>> i just want to underscore that that is why it is so important as the court case becomes a topic of the news of the day as the case gets closer that we also don't forget that putting all of our eggs in the basket will solve this problem. so we must be vigilant if we can't just depend on the courts. we have to depend on congress to do their job and do their job completely and fully and continued the road to full repeal. next question. >> i would like to take my scalpel to this whole problem and i would like to just cut it. let me ask a first comment for everybody. when the itt 10 system could perceptively come into existence, the impact on not as it intertwines with the declining reimbursement and electronic medical records could have another colossally damaging

effect on the system. mostly what we are talking about a shortage isn't just about everything. most of you know that there is now a burial finding shortage of oncologic drugs. we see shortages of immunizations and shortages in the present system of nursing care and we see this everyday in our lives. but i have a question. if there is a lawyer in the room, but would have been a following took place? an insurance company moves into scranton, pennsylvania and sells insurance without any mandate that all? pennsylvania has 63 mandates. these are those other mandates that don't get talked about. what happens then? is so very low cost insurance that is very high quality and very high coverage and actually pays people incredible way. but happens after that? >> it would be illegal under

pennsylvania law that they would not receive a license to sell in the state and therefore the entire business activity would be illegal. >> at the lot in pennsylvania are loose enough to play in the court? >> no. >> i mean, this has been litigated. the insurance commissioner has the power to license and sell insurance if you don't get a license from the state come you're not allowed to sell insurance. >> and it wouldn't fulfill the individual mandate, either. >> and i may take the liberty of asking a question that follows with that, which is that the health care that go into effect, will be in your opinion have yet another two-tiered health care system for the haves and the have-nots? >> a lot of people say i'll be alright. i can afford to pay whatever he needs for health care and i will make sure i have a catastrophic policy. i think that is just -- the health care system is a network. it is a web. it is a vital, integrated system

in which hospitals provide better surgery because medical device companies are able to, but the new and better surgical techniques and diagnostic techniques and machinery. drug companies are able to produce new and better medicines that doctors can prescribe to keep people out of hospitals. if the system is not working, if the incentives are wrong so that the pharmaceutical companies have to go through so many hoops to get their drugs approved, at some point they either have fewer drugs are they just can't do that anymore. all the insurance companies see them -- i have a paper on our website called a radical restructuring of health care that talks about health insurance companies simply feeding states because they can no longer figure out how they can comply with all the rules and regulations and make a market in health insurance. and that durst, 40% thinking of

leaving prior islamist laws are fully in effect until 2014. the infrastructure of the health system is declined. and yet, some people will be able to buy their way out. we may want the people going to canada or offshore companies being created. but the quality of health care in america will decline for everyone and people will not be able to combat the drug is not created, there is no way you can get that drug. >> i have a slightly different perspective. i actually think the bill is going to be fine for the law. it is fine for big pharma and big insurance. that is why big pharma has spent $150 million lobbying for the bill. they showed up for the white house. billy tauzin had met with the president he came out with all sorts of agreements to spend money and campaign for the bill because they know a lot of the bill were ever insurance has to cover prescription drugs at the

lot of new expansions and medicare for them and they are going to have brand-name drugs covered under the doughnut hole where they were going to generics. so they came out ahead. big insurance dropped the public option is to $70 billion a year. the small medium insurance companies can comply they will go out of business, but that is great for insurance companies who will control the market. i think the ama lobbied in favor of this bill because they think that is going to mean that their dog or is there going get special treatment under this. they look at the doc put him in things like that. so i think this is a great tool for big business. i think it is just the little guys that are going to get stepped on in terms of all of this. >> of course it is amazing the american medical association only represent 17% of the

doctors at the man on the street thinks dna represents every single doctor. my worry as i said in my talk is that private insurers will be crowded out in a lot of docs say to me, we'll just do a private concierge will be fine. if you look to canada when they took over the health care and the provinces and federal government took over the health care system, the canada act, then a private payments and so we have to be very aware that this could be an alternate consequence of the affordable care if it's not repealed and replaced. private medicine could be of automobiles and medicare for all systems. >> question up here. >> if this bill is popular as i believe it is, too, why is it our three top presidential contenders are raw each in their own way for some form of obamacare and apart from the question, more practically what we do come november presidential

election? >> yeah, you know, ross mike said he to make a move in the 51st state, so i am thinking of moving there. laughed my you know, it really boggles my mind. the fact is we talk about why are we not doing more to repeal it. the fact is the two leading presidential campaigns support an individual mandate. new to the federal level, nick at the state level. you know, and they all support exchanges. they both supported out of the insurance regulation going on, community rating a guaranteed issue provisions. for all the bases during bars at each other, there's not much of a farnsworth at the both supported prescription drug benefit expansion. $1500 of medicare part d. both were in favor of it.

so it really is hard to draw contrasts and i think is going to be much more important at the congressional level when this comment ideas sirens they are all given lipservice although they repeal it, i don't see any of them leading the fight. they will sign it if it comes out of congress. but that is for the fight will have to be. can i do think that is right. i think congress will have to lead on the senate bill shows up on the president's desk to repeal as much as they can or reconciliations necessary of the senate. all you need is a presidential assignment because i think romney said he will repeal is the first thing he wants to do, but then he says, well, we have to repeal and replace and i am glad i have shown what i will replace it with. that is not cutting it. >> and it is interesting. all three of us are critics of

omnicare. so probably mr. romney is not any of us are going to be secretary of hhs. but i just cannot understand why mr. romney will not say if that is a good idea for massachusetts. we have the evidence and ended not good. so i made a mistake. but he won't do that, so that is what makes it very, very frightening. so i'm going to buy an old ship, not the one that crashed off the italian coast. i will set up my liberty ship and they can all get our health on the liberty ship. >> i would like to also underscore what the seven what mr. shadegg said white is so critical congress gets it right this summer. they will cite an important element for the future of the health care system should go at the health care law can get repealed. and i will say also should be a cohesive plan and not just enough of that soup fan of everyone's idea that makes no sense. i think we need to be on to

explain to the american people as has been done in this book and heritages plan on saving the american dream anafranil says their own ideas on what to do. but they all sit together in an important way and that is another important feature moving ahead as the debate continues. do we have any more questions? we are bumping up on our time. >> to the congressman's point to i have a great respect for him the house side with repealing the entire lot. i note there is more conservative members in the republican caucus better for our brave repeal is only our brave repealed. so how do we move to -- i move away from if we repeal portions of the lot with the advice tax, everything else, how do we move to where we are not making a bad law better? >> there is huge amount of discussion in the congress on exactly that point.

if you repeal it, will you improve it? i think that is such a misunderstanding of how truly monstrous despot is. i mean, they could pass a law, passed a bill every week between now and november or whatever the election date is, sixth. and they would only on the margins be able to make this all better. it would still not passed the senate. so the house has to continue to keep the drumbeat as with educating the american people about what really is in the spot. they had a huge part of the spot that they just put america in order order to be able to pretend that it was a dead set reduction law. and it's just outrageous. you shine a light on nine do not talk about the independent payment device reported many talk about the employer mandate and its job killing. they just need to keep the drumbeat. there are some members. i think they have begun to realize, you need to have

handles to explain to people what is in the lot where they are just going to say the president is right and they say don't worry about this. it is just a bunch of the small stuff. what with all the fuss about? only did was for name their parents policy. the only way they understand is that if congress continues to say here to say here is what law. $575 billion in new taxes in half a trillion dollars in cuts to medicare. the unbelievable expansion of medicaid is going to bankrupt the states. mandates on businesses, mandate on individuals. all of those, part of the law that should not stand. >> well, we'll take one more question if we have it. going once? okay, one more in the back. >> with the medical loss ratio, there has been talk about the impact it will have on health

savings accounts. it doesn't appear that they are canceling these plans right now from what i see, but what kind of timeframe are we looking at quite >> we don't know for certain yet what the impact will be on health savings accounts because the rules haven't been written yet about what is going to count in terms of the medical loss ratio. a lot of it depends on which said hhs comes down on, how employee contributions are treated, how are the individual payments under the account treated? will weigh two of these things count on the minimum payout requirement that is in this? so we know that some said it now probably will fail under any structure. you may qualify. a lot remains to be seen how the rules go into effect. i believe we are talking not until 2014 until everything goes into place. so that it's been a real impact

will be. i suspect before the election there'll be a lot of talk about how lenient these euros will be because you don't want to frighten anybody and after the election rules will appear to be very tiny. because we know the president actually said he does not support health savings accounts. if you start to doubt that appeared there a quote saying he believes they are based on the people who consume health care so he thinks that this is the wrong approach and i think he's not going to be very sympathetic to them. >> so the real concern with the medical loss ratios for the federal government is still in health insurance which percentage of the premium has to stand for actual medical care versus administrative costs. the problem of health savings accounts is that the insurance itself doesn't trigger and until people reach their deductible, which is higher, which is why the insurance is cheaper. but yet the insurance company

has to keep track of, has to know if you reach the deductibles are therefore they have to do all the administrative cost of making sure i'm really figuring out that you spent $50 on this doctor's visit in $100 on your messenger here and so they know how to get to that point. so even though they are spending months on medical care, they still have to do the administrative cost to figure out how someone has reached out to the pool. and they are killing them. if they would've put in the song we are going to get rid of health savings account, i think you would've had a hard time passing it because a lot of democrats say these are valuable. what they are doing is killing them, strangling them or regulation. but here is this really narrow prescriptive rule and health savings accounts just aren't going to be able to comply with it and therefore they would not illegal policies. there are other examples, but

that is a specific one to show why i think they are on the chopping block. but as we have and that wording. >> in about 12 million americans have hsa's and they are very popular particularly among the younger population of one insurance to be there for insurance purposes and catastrophes. as michael said, the president doesn't want them in a few small companies that only offered hsa summer to come out of business. so that is a precursor. if you look at the flexible savings accounts they be able to put a $5000, this year's $2500. so i think the writing is on the wall for the fact that this is not something that is part of the agenda on the president or hhs's agenda, continuation of hsa's. >> who comes off as a question as you have got part of the tape first out of the hsa. well, if that doesn't count as a

payout against the premium, then you get into the problem or insurance companies are running up costs are not making a payout and they will be in violation of the rule. now if the a discounted as being paid out against the premium that might qualify. but then you have the other problem, what about the contribution the employer made to an health savings account. is that counted as a premium cost in which case he made the premium more expensive than a payout may not qualify as meeting the minimum loss ratio or not. that is why rules will be very important for how they play out. >> they basically say if a person pay for medical care out of their health savings account, that doesn't count. it only counts at the insurance company pays for it. but they have to calculate how much that is in medical expenses. and part of the administrative costs. it's a very demonic way, i think, of killing health savings

accounts and directly rather than doing it more exclusively. >> the authority said you cannot use your hsa account for over-the-counter meds. and so what does this mean? people go to the drugstore and get an over-the-counter med. now they want a medicine may have to go to the doctor, get a prescription this adds to the cost of health care. >> you don't use it forward the generic drugs for the stuff over-the-counter. is that if you get a prescription you can buy that with your hsa. >> i would just like to advice and i guess that was at the heritage foundation details matter and the more the american people know the details, the less they will like it. so i thank everyone for the panel. we do have books available when you came out, so please suffer to pick one up. but let's think the panel one more time. [applause]

>> and now, eric topol contends that digital technology can make it more efficient and effective. due to what the author argues is the medical community's resistance to change, technological advances have yet to be fully accepted. this is about an hour and 15 minutes. [applause] >> thanks very much. i'm really glad to join you this evening. thank you for coming out to this connecting to find it very informative and enjoyable lego. i know i will, so hopefully you will as well. we are going to talk about a new medicine that transcends the year of voltaire. so i can't disclose sitting up here where medicine is today still. i know you think that is kind of harsh. yeah, isn't that? so i mean, i think going through it will help cement where we

are. doctors prescribe medicine wishing it was secured diseases which may know less than human beings wish they knew nothing. anything that is off days, but we are going to go over the next 30 minutes or so will be a whole new year of medicine, which i'm hoping it will help push forward. because if you don't do that, it is not going to come too quickly. and the book is really adopts a creative destruction concept popularized by denoted asking economist, joseph schumpeter. you remember he was -- those of you who are into economics, he was very active in the last century. in fact in 1911, just 100 some years ago he published the book of the theory of economic development. nec the craft which basically depicts the old world and the new work, some teams as big innovation, big entrepreneurial space that have been for the new economy to foreign.

and that is what i am not trying to apply to medicine is this concept. this is very different than the clayton christiansen model of disruptive innovation that takes us to another path of innovation and radical transformation. so i'm a big fan of schumpeter obviously and my favorite column to read each week is the economist schumpeter. so last week i ran the column and it says, now for some good news. i had no idea what this column was going to be. it sounded like an interesting title and it turned out it was a review of this book. for those of you who suffer from armageddon fatigue. i have to tell you that made my day. that was fantastic. so they schumpeter in lieu of getting to -- before i do that, it is basically about digitizing human beings and how that resets the hallway medicine can move ahead. but i want to just get a sense of the crew. and i want to find out how many

of you are active on twitter? okay, we've got three people. what i want to suggest is you need to get on the kazaa is right at him a useful information. most everything i will discuss this evening i found first on twitter, just that we found out that osama bin laden would be killed and about of god through twitter many, many hours before the world knew about it. things that happens in medicine for any significant article is published, it is immediately critiqued on twitter. so if you follow a particular thing and you want to know if it's the real deal, that is a great way to find out. >> okay, i want to convince you of two things. the first is the a world has been schumpeter. the second is medicine will. this is a verb now, kind of like

google. consumers seem to drive it. and that is the most important premise and that is why wrote this book because i didn't take i could work with the medical community anymore. we need to get the whole public consumer world debated. so let's start off with the digital side that has an amazing amount of action in a short period of time. and the last decade there was a couple things of no editing captured this. there are no more cell phones i plan it then there are toothbrushes. that kind of tells you over 90% of the world's population has cell phone signal and not tells you the kind of digital infrastructure therapy is today. but the other thing that happened is really good for these devices. i'm very gratified you are not in your smartphone.

i noticed a lot of you have those so i knew at least in the digital area for that respect. but these devices that started in one, the blackberry, which then inquiries i slack. many thought the prototypical smartphone, e.u. leaders and all this happened in the span of nine years. that is an amazing amount of change that took over not just of course how we communicate any longer for how we shop or game, but even how we perceive and think. and that is radical. that is creative destruction. so in this weeks economist, this is the article, slave to the smartphone. the horror hyper connectivity and how people feel they are surgically connect it to your phone and have to just be very

responsive to anything coming through in a transaction coming. it is gotten to the point where it is not just one screen. now we have to be multiple screens. you have to have the tablet going on to watch television, also with your phone. and we have a new species of man. this is distractors. that is what is represented here. [inaudible] >> at, that too. now, this is a phenomenon that starts at a very young age and i realize there are not too many digital natives in this group that you want. this is portraying how you start. i thought this was pretty young actually. this is one that really captured it. for those of you can't see your,

mom keeps tacking me in these pics to my embryo phase. so embarrassing. so you know, that is a little hyperbole, you get the picture. so i want to answer the question in the first question as i know you get this. if you don't, i will follow. what was zero and 2004? zero. in 2011 the hundred million. good, i don't have to follow very. now, why is this so impressive? this impressive for many reasons, but perhaps the most extraordinary thing is by august it will exceed 1 billion. it's all lost about hundred 70 billion months now. soon after that it will train then the community people in china or india. this is pretty darling. this is an offering and the fact

these people can have $100 billion is anchored by the select button and an ability to digitize human beings at a very superficial level in terms of affinity is for retail. and of course you don't want to wake up and have no friends and i don't know if all of you -- by the way, anybody here not on facebook? okay that's good. we are going to get into that a little bit later. these companies are digitizing your everyday. and of course they are not just google searches, but you have got -- now shasta lake button. anything you do would be the four horsemen of our digital infrastructure today. they are digitizing. and in fact -- at enough to see an article in atlantic, but i hardly recommend you read it. this is about the 140 can't use

tracking everything you do on the web. 104 issues today. and of course we added to google. you probably saw the new "time" magazine feature article a few years ago where targeting retail stores afire these companies than they know, for example when a woman is pregnant while before her family knows she's pregnant. that's really giving you a capture of digitizing human beings, but not in the help of medical space. but i thought this cartoon -- this is how you protect yourself from being -- from google. at about the same as, but it has some interesting things like playing a sick but they cannot hear what you are typing. they have god kind produced to prevent dna of the cage, you know, unplug computer.

all these precautions are being digitized. you can't be on the web. you can do everything. in fact, the article from the atlantic you can do everything possible and still being digitized. and away, we are going to take that to a whole different level. so here is the next question. what was now zero and 2006 is now well over 300 billion per day. tweets. that is how many trees are put out each day. so, that is basically setting up -- by the way, how many on google plus in this group? okay, interesting. so we have very few in google plus. very few in twitter. even less than google plus. and the several non-anti-facebook. interesting group. in most of the world, there is an attachment of each person

with a social network. it is different in different parts of the world. you're in brazil or if you're in china it's cute shoes archly. but the point is that these people have come together and have achieved things that were never imaginable. and you know that because this occurred. and that is because of sharing a motion, pictures, dots and getting people and empowering them at a level that was unprecedented and despite the occupied movement for there hasn't been protests in the streets for over 30 years because of this phenomenon social not work. now, facebook was not designed to save anybody's life. it is a nonmedical rudimentary platform. but here's an example of saving a lot. this is a boy who was very sick. high fever and what was question was what was wrong with it. he was seen by two

pediatricians. they have no idea what this was. his mother posted the video on facebook and one of her friends made the diagnosis that he had kawasaki's disease which ended up saving his life. and now all of these online health communities, which you are probably familiar with. patients like me and care together. you've heard of these things. and that is kind of interesting because now people in these online communities trust their peers with light conditions more than they do their doctor. not all, but many in a significant portion. it is a big change in medicine. what is even more surprising is when.yours, 4000 of them are asking that you know about patients like me and these other ways that they get their information? only 11% have heard of these and here i am guessing. this is just resent. this will stop you, but what

does this picture represent? anybody? has historical significance, particularly to this region. it is in san diego at zoo. does that help you clerics note. a lot of link works. this is the first youtube video ever uploaded. 2005. and it's not worth much. this is 19 seconds and i'm at the zoo. but isn't historic and because that was in 2005. and now we're talking about 2012. look at the data for youtube. 800 million unique users a month. 3 billion views per day. 3 billion hours 4 trillion hours of video, and 60 hours of video are uploaded every minute. i want to ask you, what are we doing here? we should be uploading of a youtube video are watching one

because this is incredible when you think about this. it's staggering. all this together is of course generating immense amount of data. potato, which really gives you a picture of what happens in 2003 from the birth of civilization, but only encountered one zillion gigabytes. now we are generating set of bytes. a trillion gigabytes every year these and that gives while the first or d5 database before the end of this decade. so this is the age of big data. i think data captures this at all. this is generous. what is beyond j&r this? just incredible amount of data and of course you want to extract from the data and process to get the most information like the whole concept of money ball, which i'm sure is more like the book you read because then you find out much more about if you're an athlete or hearing a picture by having a lot more drilling into data because we don't have the ability at this point. that's a big bottleneck for the

future is working with all of this data. in one of the we speak and work with it. the idea is they can save a life. a supercomputer like ibm watson, for example, can process 2 million pages of content in three seconds. i don't know any doctor that can do that, but wouldn't it be nice if every doctorate access for every patient had access in a pointed me made when there was something complex. so ballpoint, which is one of the largest insurers in the country has now contracted since all of the very challenging patient with the capability. that is the sign of the times and i think very exciting. the other thing about dealing with the data if the cloud is everywhere with all the companies and the massive server farm and because of this phenomenon that the cartoons

would help the space to announce that last month they were going to have a cloud-based platform for.terry's, but this is the check in the cloud and was much nicer before people started storing all their personal information cloud. [laughter] annoyed that the pieces fall together and basically these pieces from technology it that are contributing to the formation of a digital infrastructure, which is what will set up this new era of medicine in so many respects. cell phones, personal computers, digital devices, did a little bit on sequencing, social networks, bigger than anyone would've forecasted. this sets up this great inflection of medicine that we would get into it what it really

can mean. so, this is of course the prediction of the demise of hardcopy books. okay, and many of you have a hardcopy book right in your lap. and i am curious about that. i wonder, how many of you only read books to review reader now? no one. okay, that's an interesting group. this is the book's worker. sometimes you go into a bookstore and order the book for your candle. anyways, that's really interesting. i am like you. i think having a hardcopy book is a great thing except when you're in an airplane and they make you shut down your kendall. people not reading the book can't even concentrate to read about because they are getting e-mails and searching the web all the time because there is no

ability to have linear action of the brain. so this is the thing that really convinced me the world had changed. i did my cardiology training at johns hopkins and the welsh medical library is the second largest medical library in the united states. i should say was because on january 1 of this year, it was closed. this whole building, which i spent an enormous amount of my time in training is no longer functional. there is no longer need and that is a reflection. today it was announced after 244 years, the encyclopedia britannica will no longer be produced. so that is kind of another creative destruction. so i hope i have convinced you in this first segment at the world has been should peter, okay? if you buy into that, then we can go on to phase two here.

if anybody doesn't accept that, please this is a good time to move on. now, let's talk about how the world will change on top of this digital infrastructure, much bigger than the microcosm. the microcosm is a cocoon that is done everything to resist this digital impact our penetration or convergence. when that happens, which will have been. it's just beginning to happen is he'll show you. that sets up digitizing and then is really where we want to be. and you'll see why that changes things in just a minute. so they now come everything we do in medicine is based on population. political trial a large populations. the recommendations for guidelines. like for example, when the shutter every year. a lot of women have zero risk of ever developing breast cancer. all the things we do every year at the same dose for all people.

that is not a good way to practice medicine. another way to practice medicine is the other 10 letter word, which is remarkable and we have no new tools to do that. and that is scientists. so these tools started in the fitness world, fitness and health. so finicky shoe, the sensor in the sole of the shoe could sense how much distance traversed and velocity and mass are. does anyone have a group? at that knob. okay, that's all right. just trying to get a sizing of the group here. it is important. then his other wireless et cetera, there is, the jawbone up, recently released last week come and make feel bad. anybody used as accelerometers? one, okay. there we go. i recommend them to my patients because they get sent to get

back to get the 10,000 that most people don't. what is greatest throughout the day you get a reading of how many steps you are getting it gets people moving because they want to be more active to fulfill not getting alarmed and having the right light show or whatever helps to remind you. the other problem we have today on the health side is ruthlessness. we are so wired to wireless devices that we cannot sleep. this is a really significant problem. and i should ask, has anyone heard of this device? no one. a couple people. that's good. anyway, that is -- there severals monitoring devices that you can put under the mattress or under your pillow. they don't measure brain waves. it measures your brain waves. but if they had then that goes directly to your phone and captures every minute is the,

what faces a pure and a goodwill clock and now can go to the phone. i was testing this. i still have it and this is what shows up on the clock. every minute of sleep so you can see the orange bars when you are awake. and sometimes during the night you are weak and don't know what, that's your brain that's your brain is awake. then there's the late sleep in gray. the rapid eye in the is some light green and in the deep restores sleep is in dark green. that is the stuff you really want in the first third of the night. so i'm using this device and my wife is a night owl. she comes in the room and looks at the caucuses eric, i know you are awake and i want to talk. so if you do get one of these things, watch out or if you don't, you really can't play possum in a locker. what is really interesting is when i use this device or the sensor, i never thought that

this story that i just told you was going to be a callout in "the wall street journal" review of the book. that was kind of embarrassing. so this was the thing they made a big deal is. i was kind of surprising. which was a wonderful review and i was very gratified. so now, this is a compilation. just think of this as your sleep managed competition against her peer groups. this is 10,000 people my age and on the same metrics. just think about your blood pressure, glucose, that is what this is. this sets up your social network, which is free to compare if people are willing. so i can compare with and a good sleeper quantitatively every aspect and that is interesting. what is really interesting if athletes have now found out this is a way to really rub up their performance much more so than even drugs. illicit drugs for the sake of us

reported in. so not try out rates are using it in the three nba teams are using it every night and they have shown correlations with the cq composite score and how will the team does in terms of their winning percentages as the athletes. what is also interesting is this is now led to getting all the data together for pro at elite. and this is a summary of that. you will note that the king is leap is that averages 12 hours a but the name. no wonder they haven't won in the playoffs. but it also wants you to note on this draft, the person at the least sleep of all pro athletes as tiger woods and i am not going to comment any further on that. [laughter] so there are these devices that exist today that you can measure your blood pressure. i often recommend this to patients because it used to be i

always recommend the om not device, which is usually $50, $60 at costco, but now i use these devices like i hope because they are fun to make it a lot more reading from patients with high blood pressure at almost every patient i see as high blood pressure. so that is a great way you can head start, get a blood pressure, archives it and sends it to your doctor or your facebook friends or whoever you want to be your google plus friend, your circle, whatever you want. in the same thing with politicos. now there's devices like at the matrix, which is appearing in northern california, same thing with lucas. if you're a diabetic, you can measure your glucose every five minutes to re-center. it doesn't go to your phone right now, but it will. in fact, i have a device to show you. so i am wearing the sensor. looks just like the one they are. you can put it on your arm or

your abdomen, whatever. and so, when i turn my phone on -- this phone. i turn this phonon. it is 7:36. okay, turn it on. and i just collected some include kos read at this moment is 96. and then if i want to see what it has been like over the last hour or three hours, whatever i want to do here, i can call that out. here it is. i'm not in a little silly here. let me get that back. well, it doesn't give you the trend, but it's giving me every minute glucose. here -- so here is over the last three hours and i can do the same thing over 12 hours, 24 hours, whatever. ..

this is the case that goes -- you see on the back these two sensors and it makes a circuit with your fingers on the center of. on my iphone i turn it on and because i'm in this system 1/2 to have a password and i put the apps on and put my fingers on

this and he will see my party and gramm. you see that? this is the cardiogram. big difference. i can tell what rhythm it is, all kinds of things about this. the credit card version if you are does your lightheaded or feeling the girl going in the agency ran you can use the credit card version, pull out of your wallet or purse and send it to your doctor or your friends or everyone to send it, i didn't realize how that would become invaluable in unpredictable circumstances. some months ago i was on a flight, cross-country flight when they called for a doctor on the plane just after they got in the air and the passenger in the last row was having chest pains and of course without a way to do a cardiogram i wouldn't know

whether it was in digestion or heart attack or whatever but because of having this device i could tell exactly if it was a significant heart attack which led to an emergency landing and a passenger who then became a patient was whisked off to a hospital to open the artery but what was interesting is pilots and flight attendants all want to have their cardia gramm done right after that. okay. there is this thing called the halt monitor which was invented by norman holder in 1949 and it has been frozen in design since then. anybody ever had a older monitor or seen at this with a balky device you have to go -- a hook of feet. you can't exercise or take a shower. you have all these wires on you and you have to get disconnected. is a little band-aid you can wear for a week or two.

another company that started in northern california and you just mailed the dedication to. it is the netflix model of heart rhythm monitoring. it captures a lot more data. the other thing, what about this year when it is not technically feasible, turn your phone on, your phone will look like this screen and all your vital signs going in real time, higher rate, rhythm, blood pressure and respiratory rate, saturation in your blood. basically for wristband. when you were taking your -- now you are checking your vital signs. it can be helpful in select people. it had to be used

indiscriminately. if you are a dermatologist you will find this threatening. all the people that would come in for a biopsy take a picture, get it text within minutes, this is nothing to worry about. there is this one. if you are an optometrist watch out. and it text to get your eye glasses made. in the u.s. in many places people can read and function as they couldn't before. then there is waste to monitor the eye pressure. in europe not yet approved, and things that analyze your breath so predicting an asthma attack suspects for using breath to digitize to find out if you have the earliest signs of lung cancer which we couldn't do

before. or breath or your or school to be digitized. this part of the world is known for great innovation. and a logo of apple after steve jobs's death was potentially change the. and this cartoon characters that from the new yorker cover and moses meets steve and update your tablet. i suspect many of you read this book. and from the 70s through 2011.

what i like most about this book was a quote from the next chapter steve jobs trying to survive to see his son read his high school graduation. a quote he has, the biggest innovation of the twenty-first century the intersection of biology and technology. not just physiology of different metrics, but sequencing. that is digital and forecast, and billions of meerut -- for medical standpoint. we have a soul and the personality and we are human and all that stuff but from a medical personality you only

need six characters. and using these next-generation devices that cost $800,000. next generation sequencing. not only were they expensive but they had to buy from proprietary agents and this was formidable and that was in this era. this year in january we fought this is really big. i am -- i like technology. i am potentially not yet feasible but will be later this year we understand to secrets the whole human genome, six billion letters, forty times to get accurate. sequence it in two hours at a cost of $1,000. that is degraded and did. in february, not even a month ago was this device. this is a device that is the size of the u.s. the port and this can be without a sample of the personal 15 minutes the this bill even genome can be done and

this can be put into a laptop. we haven't seen the data but that was announced and it was announced by reputable people and it could be a very important impact in the field when we start getting sequencing this fast, hopefully very accurate and without having prepped time to get the samples ready. why is this important? are familiar with the nicholas volcker case? a boy in milwaukee who was very ill. he had given the hospital incessantly for years about 100 surgical operations and he was desperately ill and been in a hyperbaric chamber, constant infections and before they were going to lose him the pediatrician said why don't we sequence his dna? we have never seen anything like this before. maybe we can find out what it is and they did, found the specific

mutation in the gene and this led to successful therapy. he is 6 years old and cured and doing beautifully. this is the first case of sequencing to save a life. you have been hearing about the human genome project for too long. the white house, bill clinton and francis collins stood and said we have the book of life. it to call this time to get to a point where can save a life. here's a family from san diego, had a terrible movement disorder. they were recently sequence and had a course, what is amazing is these teenage twins, they could barely get around now and he is a soccer star and she is a track star and the sequencing has led to appropriate therapy.

not just the actual diagnosis of the specific mutation. we are doing a process called idiom and working with complete joy nomex here in mountainview. what is interesting is idiopathic diseases of man. this is the first patient. of 15-year-old girl who was wheelchair-bound and we hope we can do what was done for nicholas volcker, and she is a wonderful girl who is exceptionally bright and she bloggers and can't get around. we find out what that is and if you know people who have these types of serious conditions or no diagnosis that is what we're trying to do with great philanthropy helping with this program. with this term idiopathic the medical term, fancy term for we don't know. why not just say we don't know instead of using these terms? we are going to get over that. that is the last part. it is coming quickly.

another area where gen nomex is having a mega impact as we speak is in cancer. the war on cancer declared decades ago but now there really is the real deal. this is a patient with a pets can of a patient who has metastatic malignant melanoma. that carry the mortality of 97% or something like that. with a drug that is directed to the mutation that is driving this cancer, two thirds of people have a mutation, two weeks of world therapy there is no evidence of any cancer and that is 85% of the people who have this type of condition. this is another one, a patient who was riddled with metastasis with basil cell carcinoma with a mutation in a pathway called the hitchcock half way. and inhibitor to that specific

all fare between 2 weeks no evidence of any cancer on a repeat stand. that is also being used in brain cancer particularly occurs in kids called blastoma because it has the same mutation profile. that was just approved. the problem we have today if we know someone who has cancer what happens to their biopsy specimen or surgical specimens is they are ruined. it is put in formally and destroys the nature of the specimen. and you can't do opprobrious sequencing. that is why it is wrong. it is ritualistic and that is the medical community. it -- we have to get rid of it. i call it the f word. form and fixed paraffin embedded. if europe have fallen just or

cancer specialist everything goes f f p d. when you as a patient or family member you have to say i want some of that specimen put in the freezer because if it doesn't happen, if you the requested it will not happen. if we get fresh frozen or flash frozen we can sequence and that is a whole different cascade of possibilities. there is cystic fibrosis be personally condition since 1989 we knew the mutation. the gene that was causing this but only in the last couple years did we specifically see a drug that was directed to a mutation which occurs in 4% of cystic fibrosis which these kids can now -- this is a girl, and taking this drug. and cause cystic fibrosis.

perfectly normal. the drug was just approved. they are changing the whole landscape of therapy. not just cancer because of knowing the sequencing that is digitizing the tumor or the person with respect to the conditions. we can come up with better therapy. this is just a graph to show how dramatic the personal the effect of sugar pills compared to the act of drugs for the parameter of sweat chloride which is a measure of this condition. the briefing which dramatically changed and the weight gain of kids, just dramatic. we have not seen clinical trials like this. 130 kids with cystic fibrosis. this is the glory picture but another scary thing about the united states. this is a drug that did this. you heard that drug. commonly used drug. tens of thousands of people take this drug for diabetic probably

or depression, bipolar disorder, seizures, used for a lot of things and this drug can cause this fatal, potentially fatal condition called steven johnson syndrome. setup an immune reaction in the entire skin. a burn of the entire skin. wide to mention this? we know the genes that predict steven johnson syndrome. in taiwan you can't get the drug. it is prescription written to make sure we don't get this. it is a one in thousand chance you take the drug. who wants to play roulette and have that chance. in this country there is no chance for people of european ancestry even though we know the information has been there for a year-and-a-half. a little over a week ago i published an op-ed about

stanton's. a week later still the second most e-mailed article in the new york times. the reason is there were twenty million people taking salmons. i am guessing most of you are on a staten. it is almost in the water supply. that isn't good when one of 200 people develop diabetes from staten but we have done nowhere since four years ago when this was picked up to think why they cause diabetes. we know they cause muscle inflammation which is the most common reason why stanza stopped but we don't know why it can in one of 200 people or high doses, 80 mg of lipitor cause one in 50 people to get diabetes. high potency is the highest risk and we don't have a clue yet of how or why the people need to know this but if you take a staffer primary prevention to prevent a heart attack the actual benefit is only one in 100. trading of 100 benefits for one

in 200 overall diabetes. that is what this was about. there was an fda advisory that they call the small but i tried to frame it that it is not quite so small as we would like. this is the other thing i want to touch on and that is imaging. imaging of digitizing a person through imaging. the icon of medicine is the stethoscope. this was invented by rene leonetti in 1816. it doesn't look like that anymore. it looks like this. you can see anything without a stethoscope in the pocket or around the neck or the doctor. this is the icon of medicine. we don't need a stethoscope for the heart anymore or the abdomen because we have now a more powerful device which means they look into -- listening for the heart. why would i listened to that?

i haven't used the stethoscope in two years. and hospital eco machine, it was time resolution and this was the image it produces. for one minute as quick as i could listen to what, i have every image of how strong is the heart muscle. full disclosure of the heart. i couldn't have wet with listening to heart sounds and here's a person with a sick heart where you see everything, chambers are much bigger, heart muscles not moving very well and all sorts of differences you can pick up quickly as part of the physical stand. imaging digitizing the heart of people they couldn't do before. a new tool. digitizing the brain is the scary thing i will show you. if you are worried about privacy when you google search that is

nothing. when you can read your brain, that is serious. this is a little north of here in berkeley they are read your brain. i don't think this is mind-boggling. it is mind blowing. we can now -- neuroscience tests can draw the activation maps of your brain and that is a quadrillion synapses. the only thing that is equally complex as the human genome is the human brain. these synapses are now being drawn for each person starting with the mouth and other places. this is to me the evidence that digitizing the brain, in this article does not take people and put them in and am are on a machine and do brain activation maps, they show these people a

useto video, without seeing the video to construct was in the person's brain. that doesn't look like all bets are off. this is 2011. what happens when this gets sharper? this is scary stuff. you wake of an morning and open the ipad, or even worse somebody else watches your dreams and just published -- anything that is in your brain it can capture. not only that but they just published auditory taped music. they can capture of the auditory. i reviewed the pieces, these new tools of individualizing or digitizing people and components of people whether it is their breath or their brain and put this together for a moment when

you can get all the characters of each human being. the worst thing that can happen, leading cause of death in the world is heart attack. heart attack is due to cracked artery. it is not due to a narrowed artery. that is not what causes it. it is a cracked carter usually when there's only a mild -- this is just getting your head crack and the stroke as well. not all strokes the lot of strokes are caused by a crack in an artery. tim russert, my favorite journalist on television died in 2008 and he died of a cracked artery but what was interesting was a massive heart attack, what happened to hmmm was three weeks before this event he had a stress test. this is a common scenario because the stress test only tell us whether or not there is

a narrowing that is impeding the blood supply to the heart. doesn't tell us if the artery is going to crack. until this point we haven't had a way to do that. now we have isolated cells from people who have heart attack in nearly minutes throughout san diego and hundreds of people we have done that and found that the cells coming off of the artery in high quantities compared to people who are healthy, and a gene signature, we can say, this article coming out in a prestigious journal, can't tell you where or when, we can digitize a heart attack, all we do is connect this with an embedded sensors. your car have all these answers. why don't people have since this? is more important than your car but we don't have these things yet but we will. a group that stanford has a

sensor to make a man no chip and this could be implanted in the blood. if you connect the sensor with a signature with cells in the body. and to have an apps on your phone, and this is crazy stuff. it is technically doable, same thing with cancer cells. cancer rarely can go forward out of blood supply which means of leaking to the blood which can be detected far sooner for the cat scan or anything else. and the same sort of thing. why don't we have anybody who gets on a limb in diabetes, children or juvenile forms of diabetes beckon happen in the golf? takes five years to auto destructor pancreas. why don't we pick that up ahead of time and give a drug to suppress the immune system which

we have those drugs to prevent. that is eminently preventable and another way to combine genentech signatures and sensors to change the face and prevent diseases. i hopefully convince you of two things. we have a few minutes left and we will get some questions but medicine will -- this is the last part. you need to push this because it won't happen by accident. that is why i put this book together. this was an article, march 10th, a few days ago, saturday. the article, not for doctors. you can't find a doctor on the web. you can find anything else. whatever you want, there is nothing to get doctors. nothing that is good to get information about doctors and that is because it is a relatively protected, non

accountable community. non transparent. this wall street journal article from january says should physicians use e-mail to communicate with patients? how can you ask this question? how can you ask it? that i found out 62% of doctors will not communicate with their patients through e-mail? that is amazing to me. this is 2012. i was communicating with my patients in 1995 by e-mail. that shows you how ossified the medical community -- this one really gets me. this is a leading journal. should patients have access to their laboratory tests? their laboratory test. why shouldn't they have access? they may find something and call and ask for more information. my goodness! there is this one. should patients be allowed to get their office notes from their doctors? don't you think they should get their notes? if it says a soviet might mean

shortness of breath. people can figure that stuff out. that is the medical profession of 2012. this is an article that just appeared. the one that really gets my blood boiling is the a am a, representing physicians is doing everything possible to lobby the government including the fda not to allow any consumer to get their dna information without a doctor mediating. why is that so sad? not only is it your dna and your right but they did a survey, the same group judas survey of 10,000 doctors and what did they find? 90% have zero come for dealing with the general election their practice. how can they lobby the government that they have to go through doctors? that gets me really riled. now we have this emergence because of citizen scientists. what about the family in san

diego, twins, their number who had no science background, zero science, medical, anything put together the diagnosis sequencing of their kids. what difference that made for the family and that is what we're seeing. i leave you with these thoughts about you need to step up and get your social networks to step up. you have a right to get everything in your charge. you also have a right field laboratory tests. unless you are kaiser. don't know if you are a kaiser patients, none of the health systems give access to their lab tests. you should know your scan results. you should be told when you go for your scan how much and as the radiation you're getting. about 2% of cancers in this country actually do to all the radiation. massive amount of radiation using in cat scans and pet scans

every day in this country. and about your biosensor data on your phone and a lot more of that in the months and years ahead. your dna, your tissue, and your social network and that will amplify this message and capability that you have digitizing the human being world. i want to leave you with a sense of this medicine and a the digital infrastructure reviewed with new tools that we talked about this evening. we have a point in history which is truly remarkable. a convergence. and with this activism which i am hoping to inspire, that is the goal of this, to get to a new precision. not so much waste and of course participatory. the consumer, the p