Health & Medicine

What's the near future of medicine?
    The path to an answer can be as forked and confusing as a cerebral capillary. But an odd shortcut leads straight to the Newport, Rhode Island, mansion of a passionate fellow named Richard Saul Wurman, who at the moment is holding forth on how much he loves his car's dashboard. "It has all of these wonderful gauges to tell me how the systems are doing," he says, brimming with characteristic enthusiasm. "I can tell if the trunk or the doors are open. I can see the engine temperature, oil pressure, engine speed, even my tire pressure. I have a navigation system that gives me three ways to go anywhere I want to go. So where's the dashboard for my body? If I demand one in my vehicle, I ought to demand one for my life!"
   Largely unknown to the general public, Wurman is a smart, charismatic, abrupt, and exceptionally well connected man who tends to get what he wants. He has had several lives—architect, author of 80 books, self-described "information architect," and publisher of the popular Access Press guidebook series. But he is best known as the impresario behind the legendary TED conferences held in Monterey, California. The acronym stands for technology, entertainment, and design, and since 1984 TED confabs have united artists, scientists, and corporate masters of the universe for four days to power-bond, get a good hard look at the near future, and intellectually hybridize. "It began as a result of a brainstorm I had 20 years ago that technology, entertainment, and design were, at their best, one business," Wurman says. "The people in these fields just didn't know it."


    The meetings always seem to create milestones—the Macintosh personal computer's American debut, one of polio-vaccine inventor Jonas Salk's last public appearances, Bill Gates meeting Timothy Leary—and the buzz about the TEDs has been growing each year. Nevertheless, Wurman sold the conference last year to the Sapling Foundation for $14 million. Now run by former publishing mogul Chris Andersen, TED is continuing full force (tickets for auditorium seating were sold out a year in advance). Wurman, meanwhile, is throwing his energies into a medical spin-off called TEDMED. Previously held in 1995 and 1998, the third TEDMED (see TEDMED.com) will be held June 11 to 14 in the Merriam Theater at the University of the Arts in Philadelphia.
    A TEDMED, like a TED, might best be described as aggressively eclectic. Past TEDMEDs featured the likes of Segway inventor Dean Kamen, former surgeon general C. Everett Koop, and evolutionary biologist Stephen Jay Gould. TEDites, as participants call themselves, uniformly report a TED experience as life altering. TEDMED is open to the public, but it is expensive—a ticket to TEDMED3 costs $3,000.
    On behalf of those who lack the price of admission or the time, Discover tracked down most of the confirmed speakers for the upcoming TEDMED to get an overview of just where the bleeding edge of medicine is these days. (Warning: We may simply whet your appetite for this information.) We asked the speakers to summarize their talks, then picked the best and summarized their summaries. Per Wurman's stated desire, many of the presenters will touch on their companies' products, which are versions of his longed-for dashboard for the body. Other topics, however, are simply transcendent.

Gavriel Meron, president and CEO, Given Imaging: "We have developed a capsule that a patient swallows. It is an inch in length; it is rather like a large vitamin. It incorporates optics, a light source, a color video camera on a 4-by-4-millimeter chip, an energy source, a controller, and a tiny aerial. The patient wears a data recorder on a belt with a sensor array. The array captures images that are transmitted by the capsule, and the physician reviews those images. It allows the painless diagnosis of Crohn's disease, abdominal bleeding, chronic diarrhea, and a variety of gastrointestinal pathologies. There are 22 feet [of intestine] between the stomach and the colon, most of which has been a black box in gastroenterology. All of it, including the entire small intestine, can now be viewed directly, so this is a true revolution. It was approved by the FDA in August of 2001, and we have sold 30,000 capsules around the world. The capsules cost about $450 apiece. In the United States alone, there is a potential population of 47 million patients whose insurance will pay for the procedure." [Editor's note: Researcher Amy Hara of the Mayo Clinic in Scottsdale, Arizona, reported in December that the capsule did a far better job of detecting bowel abnormalities than did a CT scan in conjunction with ingested barium, a standard diagnostic method.]

Hamilton Jordan, former White House chief of staff under Jimmy Carter: [Jordan contracted three kinds of cancer—non-Hodgkin's lymphoma, melanoma, and prostate cancer—before he was 50 years old.] "Most people don't realize we are having an epidemic of cancer in this country. Forty percent of the people living today will get cancer at some point in their lives. Yet since 1973, when President Nixon declared war on cancer, funding for cancer research has been .018 percent of the federal budget. A big problem with cancer is that it comprises 100 diseases, or 20 families of diseases, and each takes an enormous effort. There is a drug called STI571. The market name is Gleevec. In clinical trials last year, they gave it to 54 people who have something called CML, or chronic myelogenous leukemia. Within 90 days, 53 of those people were in remission. They fast-tracked it and approved it, and now it is a cure for 95 percent of CML patients. That's the good news. The bad news is that it took 10 years and $1 billion to develop, and there are only about 5,000 people in the country who get CML annually. So these efforts are very expensive. This basic research has to be sourced at the federal level, and we have to spend more on the problem. I look forward to a day when people will be told at an early age, maybe even at birth, that little Suzy is not, say, vulnerable to heart disease, but she has defects in her genes that indicate she needs to be checked very aggressively for colon cancer all her life, and she needs to do these five things to minimize the possibility that the defect will ever translate into a disease. We are not talking about decades for this. It could be five or 10 years. In some form, it is already starting to happen."

Michael Hawley, assistant professor, MIT Media Lab: "Lately I have been thinking about three general areas. First is the various means of wiring up the body through implants and creating body networks. Ours is still a world in which you go to see Dr. Jellyfinger once in a blue moon for a checkup. What kind of basis is that for maintaining health? Second, there are some amazing developments in biotech labs lately. A team in Cambridge recently announced some stuff you can squirt onto muscle tissue that turns type one fast-twitch muscle into type two marathon-running muscle. The third area is low-tech, healthy cultures. I have been spending a lot of time in Bhutan. There's a sensibility that people there have toward each other. The government's official, stated economic plan is to achieve Gross National Happiness. Their health system is not so much about pinpointing treatments but rather fostering a kind of human connectedness, and there is a great deal we can learn from that."

David Rose, CEO, Ambient Devices: "We have developed a digital dashboard for health. It tells you about the environment: the pollen index, an air-quality index, a pain index based on barometric pressure, and flu trends. All are via Internet feeds. Then it tracks changes in body metrics: blood pressure, blood sugar, weight, and heart rate. Finally, it tracks exercise, medication compliance, and patterns of daily activity such as sleep, TV watching, and sociability, which are sensed via home-security-type wireless motion detectors. If you choose, all the information can be shared with doctors, family members, or even ambulance companies over the Internet. A version will be out, hopefully in the summer, for less than $500."

Stephen Barrie, founder and former chairman, Great Smokies Diagnostic Laboratory: "The laboratory has developed predictive genomic tests called Genovations. The tests use SNPs [pronounced snips and standing for "single nucleotide polymorphisms." Each SNP constitutes an individual genetic variation] and we offer Cardio, Osteo Immuno, and Detoxi profiles. We launched these in April last year, and by now they have been taken by tens of thousands of people. We test only those SNPs for which one can modify the expression through the use of nutrients, drugs, and lifestyle changes. You can get the test through your physician. Physicians are using it for people with chronic conditions to get more information about good interventions. They are also using it for people who are simply interested in knowing what they are at risk for and what they can do to lower the chance of contracting some disease in the future. The charge for all four profiles ranges from less than $1,000 to $1,500, depending on where you get them. I can envision a day in which nearly every child gets these tests. Here is the way I explain it: Most educated people today have a pretty good understanding of what one must do to remain healthy. Quit smoking, eat a low-fat diet, eat complex carbohydrates, avoid artificial preservatives, get regular exercise—the list goes on and on. There are about 500 things that most people know they should do. The problem is that most people don't have the energy, the money, or the motivation to do them all. Testing like this helps people to understand that of all the possible healthy things that they can incorporate into their lives, they should really concentrate on these five or 10 things as being the most important for them. Personally, the test showed me that I am susceptible to weakness of the immune system, so I have been avoiding prostaglandins such as corn oils and eating more inflammation-decreasing foods, including fish oils. My children, who are teenagers, saw this and asked to be tested. Two of my three kids had indications that they had the potential for cardiovascular problems. Because they really felt that this information was about them specifically, they have been motivated and made changes, whereas my previously telling them that they should eat this or that had less of an effect. This is really the future of medicine. The pharmaceutical industry is interested in developing specific drugs for specific genetic profiles. We are also seeing the development of a new field called nutrigenics. Ultimately, you could have your own customized vitamin based on your genetic profile, giving you exactly what you need."

Niels Diffrient, designer of the Freedom chair, says, "This new kind of work we do, staring at a video screen, locks you into place, and your body takes second place to your mind." His answer is a chair that automatically senses the body's movements and responds to them in a "sympathetic" manner.

Astro Teller, CEO, BodyMedia: "In health care, we don't know what's happening during the 99.9 percent of the time when people are not in the hospital. We need regular monitoring. Can you imagine how difficult it would be to monitor weight if there were no scales? But there is no scale for sleep or pain or stress, or for a variety of basic behaviors. So you need something on your body, but it must be extremely consumer friendly, at the level of your glasses or wedding band, or people just won't wear it. It must also be rugged enough to withstand what people do every day. That's what BodyMedia set out to create four years ago, and we have created the SenseWear armband. We have been selling them now for about 18 months; we've sold about 600 so far. What we developed is larger than a watch but smaller than a jogging radio. We monitor motion in the body via an accelerometer. We also track skin temperature, ambient temperature, heat flux, galvanic skin response, and pulse. Then we build mathematical models using this data. But presenting that information is a challenge because patients, therapists, and doctors may need different levels of information."

William Tsiaras, professor and chairman, Brown University department of ophthalmology: "We are living so much longer now, our genetic makeup makes us break down before we die. The challenge today is not cancer and heart disease but how to keep us functioning well while we are still alive, rather than ending up blind and in a nursing home, not knowing a fork from a spoon. The challenge is that large numbers of people are developing diseases of neurodegeneration, like eyesight failure. But there is hope and progress. Stem cells are real. Implanted stem cells have cured diabetes in rats. The transition from rat to dog to monkey to human will happen lickety-split because the need for this is enormous. In my field, ophthalmology, progress will be just as fast. There is a tremendous amount of progress on the near horizon when it comes to regenerating retinas and vision where it has been lost. Nonetheless, in my view the events of 9/11 spared the president from being torn down by a health-care system in crisis."

David Lansky, president, Foundation for Accountability: "As the technology of medicine races ahead, how do consumers make sense of it all and use it? We try to create a bridge between the potential of modern medical science and the reality that most people actually experience. Our job is to tell a patient about standards. For example, there are three things you should be getting for treatment of your asthma. It turns out that only about half of the people are getting what they are supposed to get from their doctors for their specific conditions. This is a consistent mismatch across the country and across diseases. A good place to get information about what your care should be is our Web site, www.compareyourcare.org, but it's available only through HMOs that subscribe."

Keith Black, neurosurgeon and director, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center: "If you look at the Book of Genesis, which describes the creation of the universe, what strikes me is that the sequence is exactly the way we explain it scientifically. First there was light, which corresponds with the energy of the Big Bang. Then God separates the days and nights, which is what happened when the planets formed and started rotating around the sun. Then God separated the land from the sea, which was the next step in the scientific view, then came animals, then came man. If you go through all of those steps, you have to ask yourself, What is the probability of someone getting that sequence exactly right 2,000 years ago? My belief is that essentially the brain has within it a precoded neural circuitry that contains the answer to the origin of the universe. When we quietly meditate, we are accessing information that is already there. We already have the answer. That is essentially what my talk will focus upon."

Niels Diffrient, industrial designer: "People who go to a medical conference might say, 'What's a designer doing here?' But TedMed takes what I call the refined generalist's approach to health. Ideally, a person should work standing up or lying down. Sitting is a compromise position. It really is a kind of athletic endeavor, and it should allow you to move, and equally important, you should be aware of your body's condition—posture, pressure points, etc. Over the years, I have evolved my design of working chairs to the point where they are as sympathetic to the user's needs as possible. Buttons, knobs, and other locks to adjust chairs are no good if people won't use them, and usually people don't. So my Freedom chair senses your weight and applies a portion of that weight to resisting your reclining force. There is even a virtual lock; when you recline, it tends to hold you there until you release. If you recline far enough, there is an automatic headrest that comes forward when you need it and retracts when you don't. With the armrests, you simply grab one chair arm and move it where you want, and the other arm goes along with it—no locking required. But chairs are just one aspect of work. I doubt anyone at Enron was comfortable in its last days, regardless of the quality of their chairs. Designers should get more broadly involved in designing work itself."


William Haseltine, chairman and CEO, Human Genome Sciences: "Several years ago, I coined the term regenerative medicine. It refers to a set of new medical techniques that will allow us to restore cells, tissues, and organs that have been ravaged by disease, trauma, or time to normal youthful function. There are four approaches. The first is using medicine to trigger the body to heal itself, to stimulate our natural complement of proteins, genes, and antibodies to heal more effectively than they do alone. Second is the use of cells—either inserted into the organs to help them self-repair or extracted from the body and used to construct tissues and organs, which are then implanted into the body. The third is the use of stem cells, either placed in situ to repair tissues or used with materials to rebuild organs outside the body. Finally, if there is no other way, the use of nano-mechanical prostheses to replace function. Except for stem cells, which are at the earliest stages, there are dozens of examples of these therapies already under way. I envision a substantial expansion of these four approaches to address the problems of an aging population. The combination of these technologies should, in the next 20 or 30 years, allow most people who have access to high-quality medical care to live from 100 to 120 years. But to make progress, we must correct a misconception. The common notion that there are roughly 30,000 genes in the human genome is obviously and patently wrong. To say that the human genome has been sequenced—even in draft form—is a gross overstatement. I might talk about this at TEDMED. We used completely different methods [from those employed by the Human Genome Project and Celera Genomics to publish human genome sequences in 2001] to come up with a number that is around 90,000. If researchers take the 30,000 number seriously, they will have one-third of the tools they need. This is nontrivial. Are we as simple as a plant or a worm? We are not. A high-quality finished sequence is essential to the understanding of an organism, and we don't have that yet."




A list of TEDMED3 presenters and some basic info about the conference appear at tedmed.com.

To learn about the pill camera and see more images of what it sees as it moves through the body, go to www.givenimaging.com.

Ambient Devices' site: www.ambientdevices.com.

Great Smokies Diagnostic Laboratory's site for Genovations: www.genovations.com.

BodyMedia: www.bodymedia.com.

Try a few demos of the Compare Your Care interactive tool at www.compareyourcare.org. Also see the Web site of its developer, the Foundation for Accountability: www.facct.org.

Design Within Reach has a short bio of Niels Diffrient and sells the Freedom chair: www.dwr.com.