[Music] this week on the futurists Daniel craft
many diseases are complex but we'll see some proactive cures kind of like The Minority Report you'll cure the disease
before you even know you have it
[Music] welcome back to the futurists I'm Rob
turcic with my co-host Brett King hi Brett hey hey are you back in Thailand
now are you in the US I just got back from uh a week in Amsterdam um where we're at an event there and uh
yeah and then here for just over just over a week and then got ahead to Mexico City for another event
oh boy very well fun no perfect time of year to visit Mexico uh so here in the futurist you know we love to talk to
people who are not just thinking about the future writing about the future but actually doing something active to
invent the future and make it happen and this week we have somebody I'm thrilled to join us uh we met ages ago more than
a decade ago at Singularity University uh where he's on the faculty okay but
let me just share each version of Singularity was that that's that's the uh that's the Ray Kurzweil and Peter
demand is uh no no I mean I've done um work for uh Singularity on the finance
side oh this is one of the specialist streams no no this was back in the day when they just had Singularity
University okay and um it is a great Gathering right because that that's they
always bring together like-minded people who are thinking about the future and overachievers now now listen to this
Background by way of introduction you're gonna love this talk about overachievers um our guest today
got his undergraduate degree at Brown then went to Stanford medical school did
his residency at Harvard went back to Stanford American Fellowship he's given
four TED Talks he's the chair of the X prizes pandemic and Health Alliance task
force and he's on the as I mentioned on the faculty of Singularity University we're focuses on the future of Medicine
and he's also the creator of his own events which was previously known as exponential medicine but now it's known
as next Med Health and he gathers there about 70 faculty and uh attendees for
more than 40 countries come together each year in San Diego to talk about the future medicine the future of Health let's give a big warm welcome to my
friend and super futurist Daniel Kraft hi Dan hey there thanks for having me we're so psyched to have you here today
so you know this is gonna be a fun show because honestly for uh most people the pandemic was a period of time where they
stayed away from the doctor's office and and and rightly so um so that means for a few years we may
have missed any of the new innovations that are happening in the healthcare field and um I wanted to share I want to
hear your perspective on some of that because I know you talk about this subject all the time outside of messenger RNA vaccines of
course yes we all have that experience yeah yeah I mean especially early in the pandemic we did stay away from the
traditional clinic and that was to some folks detrimented people didn't get screened for cancer or ignored heart
attacks and there was lots of Downstream implications but if we want to zoom back big picture
um you know uh covet acted as a catalyst for many things in healthcare that were sort of stuck whether it was
telemedicine or new ways of doing virtual clinical trials or some elements of Public Health it also opened our eyes
to many of the disparities and challenges we have we're still using fax machines to communicate Public Health Data from many states
um but big picture it did accelerate some elements in in what's often incremental Health Care to exponential
and I'm an optimist by by training and I think some of the some of the things
that converged and came to came to be from the pandemic and hopefully saved more lives and the pandemic took in the
long term that's a positive view on it it's true uh in a way uh kovid was like boot camp
it was like forced exposure to some advances and candidly the healthcare industry moves slowly because it's heavily regulated and people's lives are
at stake so I guess that's that's warranted um but the telemedicine is a great example of something that you know we
got shock treatment exposure to it's like if you want to see a doctor suddenly the best way to see him was on
your phone something we've been talking about for 10 years but it was pretty hard to get people to move on that and
most people felt like well I'd rather go see the doctor but suddenly go into the clinic well that's where sick people are
so nobody wanted to go to the clinic anymore and it made more sense to turn to the phone is that has that persisted since then or has it dropped off someone
we certainly had this huge Spike particularly not just driven by the pandemic but the incentives all of a sudden the payment models were unlocked
from things like CMS and Medicare uh the HIPAA regulations were loosened so you could do a zoom call and not be breaking
the law and talking to a patient so some important things were sort of shifted in some cases those have shifted back a bit
so we certainly I don't have the same level people I think we're moving more into this new age of not just virtual care or physical but hybrid right many
things you go to see the doctor or the clinic don't require you to be there physically but they're still the important human touch certainly you
still need to have Laboratories and sometimes physical exams done um but I think we'd enter under this
hybrid agent even before you talk to a clinician on a screen you'll first talk
to the chatbot that's going to increasingly be chat GPT enabled and it's going to know Robert your entire history and your microbiome and other
omics information so you're not saying the same questions asking how old you are and uh where you have your belly
pain it'll put all that in context for you so we're just at the beginning I think of this hybrid telemedicine or or
metaverse or uh called mediverse age where how we integrate with our clinicians our care teams are our health
chat Bots is going to be dramatically different before we get into the chat gbt um you know there's there is uh
significant advancements happening in the sensor attack as well that you know results in better data inputs so we just
saw that um Apple's xpg their experimental products group has um
announced that they've had a breakthrough in terms of an Imaging sensor that can detect not invasively
um can detect blood sugar levels as an example um you know and we've seen already
significant advances in the census for heart rate monitoring and things like
that but um you know one of the things that we we comment on
um often you know Katie and I when we talk about the stuff is that you know you you can get
um you know you can walk into one hospital or one doctor and have some history there and that doctor knows all
of your history but if you go to a a new country or a new city and you walk into a new hospital you seem to start from
scratch but we're also trying to solve that with sort of um obviously DNA
sequencing you talk about gut you know gut genome and you know just uh better
sharing of of that sort of data um now you can of course carry around on
your phone emergency medical data and so forth but you know what's the uh
what's the infrastructure piece of this that's providing that data platform or
that ecosystem for better medical um you know monitoring slash analytics
Diagnostics Etc yeah we're definitely entering this sort of exponential Edge just back to the wearable piece yeah I'm
wearing my Apple watch you know it's only been what 12 13 years since the Fitbit really first came out and we've
been many of us are data Geeks we're Quantified selfers we can track our steps in our sleep and it's been stuck on our app most likely it's starting to
be able to shift from your smart wearable into your Healthcare System to your pharmacist to nutritionist uh and
be super useful Quantified Self to quantify Health the challenge is we're all generating potentially terabytes of
data your doctor if I'm your doctor I don't want to look at all your data your EKG your blood sugar your blood pressure
which is all coming to your wrist watch pretty soon the trick is how do you make that big data and synthesize that's
actionable information that you as a human consumer patient can can use proactively to be much more engaged in
your own care be the CEO of your own health but back to the systems issue where does that data reside who's
responsible for parsing it to kind of give you that check engine light if you're about to blow a gasket and uh
give you early warning um right now there's so many scattered Healthcare Systems little in the US little around the world there is no one
architecture but now that you can collect that on your smartphone and potentially own your own data and choose
where to share it I think we're going to see a lot of new Solutions where you can start to build your own personal digital
twins sort of the buzzword where it'll be a combination of your digitome your social your metabolomics Etc that can
really give you personalized guidance for prevention for early Diagnostics and for therapy but there's still huge
challenges of the systems element The Silo data the cross pollination doesn't happen because of well-mealing
well-meaning but old regulations like HIPAA so we need to think at the systems level to connect the dots for what's
already pretty magical technology today wow that's a that's a sweeping view
um I wonder if we're able to connect the dots as as elegantly as you envision uh
it seems like it seems like it's a work in progress and we're kind of like you know fussing our way and patching our
way towards the future uh we've been hearing about the progress in wearables for many years I keep pointing out 13
years or so um now it is true Apple's Consolidated all of that technology into the watch
and they seem to be in a kind of a mission to gather all that wearable data and include All Those sensors in the
phone um how useful is that actually today to doctors well right now it's not particularly
useful it's pretty hard to get your Fitbit or your Apple watch data to your clinician even if they know what to do
with that data I like to see where this is adding more as like predictalytics like each of us today can use your
standard smart watch or wearable not just to look at your spot data from the morning I can look at my aura ring sleep
score but I can also look at my longitudinal resting heart rate or how I recover from exercise or My overall
sleep patterns or maybe an oxygen saturation soon continuous blood pressure maybe even could use blood
sugar which might be relevant for many folks and then we can have what I like to call sort of like your individualized
Baseline Robert what is your rest your resting heart rate's 52 when you sleep in it starts rising to 65 and some other
changes maybe when you're engaged or other elements can be picked up that can give you kind of that that early warning that something is a little off and can
point you to be almost having a continuous physical exam I mean think about our current model you know once a
year if you're lucky you go in for your standard physical exam it's very intermittent in data that's collected once in siled and that gives us a
reactive mindset we wait for the heart attack to stroke the late stage cancer right we start to connect the dots between the existing data let alone the
future we can be much more proactive and personalized and find problems early and and cut them off at the bud and it seems
like the Apple watch is pretty close to that already you know for instance uh my Apple watch does show me my sleep cycle
and it shows me averages it'll compare my you know I guess my sleep performance to previous days in the week uh it shows
me trends so so I guess some of what you're describing is is gradually happening what's interesting is it
doesn't seem to compare my data to other people even my anonymized data I would be interested in that because you know
for instance uh my uh my Google thermostat does that it tells me about other houses in my neighborhood and it
says you know I'm in the average or maybe I'm in the high or low or something and it gives me kind of an incentive to try to be efficient with my
with my home heat my home energy use and I wonder if we could do something similar with uh with personal wearables
yeah I think making the data and not just data but actionable insights and those insights useful to you at the as a
clinician at the bedside or the website or in your context is incredibly important and sometimes it can be
gamified because you can be finding the Robert level of incentives points gaming
badges that match you yeah um and and ideally we start to crowdsource that knowledge I always love the example of
Google Maps or Waze I mean 15 years ago we're still driving with paper maps and now we couldn't imagine getting around
without Google Maps or ways that's crowdsourcing driving information what if we had the Google Maps or ways for
health Journeys that were very hyper relevant and local to you and your conditions in genetics and Beyond and
gave you insights to your health journey and we're starting to see that happen right there's the all of us trial from
the NIH where people are sharing their data their Labs or genomics there's a platform out of Israel actually founded
by one of the founders of ways called stuff that works.health where now millions of folks are sharing what's
happening for their psoriasis or their long covid or their or plantar fasciitis
and you can learn from the crowd about what might work really for you so lots of opportunity to connect the dots it's
not about the data now it's how we make that actionable and hyper hyper personalized I can see there's gonna be
a great conversation but before we rush off and Tackle all the other topics uh that are clearly popping up
um let's get to know you a little bit better so Daniel are you still a practicing doctor in addition to being a futurist
I'm still licensed to dangerous I trained uh as you mentioned in both internal medicine and Pediatrics met
beads and then I did pediatric hematology ecology and bone marrow transplantation and for while I was
doing uh clinical clinical faculty at UCSF doing pediatric transplant then got a little too busy I was also juggling
being a flight surgeon in the Air National Guard so spending um well week in a month taking care of fighter pilots
and getting to fly with them occasionally but I'm still licensed I've done a little telemedicine take care of my friends and family but I've got a few
too many hats to sort of be in the clinic on a regular basis yeah how do you get from pediatric transplants to
doing National Guard sort of combat Healthcare or something like that I grew up with a sort of
flying in space thing I grew up in DC I went to the Apollo 17 lunch and I was a kid I always wanted to be an astronaut
um almost got to be an astronaut I got to the very very final selection down at Nasa and went through all the exams and tests and my left eye was not quite 20
150 enough um but that gave me this whole pathway as a pilot as well and I thought wow I
always want to be a fighter pilot but in a 20 20 vision and it turned out I could be a flight surgeon I'm like you're actually gonna pay me to find fighter
jets sign me up so when I was a resident Mass General I raised my right hand joined the Massachusetts Air National
Guard it was an F-15 Squadron on Cape Cod and had an amazing experience flying with them really seeing the inside of
the military got to do deployments to Saudi Arabia two of my Pilots for the guys over in New York City on 911 later
with an F-16 Squadron in California but that was sort of my whole like uh flying in space uh passion which I still have
and it's still pretty cool dude yeah and there's lots of lessons from Aviation let's say for healthcare checklists and
resource management and how your jet engines now stream data down to the ground and make flying much safer so I
love the kind of overlap and you know I even went way back to International Space University when I was a space geek
in medical school and just like in healthcare you need to kind of connect the dots between different fields if we're going to really move things
forward and space is a kind of a especially space medicine is a great challenging area to help
build the future now Rob you're going to have to watch we'd get in the rabbit hole I think this is going to be this is
going to be a rabbit hole kind of a show I can already see that happening I will ask um um what do you as a ga
pilot what do you what do you fly these days well it was really tough going from 15th and f-16s I got to find the back
seat and give me the chat yeah I now uh co-own a an experimental glass there too with ah nice I know the glass there yeah
yeah that's why SR-22 are serious generally so GA but I'm I'm not current
right now but um yeah it's good to have the parachute and what's interesting I grew up on the round dials I used to run
the Brown University Flying Club 20 an hour wet you know something which we think oh wow yes seriously what's amazing now these glass cockpits and the
experimental it says overlaps to healthcare they give you so much information and in the experimental world you can just have a touch screen
it's like a super iPad and see all the planes and the traffic and where to go it gives you all what we call situational awareness and that kind of
ability to sift massive amounts of data just in time and give you a user interface is something that's still really lacking in healthcare and can
give us I think some lessons in how we translate all these new massive forms of information to actionable useful like
fly here take a left take a right here's where the airport is here's where the bad weather is um and that's sort of this from
analog to digital that we're seeing across Healthcare as well and one of the things I'm gathering from this uh which
is really instructive for our audience is um is that you've developed a methodology for thinking about the
future of medicine and one of your methods is to cross pollinate you try different experiences and sometimes
pretty extreme experiences like flying in an F-16 and and then you'll gather from that some useful Insight or some
New Perspective that you can apply to your medical practice and that helps you think about it in a different way because it's true like you know
technology is being applied at different rates in different Industries it's not always rolling on the exact same rate and so there's this differential there
and you can learn things if you're working with somebody's on the very Cutting Edge like the military of course uh and then you can bring that back to
maybe a slow-moving industry and believe me Healthcare is a slow moving industry it's saddled with regulations saddled
with uh you know slow moving bureaucracies and so forth um and so it's not really even though
it's a high-tech industry it's not the most advanced tech industry but tell me where I'm wrong about that I want to
know like how do you think about health care and find Opportunities to deploy Technologies where things can actually
get done yeah I mean just back to the coveted framing um talking about space you know Sputnik
sparked the space age and I hopefully covet is sparking a bit of a new health age and I think if we look back 10 years
into where we are now we're going to be the next decade we're going to see pretty massive Transformations I mean
um where we're sort of wrong you know not wrong but today we're now 10 years after IBM Watson we're seeing AI really
start to impact health care and you know dozens of new AI based applications and digital Therapeutics for AI meets
Radiology for example to make everything from mammograms screenings to personal handheld ultrasounds you know that you
can use in the savannas of Africa with a community health worker so we're starting to see what used to be kind of
slow these things catch up you know we know Moore's Law there's also Amara's law we overestimate what happens in two
years and underestimate what happens in a decade and some of these tools and Technologies are really starting to catch fire whether it's the aips or mRNA
and sequencing and genetic engineering all the way to this world of wearables and other bowls that are really starting
to give us this whole new picture of what is health disease and even you know
public health and Global Health at scale now back to back to covet as a catalyst so we had uh Andrew Hessel on the show a
good friend of yours I know and a colleague from Singularity University everyone talks about Andrew when they
come on this show he's like one of the most referenced guests right he he's a good cross-pollinator is why and he's he
does exactly what Daniel's just saying which is a he surveys across a broad landscape of Technologies his expertise
is uh synthetic biology and that's an industry that's often been accused of being permanent Dawn you know where the
Sun never fully Rises on on synthetic biology he said well that's not true he said everybody had an experience of that
everybody in the U.S at least in the northern hemisphere during covid-19 because that mnra vaccine is an is a
byproduct of synthetic biology and so it isn't some um you know it's not being advertised that way and candidly
probably people would resist it they resisted the vaccine enough as it was so it didn't need that additional headwind
um but it was a way for people to get the benefit of uh genomic science and uh and and then we also had
on the show and I'm not sure if you know him but he is an AI researcher in the field of healthcare and he made another
Point uh about kova that I thought was quite relevant um he said you know the big change from
uh for us are from our perspective with with uh with covid-19 is that consumers got a new expectation about Diagnostics
and he said really for the first time in history you can go to a grocery store or a drugstore and buy a drug kit a test
kit and take it home and get a result and it's not a result that needs to be interpreted it's not some sort of
diagnostic thing where you have to have a professional come in and read a set of values on a scale he says yes or no it's
black or white it's simple it's a very clear-cut you either got it or you didn't get it and he said that's a new
expectation in consumer health care why don't you respond a little bit to those two ideas because I think for most
people we've missed that um in a way it was so effective it was presented so well and we were so desperate for a
solution that we may have missed the magic behind that and the Decades of technological progress that led to the
moment when you could go to a drugstore and buy a test that gave you a simple yes or no answer yeah I mean just back to the testing now
we're all used to having some form of Home diagnostic whether that's going to be for an infectious disease you know
the flu RSV covid we're now picking up other elements home hemoglobin a1cs and
ways to track how thin your blood might be if you're on a cardiac man um and so we're certainly seeing this
super convergence of where home Diagnostics meets new data that hopefully then feeds into our Public
Health System but it might even give us that early warning that there's a hot spot and back to the synthetic biology side the future should be I mean we
heard that we sequenced the early version of covid and we're able to kind of design the vaccine within three days
or three hours that is that sort of future of n equals one medicine we'll be able to look at your particular tumor
type and generate an mRNA vaccine against your particular tumor type um that will be a home-based diagnostic
but there are now portable you know uh genetic sequencers that will soon pretty
much they can fit in our pocket today but be affordable or at least be in your clinic or drugstore and as Healthcare
shifts from hospital to home or hospital to hospital or to your corner Pharmacy where you get diagnosed the data you can
integrate and how you can make that actionable it's getting exciting but we're still challenged I actually ran an
X prize for Rapid cover testing in collaboration with Jeff Huber the founder of Grail and others it was a long path to get home diagnostics for a
coven uh part of that was the FDA they wanted perfect tests at the equivalent of PCR and sometimes Perfection is the
enemy of the good but I'm hopeful now with the blend of Telehealth and wearables and other tools and home
Diagnostics we're going to really shift the the needle back to earlier Diagnostics and hopefully making Health
Care More Equitable and and democratized around the planet because now with a smartphone and a cheap test you can at
least self-diagnose and then get the right help at an earlier stage in a disease I'm glad you brought up the idea
of what Equity because that's going to be an important topic for us in the second half of the program uh bringing Health to the whole world and not just
to the wealthiest people on the planet but you know we like to do before we take our break is we like to do a
lightning rounded questions this is where we ask our guests a series of short questions my friend Brett is
always the person who administers the particular poison and so get ready for the lightning round brought to you by
Brett King okay Daniel here's a few quick fire questions what was the first science
fiction you remember being exposed to on TV or books movies
it probably Star Wars is probably the most obvious one and uh that blew my
mind it's always funny to go back look at that movie now and it feels sort of antique in the in the the special effects are kind of meh but that was my
first mind-blowing sci-fi and I read Highland and and uh you know stranger Strange Land you know really early
uh sours was like one of the only movies I ever saw with my dad in a cinema so similar um what technology do you think
has most changed Humanity wow um social media maybe not for the best
I'm not sure that counts as a technology but how we can now cross-connect information there's actually Med Twitter
lots of ways we used it in the pandemic and and Beyond so it has just like anything else like AI or 3D printing you
can have you can print a gun or print a medical device you can have ai for good or bad and social media sort of in that
gamish and maybe print a genome mostly the biohackers right but name a futurist or
an entrepreneur that has influenced you personally wow that's a tough one uh technologist
it's influenced me I got to meet the the Google guys pretty early um you know and uh I think that was
influential just to see that they started with something pretty at the time basic the search engine and now
they built this incredible ecosystem around it and went from everything from Gmail to deepmind and uh I think you
know it I think for entrepreneurs out there it's good to start with a core problem solve it but then you have a basis to kind of amplify and do some
other magical things now something a bit more related to your field is there any predictions or
forecasts that have been made in science fiction about Healthcare and the future of Health that really got you thinking
well I've been involved for a while with xprize and I helped come up with the medical tricorder X prize which is
inspired by Star Trek which many things have been inspired the idea that you can now have a home-based sensor that can
wand you or touch the patient and give you the diagnosis and we actually ran a next prize had some amazing teams build
the equivalent of medical Tri cores which are now sort of becoming available in the pandemic and post-pandemic age
are you going to have like a title care device at home which will look in your ear and listen to your heart and lungs and be tied to your virtual visit I
think that's one example of Science Fiction becoming reality um and there's also of course 3D
printing the sort of the idea of synthesizing thing that's coming everything to printing medications which is a project I'm working on to printing
food and food is management I printed organs too right so I don't think we're going to need printed organs because now
with crispr you can humanize a pig as you know and transplant a humanized heart liver kidney it might not be kosher but if you're waiting for an
organ you'll you'll take it now we can talk about transgenics maybe there in the second half but uh we did
get into that with Andrew Hessel a bit but um all right great well that's uh that's it for this first half of the
show you're listening to the futurists we'll be right back with Daniel Kraft to talk more about the future of medicine
and health in uh on the futurist we'll be right back
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welcome back to the futurists I'm Rob turczyk with my buddy Brett King hey and
this week we are interviewing Dr Daniel Kraft about the future now Dan thanks for making time I know you're very busy
because you've got an event coming up right around the corner can you tell us what's up in San Diego what are you doing
I'm running a new new event called Next Med Health next Med DOT health is a
website it's the evolution of the exponential medicine conference that I founded and shared for the last decade
and the idea around nextbed health is that many Healthcare meetings and Gatherings are pretty silent I'm an
oncologist I'll go to I'll go to oncology if you use cardio I'll just go to Cardiology there's Pharma there's medical devices there's investor
meetings but it's rare that you mix people together from patients and Pharma and clinicians and nurses and and
investors and startups and so we spend four days looking at this convergence of what's happening in AI robotics
reprinting nanotech genomics blockchain to psychedelics you know people from all sorts of Worlds cross-pollinating and
you sort of get the taste of the art of the possible what's now near and next and not just what's now and near but and
what's new but sort of how to how do we translate some of these new technologies to clinical impact at the global scale
so um it's a great place to kind of you know find the future find Future collaborators and also change your
mindset because we have everyone from the head of innovation from NHS to the head of genetics at Stanford to Ron
policer runs innovation in Israel to false statements on the future psychedelics to to folks doing
everything from chat Bots to drones to uh the future of mental health and video games so it's a it's a great place to
touch the future today and help create it going forward that's great if you're following that it's nextmed.health March
13 to 16 at hotel Dole Coronado which is a great venue for uh for events and
check their website because we're probably gonna be doing a free live stream of the entire element and it's just a very rich for four days if you
want to catch some of it you know it's often you know there's that famous quote the future's already here just not
evenly distributed and it's a great place to sort of see what's and touch what's here now and and kind of get that
Arc in fact you know eight years ago we had the CEO moderna there you know before anyone knew what mRNA was we had
uh the CEO of lavongo and it was six months old it was now built the platform for you know virtual uh Diabetes Care a
lot of folks come there and sort of um get their inspiration but also highlight what's going to be the kind of
next big game changer it goes back to uh methodology you know one of the ways that we love to to help our audience is
to talk about what do you do in your life that helps Advance the future bring
the future to fruition and um by cross-pollinating different groups of people who are working at different
aspects of the future uh that's a really powerful way to accelerate progress as
you mentioned everybody's working in a silo and that's not limited to the healthcare or medical Fields that's true in every industry so if folks are
listening this is a great lesson what Daniel's done in his spare time just for his own pure passion is he's found a way
to create a neutral meeting ground a forum that connects people together who are passionate about the subject but they might be coming at it from
different angles and that cross-pollination is where connections get made friendships get made attitudes
get changed perspectives change and as a result a little bit of future progress gets made so that's powerful and the
second thing you're doing that I think is really important for our listeners is that you're sharing all this information publicly in a new big public database
that's available to people tell us about digital.health so digital that Health came to be number
one I was lucky to get the domain digital that helps it's very memorable um and that's a bit of a new yeah that's
so new anywhere buzzword digital Health mobile Health connected Health the fact that we can do Health Care in this new data-driven digital era the challenges
and I'm pretty good at keeping up with this there used to be you know a few wearables you know the Fitbit Etc now there's hundreds there's uh when I gave
a TED Talk in 2011 about the future of medicine there's an app for that there were 20 000 apps now there's 300 000 health related apps and now many FDA
cleared digital Therapeutics clearly evidence-based digital platforms that can help manage everything from smoking
to ADHD to you know the cancer uh therapy and so the challenge is from
clinician standpoints and I'll give a keynote to you know and speak to many folks in healthcare organizations Pharma
Hospital Systems Physicians they have no clue it's already out here let alone what's coming so at its core
digital.health is a as a resource where you can learn about The Cutting Edge of digital Health regulatory reimbursement
journals but you know also have a database of over I think 2500 Solutions and companies so if you're looking for a
solution around atrial fibrillation for example you might find the alive core device that EKG that you can run off
your phone you might be able to save that in your own digital formula and prescribe that to a patient you might
find a solution around diabetes it helps reverse it with diet called virta for example um and and it's a bit of a discovery
engine and a resource starting for clinicians to kind of build their own personal digital formulary in the future
we'll have a consumer side anyone could try it digital.health it's free and we love feedback on how to build it better
because again the the Futures here not evenly distributed the trick is matching the solution and eventually the payment
models and eventually the data flows because again the clinician doesn't want to just prescribe a connected blood pressure cuff and be overwhelmed with
blood pressure numbers needs to fit into the workflow and the incentives and the payment elements as well well part of
this must come back into sort of where these data models being built how's this
data being shared you know who has access to these data models for you know leveraging artificial intelligence for
example you know in you know particularly in the United States we've had this debate about the Healthcare
System you know being particularly inefficient right now because of the way
you know the the oligopolies or the monopolies uh present there you know the US pays twice for healthcare the oecd
average for example and often the outcomes are you know not not as great we have a high number of bankruptcies in
the US that are um you know as a result of or at least in part from healthcare costs up to two-thirds
um and so we do have some functional issues there so how do we break through
those elements of those firewalls from a systemic perspective with the the
different uh networks and you know Healthcare systems and so forth and so the progress we're seeing in the
research side you know when if we're trying to operationalize this aren't we really talking about breaking through a
lot of those sort of proprietary and sort of network um uh you know structures that are
currently in place to to get better efficiency yeah as you mentioned we have the
highest costs and often like the 14th or lower and the outcomes uh compared to other countries in the US and there's so
many systems and many things are state by state um and this is beyond my pay grade but I would say it sometimes takes outside
players we're seeing obviously everyone from Amazon to Microsoft to Apple even Facebook get into Healthcare in a
variety of ways Apple uh sorry uh Amazon just combined forces sorry just kidding
and uh and so I think what's going to be interesting is sort of the outside perspectives and these huge consumer players that have our consumer data in
some cases and they are really good at delivering care even though Amazon care got put on put on ice we're seeing
Amazon as a virtual Clinic we're seeing the ability now for everyone to be a little more empowered and not have to
wait and pay out of their uh pocket to see a clinician to use some of these new
tools themselves so I think what the customer's trying to connect the dots in new ways but we really do have the challenges on the regulatory side the
FDA sometimes the f word that has the challenge of how do you do you know software as a medical device into their
credit the FDA has accelerated new ways of combining new technologies whether it's AI for radiology or software's
medical device or new Pathways that AI meets drug Discovery but we need the regulars and we need the the
reimbursement things to come along and right now we still have mostly fee for service paying for sick care you know
the incentives to do more transplants biopsies Etc not to pay for True health care or
self-care where we can move the needle to being proactive and optimizing not just lifespan but Health span so I don't
think it's gonna happen in any one systemic world that's going to see buckets as well as learning from NHS and
other other systems which aren't perfect but have the aligned incentives to keep people healthy and not just pay for more
procedures drugs and that's really interesting to hear you say that to hear an American doctor say that that we can learn from other countries Health Care
Systems because so many American politicians get kind of bombastic on this topic you know they always begin by
saying we have the best healthcare system in the world which which is true if you've got money but if you don't have money if you're not insured it's
one of the worst right so there's a huge variation or a huge Delta there between the people who get coverage and don't
meanwhile there are other countries that have a different approach which is that they believe the best way to provide
Health Care is to give everybody a decent level of Health Care uh the UK does that Canada does that and actually
the majority of industrialized nations around the world provide you know Universal Health Care why don't we have
Universal Health Care in the United States it's uh mostly probably a political
issue I I think there's some huge benefits to having some base level of universal care you know there's also the
challenges where you can't get your hip transplant or hip replacement as fast as you might want as it happens in Canada
and NHS but to have everybody at that base level of they're not going to go bankrupt to fame and appendicitis uh or
a new cancer diagnostic cancer diagnosis I think it has huge benefits and um I think we need to be smarter about
democratizing health care and seeing whether you know where the huge disparities are I mean covet was a big
eye-opener sort of who got and had mortality and morbidity uh let alone the
long coveted implications and so I think unless we really address this it's going to be unsustainable the the sick care
costs are going to continue to go up let me talk a little bit about that because uh I've actually to prepare for this I
actually did prepare for this I gathered some info about the trends uh that are shaping the healthcare environment and
so let me share those Trends with you and then you can respond to it so the big trends the big macro trends for the next 10 years
more patients as the global population is aging that's true in almost every country in the world
um and more information you mentioned earlier each of us can generate terabytes of data and where do we put
that how do we collect it how do we analyze it more uninsured people because the costs continue to go up so of
increasing costs and therefore uninsured people of course there's more technology but how do we pay for it less pay goes to
providers so those those things together seem like a pretty formidable challenge uh you know more patience more
information more uninsured less pay to Providers and yet increasing costs and then more technology and and then
practical things like nursing Gap is a massive there's a staffing shortage yeah that's that's also true yep that's the
next topic you're right yeah I mean I'm not sure where to go exactly with this but I would say you know yes there's a
huge gap between uh the unmet need and the solution and we need to now be
um proactive about leveraging some of these Technologies to address them and sometimes that means changing the regulations and the rules but I would
argue Health Care can be addressed and the disparities be lower some technology gets expensive but almost everyone has a
smartphone today and soon that the camera on your phone today can pick up your Vital Signs without having to have any sort of wearable the chat Bots are
getting so good certainly with gpd4 and Beyond where they're going to have your entire medical history there and answer
questions for you practically in the language and and culture and and education level that matches you
um so that means as an example in China you know uh a lot of folks have no
access to care they run a platform called good doctor out of ping on I think 300 million Chinese now have some
basic level of digital chatbot technology tied to physical spaces when they need to get a actual checkup or
drugs delivered so that can sort of narrow the gaps at the extreme and then we have places like um uh you know in
Africa where there's almost no infrastructure where you can LeapFrog uh what's happened in the U.S a company called Elara health is building some of
the one medical for for Africa where you can have a low-cost portable ultrasound
device an EKG and a chatbot and an AI and help up level a community health worker primary care doctor so I think
big picture fixing the next few years we can connect some of these dots including with omics and metabolomics and sort of
that Google Maps and ways for care so that we're not doing one size fits all prevention diagnostics for therapy you know I've
seen this in the fintech space um you know you know I did the exponential Finance Finance with Peter
and um you know the Su team as well for many years um but on the on the finance side one of the Arenas where the US has
actually fallen behind um you know particularly in areas like mobile payments for example you know the
US is at least 10 years behind China now but part of that is because the regulation has tried to protect the
incumbents because of the lobbying systems and and so forth that we have do you see
um you know uh just like we have seen with the debate on nationalized Health Care from the Next Generation med techs
and and things we're talking about is it perhaps easier to build these startups
offshore or still the US the place to to come if you're trying to build a Next
Generation med tech company or you know company that fits in the service space I
mean I think the Innovations coming from around the world and often it can LeapFrog the United States it's not all being invented here
um I think a lot of innovation here does try and go outside the U.S first where there's less regulatory constraints and
again the the lobby isn't there I mean example 10 years ago there was a ai-powered anesthesia machine that was
approved in the U.S called senesis and it would do a pretty good job of Conscious Sedation pretty common anesthesia but it was killed by of
course the anesthesia Lobby right they didn't want to have their luncheon so it's all about sometimes following the money the incentives are misaligned
incentives particularly in the U.S system where those are unencumbered in some of the response in the world particularly where there's huge on that
need and a you know doesn't need to be the perfect wearable that has you know 100 gray blood pressure and blood sugar
on it but if you have something like that and it's a 20 Chinese uh knockoff that can provide some basic level of
Diagnostics and data for a huge proportion of the population that's happening in India for example they're
leapfrogging over the U.S Israel where their data comes together and helped us understand what was
working and not working in the covet pandemic so um we can definitely learn from cross pollination and not having a
failure for imagination of what's possible here in the U.S Centric model okay so so it seems to me that your your
response to the the big five trends that I shared with you about aging population and more more patients and more people
uninsured uh and then the idea of more technology and Rising costs the way to
square that circle is uh is that in different parts of the world different places they're moving at different rates
to adopt technology that works today that's available at scale today to solve practical problems what can be done
today um now let's go a little bit into the Future Let's just tweak that a little
bit and look at the future because Brett mentioned a moment ago a really important point which is that there's a increasing shortage of healthcare
workers and that's not all there's also this factor of burnout we heard about it during covid now it's here and it's a
real thing uh some 60 of healthcare workers report that they feel burnout and some 40 intend to retire or leave
the exit the field entirely uh so the the research varies there so the data is a little bit inconsistent but the point
is that a lot of people working in healthcare are fed up and exhausted and burned out what technologies might help us
supplements or maybe substitute for healthcare workers who are leaving the workforce well first just to address the
Burnett issue in general number one part of it is the technology that's in the way we have now this world I used to
handwrite notes when I was a medical student but by the time I was done with training was all electronic medical records and those are a huge barrier to
care right now and a huge burnout Factor we call them I like to call epic fail I mean they're they're made for billing not really electronic medical records
they're billing records and they're really getting in the way and Cause part of the burnout challenges others challenges especially in the U.S system
is is folks feeling like they're not empowered as clinicians and they're widgets in a a big big machine so
there's some way somehow we need to get the technology to help get out of the way for example now our voice can help us write a note if I'm your doctor we're
doing a clinical visit it can help write the electronic medical record note for me that can help uh give us more human
face time and increasingly as technology gets better at helping make decisions and pick the right drug the human piece
not just holding the hand but that's going to still remain very valuable it's not going to replace you can't really
replace the game a touch so there is forms of digital and empathy that are going to be more and more important for virtual care so um I I think uh if we
take a few steps forward we have a shortage of nurses uh and other healthcare workers robotics is going to
play a role it already is starting to we're seeing humanoid type robots Avatar like elements that are getting empowered with um AGI to help whether it's Folks
at home all the way to uh in the operating room you know robotic surgery is already here that's going to become more and more autonomous we're enable a
surgeon in San Francisco to teleport into a surgery in a war zone so you know
we're going to see a lot of new ways of extending our reach the metaverse is sort of here now you can collaborate and
bring teams together uh is going to be part of that solution and I think the Advent of AI and chatbots Etc will start
to decrease the burden of that 101 stuff that has a lot of friction doesn't really take a lot of cognitive load
today that that could be supplanted uh with with smart technology one of the things I noticed is that uh
at least in the United States but this is probably true that a lot of industrialized nations we don't really have Public Health Care
crises in fact that was what was weird about the covid-19 outbreak it's the
first time we've had a really serious infectious disease uh spread across the country all at once and it caused a kind
of a panic because we're frankly from a public health standpoint we're out of shape we're not used to complying with public health mandates uh so that was a
tough one for most Americans to contend with but the real issues facing the Americans and American Health Care are
are self-inflicted and by that I mean the number one uh cause of of uh Health disorder is is diabetes and then broadly
nutrition bad nutrition but also tobacco HIV and now increasingly environments
these are all factors that that affect Health Care Health in the U.S in an adverse way and in a sense they're all
self-inflicted they're all lifestyle choices that we could do differently I'm wondering if the Technologies you just
mentioned things like chat Bots uh and monitor self-monitoring so on if that can help us correct some of those bad
habits and lifestyle choices that lead to bad Health outcomes yeah 100 like 80
of our costs morbidity mortality is not from our genetics but from our bad behaviors too much stress bad sleeping
bad environments uh nutrition Etc and so yes you can have I think this emergent future I like to call it you know
generative health is instead of getting that one little pamphlet that says eat eat less and exercise more you'll have
that sort of generative environment that's going to talk to you in your language it'll build the VR environment the music for your workouts the coaching
for your um diet nutrition Etc that can really uh you know help you build your
personal health coach and essentially through your entire Health Journey as well as already have your genome sequence from before you're born you
know over we've already entered this Gattaca moment not just a bit of measure but even manipulate the genome
um so I'm I'm hopeful that uh we'll be able to sort of connect those dots again
I'm putting my pediatrician hat on if you do something simple like when you have a six month old baby and you start to eat solid foods and you give them
whole grains as opposed to the white Gerber you know white rice trippy stuff it changes their gut
microbiome and their epigenetics and their Downstream risk for diabetes and other diseases goes down dramatically so
simple proactive things early in life not subsidizing school lunches to have lots of cheese in them being smart about
tobacco all those things the social determinants of health and other elements so much more impactful than the
crisper and the robotic surgery in terms of um big picture impacts we've also seen
um some Leaps and Bounds in a couple of areas one is the use of psychedelics
which we'll we'll speak about in a moment but also um you know sort of no I wouldn't call
it biohacking but the fasting movement for example you mentioned you know control of diabetes with changing your
uh you know being able to reset your internal levels with fasting and we you know we had Aubrey degree on talking
about the benefits of caloric reduction and fasting for longevity in the show
and what it does first um you know sort of cell regenerate and so forth
um so they're these are sort of sort of non-traditional areas where we're seeing
um significant improvements um are there other areas like that that you're excited about that sort of are
coming from a bit of left field and changing the way we think about medicine I know Aubry has been a great instigator
to think differently about aging as a disease and then it's you know multifactorial
um and I think what I'm excited about is now you know we're moving from this age sometimes of the transhumanists who want
to live forever and the outcourse of the world which sort of is not my sweet spot to think about more like extending
Health span you want 120 to be the new 90. I was actually my my wife's grandmother's 104th birthday a few months ago uh we're also there at 100
you know she's had an incredible Health span part of it from her social environments of course genes and habits
Health what I think is interesting now is this element of not just you know Precision medicine for precision
wellness and health span optimization and that's going to start with obviously the basic things exercise sleep social
connection sense of purpose but now we're seeing potentially things like intermittent fasting or
some drugs still improving like metformin I think we're going to move from Europe pretty quickly where now you
know folks like David Sinclair are published at least in mice the ability to tune up and down your epigenetics right you might have your own
personalized cocktail you might have your own personalized cocktail uh you know the the Brett or the Robert or
Daniel personalized longevity pill will be different based on our genomics and other risk factors in fact I've been
building a little new startup you can watch a TED talk about this about 3D printing your own personalized poly pills so imagine in the morning you wake
up and just like your coffee can have a cartridge you'll have your little cartridge that blends your dose of aspirin Statin rapamycin metformin
whatever it might be that's appropriate to help prevent disease or manage it but
that we that would be optimized for you based on all the you know internet of things and digital
twin elements that we're learning crowdsourcing from around the world it was actually depicted in the peripheral
um the new Williams Gibson series that was on Amazon Prime where they went to the pharmacy and they had uh compounds
sent from the future for them to 3D print in in the pharmacy and that was the personalized medicine so
um maybe we can use that as a as a discussion and we like to wrap up the show with getting really sci-fi you know
out there so looking out 20 or 30 years um you know what do you think the world
of healthcare is going to be like then I think in 23 years every kid that's born will already be sequenced pre-birth
that's already happening we'll use this sort of polygenic risk scores to give you a much better guided Healthcare
Journey so we can be super proactive you know what your risk of diabetes heart disease or Alzheimer's from early on in
life you'll be much more integrated with the right tools to help Stave those off we'll have the ability to have you know
your AI clinician with you at all times in your medical history streamed from your wearables there's definitely dystopian elements about who has this
data and what it can do and who gets up leveled and data level but we'll have a much better picture of true personalized
Precision Health and we'll have Quantum Computing that we'll be able to make sense of your digital biomarkers or design that in a one drug that's right
for you to prevent that cancer or manage your risk for dementia and Stave it off
we'll be in the era of regenerative medicine where you can regenerate organs and tissues just by turning the right
genes on and off epigenetics inside the body companies like Altos Labs moving that direction so you know it's hard to
predict the future but some of these things are going to come a bit faster than we'd predict if we can sort of get way or smartly you know Melody the
understand the ethics the regulatory the reimbursement elements and I'm trying to make it fair and Equitable and so it's
not a habit have not component but I think it's a really exciting time particularly with multi-ohmics digital twin wearables
other Bulls the sort of AI clinician in your pocket that we can start to really bring health care for all and bring
folks from all sorts of fields particularly for mental health video gaming um all the way to uh you know
psychedelics as ways to really be much more proactive and not wait for disease to kind of cause our crushing uh
challenges and costs and and it should lower the overall National Health Care
costs these combined Technologies you know if you've got genomics gene therapy
that is eliminating diseases from your genome then you don't have the cost of servicing that but that's that sort of
breaks the big Pharma model right right that's in Trials today that you'll take in in Vivo gene therapy to knock out the
bad Gene that causes like super high cholesterol for example that's not a sustainable model for Pharma where they
want to keep giving in the Statin this will be a one-time potential proactive cure um and that has lots of implications and
that's already sort of coming here today we can already cure diseases like sickle cell and thalassemia from my bone marrow transplant world with gene therapy many
diseases are complex but we'll see some proactive cures kind of like The Minority Report you'll cure the disease
before you even know you haven't wow what an inspiring vision Daniel it's
such a great pleasure to reconnect with you thank you very much for joining us on the futurists but folks if you're in the San Diego area in mid-march be sure
to check out nextmed.health that's that's Daniel's Gathering of uh of worldwide experts on the future of
medicine the future of healthcare and if you can't be in San Diego then definitely check out digital.health
that's David Daniel's new repository of all the information uh that we just described and it really is kind of
comprehensive I know you feel like there's a lot more to do but boy when I went there I could spend hours perusing that information so that's sort of an
interesting uh uh he makes available all of his findings and all of his research for everyone thank you very kindly for
joining us on the show it's been a real honorable pleasure I'll just give you one parting thought um and some of this is on my website
danielcraftmd.net but the idea that we all should be Healthcare Futures a lot of these Solutions are out there now you can find them on digital.health but your
doctor your nurse your pharmacist your nutritionist has no clue that they're already here you can start to use them to match and find the solve your
Healthcare problems and also the future is being built by people outside of digital Healthcare you know if we did Doctor pharmacist biotech person to see
a problem and help build the app with a kid down the street or 3D print the mock-up of the wearable or otherwise
it's a real interesting time now for everybody to play a role in not just predicting the future of health and medicine but but collaboratively uh
creating it for for all of us we could be active stewards of our own health we just have to get involved and get
informed yeah that's a really good point I mean It ultimately it does come down to personal responsibility and taking
making the right choices uh well with the resources you're providing people can make better decisions so I think that that's really a laudable and huge
achievement so thank you for joining us and sharing that with us today Brett you want to wrap up for the show Sean thanks
for joining us on the futurist this week next week we'll be back with more interviews um of course one of the ways
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next week with another episode of the futurist until then we'll see you
in the future [Music] well that's it for the futurists this
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