SCIENCE AND TECHNOLOGY AGENTS OF TRANSFORMATION

We are privileged today with amazing possibility and bounty -

• music, videos, books, Internet,

• links to friends anywhere,

• shelter, food, medicine . . .

yet life can be difficult, chaotic, disorienting.

LET’S STEP BACK …

WE ARE AT A TRANSITIONAL MOMENT NOT JUST IN

HUMAN HISTORY, BUT IN THE

HISTORY OF LIFE

ANIMATING THE INANIMATE

WE ARE BREATHING INTO THE INERT SAND

AT OUR FEET A LEVEL OF COMPLEXITY

THAT RIVALS LIFE ITSELF

LIFE IS TAKING CONSCIOUS CONTROL OF ITS

OWN EVOLUTION

BLURRING BOUNDARIES

SYNTHETIC LIFE

LIVING & NONLIVING

Craig Venter – May 2010

Natural vs Artificial

GMO FOODS

VITAMIN-A ENRICHMENT

DIRECT NEURAL LINK

CLAUDIA MITCHELL $3M MYOELECTRIC ARM, 2010 OURSELVES & OUR TOOLS

PHARMACOGENOMICS

EMBRYONIC STEM CELLS

Functional Rat kidney 2013 Nature Medical

Human Trachea 2011

A JOURNEY

TO WE

KNOW NOT

WHERE

THE NEXT FRONTIER IS NOT SPACE,

BUT US

SAO PAULO

HONG KONG

NEW YORK

TOUCHED BY TECHNOLOGY

WINGED CREATURES RESHAPING

BIOLOGY

EXTENDING LIFESPAN?

WHO WILL WE BECOME?

•SEX, SUGAR: PORN AND PASTRY • FULFILLMENT:

A fetal stage with gene overlay. WHAT

ABOUT OUR KIDS?

TEMPERAMENT, PERSONALITY, VULNERABILITIES,

LOOK WHAT WE DID TO THE WOLF

TO CROPS

GMO ANGST

(c) Gregory Stock 27

GMO ANGST

Brasil (Embrapa)

TRANSFORMATION OF AGRICULTURE

Pinto Beans resistant to Golden Mosaic Virus ( EMBRAPA developed,CTNBio approved 2011)

EMBRAPA Folate-Fortified Lettuce

TRANSFORMATION OF HEALTHCARE

• We care so much about it. • It will affect us each directly. • It is not in great shape anywhere, and it is a

HUGE challenge.

• Brasil aspires to provide universal, free care: Health is a right of every citizen and a duty of the state.

• Technology will transform healthcare.

Everything else looks easy in comparison.

WHY HEALTHCARE?

THE FUNDAMENTAL TRANSITION

PHYSICIAN CENTRIC INFORMATION CENTRIC

DISRUPTIVE HEALTHCARE TECHNOLOGIES

TELEMEDICINE

REMOTE MONITORING

QUANTIFIED SELF

SYSTEMS BIOLOGY

MACHINE LEARNING

BIG DATA

GENOMICS

AI DIAGNOSTICS

IMAGING NATURAL LANGUAGE

INTERFACES

ADVANCED PROSTHESES

IMPLANTS

ELECTRONIC HEALTH RECORDS

APPROACHING DISRUPTION

• SCIENCE AND TECHNOLOGY DRIVEN

• BROAD, MASSIVE, UNAVOIDABLE

• WILL PLAY OUT IN DECADES, NOT CENTURIES

• MOST WILL BE CAUGHT BY SURPRISE

Courtesy Zuli Zami

Hurricane Irene 2011

A BROAD FRONT

RETAIL

TRANSPORTATION

MILITARY

ECUCATION

DEALING WITH A STORM

EXPONENTIAL PROCESSES

Courtesy FutureMed, Singularity University, 2014

Long Haul Truckers

Telephone Call Centers

Mass Transit Projects

Sports Writers

Auto Manufacturers

2000: THE VISION

EXPONENTIAL PROCESSES

DISRUPTIONS

o INDUSTRY LEADERS RARELY LEAD … AND ARE USUALLY DISPLACED

o BIG OPPORTUNITIES FOR NEW ENTRANTS

CAUGHT BY DISRUPTION

UBER

$18 B Valuation (5 yrs), 144 cities, 38 Countries Opened in June in Sao Paulo

DRIVERLESS CARS

LONG HAUL TRUCKING

REMOTE MONITORING

We need an integrated view of what technology is likely to be 10 to 20 years hence to know how to proceed today.

FUTURE HEALTHCARE

• Integrate all health knowledge

• Accessible anywhere, anytime

• Affordable for virtually everyone

• Highly personalized

DISRUPTIVE HEALTHCARE TECHNOLOGIES

TELEMEDICINE

REMOTE MONITORING

QUANTIFIED SELF

SYSTEMS BIOLOGY

BIG DATA

GENOMICS

AI DIAGNOSTICS

IMAGING NATURAL LANGUAGE

INTERFACES

ADVANCED PROSTHESES

IMPLANTS

ELECTRONIC HEALTH RECORDS

MACHINE LEARNING

ADVANCED ROBOTICS

da Vinci Surgical System

ADVANCED ROBOTICS

da Vinci Surgical System

ADVANCED PROSTHETICS

> 100,000 lower limb amputations annually in U.S.

KEY DEVELOPMENTS

o DATA, DATA, DATA

o DECISION MAKING

o ROLE OF THE PATIENT

- GENOME - TRANSCRIPTOME - PROTEOME - METABALOME

TSUNAMI OF

DATA

Courtesy of Eric Schadt Pacific Biosystems / Sage

ADVANCED IMAGING

IMPLANTABLE PRESSURE SENSOR TO MONITOR ARTERIAL PRESSURE

ADVANCED PHYSIOLOGICAL

DATA

Reebok Impact sensor

NEXT GEN WEARABLES

MC10 – temp, heart rate, uv, hydration, etc.

Hexoskin: heart rate, sleep,

breath rate & volume, etc.

INTEGRATED MONITORS

B1 Band by Basis Science 2014 (INTEL)

Skin Temp

Perspiration

Calories

Heart Rate Steps

GENOMICS

SEQUENCE COSTS

TUMBLE

COMPREHENSIVE DATA CLOUD

MEDICINE AS

INFORMATION SCIENCE

BIG DATA

KEY DEVELOPMENTS

o DATA, DATA, DATA

o DECISION MAKING

o ROLE OF THE PATIENT

PHYSICIAN OVERLOAD

EXPERT OPINION IS UNRELIABLE

17 “experts” estimate the percentage of colon cancer deaths that screening would prevent

2ND OPINIONS

DISAGREE WITH DIAGNOSIS: 11%

NEEDS FURTHER TESTING: 15%

MAJOR TREATMENT CHANGES: 18%

MODERATE TREATMENT CHANGES: 26%

TOTAL WITH SERIOUS DIFFERENCES: 70%

Cleveland Clinic Study reported by Vinod Khosla

EXPERT SYSTEMS …

But, there are 1.5 M science papers each year in 25,000 peer- reviewed journals.

IN-SILICO MODELING

• Calcium Dynamics • Cardiovascular Circulation • Cell Cycle • Cell Migration • Circadian Rhythms • Electrophysiology • Endocrine • Excitation-Contraction Coupling • Gene Regulation • Immunology • Ion Transport • Mechanical Constitutive Laws • Metabolism • Myofilament Mechanics • Neurobiology • pH Regulation • PKPD • Signal Transduction • Synthetic Biology

TRUSTING THE GLOBAL BRAIN

NEXTGEN HEALTHCARE

WHAT, WHEN, WHY, WHERE, HOW

WHAT? • Focus on prediction, prevention and wellness

• provide unlimited, 24-7 access to affordable, reliable, personalized care and guidance.

• help people actively participate in their own care

WHEN?

5 to 25 years … depending on whom and where

WHY?

Easier, better, cheaper ... Always at our fingertips

... And because it is demanded as a basic right

WHERE?

• From our phone … at home … anytime.

• Nearby clinics, offices … sometimes hospitals.

HOW? • Costly Private Care (Pilot Programs)

• Public Health Programs and Rural Access

MOTOROLA DynaTAC 1 Kg; 30 min talk time

GORDON GEKKO WALL STREET, 1987

NOT JUST FOR THE WEALTHY

MASSAI 2011

$10 M TRICORDER PRIZE

HANDHELD DEVICE TO:

• Monitor physiology

• Diagnose 15 diseases

Star Trek 1966

SCANADU

• Pulse transit time, EEG, EKG, temp, heart rate and variability, blood oxygenation

• Urine: pre-eclampsia, gestational diabetes, kidney failure, urinary tract infections

• Saliva: Strep A, Influenza A and B, RSV, Adenovirus

THE NEXT FRONTIER IS OUR OWN SELVES

THE CHALLENGE

THE TECHNOLOGIES

THAT TRANSFORM HEALTHCARE

WILL HAVE

MUCH BROADER IMPACTS.

THE PROMISE

THE TOOLS ARE IN EVEYONE’S HANDS …

AMAZING OPPORTUNITIES ABOUND!

THE BRAVEST ARE THOSE WITH THE CLEAREST VISION

OF WHAT IS BEFORE THEM,

GLORY AND DANGER ALIKE, YET NOTWITHSTANDING

GO OUT AND MEET IT -THUCYDIDES , 430 BC

SCIENCE & TECHNOLOGY:

ENGINES OF

DISRUPTION

AND

TRANSFORMATION