It’s over. TEDMED just ended with yesterday’s morning session of talks by Ken Kamler, surgeon and mountaineer, oceanographer Dave Gallo, another short talk by VisualMD founder Alexander Tsiaras, an insightful talk by David Blaine, who told the story behind how he held his breath for 17 minutes and 4.4 seconds, and a closing performance by Jill Sobule.
Kicking off the morning theme of extreme feats, surgeon Ken Kamler told us about some of his experiences climbing Mount Everest and the sort of medicine, or lack of medicine, they’re able to practice at such heights. Medications commonly used on Everest are simply steroids and pain killers. After Ken, oceanographer Dave Gallo gave a talk about his ocean exploration that had stunning imagery (take a look at videos from his previous TED talks) and spoke of the ocean’s health as being indicative of human health.
But by far the highlight of the morning was David Blaine, who gave a fascinating, candid, and behind the scenes talk about what it took to hold his breath for 17 minutes and 4.4 seconds. Richard Saul Wurman, in introducing him, mentioned that David was extremely nervous for the talk, as he doesn’t generally give presentations in front of people, rather he just does magic. In fact, this was the first time David had spoken in front of a large audience. Yet David was calm, humble, and reflective on stage, and he opened by talking about a little teaching session he did the night before with some members of the TEDMED audience. At the end of yesterday, he asked ten people to stay afterward so he could teach them breathing techniques to help them learn how to hold their breath too. The basic strategy David discussed was to not move a single muscle when holding one’s breath and purge off as much CO2 as possible by essentially hyperventilating. The body has two molecular signals that lets it know it needs to breath, oxygen concentration, and carbon dioxide concentration. When oxygen concentration is low, your body wants to breathe, but also when carbon dioxide concentration is high, your body wants to breathe, in order rid itself of the CO2. When you hyperventilate, you breathe off much of your CO2 and it makes holding your breath much easier. With this training, David was able to get members of the audience, with no prior experience in holding their breath, to do so for 4 minutes.
David went on to talk about his own journey toward breaking the world record for holding one’s breath. After his surgeon friend told David he’d have irreversible brain damage if he held his breath for over 6 minutes, he started by brainstorming all sorts of cooky ideas to create a breath holding illusion: a tube device that would filter out CO2 that they tried to shove down David’s throat and breathing through a liquid that’s high in O2 content. When none of those worked he decided to actually give it a go, and met up with an ocean free diver to help him train. To prep for his famous and failed Lincoln Center attempt, he lost weight and slept in a hypoxic tank at night to trigger the physiologic adaptations in the concentration and properties of his blood hemoglobin. His big mistake at Lincoln Center was to try to and perform the stunt while releasing himself from handcuffs, thus burning too much oxygen from his movements. After his failure, he went back to the drawing board, started another training regiment, and ended up holding his breath for 17 minutes and 4.4 seconds live on Oprah (a different world record this time, one where you breathe pure oxygen before you start holding your breath). His description of those 17 minutes was riveting. We apologize for the poor quality of this clip, but listen in on David’s description of his heart rate during the last few minutes of his record:

TEDMED then wrapped up with some more beat poetry by Sekou Andrews, and a lovely musical performance from Jill Sobule. Well, that’s it. Thank you for following Medgadget’s coverage. Also keep in mind that all of the videos from the conference will be posted online at TEDMED and TED. We will let you know when that happens so you can relive the conference yourself.
We’d also like to say a big thanks to the organizers of TEDMED, Marc Hodosh and Richard Saul Wurman, both for their extraordinary efforts in putting together a great event, and for working with Medgadget to help get us there.

The third day of TEDMED came and passed in a blur, with twenty three talks, the filming of some great video content for Medgadget, lunch outside on the lawn, and a few cups of coffee to keep us going. As with yesterday’s overview, we cannot cover all the talks so we’ll focus on a subset that stood out.
Another Jill Sobule original song kicked off the day, this time about a girl named Lucy who goes to the gym. She’s been doing TED conferences for many years now and has become in a way, a TED tradition. Her story based songs are quite fun and I’m looking forward to listening to more of her after the conference is over.
Jill’s songs led into the first talk of the day, a joint conversation of sorts between the spiritual Deepak Chropra and the scientific Dean Ornish. Richard Saul Wurman and Marc Hodosh, the two leaders of the conference, thought it’d be a good idea to let these two people, with relatively different ideas of medicine, meet head to head on stage. And it largely worked and made for insightful conversation. After establishing that their end goals of health, positive relationships, empathy, and community, were similar, the two of them talked about how they believe people should get there. Dean discussed the importance of a patient having a support community and gave a short presentation with content such as the fact that depression increases one’s risk of a slew of medical maladies. Deepak spoke of spirituality’s role in healing and gave his outline of how one should look at and treat his or her’s soul in order to treat the body. By far the best quote of the talk, however, goes to Deepak when he jokingly said that “Dean is a real doctor and I am a witch doctor” when asked about what makes the two of them different.
Keith Black, Chairman of the Department of Neurosurgery and Director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center, came on next to talk about his work on using the immune system to target cancer of the brain. He noted that cancer cells essentially cloak themselves from the immune system in order to hide their abnormal physiology and growth from the body’s natural defenses. To do so, cancer cells release a flood of immunosuppressant cytokines and the healthier a person’s immune system, the more likely they are to survive a brain cancer. In fact, age is the strongest predictor of surviving a glioblastoma. Why? Because younger people have healthier immune systems. He talked about his attempts to make the tumor cells more visible to the immune system by using dendritic cell vaccines based off samples excised from the patients’ cancers. Essentially they make a vaccine off tumor markers that hyper sensitizes the patients immune system to their cancer. In about 60% of patients given this vaccine, they were able to both activate the immune recognition of the tumor as well as activate the killer T cells to help fight the tumor. And interestingly, in the 40% of patients where this immune modification did not occur, there still seemed to be the effect of increased sensitivity to chemotherapy. Strong data in support of this research comes in the from of a direct correlation between the intensity of the patient’s immune response and their length of survival.
Right after Keith was Peter Diamandis, founder and chairman of the X-Prize Foundation. As most of you know, the idea behind the X-Prize is simple: offer a lot of money to spur private industry competition and innovation. So far this framework for innovation has worked remarkably well, with the Ansari X Prize for private space flight producing the Space Ship One, and the Archon X Prize for genomics likely months away from being awarded. In crafting their prizes, the foundation tries to find goals that will be achievable in between 3-8 years – any fewer than 3 and it’s too easy, and more than 8 and people loose interest. The big item of interest in his talk was the upcoming Healthcare X-Prize, set to be launched in the spring of 2010. The Healthcare X Prize awards first the creation of a suitable metric to determine the health of a community, because you can’t improve what you can’t measure, and then the creation of a healthcare system for a population of 10,000 people that most improves this wellness metric for the least amount of cost. A set of five 10,000 person large groups of people have been identified for participation in the prize. We can’t wait to see what might come out of this.
The next person to keep the morning excitement going was Kary Mullis, who won the Noble prize in chemistry for developing PCR. He discussed updates to his latest project (that was previously highlighted at TED; see video below) that involves taking randomly generated 30 base pair DNA oligonucleotide aptamers, or more simply, random lengths of DNA that have binding affinity to a variety of molecular substrates. The idea is that it is relatively easy to create a massive library of aptamers that bind to almost anything at a highly selective level. So, if you’ve got a microbe you want to kill, you figure out which unique surface proteins it’s got that you’d like to target and select an aptamer that binds to it. Then, you take this aptamer and attach it to something that the body has a strong innate immune response to. This combination means that the aptamer binds to the microbe but is attached to a giant flag that tells your immune system to come over and eat up whatever the aptamer is bound to. The technology has been proven to completely eliminate anthrax in animal models and we’re quite excited to see where it goes over the coming years. Here’s an overview of this technology from a previous TED conference:

After quite a content strong morning session, we had a one hour coffee break during which we interviewed a few companies and wandered around between snack tables. Soon after the break, we heard from Steve Cole, one of the men behind HopeLab, the company that makes a cancer fighting video game called Re-Mission to help pediatric patients contextualize and play a more active role in the fight against their disease. The idea is to give these patients the experience of taking charge in their fight against cancer and have them understand both visually and emotionally what the chemotherapeutic agents might be doing to their body so that they remain more optimistic, more compliant with their medications, and more engaged with their treatment.
After a few more talks we went off to the lawn of the hotel for lunch, during which time we talked to David Bolinsky, founder of XVIVO, an animation company that makes beautiful videos of molecular biology events. They had been showing David’s company’s videos after almost every talk and each time they completely captivated the audience. You can see our brief interview with him up on Medgaget, few posts below.
After lunch Colin Angle, the co-founder and CEO of iRobot gave a talk about his company and the sorts of robots they might build to help elderly people stay out of the nursing home longer. The staggering statistic he spoke of as impetus for his work was that 23% of people self-identify as informal care givers. That’s quite a lot of people whose lives are dramatically affected by the need to constantly care for a loved one. To illustrate his point, he used the example of his mother (including a life-size cardboard cutout) to talk about the sort of assistance she might someday need and how robotic technology might be able to help provide her with that and let her live in her home longer, grounded in the statistic that 3/4 of seniors would prefer to stay in their home rather than go to the nursing home. He attacked this problem from a few angles. The first was monitoring. He noted that one of the biggest reasons a son or daughter might choose to put their parent in a nursing home is simple worry, the constant concern that their parent is not OK and the pressing need to always keep in touch with them. iRobot might someday have a solution to this in the form of a household robot that provides a video feed and activity monitoring of the house and the people in it. This sort of always-on monitoring would help alleviate concerns from the parent’s side. He also noted that the inability to comply with complicated medication regimens is the number one reason that an elderly person ends up in a nursing home. iRobot is looking at how they might be able to take a more active stance in this problem by programming a robot to literally hand a person the right medication when the need it, allowing elderly people to just sit back and wait for the robot to offer up what pills they should take. Lastly, Colin noted that the point of the robot is to extend independent living, not replace it. An example of the type of robot that might someday be tweaked into a household version can be seen in the video below.

Next up was Rick Satava, the Senior Science Advisor at the US Army Medical Research Command. One of his major ideas was that as science progresses, the methodology needs to keep up as well. Double blind clinical trials are certainly a gold standard for much of medical progress, but he advocates for supplemental approaches such as simulations that will be valuable in their own way. He also said that he thinks we’re on the verge of the fourth wave of human technological revolution, the first being agricultural, the second being industrial, the third information technology, and the fourth, biointelligence, which he defines as a hybrid of IT and biology. Richard went on to present a flood of impressive medical technology, much of which we’ll cover in subsequent posts.
After Rick, Helena Foulkes, the Executive Vice President of CVS spoke about how dismally poor patient compliance is for medications, especially those to treat chronic conditions. More than half of patients who start taking “maintenance” medications stop taking them after a year. And over 70% of hospital readmissions are due to medication noncompliance. CVS is testing out a medication counseling program called First-fill that aims to address these problems using the pharmaceutical staff as more of a resource. So far they’ve seen that this program can improve refill rates by over 15%.
Last on the list we’re going to cover is Jamie Heywood, co-founder and chairman of the medical networking site PatientsLikeMe. He gave a riveting talk, both in content, presentation, and graphics, on how PatientsLIkeMe is not only providing a support network for patients with similar medical conditions, but is looking to be a hotbed of the aggregate mock clinical trials. The site collects structured data for multiple medical ailments and their associate symptoms, treatments, and responses for each patient. On the individual level this is valuable as a source of record and a way to seek out others who are undergoing similar treatments, but at aggregate this power really shines. Jamie used the example of ALS, which his brother died from, to show just how powerful something like PatientsLIkeMe can really be. A study in PNAS came out that demonstrated that lithium helped to slow the progression of ALS. The study, though, had multiple methodological problems, yet many ALS patients who used PatientsLIkeMe started taking lithium as a result of the study. Using PatientsLIkeMe data to compare those who didn’t take lithium to those who did (along with some advance mathematical transformations), they were able to demonstrate that lithium did not have an effect in their patient population. The results for an aggregate patient “trial” like this were vastly quicker than what current medical literature can produce. We’re definitely going to keep an eye on PatientsLIkeMe in the next few years.
From San Diego and the beautiful Hotel del Coronado, that’s it for day three. Stay tuned for the last wrap up of day four.

Yesterday we spoke with Ari Kiirikki of Knome, a company that provides full DNA sequencing for people willing to dish out $68,000. This is a bargain considering the price just dropped from $99,000. Of course this isn’t for everybody, but people willing to spend the money are promised some tangible benefits. Here’s our interview with Mr. Kiirikki at TEDMED 2009:

Link: Knome, Inc.

We had a chance to catch up with David Bolinsky, co-founder of XVIVO, a company that does some amazing animations for the life science companies and organizations. We asked him to briefly speak about what his company does and how high quality visualization can help people understand medical concepts.

XVIVO flashbacks: Video: The Beautiful Side of a Viral Infection; The Inner Life of the Cell; The Inner Life of the Cell: A Full Version ; Can a Digital Projected Heart Replace a Much Beloved Solid One?
Link: XVIVO…

One of the attendees to this year’s TEDMED was the venerable Steve Wozniak, founder of Apple Computer. Steve is an engaging person so he wanted to show us his NIXIE tube wrist watch and how he uses it to intimidate fellow airline travelers. It ain’t medical, but is surely amusing:

We had a long and eventful second day at TEDMED, filled with plenty of laughs, thought provoking technology, spitting into vials for 23andMe, embarrassing ourselves in front of med tech celebrities, and even a conversation with Aubrey de Grey over a clam bake dinner on the beach. Yesterday sessions featured twenty two speakers, far too many to write up, but we’ll highlight a few that we feel stood out from the rest, those that showed something new or especially interesting.
The conference opened with the second appearance of songwriter Jill Sobule. She’s quite talented and today’s song was a bit more upbeat than yesterday’s, about the apocalypse, and was a great lead in to John Abele, co-founder of Boston Scientific. Everyone expected John to talk about catheters, stents, or something else from his world, but instead he threw a curve ball and discussed the concept of collaboration. It seems that research into how people best collaborate is a deep personal interest of John’s, and he even bought a conference center called the King Bridge Center to better investigate his ideas on collaboration. He thinks medicine is lacking in the sort of productive collaboration that helps other fields quickly advance and be optimally productive. Through his talk he discussed a few ideas surrounding collaboration, but the kicker was his insight into the idea of surgical collaboration, where an audience of medical professionals sit in an auditorium with real time high definition operative data, and they all participate in a procedure by giving advice on what the surgeon should do next. This is actually already happening. He showed a video of a vascular surgery event of sorts in which at least one hundred leading vascular surgeons were all participating in the surgery. The doctor actually performing the procedure was collecting advice on what to do next and getting real time consensus data via real time polls. This, no doubt, made the procedure last longer, but most of the doctors in attendance said they thought they learned from it and that it produced a better result for the patient. A poll even indicated that they trusted their established consensus more than something they would read in a peer reviewed journal.
Soon after John, David Agus, professor of medicine at the University of Southern California and founder of Oncology.com and Navigenics spoke of his views on cancer. He would like to see a paradigm shift in the thinking of cancer as a tissue defined disease to a molecular marker defined disease. Rather than calling a disease breast cancer, for instance, we should eventually know the molecular gene mutations that caused the disease and be able to identify the cancer as HER2 cancer, etc. This hyper specific focus on the molecular basis of medicine should help refocus our thinking of the disease into a more curative direction. He also requested that researchers examine other ways to attack cancer besides targeting the diseased cells themselves. Citing a highly successful trial with zoledronic acid (a drug that improves bone growth), he noted that sometimes when you “change the soil” (make the bone more healthy), “the seed can’t grow” (the cancer cannot thrive).
After a quick break in the coffee room, which, by the way had a 103″ flat screen TV broadcasting the talks as they went along, we heard from Alexander Tsiaras, artist, scientist, and founder of The Visual MD. The idea behind VisualMD is to be the Google Earth for medical imagery. News organizations, for instance, might use the images from VisualMD to explain health concepts to their audiences just as how now they use Google Earth to convey geographic information. His goal is to make all of the data free and available and to serve as a resource for individuals, as well as doctors explaining health matters to their patients. Their images are beautiful 3D reconstructions of organs that the user can spin around, interact with, annotate, and even create their own slide shows for easy email to others.
Also before lunch was the science of aging pair up with Aubrey de Grey, CSO of the SENS Foundation, and David Sinclair, professor at Harvard Medical School. If you’ve not heard of these gentlemen before, both view aging as a disease but both are approaching aging in very different ways. Aubrey spoke first and has a more futuristic view of aging. His mantra is that aging is metabolism caused cellular damage that leads to organism pathology, and the human body, just like cars, can be made to run longer with adequate maintenance and repair. He views age related problems as belonging to seven types and in order to tackle aging, all seven cellular and molecular problems need to be cured. Aubrey also coined the idea of a Longevity Escape Velocity (LEV), which is the point of life span where progress in aging science is occurring faster than the degradation of the body itself. He believes that if someone is able to live to 150 years old, then by that point the progress in the ability to keep them alive will be faster than their rate of death, thus they will live into their 1000s. Still focused on the same target, but shooting from a different angle was David Sinclair, who focuses his research on a set of proteins called sirtuins. Multiple studies have shown that when an animal (it has been done in many specifies, including primates) undergoes caloric restriction (fed about 75% of what would be considered normal for that animal), they live about 30% longer. David has some great data to show that this is due to a cellular starvation response that is healthy for the cells and is activated by sirtuins proteins. He founded a company off this idea called Sirtris™ Pharmaceuticals which was quickly snapped up by Glaxo Smith Kline for $720 million dollars. Yes, you read that correctly, a $720 million dollar buy out for a company that so far has no proven drugs. Clearly GKS is betting big on this technology. The early uses of Sirtuins would be for diabetes, but might carry the side effects of less cancer, stronger bones and muscles, a longer life, and a few other wonderful things.
Eric Dishman, the director of Intel’s Digital Health group spoke next about the power of in-home care. His central insight is that medicine needs to leave what he calls the mainframe model and move to a personal computer model, where care is delivered in the home if at all possible. He noted several ideas that might have clinical significance in gerontology. The first was simply engineering a smarter monitoring phone, that over time would track the responsiveness of the elderly person answering calls to determine how quickly they recognized the person calling in an attempt to detect any early signs of dementia. They would also be able to monitor the person’s tremors to check for trends in motor deficiencies. Along these lines of elderly monitoring, Eric showed a prototype system that can be installed in a patient’s home that might delay the necessity for them to move to a nursing home. Through a network of sensors and an high quality pedometer, an elderly person can be monitored to make sure they are able to take care of themselves in their house, are physically stable while walking, and are not injured or in need of help. These sorts of innovations let those who might be at risk of going to a nursing home live in their own home longer and safer.
After a lunch on the lawn of the Hotel Del Coronado, we heard from Greg Lucier, CEO of Life Technologies, the company that makes a slew of biological technologies, but of more recent relevance, DNA sequencers. He talked about how quickly DNA sequencing technology has grown and scaled, with the first genome being sequenced in 2000 for a cost of $3 billion. Now full human genome sequencing can be done for $10,000 in 10 days. This technology has advanced even quicker than Moore’s Law (seen in cpu speed increases), and has far outpaced how the data is used clinically. With all of the genetic information that will soon flood the field of medicine, Greg advised the creation of a specialty of medicine akin to a genetic doctor, or someone who would help interpret genetic test results for clinical action. The technological advance of DNA sequencing, to Greg, parallels the introduction of more advanced radiological techniques which spawned the creation of a dedicated branch of medicine.
Keeping with the DNA sequencing trend, we then heard from Anne Wojcicki, founder of 23andMe. She spoke of her frustration with patients not being able to take an active stance in their medical care as the impetus for founding the company. We’ve covered 23andMe many times before so we’ll hold off on most of the smaller details, but the two big announcements she made at TEDMED were that 23andMe now has 30,000 genomes in their library (likely one of the larger collections in the world) and that the company is introducing a relative finder that looks for people who might be your cousins (from 2nd to more distant) based on your genetic profile. But by and large our favorite thing about 23andMe being at the conference was that we got to spit in tubes and get our DNA sequenced for free. It took us imaging a quality cut of steak to work up the requisite saliva, but we did so, sealed it off, and it will be sent for processing.
In the last session of the conference, Philip Low, the founder and CEO of Neurovigil told us about his mathematical techniques for processing EEG readings. EEGs pick up electrical activity in the brain and Philip figured out a miraculous way of processing them that not only showed a brand new stage of sleep (a subset of REM) but also might, in combination with a large database of EEGs, be able to clinically diagnose neurological pathologies such as schizophrenia or depression. It’s still in the early stage, but his preliminary data looks remarkably promising.
The last of talk of the day was David Pogue, from the New York Times, who gave an entertaining review of all of his favorite medical iPhone apps on the topic of “will your iPhone save your life?”. We’ve covered many of the ones he’s talked about, but for all of you medical students out there, take a look at Anatomy Lab, which lets you virtually dissect a cadaver on your iPhone. It looks like a slick application.
That’s it for day two. We’re looking forward to be fascinated by today’s sessions. The report is coming up tomorrow…

Yesterday at TEDMED we got a chance to speak with Patch Adams, the world famous physician, author, and activist. Being the eccentric that he is, we were wondering what novel medical technologies he uses in his practice to help people deal with their conditions. Here is the premiere of the uncut interview as it unfolded before our eyes:

More from Dr. Patch Adams blog…
Dr. Patch Adams on Twitter….