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At TEDMED 2015: Thinking about “breaking through” the valley of death in science

At TEDMED 2015: Thinking about "breaking through" the valley of death in science

This year’s TEDMED was held Nov. 18-20 in Palm Springs, Calif. Stanford Medicine is a medical research institution partner of TEDMED, and a group of MD and PhD students who represented Stanford at the conference will be sharing their experiences here. 

“I am #BreakingThrough the ‘valley of death.’”

That’s what I wore on my nametag last week at TEDMED. The theme of this year’s conference was “Breaking Through,” and every delegate was asked to write a brief statement that illustrates an area of health care that they’re most passionate about.

The “valley of death” refers to the vast gap in the landscape of biomedical therapeutic development between academia and industry. Traditionally, an academic institution and industry have played two separate but equally important roles in the lengthy and expensive process of bringing new medical innovations to the patient. Academic researchers investigate new mechanisms, pathways and methods, making discoveries that yield promise. Industry then takes these experimental innovations and conducts product development, safety profiling, clinical trials, and manufacturing and distribution, ensuring that extensively tested, safe and efficacious products are widely made available.

However, this transition between academia and industry is not always a smooth one. The pharmaceutical industry is notorious for its extreme risk aversion with new products – and with an average cost of $1B, a 10-year path to FDA approval, and a failure rate north of 95 percent, who can blame them? Meanwhile, most academic labs are neither equipped to nor interested in spending the resources to conduct important yet labor-intensive preclinical work (which, quite frankly, won’t help a scientist graduate, secure tenure, or win a Nobel Prize). And so, because of this, potentially beneficial therapeutics are liable to languish in the valley of death between discovery and human trials.

On Thursday, Stanford professor Daria Mochly-Rosen, PhD, took the TEDMED stage to describe her own experience crossing that valley on the TED stage. In the early 2000s her lab had discovered a novel class of compounds for reducing cardiac injury after heart attack. After receiving universal rejections from pharma companies that they hoped would license the compounds, Mochly-Rosen and one of her graduate students reluctantly took matters into their own hands, left the university, and started KAI Therapeutics to bring their compounds into clinical trials. Long story short, they were eventually wildly successful and acquired by Amgen after demonstrating efficacy in Phase II clinical trials. The experience drove Mochly-Rosen to start the Stanford’s SPARK program, which offers a variety of resources – including classes, industry mentors and grants – to help scientists here survive their own journeys through the valley of death.

As a scientist developing new potential tools for diagnosis and therapy, and as someone who works frequently with early-stage life science companies, I spend a disturbing amount of time thinking about the valley of death. But to me, the valley is much deeper and wider than what it means for pharmaceutical development. It spans similar challenges in medical devices, diagnostics, and even digital health solutions.

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Big data, Medical Apps, Patient Care, Precision health, Research, Stanford News, Technology

Precision health in practice: Using HealthKit to monitor patients’ blood-sugar levels

Precision health in practice: Using HealthKit to monitor patients' blood-sugar levels

Rajiv Kumar and patient - 560

Imagine having to keep track of your diabetic son’s constantly changing blood sugar levels by typing each individual reading into an email. Then, once in the doctor’s office, having to spend a chunk of your precious time with your clinician waiting for her to download that data.

That was the plight of Lori Atkins, whose son has Type 1 diabetes, until this March, when the Atkins joined a pilot project involving Apple’s HealthKit. Pediatric endocrinologist Rajiv Kumar, MD, is using HealthKit – a new technology that can securely share health data with third-party applications – to more easily monitor the blood-sugar levels of 10 patients.

A recent Inside Stanford Medicine article describes the project:

Patients like Blake wear a continuous glucose monitor that sends 288 blood-sugar readings a day to an Apple mobile device through Bluetooth. The data is securely transmitted via HealthKit into the patient’s electronic medical record at Stanford Children’s Health through the MyChart app.

The system also improves clinical outcomes, Kumar said: “Our endocrinologists are now able to easily assess large volumes of blood-sugar data between clinic visits — and quickly identify trends that could benefit from insulin dosing regimen changes.”

Kumar is planning to expand the use of the app to more of his patients.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health, Harnessing mobile health technologies to transform human health and A picture is worth a thousand words: Researchers use photos to see how Type 1 diabetes affects kids
Photo by Norbert von der Groeben

Bioengineering, Cancer, Imaging, Public Safety, Research, Stanford News, Technology

A new way to scan for plastic explosives could someday detect cancerous tumors

A new way to scan for plastic explosives could someday detect cancerous tumors

14591799636_128fbe50ee_zSci-fi shows and superhero films are full of gadgets and beings that have the power to remotely scan their environment for hidden things. For us mere mortals this superability may sound unachievable, but now Stanford engineers are working to develop a safe and portable way to detect concealed objects by scanning with microwaves and ultrasound.

As this Stanford Report story explains, the idea began with a challenge posed by the Defense Advanced Research Projects Agency: Design a way to detect buried plastic explosives from a safe distance without touching the surface of the ground.

A team of electrical engineers led by assistant professor Amin Arbabian, PhD, and research professor Pierre Khuri-Yakub, PhD, took up the challenge, paying homage to the scanning device made popular by sci-fi show Star Trek in the process. They created a tricorder-like device that senses the ultrasonic waves created by objects as they expand and contract when warmed by electromagnetic energy (e.g., light and microwaves).

Here’s the really interesting part: Because everything expands and contracts when heated — but not at identical rates — this scanning tool could have medical applications as well. For example, blood vessels that sprout from cancerous tumors absorb heat differently than surrounding tissue. So, blood vessels radiating from tumors could appear as “ultrasound hotspots” when scanned with the tricorder device.

The team is working to make this device ready to detect the presence of tumors and other health anomalies sometime within the next decade or so.

Previously: Beam me up! Detecting disease with non-invasive technology and Tiny size, big impact: Ultrasound powers miniature medical implant
Photo by Joe Haupt

Big data, Patient Care, Stanford News, Technology

OrderRex taps decisions of thousands of “doctors like me”

OrderRex taps decisions of thousands of "doctors like me"

chen_vaAs a new clinician, Stanford’s Jonathan Chen, MD, PhD, struggled to treat patients with unfamiliar conditions. He yearned to ask one or, even better, dozens of more experienced physicians for advice.

For most people, that would be a passing wish. But not for Chen, who has a PhD in computer science and experience working as a software developer. (Oh yeah, he also started college when he was 13).

A recent article from the Center for Health Policy and Center for Primary Care and Outcomes Research (CHP/PCOR) describes Chen’s next steps:

“I thought about how the Amazon product-recommender algorithm works and thought, `Can we do this for medical decision-making?’” said the 34-year-old Chen, a VA Medical Informatics Fellow at Stanford Health Policy.

So instead of, other people who bought this book also liked this book, how about: Other doctors who ordered this CT scan also ordered this medication.

“What if there was that kind of algorithm available to me at the point of care?” he asked. “It doesn’t tell me the right or wrong answer, but I bet this would be really informative and help me make better decisions for my patients.”

Chen’s idea differs from the Green Button concept, which draws on thousands of medical records to search for patients with similar conditions. Instead, Chen is trying to capture doctor’s decision-making process by developing a digital platform to mine electronic medical records; he calls his project OrderRex.

It “looks for ‘doctors like me,’ and anticipates what the doctor wants before they ask for it,” Chen explains in the article.

Chen received a five-year National Institutes of Health grant and is working to develop OrderRex with the guidance of his mentor, bioinformatician Russ Altman, MD, PhD.

Previously: Push-button personalized treatment guidance for patients not covered by clinical-trial results, Big Data in Biomedicine panelists: Genomics’ future is bright, thanks to data-science tools and Euan Ashley discusses harnessing big data to drive innovation for a healthier world 
Photo by Joseph Matthews/VA Palo Alto

Applied Biotechnology, Bioengineering, Stanford News, Technology

The rocket men and their breathtaking invention

The rocket men and their breathtaking invention


It’s a gadget straight out of Star Trek — a breath analyzer that may someday quickly and noninvasively detect everything from diabetes to cancers.

In a new Stanford Medicine magazine story, you can read about how three Stanford rocket-combustion experts — Christopher Strand, Victor Miller and Mitchell Spearrin — designed and tested a Breathalyzer-like device to measure toxic ammonia levels in critically ill children, all in about a year.

Breath testing with the human nose has been used in medicine since ancient times. (The rotten-apple smell of acetone is a sign of diabetes. A fishy smell is indicative of liver disease.) The rocket men in the story recognized the opportunity to develop a medical device that could transform this art into a science.

They figured that the technology they used in rocket testing, laser absorption spectroscopy, would be sensitive enough to make measurements of trace compounds in the breath. Just as engineers can use these data to tell if a rocket engine is operating efficiently, they could tell if a human biochemical engine is operating in a healthy range. Their project mentor, Gregory Enns, MD, a biochemical geneticist who diagnoses and treats metabolic diseases at Lucile Packard Children’s Hospital Stanford, helped the team get up to speed on metabolic disorders and remove bureaucratic roadblocks to clinical testing.

What was most inspiring to me about this story was the indefatigable optimism of the engineering team. The rocket men chose the most difficult molecule to measure (ammonia), a disease caused by a rare genetic defect with little commercial potential (hyperammonemia), and a hard-to-test patient population (infants). During the development process, they demonstrated the same mental toughness as abandoned-on-Mars engineer Mark Watney in the film “The Martian“; as each insurmountable technical challenge came up, they did what Watney did: “science the hell out of it.”

Previously: Stanford physicians and engineers showcase innovative health-care solutionsRaising awareness about rare diseases, Extraordinary Measures: a film about metabolic disease
Photo by Misha Gravenor

Behavioral Science, Chronic Disease, Health and Fitness, Medical Apps, Technology

Can cute cat texts motivate patients to take their medication?

Can cute cat texts motivate patients to take their medication?

Sammie resizedThe right kind of motivation is key when you have a difficult or mundane task at hand. For example, when I wanted to learn Spanish, I tried several top-rated, online language tools to no avail because they felt like work to me. Then, half as a joke, my boyfriend suggested an app that associates Spanish phrases with images of cats acting out the meaning of the words. The app was so silly I used it often, and — to our amazement — it actually worked.

So when I saw this story on MedCity News about a company that plans to use cat photos to motivate people to take their medicine, I knew they were on to something. As the story explains, the texts are part of an online assistant that will pair irresistibly cute cat images with health prompts so the reminders are memorable and fun.

The company, called Memotext, plans to pilot test this tool on Type 2 diabetes patients (followed by patients with other chronic illnesses) to gain insights on the patients’ state of mind when they skip or forget to take a medication. They also hope to learn more about what can be done to change patients’ behavior so they’re able to follow their medication regimen better.

“We’re not only asking whether you did something, but why did you do it,” said Amos Adler, the company’s founder and president. Based on what I’ve learned about motivation so far, I think a cute cat text or two probably can’t hurt.

Previously: “Nudges” in health: Lessons from a fitness tracker on how to motivate patientsStudy offers clues on how to motivate Americans to change and Understanding the science and psychology of how habits work
Photo courtesy of Anna MacCormick

Aging, Medical Apps, Stanford News, Technology

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford Letter Project, which helps users have end-of-life discussions, now available for mobile devices

Stanford_LetterFor many of us, the topic of how we want to spend our final days rarely comes up in discussions with our family members or doctors. And a big reason why is that we think of reflecting on how we want to die as highly emotional and unpleasant.

But there are some compelling reasons to take the time to clarify what matters to you most in your waning days of life: It can reduce stress on your loved ones and help your physician provide a better quality of care.

Earlier this year, VJ Periyakoil, MD, director of palliative care education and training at Stanford, launched the Stanford Letter Project, a campaign to empower all adults to take the initiative to talk to their doctor about what matters most to them at life’s end.

Recently, Periyakoil released mobile app versions of the Stanford Letter Project for both the iPhone and Android. The apps, which offer templates comprised of simple questions aimed at getting the end-of-life conversation rolling, are free and can be downloaded from the iTunes and Google Play stores. Templates are available in Spanish, English, Italian, Taglog, Russian and Hindi.

As Periyakoil explained in a recent 1:2:1 podcast, “2.6 million Americans die every year, and very few of them get to talk to their doctor about their end of life wishes.” She urges every adult to tell their doctors about how they want to spend their last days; she suggests engaging in end-of-life discussions each time you reach a milestone in your life such as getting married, having a baby or being diagnosed with a chronic illness.

Previously: How would you like to die? Tell your doctor in a letter, Stanford doctor on a mission to empower patients to talk about end-of-life issues, Medicare to pay for end-of-life conversations with patients and “Everybody dies – just discuss it and agree on what you want

Medical Apps, Medical Education, Medicine X, Patient Care, Technology

A look at using smartphone apps for patient-centered research

A look at using smartphone apps for patient-centered research

The usefulness and power of mobile apps in research was one of the last topics at Medicine X yesterday. One of the panelists in the late-afternoon “Clinical research in the palm of your hand” session was Stephen Friend, MD, PhD, who told attendees how willing most patients are to share their health data for science. “If you give someone a choice and ask them, ‘Do you want your data to be looked at by qualified researchers around the world?'” people usually say yes, reported Friend, president of the nonprofit biomedical research organization Sage Bionetworks.

Panelist Michael McConnell, MD, professor of cardiovascular medicine at Stanford, can certainly attest to this: He’s principle investigator of a study, MyHeart Counts, that has seen tens of thousands of users offer up their heart-related data for study.

Stanley Shaw, MD, assistant professor of medicine at Harvard, shared thoughts on how having an ongoing data connection with patients can feel for a physician-researcher: “I had a surprising sense of immediacy when I started looking at… data. We had people upload information such as their blood glucose levels. You can see people cranking the level down day by day over weeks or months. It really does remind you of that pact between an individual and their physician and that it’s a privilege to take care of patients. It’s very exciting.”

Also exciting is when apps are shown to have a direct impact on a patient’s care or quality of life. Friend gave the example of a program that reduced emergency room visits and hospitalizations by allowing providers to keep track of patients via an app. “If someone has been holed up in their house for four days, we can send someone to find out why,” he said. And if a patient stops taking a daily walk, that provides the medical team with clues as well.

Of course, not every patient— especially one with a chronic illness — is going to bother logging onto an app to share data every day, said Yvonne Chan, MD, PhD, assistant professor of emergency medicine at Mount Sinai Hospital. “We talk about access and engagement,” she said, but different types of users are going to engage with an app differently. For example, asthma patients with severe, poorly-controlled baseline disease are easy to engage and keep — especially if they happen to own a smart phone. Such patients are highly motivated to better control their disease and stay out of the emergency room.

“But people with minor disease that’s well controlled, maybe they have better things to do,” she said. Apps could be designed to engage different patient populations; maybe that asthma app could have a mode that included more entertainment for patients who are less sick and less motivated.

More news about the conference is available in the Medicine X category

Events, Medicine X, Technology

From patient to entrepreneur: Three Medicine X panelists offer advice

From patient to entrepreneur: Three Medicine X panelists offer advice

patient panel

“Who better than to solve our problems in health care than the people who live it and breathe it every day?” That was the rhetorical question posed by Darla Brown, a panelist in a Saturday Medicine X session on patients as entrepreneurs. Brown, a cancer patient who co-created digital health company Intake.Me, and her two co-panelists, Molly Lindquist and Michael Seres, talked about how they took their health-related ideas from concept to reality and offered advice for the other big thinkers in the audience. Among the points made during their 45-minute session:

-Do your due diligence: As noted by Seres, a prolific patient blogger who founded the health tech start up 11Health, “there are thousands of patients who are solving real problems every day” but there may not be a widespread need for such solutions. In other words, a product or service that is helpful to one patient may not be appealing to many others. “Make sure you’re not the one person who wants this end solution,” said Lindquist, a breast cancer survivor and founder of Consano, a nonprofit crowdfunding platform for medical research.

-Talk, talk and talk some more: When exploring the validity of an idea, pick up the phone or hit the keyboard. “You don’t need to do big market research – just talk with other patients,” advised Brown. Lindquist agreed, noting that when she was thinking of starting Consano she reached out to numerous people in her professional and personal life. (She joked that when her number comes up on her friends’ cell phones these days, they likely think, “Oh, what does she want now?”) She said the ensuing conversations “helped vet the idea and the potential issues and benefits that would come from creating an organization.”

-Be able to communicate your product and its need: Especially when working with potential investors or donors, “being really solid in your mission and intent and being able to communicate that” is key, said Lindquist. Seres shared with the audience that his first investor gave him only a “tiny bit of money” and wanted Seres to show him he could be successful on a larger scale. “Ultimately you have to prove the business model and be clear on who your target audience is and whether [your idea] is big enough,” he said.

-Know there will be challenges: “I’ve been patient for more than 30 years. I felt I knew everything about my condition and my health and my journey,” but navigating the business world was a whole different ballgame, Seres said. (He later noted that he still doesn’t think of himself as founder of a technology company: “I’m just a patient providing a solution for a problem no one else” was working on.) But patients have resilience, he pointed out, and “given what you’re dealing with on a daily basis nothing is impossible.” Brown also offered the practical tip of reading The Business Model Generation, which she and Emily Lu, MD, (the panel’s moderator) consulted before starting Intake.Me.

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Events, Medicine X, Patient Care, Technology

At Medicine X, designers offer their take on why patient-centered design is top priority

At Medicine X, designers offer their take on why patient-centered design is top priority

Aaron Sklar at MedXAs a Medicine X veteran, I’m used to hearing patients talk about the importance of putting patients’ needs first. But yesterday afternoon, I got to hear about patient-centered design from designers.

At a session called “Fulfilling the promise of technology in health through human centered design,” Joan Saba, an architect who designs hospitals for NBBJ, used a personal story to illustrate how good design is essential to patient care. Her mother recently became sick and needed to stay at the hospital overnight, and “this is where she spent 24 hours,” she said. Sounds of ambulances wailing and doors slamming filled the lecture hall while an image of a bed surrounded by electrical cords and medical equipment lit up the screen. “Her room was right above the ambulance bay,” Saba explained.

With recent advances in technology, hospital rooms don’t need to look, sound or feel like this, said Saba. “So, what should a patient’s room look like now?” It being a calm place (unlike her mom’s room) is important, but there are other considerations, too: “Now we are thinking about it being a place for learning and information exchange.”

This desire to think about such an exchange, and improved doctor/patient communication, was echoed in the talk by Marc Katz, MD, MPH, chief medical officer of the Bon Secours Heart & Vascular Institute. He told the story of meeting patient-advocate Sarah Kucharski, who has the rare disease fibromuscular dysplasia and has endured many medical procedures, including a triple bypass surgery, back at the first Medicine X. “I go to several media conferences a year, and this was the first time I’d seen a patient present,” he recalled. “This was an eye-opening experience.”

Hearing about what Kucharski went through, prompted Katz to start querying other patients about their cardiac surgeries. “The biggest problem was communication — patients didn’t feel they understood what was happening [while at the hospital],” Katz said. So he helped develop Co-Pilot, a program that assigns a personal nurse to each patient. The program is still in its early stages but it seems to be paying off, Katz said: In a sample of about 150 patients, the Co-Pilot program reduced the duration of hospital stay and readmission, also, patients reported greater satisfaction.

After a talk from pain management expert Frank Lee, MD, on a project he started to increase transparency about the way patients’ prescription narcotic use is tracked and to hopefully, in turn, curb prescription painkiller abuse, speaker Aaron Sklar closed things off with a provocative statement. Sklar, managing director at Healthagen and co-founder of Prescribe Design, suggested it may be “time for technology to fade into the background.” What he meant is that it is the patient, not technology, that should be at the center of health-care design. “Actually we just coined a new term to describe this,” Sklar said. “D-patients: Patients that design.”

More news about the conference is available in the Medicine X category. Those unable to attend the event in person can watch via webcast; registration for the Global Access Program webcast is free. We’ll also be live tweeting the keynotes and other proceedings from the conference; you can follow our tweets on the @StanfordMed feed.

Photo of Sklar courtesy of Stanford Medicine X

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