[Music] [Music] I am gonna attempt to cowl a variety of floor pretty rapidly I will get to blockchain and it is promised in healthcare and what that is prone to seem like within the very close to future however I wish to do a little bit of setup earlier than stepping into blockchain itself however I wish to speak about among the gaps that we face as we speak in healthcare first a few viewers questions so what number of of you’ve had a video go to with a physician so perhaps 20 30 arms okay what number of of sequenced your genome perhaps 40 arms and of these what number of of you’ve donated your genome to science cool virtually all people anyone learn Blue Zones superior and what number of of you personal a related chat bot whether or not it is a lexer Google house or any kind of chat bot a couple of third what number of have Bitcoin in your pockets put your arms down the IRS is watching they wish to do capital positive aspects tax on a forex different cryptocurrency how many individuals personal different crypto aside from Bitcoin okay a pair anyone learn weapons of mass destruction MIT h sus not my Lisp okay so it is it is a actually fascinating spike Kathy O’Neill got here out a couple of 12 months in the past and talks about systemic biases that result in social inequity and the way a variety of AI is being constructed a very essential learn and the seventh sense is anyone learn the seventh sense it talks about how the community impact is resulting in pure monopolies there’s a variety of debate in Washington now in regards to the massive tech firms and the and the affect they’ve so these are all related to what is going on on in blockchain as we speak so a few related quotes that thinker Spinoza stated nothing in nature is random a factor seems random solely by the incompleteness of our data and this was a whole lot of years in the past and has by no means been extra true than as we speak William Gibson as Daniel stated earlier famously stated the long run is already right here it is simply erratically distributed I like so as to add converged operationalized and scaled and the rationale I say that’s that now we have all these exponential applied sciences and but the uptake of those exponential applied sciences in healthcare is comparatively sluggish and incremental I will come again to that time however the uneven distribution has to do with how we converge and operationalize them the third one is from Larry Smarr who stated your immune system is booted up by your microbiome and there is profound proof that well being and illness are decided by the micro organism in our intestine after which lastly Frederick Douglas who stated it is simpler to construct robust youngsters than to restore damaged males and I believe the essential level right here is we want to spend so much extra of our effort occupied with learn how to develop wholesome habits at a really early age now at an occasion yesterday afternoon Katharine who simply spoke and I have been speaking about what we have been going to cowl and we discovered we’re each going to speak about sperm sarcastically and he or she talked about in gender within the sorting what I wish to point out is that within the massive debate between Darwin and Lamarque Lamarck was fully discredited as there being any inheritance of acquired traits turned out that he is proper we now have a number of research displaying that in case your father your grandfather had caloric stress throughout their puberty years the cytoplasm and the micro RNA and their sperm confer longevity to their offspring and there are different examples of that however is absolutely fascinating so stress and her mother and father stress throughout the perinatal interval and stress throughout early childhood experiences the pioneering work being achieved right here in San Diego and opposed childhood experiences have a profound influence on our well being is all through the remainder of our life so I will speak about six vital gaps and that is the arrange I wish to do 4 blocks so blockchains the final subject however the first of the evolutionary behavioral hole the second is the lifespan well being well being span hole third is the empathy hole fourth is what I referred to earlier is the exponential incremental hole the fifth is the motivation mannequin hole and I am not going to talk an excessive amount of about that subsequently so I am going to simply point out proper now that everyone is aware of that the fee-for-service mannequin if you happen to pay individuals to do stuff they do extra stuff however if you happen to do it based mostly as daniel stated on outcomes we will convert from a sick care system to a well being care system and focus extra on prevention the second factor is in giant establishments like my very own the way you incentivize innovation actually issues there’s many alternative fashions and I’ve really written a weblog about that very concern about learn how to incentivize innovation in giant establishments after which lastly the belief and company gaps and that is the place blockchain guarantees to play a very enormous function so I will be setting that up so within the UK they’d prefer to say thoughts the hole take note of your buyer and give it some thought extra from a root trigger evaluation perspective so we will shut all six of these gaps with the assistance of exponential applied sciences and in the end create what I name a community-based and personalised behavioral symphony of wellness by bringing these applied sciences collectively and serving to them converge and assist us obtain our personal private well being targets we additionally must renew our give attention to wholesome parenting and early childhood experiences to construct resilience and mindfulness and our kids it’s less expensive to develop wholesome habits and youngsters that it’s to restore the the morbid sequelae of unhealthy habits as a baby there’s really economists at College Chicago that is really demonstrated this very definitively that you simply get a 7ex return on funding in youngsters so the primary two gaps are type of associated the evolutionary behavioral hole and what I imply by that’s that our total early evolution as a species was based mostly upon are dying at 20 years of outdated and preventing for each calorie we may get however now now we have an abundance of meals and it is driving the morbidity and value of well being care in an enormous method Blue Zones have so much to inform us about that I will come again to the Blue Zones the second hole is the lifespan well being span hole so who needs to reside to be 120 if you happen to’re sick from the age of 80 on so how will we use particular person how will we personalize our know-how inside a neighborhood context to give attention to constructing wholesome lifelong habits that assist us reside not only a lengthy life however a wholesome lengthy life and once more the ACE research are very informative if you have not learn it I extremely encourage it achieved by Kaiser Permanente right here and the Facilities for Illness Management a long time in the past and there is nonetheless the benchmark in that after which lastly how will we create private chatbots similar to a sage on the shoulder that assist us our personal choices all through life so once more Daniel stated it nicely we have to go from sick air to healthcare so that is the primary graphic of the evolutionary behavioral hole and so the introduction of abundance of energy which are very low-cost have led us down this path and never solely does weight problems result in diabetes it additionally results in many types of most cancers coronary heart illness strokes and all types of dementia together with Alzheimer’s so we speak about well being care reform trying all of the coverage within the provide facet we’re lacking the purpose that a variety of the prices and the morbidity has to do with our behavioral decisions so the Blue Zones if you have not learn it please choose up a duplicate Dan Buettner went all over the world in search of locations the place individuals had lengthy wholesome lies and stated what are they doing what differentiates them and these are the 5 websites and we now have the chance to take the knowledge that he discovered from that and apply fashionable behavioral and motivational science to assist broaden Blue Zones to aside from only a few small areas on earth so the 4 issues that he discovered and most are fairly well-known is food regimen train common adequate sleep and the fourth one which’s a lot much less nicely acknowledged is having a wholesome social help construction there is a examine achieved at Carnegie Mellon revealed a few years in the past the place they took 400 volunteers gave all of them publicity to a virus and watched you bought sick and the way sick they acquired then they checked out their Fb Timeline and did a survey of what number of hugs they’d had previously two weeks and what they discovered is that individuals who had a wholesome help construction we’re way more immune to getting sick and have been a lot much less symptomatic in the event that they did get sick and that was unbiased of whether or not or not they have been beneath stress that it was the wholesome social help community that conferred the improved immunity and so those that did not have a wholesome help construction who weren’t beneath any undue stress in the meanwhile have been extra prone to get sick than those that have been beneath burdened however had a wholesome help social help system actually actually essential to consider this can be a traditional examine revealed within the Journal of Drugs displaying that what we do in well being care actually impacts solely about 10 % of our well being genetics 30% our particular person behaviors are 40 and we have to pay much more consideration to that and these exponential applied sciences are going to play a severe function in serving to us there so that is Larry Smarr who’s going to speak tomorrow I believe and he he talks about farming your microbiome so there’s extra micro organism than cells in our physique the microbiome helps regulate the genome in a diurnal sample if that impacts their immune system and our neurologic wiring if you happen to give antibiotics to a baby excessively at a younger age their mind is wired in a different way for all times and so what we what can we do to assist farm our microbiome most significantly a plant-based food regimen with not less than 15 differing kinds and Rob Knight’s going to speak about this 15 totally different greens on a weekly foundation and it seems that periodic fasting can be actually useful and convergent with our our evolutionary historical past so what number of have seen this e book or learn it to a baby earlier than a great evening moon superior okay so it is not simply that sleep is nice to relaxation there’s been a number of debates about what why will we sleep within the first place however in truth what we all know is that we consolidate reminiscence and sleep and we additionally take out the trash so there’s an accelerated elimination of amyloid from the mind and the mind really has a little bit of movement to assist excrete the metabolites and nights of sleep and common sleep patterns are extremely vital so how does know-how how does exponential know-how are available there are a few startups which are performing some actually fascinating issues round resilient and conscious well being and the way you inspire individuals in the direction of their targets so the primary is nicely up and so they have a look at the social determinants of well being they have a look at individualized studying types they do motivational interviews after which they customise this system to handle individuals’s points with each studying types and motivational instruments body well being does a motivational survey and might inform who responds to humor who responds to very directive sorts of messaging who responds to a number of choices and shared decision-making and we will we will remodel our motivational instruments into what I name personalised emotive icons in a motivational formulary so utilizing a motivational type moderately than a drug formulary so the third hole is the empathy hole and there is an epidemic burnout of overwhelmed physicians and folks like to blame the well being report however that obscures a variety of the alternatives to handle this concern chatbots with open ap is Dan you talked about that with self-service and clever escalation to an expert as applicable VR and AR I am going to come again to that AI IOT and robotics Neil spoke about that however these are actually going to assist offload routine duties and assist restore time house and the incentives for empathy and so once I say incentives now we have very intensive affected person satisfaction surveys with all the pieces that we do and so when physicians know that how their sufferers reply to them they’ve an incentive house in addition to time to revive the empathy that they went to medical faculty for within the first place this can be a cartoon from the LA Occasions various years in the past displaying simply how wired the doctor is making an attempt to cowl all the pieces that pops up at each encounter augmented empathy within the function of digital actuality is absolutely fascinating the Stanford digital actuality lab has proven that if you happen to determine with your self in a digital house and you then bodily switch your picture off within the distance you’ll be able to then remodel your picture as to gender as the peak as to weight as to racial and ethnic background and and construct a kind of empathy with that and reycarts whereas in a tremendous interview by Peter Diamandis simply final month I I strongly encourage you check out it stated in digital actuality you might be another person proper now really altering your gender in actual actuality is a fairly vital profound course of however you would do it in digital actuality way more simply and you may be another person a pair may change into one another and uncover their relationship on the opposite’s perspective would not that be cool if we may be taught that ability at a a lot youthful age the fourth is a translational hole and that is what I discuss with is why all these exponential applied sciences are simply not being embraced and applied in giant healthcare enterprises worldwide and in it and it has to do with that convergence and the operationalization and the scaling that is actually onerous developing with an important concept in a brand new know-how it is tough sufficient however converging it and operationalizing it’s fairly a problem I will give a pair examples of that so we additionally must ensure that we’re utilizing knowledge in our massive knowledge analytics and our machine studying that is similar to what’s accessible to us as we speak in order that it is related to how we apply it to future datasets so one of many massive issues about AI is the coaching set that you simply use for a specific machine studying atmosphere it has a profound affect there’s a number of issues that Neal articulated that may be traps if you happen to’re not cautious so now I will give a few examples and the primary is imaging alone so there’s some nice apps that do unbelievable picture analytics in healthcare but when they do not embody the opposite accessible info to a doctor they will fall quick in some circumstances in sure circumstances unnecessarily so we have to ensure that now we have a comparable set of information so first one is telemedicine digital care and social service that appears actually apparent and very easy simply load up a digital camera make an employment away you go it seems that the staging of the way you get individuals to ensure that they’re registered on-line when the doctor or the case supervisor is on the market and so they have all the knowledge accessible and that it is a extremely environment friendly course of is tough belief me we have been at it for a pair years we’re as much as about seven or eight thousand video visits a month nationwide now second is first responder drones so I am simply launching a undertaking now with UCSD and the Qualcomm Institute and and with Verizon than a drone fleet administration firm they simply required to implement first responder drones as a result of they may very well be wherever within the metropolis of San Diego within the County of San Diego in 3060 seconds which throughout visitors hour may be very tough the variety of parts and components to make that puzzle match is profound and so we’re simply starting to work on that massive knowledge analytics for sepsis that is actually fascinating as a result of now we have our personal mannequin of detecting out utilizing massive knowledge analytics however proper across the nook are all these exponential applied sciences trying on the nucleic acid of the micro organism in your blood and oh by the way in which they’re an abaya antibiogram whether or not have been their antibiotic sensitivity so a variety of that is going to alter with that inch at I am I am gonna skip a pair slides and speak in regards to the company hole so restoring company the people and communities is absolutely vital traditionally within the hospital centric world and the physician centric function that is all been about I am gonna do these assessments on you I will inform you what is going on on after which I am gonna provide you with one thing a prescription for what to do but when we’re gonna go from sick care to well being care we have to be way more involved about our each day habits and the way we take into consideration that so affected person centric is an oxymoron as a result of sufferers are what medical doctors name individuals and folks have lives exterior of being a affected person once they simply present up in your clinic your hospital emergency room appears type of apparent but it surely’s it is a distinction that does make a distinction so what if we every had a private cloud as Lee hood really useful right here at this very stage final 12 months an enormous private cloud of all our well being knowledge that we managed and that it was maintained utilizing the safety and the privateness of blockchain companies in order that it might be safe and beneath our management and that we may apply one of the best resolution help AI and machine studying accessible to our personal knowledge with out essentially having to show that in a way more public house so the private well being report which has died a number of deaths there was Google well being there was Microsoft well being fault there’s been various others which have did not get traction it might be it is it stays to be seen however it might be that after now we have a seamless easy course of the place all you have to do is have your identifiers in your blockchain pockets and that all your healthcare encounters are mechanically uploaded into your private well being pockets after which you would subscribe to varied resolution help companies to use to that info and voila you’ve self-service I believe that is an actual risk it isn’t going to occur this 12 months subsequent lots of people engaged on it there’s two startups alone in San Diego engaged on that is one in Denver this couple in Boston lots of people are taking a look at blockchain and private well being data so I additionally wish to point out the equity Mulligan so in golf a mulligan is the place you get a get to take a shot over once more Thera is aware of actually poisoned the waters the corporate that famously promised that they have been doing all types of amazingly cheap testing on micro drops of your blood however in truth has confirmed to be fraudulent and what’s occurred is that they poison the water as a result of there’s so many cool applied sciences in that very same house which are rising and it is tougher for them to get funding than pre thier nostril meltdown however they’re progressing nonetheless and with a Qualcomm tricorder X PRIZE and with many different firms on this house I’ve seen some superb stuff that simply must be a bit extra miniaturized a bit higher battery life and rather less costly and a few of these are coming to market within the subsequent 12 months – and are extremely promising to revive autonomy by permitting us to maintain ourselves one such service can be for diabetes as a result of any anyone right here is caring for individuals with diabetes is aware of that in the event that they lose 30 kilos the algorithms with the which you deal with them completely should change in the event that they stopped in the event that they entered themselves and so they stopped exercising the algorithms modified it might be short-term or in the event that they achieve weight it goes within the different course so how do we offer an entire set of information and expose it to machine studying that’s educated on you it is your knowledge that it is educated on and it is aware of you and it is aware of learn how to adapt based mostly upon your food regimen your train your weight your stress degree your autonomic nervous system tone which has a profound affect on diabetes administration so there’s already some work being achieved within the house and I anticipated I do not 5 or ten years it will likely be simply the usual of care that everyone has their very own personalised algorithms for diabetes after which collective company and communities that is the place the social determinants of well being are available and the way will we ensure that communities restore a few of that social help construction that so evidently within the Carnegie Mellon examine confers upon us a more healthy immune system extra resistance to an infection and illness we can be opening our Faculty of Drugs at Kaiser Permanente a primary quarter of 2019 and we’re embracing these ideas in how we’ll remodel the schooling of physicians so blockchain and distributed ledger know-how I discussed a few instances it truly is profoundly distinctive in how the know-how has been introduced collectively so what number of of you’ve a fundamental understanding a block change a present of arms okay nicely nicely over half does anyone know when Milton Friedman predicted Bitcoin any guesses okay I am going to reply the second what number of of you’ve Bitcoin in your pockets okay anyone participated in an IC o—- preliminary coin providing okay it is a new method of funding startups and a quite simple method so a few quotables blockchain is straightforward if applied property must be invisible to the person that is from Mike of the CEO of gem after which brian behlendorf of the hyper ledger undertaking stated we expect coalition constructing is the way in which to do this blockchain permits us to alter the physics of information sharing by permitting us to broaden safe non-public entry to knowledge in a decentralized equitable method so no person has to personal this it does not need to be a hospital system does not need to be a authorities it may be in a distributed atmosphere so three vital paths to implement blockchain the primary is simply do all of it from scratch which is absolutely onerous as a result of you must construct a coalition of various establishments the second is substitute for an current platform and that is what pocket doc is doing the place you’ll be able to have incremental substitution of particular person parts in order that I believe that the web goes to be one of many main forces for decreasing the function of presidency the one factor that is lacking however that may quickly be developed is a dependable ecash the tactic we’re shopping for on the web you’ll be able to switch funds from A to B with no figuring out B or B figuring out a the way in which through which I can take a $20 invoice and hand it over to you and there is no report of the place it got here from and also you you might get that with out figuring out who I’m that type of factor will develop on the web and that may make it even simpler for individuals to make use of the in and naturally it has its detrimental facet it implies that the gangsters the people who find themselves engaged in that unlawful transactions can even have a simpler approach to stick with it their enterprise so 18 years in the past the economist Milton Friedman really charted the design of what has change into Bitcoin and among the pitfalls related to that pleasure Searles has stated that blockchain is just like the opposing thumb to the hand of the Web so the web was designed to be very free however not essentially very safe so blockchain is an extremely highly effective instrument in live performance with the Web to supply that type of safety so how does it work mainly every of the blocks and the chain is referenced to the one earlier than it and there is a hash construction based mostly upon the product of prime numbers and so you’ll be able to decide whether or not or not H a whole chain is legitimate based mostly upon whether or not or not the hash from every prior block matches the prior block and the longest chain wins in any kind of contest that is disrupting each vertical in together with healthcare so in well being care private well being data identification administration world safe knowledge sharing for analysis and medical use researchers sufferers ontology digital property administration within the Metaverse within the digital world how do you guarantee that one thing is a professional supply after which provenance administration chain of custody for units medication and fact versus pretend information whether or not medical info or in any other case so blockchain belief firms this can be a e book that simply got here out in July the stated the printing press closed the data hole the steam agent closed the facility hole the web shut the gap hole and blockchain is closing the increasing belief hole and we have change into an essence of world the place we feature the burden at all times need to belief however confirm virtually each transaction and each firm is vulnerable to being disrupted by a trusted model of itself blockchain isn’t going to trigger world peace blockchain isn’t going to remedy all the pieces but it surely’s having profound results in each vertical and the ramp as much as it’s a traditional exponential the ramp as much as it might be lengthy however because it begins to take off in every vertical it is it may disrupt all the pieces so present issues consensus round forks within the software program code resistance to quantum laptop so Google can be utilizing a quantum laptop by the top of this 12 months 49 qubits which can profoundly disabled virtually each encryption system based mostly upon prime numbers so there’s a complete initiative proper now to make quantum resistant blockchain there’s there’s some points about transparency and a few points in regards to the efficiency of writing to a blockchain very last thing I wish to point out is when now we have the flexibility to handle all of our personal knowledge after we can then expose it to one of the best machine studying that is that is actually related to us we will have what I like to consider as a sage on the shoulder the place we use pure language processing to transform to neuro linguistic programming and cognitive behavioral remedy and actually start inspiring wholesome habits and wholesome response patterns and resilience and mindfulness from a really younger age and at last utilizing exponential know-how ought to assist democratize D materialize and decentralize blue zones and prolong our lifespan and well being span and this quote from Hubert Humphrey that is hanging within the halls of Well being and Human Companies in Washington DC is has by no means been extra related than it’s as we speak with what is going on on in well being care reform on this nation for positive it has been stated the ethical take a look at of governments is how that authorities treats those that are within the daybreak of life the youngsters these are within the twilight of life the aged and those that are within the shadows of life the sick the needy and the handicapped and all of us as technologists and entrepreneurs actually need to concentrate to this I like to recommend you learn weapons of mass destruction and the seventh sense to know among the recognized pitfalls and thanks all very a lot [Applause] [Music] [Music] [Music]