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transcript: transformers health

by:Tuowei     2019-09-08
This transcript has been edited for readability.
Precision medical Bernstein: Hello everyone.
I\'m Lenny Bernstein, health and medicine correspondent for The Post.
They just told you.
I was on stage with the doctor.
Francis Collins, director of the National Institutes of Health, we will discuss the efforts of the National Institutes of Health to accelerate progress in scientific research, especially in the field of precision medicine.
For viewers and people watching online, you can use hashtag Transformers to send us your questions on Twitter, or you can comment on our Facebook live stream. Dr.
Collins, thank you for being with us.
Thank you, Lenny.
It\'s great to be here as part of Transformers.
You lined up here for an afternoon.
Bernstein: just about a year ago, I think you and I were at the same stage and we were talking about precision medicine.
Collins: what about that?
The National Institutes of Health did not disappear. [LAUGHTER]
The National Institutes of Health has a large project called \"All of us\" in progress. Collins: Yes.
Bernstein: Can you update us on the situation?
I \'d love to go.
So this is one of the boldest ventures that NIH is trying to design and implement.
When it is fully enriched and fully registered, it will include 1 million Americans as long-term participants
Long-term research on health and disease.
All of these people will be required to register, provide their electronic health records in the security system, wear wearable sensors, like Fitbits and other things to track the performance of their bodies, fill out a lot of questionnaires about their personal health and provide blood samples for various laboratory measurements, including the complete DNA sequence of their genome.
Be a participant, not just a subject.
I think we probably shouldn\'t use the word again in medical research because it has unfortunate implications for what you have done.
These are for the participants;
Partners in hard work.
They will get a lot of information about themselves that can be very interesting and a bit useful in their own health care, they will be a part of it in this amazing national adventure, which will reveal more clearly than ever before how to keep people healthy and how to manage chronic disease done
At the moment, we call it the \"test phase \".
\"10 health care organizations across the country have been involved in the work and have been funded to participate in the work.
For now, we will spend about $0. 3 billion this year to drive this all, a project that will last for many years.
They then contacted the participants and invited them to join.
This includes a very careful process of consent.
But we also want to make it available to anyone in the US, so people will have a direct volunteer opportunity to sign up.
We will also contact the Community Health Center.
In particular, we want to bring in many people who are not traditionally part of medical research.
In fact, we want more than half of the 1 million participants to be underrepresented groups, which is very bold.
Bernstein: So these people are ethnic minorities?
Collins: Ethnic and ethnic minorities, social and economic status.
People who are not necessarily engaged in research.
Rural participants are not usually moved by medical research opportunities.
Let\'s take a look at the different groups.
We want a lot of people like this because we also want to know about health differences.
Bernstein: why is it so difficult to recruit these people?
I think many times this is just a logistical issue and the main medical center that does the research happens to not be near where some people in the country live.
Frankly, given some of the experiences that have taken place in the past, some ethnic groups are skeptical about medical research, and there may be good reasons.
If you\'re doing a medical research project in Africa
Americans, almost always, you have to talk about tuskeji, what\'s going on there, and how can we make sure this never happens again?
I think it\'s because of this project of \"all of us;
This is what we all call\"
As a team member, its goal is to have the same diversity as the participants, which gives some credibility to the full content of the project.
So the test is in progress.
We have recruited thousands of people.
We are kicking the tires.
We want to make sure that all the components work properly.
The Mayo Clinic has a library of 32 million samples ready to be collected and stored in a carefully selected bar --
The way it is coded so that you can find the person you are looking.
There is a database plan and a security system that is the best in the world because we want to make sure that this system is not hacked, which can be very unfortunate, many people may wonder if they want to attend.
Director Eric Dishman, who I hired from Intel, is responsible for managing this person and person, and does he know how to run a program? We have a lot of people in line in these 93 organizations trying to make sure everything goes in the right order.
But we want to start when it\'s ready and right, and if there\'s any concern about whether the beta test tells us there\'s some work to do, we don\'t want to start in a hurry.
So before we start this national conference, you\'ll hear a lot when we get there --
It will take a few more months.
Can the children attend?
Collins: At the moment, our goal is not to start with the child, but to start enrolling the child after the first year.
There is more complexity in terms of parental consent and participation.
We now have a working group that tries to make sure that we are doing the right thing when we do that part.
However, it may take another year to open to children.
Bernstein: If you can take shorthand for us in the next few years, what is expected to be the reward for collecting this data?
What is the return?
Collins: a bunch of things. [LAUGHS]
Let\'s just say one.
For example, we know that the way people benefit or not through medication depends on their personal circumstances, especially their DNA, which is called pharmacogenomics.
On its label, the FDA says more than 100 drugs, you may want to know that your specific DNA caused this specific enzyme before a doctor prescribed this prescription, this enzyme may metabolize the drug because it affects the dose you should get.
But we did not do so, nor did we do so because the information did not exist.
Just not practical.
If you go to the doctor today and you have a situation where you need a medication prescription to write --
Maybe you need statins.
Your DNA is not available and it takes a long time to really get the test and get the results and explain it.
These millions of people will have their DNA.
It\'s done.
It\'s in the record, so we can test the genomics of drugs very quickly: does this actually improve the results of a long list of drugs, which we think should lead to better results, because you get the right drug dose for the right person at the right time.
Not one-size-fits-all approach.
This is a fairly early benefit for all of us, and when we look at signs of disease or actual disease that people have in a few years, we can look back, because we\'re going to get the data for these people and try to figure out the triggers and then use that information to help prevent other people\'s diseases.
This will focus to a large extent on prevention, but it will also focus on chronic diseases.
Another thing I think we can do is that all other public and private research communities are very interested;
If you have millions of people with all this data and are interested in research and have agreed to bring people back to them and invite them to another trial --
Let\'s say you want to do a test for a diabetic artificial pancreas and you want to reach out to those who are eligible for the test.
In a study of millions of people, there will be thousands of people who may be very interested in your letter.
Therefore, this will enhance all the ways in which we conduct clinical research through this basic framework. And by the way—
Bernstein: you eliminated your leadup time?
Yes, it is.
Bernstein: because it could take years.
Collins: This is the most important thing. Many years.
By the way, we call it millions.
I would be happier if it were more than millions. [LAUGHTER]
That\'s what we can afford.
Bernstein: I want to move us to something that is currently affecting the prevalence of our opioid.
NIH is working on this issue in a big way.
Collins: big way.
Bernstein: you are starting a project with a pharmaceutical company. It has—
You can correct me if I\'m wrong
Three ambitious goals.
You want to be
Addictive drugs for chronic pain. Collins: Yes.
Bernstein: better treatment for opioid addiction. Collins: Yes.
Bernstein: this is a huge improvement in itself, and the antidote has been improved.
For example, the next generation of naroone
Can you give us an overview of what NIH is doing there?
I \'d love to go.
As one of our 27 institutes and centers, we have the National Institute for Drug Abuse.
Its director, doctor.
Nora Volkov is one of the world\'s neuroscience experts studying drug addiction, especially opioid drugs.
This is where one really needs to understand the evil way this particular compound reconnects the brain, in order to understand how those addicted people really become addicted in situations they can\'t control, it\'s more of a decision out of free will to get rid of addiction so that you don\'t have to eat or drink.
This has become an absolutely compelling incentive to get people to do things you can\'t imagine, and it\'s a good judgment, but it\'s overwhelming in demand.
We also need to recognize that because I think some people who haven\'t noticed the epidemic think this is the person who just started injecting heroin, 80% are currently addicted to opioid drugs, starting with prescription drugs, many are not syringes.
I am sorry to say that this is the medical industry, and at the end of 1990 the prescription for opioid drugs began to increase significantly because there is a feeling that they will not become addicted as long as someone is really in pain.
We found it absolutely wrong.
So we have an urgent need.
What can NIH do?
You mentioned these three aspects.
We do need better ways to treat patients with chronic diseases whose severe pain in the drug does not get them into this addictive state, and we now see tens of thousands of deaths each year from overdoses.
There are some very good ideas.
We learned a lot about the neuroscience of pain.
As a result, there are other drug targets that have not yet been fully achieved and the company is interested in that.
So on Monday, I was in Trenton with Governor Christie and the CEOs of 15 pharmaceutical companies, and the FDA and governors got together to be the head of the president\'s opioid use crisis committee, basically committed to working together to accelerate the development of these non-opioid drugs
Addictive but effective painkillers.
If we really make this a priority
Maybe it\'s like we treat HIV.
AIDS 20 years ago, I think we can find a better treatment.
Bernstein: So the idea of separating this addictive quality is --Collins: Yes.
Bernstein: judging from the quality of that painkillers?
That\'s right, Lenny. that\'s what we need.
Because currently, opioid is the most effective drug for the treatment of acute pain.
They do, but they have this very scary side effect and need more and more people, anyone who has been working on these sites for more than 10 days will have trouble leaving them, too many people don\'t know this and end up stuck in a difficult place.
We also work with the industry to provide better treatment for 2 million Americans who are already addicted;
There are 2 million people.
How many people are in effective treatment now?
This is a small percentage.
Part of the problem is that the treatment options currently available are very limited.
There is methadone, which means you have to show up at the clinic every day so you can take your pills or liquid.
It does work well with Ding binofen, but we need more ways to distribute it.
It can be taken daily or once a week, or even six timesmonth dose.
Now that there is nathrone, it is an inhibitor against any kind of opioid, it is very effective for people who are already completely clean and can help them keep this state.
But we need more choices. they are actually ways to do this in the short term.
Terms we can work with the industry.
Bernstein: Why are few people taking these drugs if they are found to be effective?
Collins: I think it\'s an epidemic, it\'s a bit sneaky for us, the increase in the number of addicted people and excessive deaths is amazing, and the medical system is not very well prepared for that. The medication-
The assisted treatment MAT that you really need to treat an addictive person and have the opportunity to work on has not been provided, even in clinics where many advertising campaigns can help people.
I\'m not sure if this is a good thing.
The recurrence rate is very high for many such clinics.
So the data becomes clear.
The 21st century cure bill, however, is a good thing that Congress has passed, with billions of dollars flowing to states to put more drugs in
There are auxiliary treatment clinics.
But there\'s still a mismatch.
A serious mismatch between supply and supply, as well as the needs of people looking for these clinics.
We still have a long way to go.
I think doctors don\'t usually want to engage in this kind of treatment, and we need the medical community to stand up and say, \"Hey, if we can prescribe opioid drugs, you should also be willing to participate in the treatment plan for addictive people.
Bernstein: Now, I think one of the things after 70 is naronone, which is very effective, thankfully. Collins: Yes.
Bernstein: But do you think it can be improved? [OVERLAPPING—INDISCERNIBLE]
Bernstein: it\'s actually-
Collins: Also called narken.
If you take an excessive opioid and have stopped breathing, you \'d better hope that someone close by will have drugs for the next four minutes, or as an injection form, or better, as a nose type.
By the way, the shape of the nose is just a little foggy.
This is something we developed in partnership with a company, NIH.
It is now available to many first aid workers.
It is much cheaper than the injection form and easier for the non-injection form
Medical staff to be managed.
Just stick it on their nose and spray it.
Bernstein: It\'s almost everywhere at this point.
Collins: That\'s true.
The problem is that these synthetic opioid drugs, called fen, are introduced into the heroin supply and, worse yet, ka-fen.
They are so powerful that we hear the story of more and more people taking an overdose, who gets the naroone antidote, who seems to be coming, but then falls into a breath stop because it\'s not strong enough, so much of a very, very powerful overdose of fen.
So we may need a more powerful version that lasts longer.
We are working with companies that know how to do this, and if we work together, it\'s one of the things that can be done quickly.
So, I think NIH can help with this partnership, and that\'s what we\'re trying to get into reality now.
The FDA is also there to a large extent.
We have built partnerships for other things like diabetes, Alzheimer\'s, arthritis, Parkinson\'s and cancer.
These are the partnerships between NIH and industry.
Let\'s see if we can do something similar for this incredible health crisis.
There were more people who died of opioid overdose last year than those who died of HIV.
Aid at the peak of the outbreak in the United StatesS.
At the end of 1980.
However, the focus on this is not the same as it is now.
Bernstein: You mentioned the recurrence, just to put it simply, because there is one more thing we have to talk about --
Biologically, why do more than half of people get some form of treatment, some form of rehabilitation, relapse, and opioid treatment?
Collins: This is a question of reconnecting the brain, which has already happened when you are addicted to opioid, and it takes a long time to recover from this situation, and going back to the kind of completely forcing yourself to take the next opioid is actually something you can resist.
This is a very important question.
Obviously, the recurrence rate of most programs that treat 28 days is even higher than what you said. Some of them—
More than 90%, we need to know exactly what these recurrence rates are.
In fact, we do not know, for individuals, what should be the duration of the treatment before you begin to gradually decrease and relapse, rather than the immediate recurrence.
This is a key issue.
Bernstein: So, is there a biological or neural way to improve these numbers?
Collins: I think part of going back to precision medicine is recognizing that we\'re not exactly the same, and that could be a process that needs to be treated longer than others.
One thing we are working with industry is Biomarkers;
An assessment of whether the person is now at the point where they will not have such a high risk of recurrence without taking the risk of withdrawing from treatment and having this happen.
For example, there are some very good ideas on how to do this by imaging.
If you can look at the brain, you will actually find that the connection between the addicted person and the non-addicted person is different, and then, maybe you can watch it gradually return to normal, and there\'s a correlation there that tells you, \"Well, it might be safe to start taking the drug now --
Auxiliary treatment.
Bernstein: a more pleasant topic.
Whenever the government tries to cut the budget, Congress will resume it.
Sometimes, maybe every time, if I remember correctly, they add money to the request.
These people want what you have, so what is the secret to keeping your budget healthyS. Congress?
Collins: Well, I think the real secret is that the value of biomedical research as an investment by the federal government is very notable, when you look at what this does to advance the cause of human health and save lives, you can look at decades of records and see how it pays off.
Life expectancy is prolonged, and the number of deaths from heart attacks is declining.
The number of cancer deaths is also declining, HIV-
AIDS has become a chronic disease, not a certain death.
All of this is very well documented because the federal government\'s modest investment in medical research has paid off in terms of human health.
It also pays off from an economic point of view, and I think Congress is very concerned about that.
Every dollar the NIH has invested in the grant will be returned to $8.
38. in terms of economic growth over the next eight years, the resulting partnership with industry is taken into account.
If you want to change the medical cost curve of a disease like Alzheimer\'s, this also has this argument, otherwise it will destroy the banks of our economy, which is close to $300 billion a year.
This is where you have to come up with a research plan that will give you a way to prevent or treat diseases like Alzheimer\'s.
So if you really want to invest, choose NIH.
Work with the industry, but we do the most basic part where you want to put your investment.
Finally, there is a question of leadership in the world.
There is no doubt that the United States has been a leader in biomedical research for the past 30 years.
Other countries are challenging this leadership, and it is good for them to invest in science, especially in China.
But when you can see what the benefits of being a leadership role have brought to our country, do we really want to leave this stage?
Don\'t you think we should support it?
Congress also tends to focus on this.
So I don\'t need.
When it comes to the decision of where the taxpayer\'s money should be placed, it makes its own decision.
With Congress representing them, medical research is always a bipartisan, non-
Political preaching.
Bernstein: not only that,
Collins knew everything, but he stopped at 0 or 0. [LAUGHTER]
This is amazing with this in mind.
I interviewed a lot of people.
We have so much time today.
I want to thank the doctor.
Collins attended our meeting and started our meeting, and I will hand things over to William Wan, my colleague.
New frontier: kayywan: Great. Good afternoon.
I\'m William Wan, and I\'m a science reporter for The Washington Post.
Our next discussion will focus on the Integration of Medicine and emerging technologies.
So, having a conversation with me on stage, we have the Dr. Anthony Atala.
He is the director and doctor of Wake Forest Regenerative Medicine Research Institute.
Atala has been doing this pioneering work in the fields of creating organs, manufacturing bones, tissues, various methods (including 3D printing), some of the most exciting work in the past decade.
And join us. we have doctors. Daniel Kraft.
He is the founding executive director and chairman of index medicine at Singularity University. And Dr.
Kraft\'s project explores integrated, rapidly evolving technologies and their potential in the fields of biomedicine and healthcare.
And then we have the doctor. James Lu.
He is senior vice president of Applied Genomics and co-founder of Silicon Valley startup Helix.
Helix is sequencing the customer\'s DNA and matching it with genetic testing for genetic diseases and other personalized and health tests
Related products.
Finally, we have a doctor. Girish Putcha.
He is chief medical officer at health tech startup Freenome, which conducts research to accelerate accessibility and non-
Screening for invasive diseases that treat cancer and other diseases early.
I think some applications are called liquid biopsy, right? Yeah.
So, I want to say thank you for joining us.
So, I think I\'ll start with you first. Atala.
I\'m just curious, can you tell us what\'s going on now?
We \'ve always heard that creating organs is a way to help this huge need for organ transplants.
Can you tell us the location of the land?
Tara: Sure. Thank you.
So one of the challenges today is that there are too many people who need organs.
The actual number of patients on the waiting list is actually-
Six times higher-
About 25-6 timesyear period.
The actual number of transplants has barely increased during that time.
The challenge, of course, is that we need more organs because we live longer.
So, when we live longer, the organs fail, so this field of regenerative medicine will really try to create these tissues and organs, try to replace some of them in terms of shortages.
What is the direction of things?
So, what are we going to see in your mind in ten years?
Atala: Well, right now, we do have some organizations that have entered the patient trial.
So we have a lot of organizations right now.
The least complex flat structure, such as the skin, for example;
The tubular structure has also entered clinical trials such as blood vessels; hollow non-
Tubular organs such as bladder and vagina.
These organs are now in the patient, so the patient walks around with these engineered organs.
The biggest challenge, of course, is solid organs;
Heart, lungs, kidneys, for those people, I think it will take a while to transplant these organs to patients, but now with cell therapy, patience-specific.
It\'s not stem cells, it\'s the patient\'s own cells that can grow and expand, and then put them back in the body to enhance their function, which is now also in clinical trials.
So, I think in the next 10 years, you will see more of these tissues coming into the patient and you will see more patients looking to benefit from these technologies.
Wan: Is there a Holy Grail-
The white whale for you?
This is the most complex organ.
If we do that, we can achieve regenerative medicine.
Attara: in fact, one of the most needed organs is the kidney.
So if you look at the entire transplant waiting list, 90% of the patients waiting for the organs are actually waiting for the kidneys, which is a huge cost to our health care system.
So, for example, the average cost of getting a patient on dialysis is a system to make sure your-
These machines can take care of the function of the kidneys, and the average cost per patient to receive these treatments is about $250,000 per year.
So, you can imagine the numbers adding up.
So, from a social perspective, to make the lives of patients better, to improve their health, to improve the quality of their daily lives, and to save money for our health care system, the kidney is ideal. Wan:Great. And then Dr.
Lou, I wanted to ask you, you\'re-
Like the border. Dr.
Atala, who has been doing this regenerative medicine for decades, despite slow progress.
You seem to be at the cutting edge of the new frontier of genomics, and I\'m curious, what do you think is the possible application in the short term, and then look at 20, 30 years, what do you think of this?
It\'s a good question, William, thank you for letting me be here and for giving it to the Washington Post.
I think what I\'m going to do is take a quick step back and explain how we see the main trends in the health care system and why we build a spiral like we do.
I think the first issue is that we see more information about the growing desire for individuals and patients to know their personal health.
We see this in the rapid application of digital health technology.
Now a lot of people are texting their doctors, they are using wearable technology, they are using telemedicine, and frankly, over time, these engaged patients will be an important part of their health and it is also important to know themselves and their genetic data.
I think the second thing we see is that, frankly, the cost of sensors and collecting personal data is basically zero, although the price of the iphone seems to have been rising all the time, but sensor technology is falling to zero.
In this way, the genome will be quite similar, which is also the cost of obtaining the genome will decrease.
So the real opportunity will be the intersection of all these different data sets that reside in all these applications around people.
To be frank, I think the health data of the vast majority of individuals so far is actually no longer being generated in the health system.
This will be generated on your phone and with 2.
Now there are 5 billion mobile phones in the world, and everyone is walking around with sensors.
I think the third question is
When we think about the app, there is no golden egg app and there is no such perfect app --
Unicorn app
In order to really provide new research or results for individuals, you have to take advantage of the power of the wider player ecosystem.
So when we build Helix, we build it as a user-centric personal genome platform where users sequence and they can control the data in a way that they think is appropriate, they can explain it with quality partners like we did at the Mayo Clinic or Geisinger.
We think that for everyone, they will have different apps that they care about.
So some people will come in and say, \"My biggest question for myself is, where am I from and who am I?
Someone will come in and say, \"Can I have a healthy family ? \"?
\"There will be apps like carrier screening.
Some will come in and say, \"What can I do from a preventive point of view?
\"We have partners like Mayo clinic there.
Therefore, we hope that these applications will help people make better decisions for personal health, while also providing a broader opportunity to potentially contribute data to a wider range of humanity.
Wan: So, for example, 30 years later, when everyone\'s genome is sequenced according to the routine --
Like going to the bank or something.
How do you see this interaction in their daily lives?
So, will it be part of you?
What part of the daily experience will it be?
I think this is a good question, and I think the first part is to realize that if the cost tends to be zero, I think everyone wants to be sequenced, so everyone here today, if they want, there is a good chance that they will be sequenced.
The second problem is that I think it is an activation energy to talk about sequencing today.
I\'m going to sequence my DNA.
But it will be everywhere in 30 years.
So, this is not a problem, have you been sequenced?
Yes, why haven\'t you been there?
The question won\'t be, can you show me your data?
The data already exists, so your first interaction with the data will not be a DNA problem;
The data will exist in your health records, you will appear, they will know about you, your doctor will ask you targeted questions based on what they see in your genes, rather than you will go and bring your genetic data to them. Wan:In that 30-
Year scene, what application will there be?
Is this a strict diet?
Is there anything else besides that?
Lu: I think what we should consider is not a genetic problem, but a problem that consumers may have, or a health problem that the medical system may have.
So, on the issue of drug genetics,
The question Collins just talked about is, how can I provide you with a more personalized treatment and how can I get healthier faster?
Genes will play a role in this regard.
I don\'t think you will use it as a DNA test.
It will be embedded in the system.
You may decide that you want a family, so the carrier screening will be in fact;
It is normal to perform carrier screening.
From the perspective of chromosome recessive inheritance, you may know what disease you may carry, which is much earlier in life.
If you have a family history of heart attacks and coronary artery disease, you will also have this history, which will be combined with your genetic score, let you have a more complete understanding of your health.
Wan: Do you have a lot of questions about the nightmare scenario where DNA exists?
Discrimination, biosafety, and the like? Lu:Yeah.
In fact, what I think will happen is that our normal access to DNA information is that we will start treating it in a proper way.
Today, I think, your destiny is like this.
I think we have to eliminate this myth very quickly, which is healthier for everyone.
OK, this is very helpful. And Dr.
Putcha, I\'m curious, can you talk about the working state of the liquid biopsy?
Putcha: Yes, thank you very much William for inviting you again and for the article. Sure.
So, when the phrase \"liquid biological system\" is said, I always shudder a bit because it means everything a bit and nothing.
I mean, it actually contains many different applications that can effectively look at things in circulation or other non-available
Whether it\'s saliva or urine or something like that, it\'s invasive.
Trying to gather information from the kind of health state that used to require essentially invasive biopsy.
Fundamentally, this is the promise of a liquid biopsy.
But I mean, when I say this method contains a bunch of intended uses, if we just take cancer as an example, because this is really where this technology and approach plays the most important role at the moment, and it can be everything from the early detection of cancer, depending on the mutation spectrum you see in circulating tumor DNA, actually determine how to treat this cancer to actually effectively monitor the effectiveness of this treatment and look for tiny residual diseases and similar things.
The fact is, from a purely effective point of view,
Did you really see what you think you saw? Does this mean what you think it means, the level of evidence needed to prove this is one thing, and then again, and more importantly, from the point of view of clinical utility, going back to the previous comment, if you can detect this, can you intervene in a way that is actually good for health?
The two threads are not well combined, so in many ways, it seems to me that the current challenge in this field is not so much technology as what we can do, if we do, the patient will benefit.
The cost of doing this-
Effective way.
Wan: especially in your work, I think when you start with something like this, you will meet a lot of skeptics, whether it\'s investment or regulation. Have you—what is—
How did you respond to this?
Or any lessons learned from it
Census: Well, I think-
We can say that my background is a bit vague.
I have always been an investor in this regard.
Obviously, I have been trained in molecular genetics.
In fact, I \'ve also been to start-ups like I do now, but I \'ve also worked with payees and regulators.
The good, the bad and the bad of having these different opinions is that I am born to be a skeptic myself.
So, I think, frankly, at the end of the day, the best proof is good science and good medicine, and there is transparency in that.
So, what I\'m talking about is the clue, very simply, the effectiveness of the analysis of what you\'re doing, the clinical effectiveness of what you\'re doing, and that\'s actually just saying, \"are you measuring what you said accurately and replicably?
Is it really important what you are measuring?
Is it related to some clinical endpoints, such as detection of cancer or an important drug response?
Then, if you use it, does this really prove useful for the benefit outcome?
So, I think at the end of the day, what will we do
I think this area must be put on hold or closed as a whole.
The best way to do this is to provide-
Do good research on proper size and motivation.
I mean, it\'s not the sexiest thing to do, but at the end of the day, that\'s the way medicine is moving forward.
To be frank, you will want to answer these questions if you are a patient. Is this—
If I were to do this, would it really change the way you look after me?
Can this change really help me?
Just say, we don\'t need another Theranos on our hands. Wan:And Dr.
Kraft, I\'m curious that you have such a unique perspective from seeing all these areas, and how they develop, and how it crosses with technology.
Can you talk about what you\'re most excited about in all the fusion between technology and health?
What are you most excited about?
Kraft: I think the real opportunity here is to change our perception of health care, which is actually more patient care.
I have been trained in medical trials, pediatric oncology.
We now have a system where the data we get, whether it\'s our blood pressure or our genomics, come to us in a decentralized, intermittent way, so we are very passive because the data flow is broken.
We wait for a heart attack, a stroke, or a late stage of cancer, or someone in the kidney --
Kidney transplant surgery
I\'m super excited about this-
Fusion is now able to move to more continuous data through our smartphones and connected rings and is associated with our personal genetic database.
Then be more proactive as an individual.
If you have your own check engine lights, exhaust your medical IoT based on your digital.
Including going to your clinician, your medical team, if you have diabetes or other diseases, take the disease as early as possible rather than later, and manage it in a smarter, more optimized way.
We live in an amazing age of indices.
You know, 17 years ago, when
Collins first sequenced the human genome, with billions of dollars and millions of dollars;
The price of sequencing has dropped to twice that of Moore\'s Law, quickly reaching thousands of dollars or hundreds of dollars.
The price of wearable devices and data is getting cheaper and cheaper.
3D printing is becoming something you can have at home.
So, I can get together with current clinicians, researchers, other people from different fields to see how we can match these, to address the many challenges we face in health care. Wan:Do you—
I also want to ask you a little bit, everyone here --wear two hats.
There is a medical side, a research side, and a business side.
I\'m curious, can you talk about the integration between technology and health, Silicon Valley and medicine? How has this developed over the past decade?
Kraft: an example
I mean, we came in 2017.
In fact, the first iPhone was released this fall, ten years ago.
These have become, obviously, medical platforms.
My old iPhone 2, this antique, looks slow and bulky if you have to use it.
It was amazing.
The upcoming iPhone 10 will soon look quaint.
So, interestingly, at least I\'m from the Bay Area, silicon.
At Singularity University in exponential medicine, you have a lot of people from other technical fields --
Those who do machine learning, and those who want to apply them on our mobile platform or are building games --
And my Google glasses.
VR programs, augmented reality, things they can use for games are now playing in the operating room.
The challenge is often that these people are very enthusiastic, but a little naive about the reality of getting paid for these things, regulation, and how surgeons will interact with patients and caregivers.
Sometimes these need to be matched, but there is a lot of new energy, and the minds of many new beginners are helping to catalyse new thinking.
Can you talk?
What are the pitfalls when you encounter this situation --
Are these two cultures or the fusion between the two worlds?
From what you have seen in recent years, what are some of these potentials and pitfalls?
Kraft: We discussed the possibilities of all these groups. ph]
Information, movie cataka, 20-
The year old movie, raised some questions about what happens when you have your group and other people who don\'t understand it or apply it in strange other ways. I finished my—
Twenty years ago, I began to be hospitalized in the mass hospital;
I can\'t keep up with all the group learning, not to mention what has just been published.
Therefore, some traps do not allow it to reach the clinician at the last mile. If Dr.
Atala is working on my genome, how will he choose the right medicine or the right 3D-
Print me the kidney?
How do you integrate this information, how do you get all the medical information and screen it, and proactively provide it to consumers, patients, caregivers, pharma, healthcare industries?
So, this is one of the traps.
Lu: Actually, I \'d like to add a little bit.
I think you actually have to provide information this year in a way that suits the patient\'s situation.
You want to make sure that they understand this anyway and that you can meet them where they are and don\'t have to bring them to you.
So we thought a lot about how you build an ecosystem of partners, and the right players from different places, whether they are large institutions like the Mayo Clinic or not, or small app developers?
How do you build a localized experience that helps deliver this information at the right point in time?
So, it\'s not just like personalized medicine, it\'s also like how do you see the personalized experience around this?
I think that makes it more relevant and provides the right context.
Putcha: I think I might add a little bit, especially when you work for the kind of company I work for, or many people here have connections, there are sometimes cultural challenges.
But this is really the case.
That\'s exactly what we\'re all talking about, of course, and I think it\'s very exciting.
But I think one of these things, especially from an investor\'s point of view, you have to calibrate them, especially when you have tech investors coming into the biotech space, the cycle time from start to end is very different.
Not 18 months, not two years,
It\'s more like 7 to 10 if you\'re lucky, and if you\'re really lucky, it\'s really good and happens to do all the right things, it could be 4 to 6.
So, I think, in a sense, setting expectations, some of the medical challenges are medical challenges, because you start thinking, Oh, if we adopt artificial intelligence, machine learning and all of these things apply it to a lot of data that we can learn from the health care system, and somehow these things magically disappear.
There\'s a reason these things are tough.
So, we have better tools, but it will take some time to get there. I think this is part of what we learned when applying these truly revolutionary technologies and methods --
Old Problems in Medicine.
Kraft: But what I want to say is that it still takes 10 years, billions of dollars. plus per drug.
We do have the opportunity to reshape how clinical trials work.
You can download an app with a clinical trial and you can share-
We were still using paper maps 10 years ago and I like to use this analogy.
Today we drive with Google Maps or Waze.
Crowdsourcing including traffic.
We will have some personal GPS to help guide us in the future or in the near future.
It fits our personality type, our group, helps us, and we share that data to improve the map for all of us.
We need pharmaceutical companies, MR companies, academic groups to start sharing so that we can do these things in a faster, smarter way.
This is a problem for all of you, but we are in Washington.
We were in a room where some of these people were involved in the regulation.
I\'m curious about what you think about the role of regulation, such as how regulation accelerates or hinders innovation, and how you see some regulation working in your own work.
Putcha: I \'d love to go first if you like.
So, to be honest, I think my approach might actually be a bit counter-intuitive, because the usual fixed answer is of course the way that it\'s blocking innovation and killing it.
In fact, I think, you know, I don\'t think it\'s a contradictory statement, but doing it properly can actually promote innovation.
The reason I\'m saying this is if it can express clear and consistent lines of goals, compete fairly, and effectively promote innovation by protecting innovators, I feel-
I think it actually promotes both value creation and innovation behind value creation.
I just want to give you a very specific example, if I can, and I think that\'s, if you take a look, you just compare, as an example, the situation we\'re having in the diagnosis, it\'s a very old discussion about LDTs and how to supervise them, and you compare it to our drug situation.
I think our situation in terms of diagnosis, reimbursement and value creation is very different from that of the drug and no one will argue.
Part of the reason is that what we basically do is to allow generic diagnostics or generic drugs to market on the market, basically at the same time, even before a drug with a brand, then claim what it wants.
You can see clearly how this unfair competitive environment really creates a situation where innovators who go through this process, and developing strict evidence will not be rewarded, there is no incentive to do so.
Most importantly, they are not in good health due to intellectual property and everything --
Even if they do, they will be protected.
So, I think proper regulation can actually promote innovation and create wealth.
Lu: I will shoot it out soon, too.
I think I really admire the regulators because they have to see the whole new technology and evaluate how you can regulate something safe and effective in a very short time?
They came in-
You come in, you are an expert in your field and they basically have to work hard to figure out how to be 30-
Expert in minutes in your field.
I think when we introduce new technologies, no one disagrees with what they should be safe, what they should do, and they should be effective.
I don\'t think anyone agrees with these things.
I think proper regulation can be a good catalyst for innovation, and it helps to compete fairly and helps prevent people from getting dirty with water, resulting in great technology.
Kraft: Now with this fusion, we have digital products.
We can specify the application for behavior change etc.
We did some work.
We have the FDA\'s digital health supervisor do Index medicine, we have done workshops, and now they have introduced a software medical device element to speed up the regulation of drugs, devices, and the elements that span the digital and therapeutic divide, as well as our former
Check the system and try to speed up to some extent to get the regulator on the index train.
Well, I think-
Two things I want to mention.
Of course, the first instruction is patient safety.
That\'s why the FDA has patient safety and that\'s what we want.
This is the most important thing.
But the other thing is that as these innovations start to progress in the cycle of the health care system, we need to make sure that the regulations are actually up to date.
They actually solve the problem of new technology, which is the new rules unique to new technology will be important.
There are not so many bad regulations; they are not.
They are actually pretty good, but how do you improve them based on new technologies?
I want to ask you, doctor.
Tara, you \'ve been pushing this border for so long.
I\'m curious about something-
For other areas that have just started, such as genomics or others, what are some of the harder lessons you have learned.
After trying to make this a reality for so long, what are some of the lessons you learned?
Atara: I think it\'s really important to learn early lessons, where you really-
We really try to make sure that these technologies are validated and that they prove to be long-term --
Before they really develop into a large number of patients.
This is very important.
If you look at new technologies that have emerged over the last few decades, such as gene therapy, gene therapy is progressing very well, very well, suddenly, a sudden death of a child is very tragic.
It has indeed paralyzed the field of gene therapy for decades.
Because people are acting so fast that they can\'t do something that they\'re not quite sure they\'re safe, it really paralyzes the field.
So I think the main reason for these technologies moving forward is that we want to apply them to patients as soon as possible,, to make sure you do have all the stars and Ts before you actually cross the barrier and send them to the patient and make sure they do work.
Wan: I am also very curious. all of you here are MDs, working in the Frontier Field, and also working in the field of entrepreneur spirit.
I\'m curious-
If you were talking to a doctor at the beginning of entering the startup world, what advice would you give them?
Kraft: I think all doctors, clinicians and all of us can be entrepreneurs in the health care field.
One of the opportunities, if you are a young medical student or a resident of a clinic, seeing unmet needs, has found new ways to solve the problem, whether using a chatbot, or a 3D printer-
In the manufacturer\'s campaign, we have a lot of new tools to solve the problem, then crowdsourcing clinical trials and funding them in new ways.
What can you do with molecular genetics in a high school garage, which is something a large pharmaceutical company could do ten years ago, so we have a lot of opportunities to find problems, and solve problems with a common attitude.
Yes, I would say I did the training.
I live in many places, not just the valley.
I spent many years in the northeast.
I trained in Texas.
I also spent some time in the southeast.
What I want to say is that there is no monopoly on innovation in Silicon Valley.
There are many people everywhere who are interested in how to be more favorable in various fields, and I think we just need to help them get the right tools and motivate them appropriately, so that they can have an impact locally.
Putcha: It\'s interesting because I don\'t know about you guys, but I have a lot of colleagues or others who want me to talk to their kids about what to do next, things like that.
It\'s kind of like-
It\'s always a bit dangerous to catch a part of your life, because you don\'t always realize that they are connected to each other, so I\'ll definitely do something different.
But my advice to them is, I think, what Daniel said, at the end of the day, what is the doctor\'s goal?
What is the goal of what any of us really do, right?
It\'s really not just about healing the disease.
In fact, it is to prevent diseases and promote health.
I think I sent you a question about what is the actual biomechanical limit of human life, and I never got a good answer to that question.
If you can, it\'s not a disease prevention.
This is the first step, but it is towards an improved approach --
The quality of our lives.
So for undergraduate students in medical school, high school students, whoever it is, I think the advice is just to follow your passion, if that passion is really serving people and trying to help them improve their quality of life, then follow your nose and don\'t accept the negative answer.
Wan: Have you ever thought about using the science you are doing and the medical applications you are trying to achieve to cope with market pressures?
Kraft: I think to put it simply, it\'s not just technology, new applications, devices, widgets;
This is integrated with incentives, and we do not practice evidence --
Basic Medicine, reimbursement-
We are entering this valuable field.
Based on care, pay when things happen, so no matter which system you\'re in, no matter where you are, no matter if we have Obamacare, Trump care, there\'s something else, we need to consider adjusting incentives to stimulate these new innovations and bring them to market faster.
Yes, I think it\'s about-
In fact, I agree with the statement that how do you adjust the incentives and how do you turn the steering wheel faster?
How do you do this in the right way, but how do you speed up research and results?
How do you use the convergence of these technologies to drive the results we want?
I think how do we think systematically about incentives for institutions, large academic institutions, individual physicians, individuals themselves --
Patients and participants, as well as companies that are part of the ecosystem.
Atala: I think one of the main things, though, is to make sure that the risks these technologies face in the internal, academic centres, before you bring them to the corporate entity, in the lower-cost area.
Because if you do it too early then the price
The cost of the technology has actually increased exponentially.
Putcha: I\'ll add one more sentence if I can.
There are clearly structural problems with our medical system.
What does that mean about Americans always do it right away after they have exhausted all the other options? Well, yeah.
We did that, so we created weird financial incentives because we had different sources of funding in different aspects of health care --
Hospital services, doctor services, medicines, etc.
So, it\'s hard to be valuable-
Based on metrics, it doesn\'t span everything optimized for result quality and cost.
So before we really start to fundamentally change some of these, I think we\'re going to continue to optimize in barrels, not in barrels.
Wan: Unfortunately, I think we only have so much time today, but I want to thank you. Atala, and Dr. Kraft, and Dr. Lu, and Dr.
I would like to welcome Chris Coratti of The Washington Post back on stage.
Front line: The Future of Public Health. Okay, thank you. I’m Lena Sun.
I\'m a health reporter for The Washington Post.
Our last group today will focus on public health issues in the United States.
So join me on the stage on my left
Regina Benjamin.
She is the founder and CEO of Bayou La Batre Rural Health Clinic.
But in 2009
Benjamin, who was appointed by President Obama as the 18 th American surgeon, held the post until 2013.
On her left.
Richard Beiser, President and CEO of the Robert Wood Johnson Foundation, held the position earlier this year.
Bether\'s previous titles include acting director of CDC and chief health and medical editor of ABC News.
On my left, along the way, it\'s the doctor.
Sandeep Jauhar, a practicing cardiologist and best-selling author.
He is also a point writer for The New York Times, covering health, medicine, aging, and ethics.
Thank you for joining us today.
I would like to remind the audience and those watching at home that you can post your questions using hashtag transformers.
You can also leave them in the comments section of Facebook live stream. So let’s begin.
I wonder if the three of you can take a few minutes to describe to us, as we look forward to the next 20 years, what are the biggest public health threats you see, and what are some possible solutions.
Keep your answer for five minutes. Dr.
Do you want to start, Benjamin?
Of course, I told Richard he could start.
Well, one of you
Who wants to jump in?
Yes, I\'m glad to kick you out.
Thank you very much for having this group.
I think it is important to discuss public health issues with discussions around technology.
When I think about the challenges we face in public health and the challenges we face in the world, there are some big threats that can destroy the population --
Like the epidemic we see, large-scale natural disasters.
But I think of the problems that we face every day, and I think that is the daily problems that we have to face as a society.
At the Robert Wood Johnson Foundation, we are very concerned about what it takes for everyone in this country to have fair and just health and well-being opportunities.
When you see the health and happiness of the driver, it is not whether you have a doctor to go.
This accounts for about 20%.
This is critical and we may touch on the legislation that is being considered in Washington, and I think it will have a terrible impact on people getting care.
But about 20%.
It really boils down to where we live, where we work, where our children learn, and where they play with these factors.
Are we creating a community and society that makes health easy?
This makes it easy for us to have access to nutritious food, and it is also easy for us to do sports activities.
There, it is easy for people to find jobs that pay for their living wages, so that they do not engage in three or four jobs that do not have benefits and do not give them access to health care.
Do we create factors that lead to health in our society?
I think, as a country, as a world, we will come back to this issue.
Everyone should be exposed to these things.
This is our responsibility.
Yesterday we released a prize-winning culture, and I was in a small county in central Kansas, Allen County, in this county of 13,000 people, and they decided to do everything they could to make their county healthier.
They know people are leaving their county.
It is not a good reason for people to stay.
There is no supermarket.
There is no place for activities.
They have accepted this and decided, \"we will make it better,\" and those little highlights across the country have given me hope, as a nation, we can do everything we can to make everyone feel that the system is useful to them.
Benjamin: We are basically the same.
So that\'s why I started him.
But my whole purpose is prevention, and I think the biggest problem we face is those lifestyle problems.
Chronic diseases such as diabetes, high blood pressure, stroke and behavioral health.
What we talk about.
They are not sexy, but they are them.
If we are going to change the health of this country, it is really a problem that we need to solve.
One thing I did in our clinic.
I went back to the little clinic in bayuela Battel, Alabama.
But we have set up a Center for Health Policy Research.
The reason I set up this Center for Health Policy Research is
Known as the Gulf health policy research center
It focuses on five countries bordering the Gulf of Mexico.
We have great hospitals and great doctors.
Even if we do have access to health care, there are things that make our health worse.
We are the worst in the country.
So there must be a problem.
I suspect it\'s a health policy, so we started doing science. and evidence-
Use the NIH grant to launch the basic research of this center to study these. Things like—
If you think my favorite topic is tobacco
In the state of Luis Anna, the tobacco tax is about 50 cents per pack.
$5 in New York. 50.
These policies are important.
You will find that young people are more sensitive to prices.
Are there any other policies around?
We have a policy on how many liquor stores a community has.
There\'s really a result.
So look at these policies.
As a result, we have already issued grants and we will publish the first issue of the subject issue.
But that\'s exactly what we need to do.
But we are also focusing on the community.
Engage the community and say, \"What do we need?
\"Over the years, we have young people and people working in the community who suddenly look at the research and say,\" I am a researcher. ” As Dr. Francis [ph]
It is said that people who are afraid of research and are afraid of participation are now interested in showing some of the evidence they need.
That\'s what I think we need to focus on in the future. Sun:Dr. Jauhar?
Jauhar: Yes, I mean, I think any discussion about public health threats should be done by acknowledging that public health is-
Public health programs are being threatened and threatened in a way that they have never been involved in, you know, maybe never. Dr.
I was chatting with Benjamin in the background and she said: \"The public health program has never been well funded.
\"I think it may be true, but this administration is looking at ways to cut the budget for health and human services that will affect the U. S.
Public Health Services, Centers for Disease Control and Prevention, National Institutes of Health, etc. it is important to recognize this fact and see that our response to public health threats is in itself, may be threatened by lack of support.
I understand your question literally, that is, you know, what do I think is important for public health threats in the coming decades?
So, for me, they affect the two most important organs of the body, the brain and the heart.
I\'m a cardiologist.
So I think the prevalence of dementia is a big threat.
You know, today, we have more than 5 million of Americans with Alzheimer\'s, which is just a form of dementia.
In the next 30 years or so, the number will definitely triple.
Unlike other types of public health issues
Chronic diseases like heart disease and cancer, for example, have already achieved great success --
There\'s really no cure for dementia.
What makes this problem even more complicated is that in this country there is a large team of unpaid carers who are becoming more and more tired by caring for patients, family members with dementia.
At present, it is estimated that about 15 million Americans take care of family members without wages.
To some extent, their own mental health, physical health and the loss of wages, work efficiency are staggering.
So I think this is something that needs to be acknowledged, and there is little action on that by the states.
There is a pilot program in New York State that finances a project that will provide some kind of supportive consultation, and in some cases, subsidizes hiring assistance to relieve some of the stress on these caregivers.
But it\'s a state project and we need to do more.
You know, the doctor needs to do more to ask the family, \"Do you have the ability to take care of the person you love?
\"I mean, as a doctor, I didn\'t really think about it myself.
But when nieces, sons, or daughters accompany their parents to the doctor, I think we just assume they will be at home.
I don\'t think we can make that assumption.
Another big problem I see as a cardiologist is heart disease.
Some of you might say, \"Wait, have a heart attack.
This is an old news.
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