” To him, we all spend so much time dealing with problems that could be anticipated and resolved with better and more distributed information.
He argued that the fundamental good of many of these technologies was to create time – allowing us to pursue our higher needs.
He emphasized the need for extremely fast processing (“latency and bandwidth matter”) with regard to immersive virtual reality environments as our vestibular-ocular reflex is on the order of 7 to 10 ms. The immersive virtual world needs to keep up with our head movement on this time scale otherwise many will become nauseated rather than reap the benefits of such environments.
Overall this was an inspiring and information-rich “big picture” talk that was not only optimistic but conveyed a sense of inevitability of an incredible future.
-founder of MC10
He started his talk with showing what’s already out there – a cheap and flexible stick-on patch that measures UV exposure. It’s made by Lorealle and is disposable – very useful to gauge when one should get out of the sun to avoid sunburn.
He went on to talk about “biostamps” – stick-on devices that can measure continuously and with high fidelity, EKG as well as blood oxygenation, blood perfusion, and pulse-related pressure wave arrival time, and showed data indicating that the time delay between EKG and pulse arrival time is an alternative and high fidelity measure of blood pressure.
(My own thought is that we potentially can do this for the entire body already with MRI/fMRI – as pulsation is clearly visible, and accurately measurable in nearly all MR images – which might be worth looking into.)
-Director of Digital Health, Bayer
He started his talk lamenting the extremely long, expensive, and flawed process of clinical trials for drugs (1% success rate and taking up to 12 years) and suggested that there should be a new model to potentially bypass this – that of giving health advice rather than drugs.
He went on to talk about his ongoing work on a “smart shirt” that measures heart rate, skin temperature, impedance, respiration, posture, and steps.
He also pointed out that with more data that we can measure continuously in individuals, we may find that we currently are not even measuring the most useful things in current clinical practice.
Mary Lou Jepsen
-Founder of Openwater
Her talk was mostly about her vision for Holographic Near Infrared Light devices. She suggests that because NIR light can penetrate skin and scatters in relation to different densities and different blood oxygenation levels, this technology could replace the much more expensive MRI and fMRI technology today.
While I would love to think that this was possible, I’m still a bit skeptical as NIR at current energy levels has a penetration problem – at least as I understand it. I don’t fully understand how this can be overcome – especially when trying to resolve blood oxygenation changes below a depth of a few cm at most. Perhaps I missed a key point of her talk but I remain interested but skeptical.
-Distinguished fellow at Carnegie Mellon University and Director of Research at Duke University’s Pratt School of Engineering
He started with a prediction that by 2023 the iphone will have the computing power of the human brain. He’s also a bit more optimistic in that he states that in 5 to 7 years there will be fundamentally transformative changes as AI and smart cloud-connected devices will permeate every aspect of our lives.
In 2030, he posits that we’ll have our first bionic man.
His talk was all about brain-machine interfaces for helping the paralyzed walk again, showing many examples of how monkeys could move cursors and carts and arms by learning to control neuronal activity being picked up by only a few electrodes in their brains.
He was part of the famous demonstration before the world cup game where a paralyzed person made the first kick of a game. It was awe-inspiring.
Lastly he introduced an interesting expansion on this technology termed “brainet.” This is where two brains are learning to generate signals together to move a cursor to the appropriate place – suggesting that this comes easily to primates as they evolved to work together – to pick up on what each is doing. Fascinating stuff.
My former boss at NIMH has been a denizen of Silicon Valley for over a year and I was very curious as to what he was up to. He started his talk with some eye opening statistics. One was that in the US, suicide rate is 3 times that of homicide rate. This is a very big problem.
He also quoted Sydney Brenner “Science depends on New Techniques, New Discoveries, and New Ideas, likely in that order”
He talked a bit on genetics and it’s challenges.
First, in using genetics to understand disorders, it’s clear that the area is complicated. All it can do is assess “risk” as many with the clear genetic signatures associated with disorders never acquire the disorder. He went on to emphasize that genetics of mental illness is really genetics of brain development.
As a founder of RDoC, his emphasis of three points was not new: 1. Mental disorders are brain disorders. 2. Circuits matter and individual differences are profound. 3. Brain imaging may contribute to better psychiatric health care…music to my ears..and likely true.
Along these lines, he emphasized that DSM-5 diagnostics are imprecise and really have no clear biomarkers – essentially a dead end in data driven science.
He emphasized that we need measurement based cures (both before and after treatment – we need more follow-up studies!)
As a side note, I was intrigued by his mention of two pieces of data.
- Anyone who is having a crisis can text 741741 and will receive immediate feedback from a professional. This is a simple and amazing service.
- In big data analysis of google searches (I think), the most telling word that predicted suicide attempts was surprisingly “ibuprofen” as individuals were looking up what a lethal dose would be.
He outlined a three pronged strategy for new health care: 1. Mobile interventions 2. Care management, and 3. Digital phenotyping.
He also re-emphasized the prevailing themes that we need to show that cool tools make a difference and that we need, importantly, trust and transparency and to give people agency – the capacity of individuals to act independently and to make their own free choices.
Again, similarly to several other speakers, he mentioned how exponential growth (this industry) will take us by surprise as we are more sensitive to linear changes, quoting Bill Gates: “ Things will change much less in the next two years than we expect but much more in the next ten years than we expect.”
His main point was the need for more data collected directly from the patient, suggesting phone apps could do much more.
(My own thought is that we might also want to give physicians an app in which they could report – of course anonymously – on their patients with perhaps more curated information.)
-Tel Aviv University and Founder of Neurosteer
This talk was exciting. One of the best of the conference.
He started with a puzzle. How, with one microphone above an orchestra, can humans so easily pick out any instrument they decide to listen to? The answer is that the instruments are differentiated not by frequency but by timbre. He then went on to apply this concept to his revolutionary idea.
He started his talk on the history of various signal processing methods for extracting unique time series information from complicated signals…FFT, wavelets, and his own Mother Wavelet Optimization. (my own thought – I have to look this up for use with fMRI data!)
He then went on to describe his big idea:
EEG signals can be fed into an EEG database where “basis packets” are discerned. These are used as templates (generated from many experiments in which the brain activity is known) to then be used to accurately decode whatever the brain is doing at that moment or the state of the brain during a longer time period.
(my own thought – resting state fMRI could potentially do the same thing – generate a library of pairwise correlation templates – to be applied to the time series to understand what the subject is thinking in real time).
He took this further. He has developed a simple two electrode patch that can be worn discretely by anyone. The data can be continuously fed to an iphone or ipad where it’s then uploaded to the cloud where the above analysis is performed. Over time, templates can be perfected such that the conscious state of each individual can be assessed in real time – allowing direct treatment or intervention, bypassing a clinician – all from two electrodes.
I certainly don’t have a good feel for this processing technique and wonder about the efficacy of using only two electrodes – however, I’m very much looking forward to see how this amazing idea will play out.
-Co Founder of Sun Microsystems
Vinod is an individual who was treated (with good reason!) with special reverence by the organizers of this meeting. He didn’t give a talk, but rather gave an interview where he answered questions from the moderator and audience.
He suggested that not only will algorithms improve but they will also substantially improve human functioning – giving us insights into avenues of thought that we had not realized. One telling example that he brought up: The best Go player in the world who was beaten by an algorithm last year. After his match in which he was defeated by AlphaGo, his winning percentage against other humans shot up substantially. Apparently he gleaned some significant insights from playing the computer. This is particularly interesting as this did not happen in the context of Chess. However AlphaGo was a trained neural net, while Deep Blue (the algorithm that defeated the best chess player) was a brute force deep ply digger.
He suggested that conversational AI may be a good way for the elderly to fend of loneliness and depression as they can have conversations with such a system whenever they want.
Another interesting quote from him about predicting the future: “Extrapolating the past tends to underestimate progress. Inventing the future comes from future focused people.”
Another quote on a problem that all big data people grapple with: How do we motivate people to share their data?” We need to give people reasons to share. They won’t do it without a motive – preferably short term…a very hard problem. Of course, we could work harder to create a culture where it’s a given that it’s simply the right thing to do!
He spoke on two systems: 1. Epidermal wireless electronics and 2. Skin integrated microfluidic systems.
Regarding electronics, the goal is to make electronics fully biocompatible and progress is being made: Science 333, 838 (2011), Science 344, 70 (2014), Nature Communications DOI 10.1038 (2014).
He provided a vision for electronic temporary tattoos and stretchy electronic materials.
Such devices can measure ECG, hydration, temperature, sweat and more.
He talked on an ECG patch that also measured respiration rate (from the time dependent modulation of ECG)
His talk really got interesting when he started talking about Epidermal Microfluidics that could measure lactate, chloride, pH, glucose. Apparently Dr. Whitney on the “Rachael Ray” show advertised this.
He talked of a neat device that performed time-stamped chrono-sampling using multiple reservoirs that were filled with sweat in a sequential manner.
This was also one of the best most inspiring talks. He’s an amazing communicator.
He started with the concept of the “umwelt.” Every animal has it’s own window of the world, determined by how their senses take in and code outside reality.
He then went on to describe how the human “umwelt” could be expanded not only to treat those who are blind or deaf but for normal healthy humans. He mentioned specific people working on various devices:
Leslie Kay – “sonic landscape” converts visual information to auditory information
Kanno Kajimoto – tactile device on forehead that converts visual (or sonic) information to tactile information
He also described the BrainPort which converts visual information to tactile tongue-specific information.
He demonstrated a very interesting thing called the VEST – which is, in fact, a vest that one wears that converts sound information to coded tactile information on the torso and suggested that the information that can be converted to torso “feel” is vast: internet information (stocks), drone control information (pitch, roll), smell, UV light, and more.
(Personally this seemed like a perfect way to test how the brain learns to code new information from other senses. An fMRI study of receiving the stimuli before it’s coded vs after it’s coded and learned would be helpful for understanding plasticity as well as cross modal interaction).
He is a proponent of the use of photoactive information for tracking neuronal activity rather than being limited by electronic arrays. He showed some spectacular high resolution images of optically detected calcium activity throughout the brain – performed by Mark Schnitzer. He suggested one can decode this information using automated segmentation approaches.
He left us with an interesting puzzle: “We don’t know how motor precision is represented in the nervous system” We have uncovered correlates of movement, but precise movement has eluded us. (My own thought is that again this might be an interesting fMRI task – comparing subjects doing low precision motor tasks vs high precision motor tasks. Perhaps this has been done. I’ll have to search the literature). Email: email@example.com
Demonstrated high density multi-spike activity and suggested that a significant aspect of the neural code is not simply in the discrete bits of spiking activity but a more continuous discrimination of spiking synchronicity across multiple neurons.
He left us with a question of what would we do with a high bandwidth neural interface? What information could we obtain?
Karl talked on his work on CLARITY and explained clearly that the reason brains are not translucent is because of the lipid content. CLARITY is a method that carefully removes all lipids, rendering the neuronal structure in great detail.
He also mentioned a method by which he could create CLARITY type maps that are sensitive to neuronal activity over a period of time before the process.
He demonstrated – using a mouse model – optogenetic targeting of the nucleus accumbens that modulated risky behavior.
Interestingly, he brought up the use of TMS to modulate dorsal-lateral prefrontal cortex to turn down cocaine craving. (Frenczi et al, Nature Neuroscience, 2016)
-US Olympic Committee
He gave a pretty light but inspiring talk on how smart sensors, smart fabrics, computer vision, and augmented or virtual reality are directly impacting performance of athletes (better than drugs).
-Olympic Cyclist, World Record Holder in Velodrome, Founder of Optimized Athlete
He gave an energetic talk on his own personal experience using various high tech strategies for maintaining health especially for older athletes.
For sleep tracking, he suggested the use of “emfit qs” which also provides information on heart rate variability – an increasingly useful measure of state of recovery. Low HRV typically indicates overtraining.
He also emphasized his pleasure in the use of the “Chilipad” for sleep. It’s a water chilled mattress pad that can precisely control temperature. He sets his to 66 degrees. This helps significantly in increasing the quality of sleep during the night – especially hot humid summer nights.
He also mentioned that there is an app coming out called “Gold” that will help intelligent decision making for training.