>> i thought because of this phenomenon that these cartoons would help just before that mentioned that united health was

the last to announce last month they're going to have a cloud-based platform for doctors and patients who are insured by united health. this is the check is in the cloud. this one it was much nicer before people started storing all their personal information in the clouds. [laughter] so now we've had to put the pieces together. basically these pieces from technology that are contributing to the formation of a digital infrastructure, which is what's going to set up this new era of medicine. cell phones, personal computers, internet. these things we just talked about, digital devices, social networks good evening in one would've forecasted help cloud computing. this sets up this great inflection of medicine. we will get into what that really can mean. so, i did want to get this, this is of course the prediction of

the demise of hardcopy books. many of you have a hardcopy book right on your lap. i'm curious about that. how many of you only read books through and the reader now? no one. that's an interesting crew. this is a bookstore grew. sometimes you go into the bookstore and you borrow the book for your kindle, right? i guess. i'm like you. i think having a hardcopy book is a great thing except when you're on an airplane and italy important to have it because you shutdown your kindle order either. in your times last week there was an article that people now reading a book on and i've had can't even concentrate to read the book because they're getting all the e-mails and searching the web all the time because there's no ability to have linear action.

so this is the thing that really convinced me the world had changed. i did my cardiology training at johns hopkins and the library is the second largest medical library in the united states. i would just say was because on january 1 of this year it was close. this whole building which i spent inordinate amount of my time in training is no longer functioning. there's no need for medical library at johns hopkins. so that i think is another reflection. just to add to that, today it was announced after 244 years the encyclopedia britannica will no longer he produced. so that's kind of another creative destruction. so i hope i have convinced you in this first segment of the world is changing. and if you buy into that then we can go on to phase to. if anybody doesn't except that, please come this is a good time to move on. all right, now let's talk about

how the world will change on top of this digital infrastructure, much bigger than the medical microcosm. it is a cocoon. when that happens, which will happen, it is beginning to happen as i will show you, that sets up digitizing man. that's where we want to be. you will see what changes in just a minute. so right now everything we do in medicine is based on populations. medical trial on large populations. the recommendations or guidelines, like, for example, women should have a mammogram every year. a lot of the women have zero risk of ever developing breast cancer. why do they have to have a mammogram every year? all the things we do we give the same drugs for the same condition same goes for all people. that's not a good way to practice medicine. is another way to practice medicine which is the other 10 letter word which is remarkable,

and we have now new tools to do that. that's what's so exciting. these tools kind of started in the fitness world. fitness and health. the nike shoe, the sensor in the sole of the shoe could sense how much distance you have traversed and velocity and all sorts of physiologic metrics. does anyone have a nike plush issue and this group? i bet not. i'm just trying to get a sizing of the group year. it's important. then the other -- direct life, the jawbone up recently released last week nike fuel been. does anyone use that? one, okay. there we go. i recommend them to my patients because that gets them to get active and get to 10,000 steps that most people don't. what's great about it is throughout the day you're

getting reading of how many subjugating and gets people moving because they want to be more active to fulfill not getting alums and having the right like to show or whatever it helps to remind you. the other problem we have today in the health side is sleeplessness. we are so wired to our wireless devices that we can't sleep. this is a really significant problem. i should ask, has anybody heard of this device? no one. a couple people, okay, that's good. that is the only -- the are several sleep monitoring devices you can put under the mattress or under your pillow. they don't measure brain waves. this measure bring ways. it is a headband and it goes directly to your phone and it captures every minute of sleep, which face of sleep you're in. it started out with the clock and now it goes 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 are when you're away. and, of course, sometimes during the night you're awake and you don't even know. then there is a light sleep which is in gray. the deep sleep is dark green. that's the stuff you really want to usually in the first third of the night. so i'm using this device, my wife is a night out. she comes in a room and she looks at the clock and she says i know you're awake and i want to talk. [laughter] so you do get one of these things, watch out. you really can't play possum any longer what's interesting is when i use this device or the sensor, i really was, i never thought that this story that a just told you was going to be a callout in "the wall street

journal" of the book. that was kind of embarrassing. this is the thing they made a big deal of. that was kind of a surprise. which was a wonderful review and is very gratified. this is a compilation. just think of this, this is your sleep manage competition and against your peer group it there are 10,000 people my age and all with the same metrics. just think of it being your blood pressure, glucose, your heart rate, any metric you want. that's what this is. this sets up with your social network which is free. so i can compare whether i'm a good sleeper and quantitatively every turn aspect of it, and that's interesting. what's interesting, athletes have now figured out that this is a way to really ramp up their performance. much more so than even drugs. illicit drugs or things like -- triathletes are using it. the three nba teams are using

every night and they have shown correlations with a composite score and how well the team does in terms of their winning percentage and the athlete. what's also interesting is, this has now led to getting multi-dated together for pro athletes. this is a summary of that. you will note that the king of sleep is lebron james who averages 12 hours a night of sleep. no wonder they haven't won any playoffs. but i also want you to note on this graph the person with the least sleep of all pro athletes is tiger woods. and i'm 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 he used the i would always recommend the one device which is usually 50 or

$60 at costco. but now i use these devices because they are fun. i get a lot more reading from patients who have high blood pressure. so much of a great way that you can hit start, get the blood pressure and archives it insensitive to your doctor or your facebook friends or whoever you want. your google+ france, your circle, whatever you want. in the same thing with glucose. there's devices which was up here in northern california, same thing with glucose. if you're a diabetic you can measure glucose every five minutes through a sensor, and it doesn't go to your phone right now, but it will. in fact, i have a device to show you. i am wearing this center. it looks just like the one there, and you can put it on your arm or your abdomen, whatever. when i turn my phone on, i have two phones, i turned to stone on, it's 7:36 and i just hit,

okay, and i just like this in my glucose right at this moment is 96, okay? if i want to see what it's been like over the last hour or three hours, you know, whatever i want to do here, i can call that up. here it is. it's acting a little silly here. well, it doesn't give the drink but its giving me every minute glucose. i don't know what -- okay. here. so here is over the last three hours, and i can do the same thing over 12 hours, 24 hours, whatever. why is this important? you know you're connected to your phone and then you're looking at this really nice piece of cake or cookie, whatever it is.

this changes everything. do i want to eat that snack that's going to screw up my glucose and put my pantries into a taxing experience? this is an interesting thing to have on your and looking at your glucose all the time, particularly if you're prediabetic and don't want to get into diabetes. okay, now the next one i want to show you is alive court electrocardiogram which i use on all my patients now instead of normally getting a cardiogram. this is a case that goes on the iphone. you see on the back and as these two sensors. it makes a circuit with your hard with your fingers on the center. i just pop this case on my iphone, i turn it on. because i am in the health system i have to have a password and have to put this on. i will just put my fingers on this, and you will see in just a second my cardiogram. see that? this is not heart rate.

this is your cardiogram, a big difference. i can tell what rhythm it is and i can tell all kinds of things about this. there's a credit card version, so if you're dizzy or lightheaded or you're feeding a pounding in your chest, instead of going to the emergency room you can use the credit card version apple out of your wallet or your purse and send it to your doctor or your friends or whoever you want to send. i didn't realize how this would become invaluable in unpredictable circumstances, but back some months ago i was on a flight, cross-country flight nonstop, when the call for doctor on a plane. just after they got up in the air. the passenger in the last wrote on the plane was having chest pains. of course without a way to do a cardiogram we would know, i would know whether it was indigestion or heart attack or whatever. but because of having this device i could tell exactly that

there was a very significant heart attack which led to an emergency landing, and the passenger who then became a patient was whisked off to a hospital, open the artery. but will was really interesting is the pilot and the attendance all wanted to have a cardiogram done right after that. [laughter] there's this thing called a halter monitor. the halter monitor was invented by norman halter in 1949. it's been frozen and design since then. anybody ever hold or seem is but this is a bulky device. there is a hookup fee and you have to work for 24 hours and you can exercise, you can't take a shower. you've all these wires on your. then you to come back and get disconnected. now there's a new way to do this, it's a little band-aid you can wear for a week or two weeks. another company that started here up in northern california. that you just mail to the

patient and they mail it back. no wires. it captures a whole lot more data. the other thing is what about this year when it's now feasible where you can just turn your phone on at get a readout of all your vital signs. so your phone will look just like this screen and you of all your vital signs going in real time heart rate rhythm blood pressure, respiratory rate, temperature, oxygen saturation. all it can be done basically three wrist band. so what is that going to do to our world when you're checking your e-mail and web and i you're checking all your vital signs. so if there ever was a potential for cyber congregate, this is a. but it can be very helpful and a select people of course. so it has to be used discriminately and it can be very powerful. things like this. if you're a dermatologist you will find this very threading.

all these people would come in for a biopsy, they can just now take a picture and have it analyzed and get a text within minutes and it saying there's nothing to worry about, and it's often accurate. if you're an optometrist look out. this is an add-on which cost $2. it does retraction after i actually and it does the text to get your eyeglasses me. it has changed the world, not in the u.s. but in many places now where people can read and function that they couldn't before. then, of course, there's ways to monitor i pressure for glaucoma. in europe not yet approved any less right to the phone. there's things that can analyze your breath. so predicting an asthma attack, or even using the breath to digitize to find out if you're the earliest signs of lung cancer, which we couldn't do before because we are digitizing all the things. all these things can be

digitized. so now this part of the world is known for its great innovation, and apple has been center stage. the whole logo of apple after steve jobs' death was except that it should be potentially change, but the impact of course has been worldwide. and i think it's very interesting because this cartoon kind of captures it from "the new yorker" cover to moses meets steve, he's going to upgrade your tablet. [laughter] so what's interesting here is i suspect many of you read this book, right? and if you haven't i highly recommend it. because it traces the whole digital age from the '70s all the way through 2011. it's a pretty impressive book. but what i like most about this book was a quote from the next

last chapter. steve jobs was trying to survive to see his son at his high school graduation to his was a quote to walter isaacson. i think the biggest innovation of the 21st century will be the intersection of biology and technology. that's what we are talking about tonight. so now let's talk more about the real biology, not just ideology of all these different metrics. let's talk about sequencing. that's still digital. for characters. but all of us basically, each of us i should say are just billions of zero ones actg, from a medical standpoint. yes, we have a soul and personality, and we're human and all that stuff but from a medical personality you only need six characters. the way we sequenced people in the past was using these next-generation devices that cost seven, $800,000,

next-generation of sequencing the not only would incredibly expensive but we had to buy these proprietary agents and these were formidable. we are in this era. this year in january we thought this is really big. life technologies announced this, not yet feasible will be later this year can sequence a whole human genome 40 times, sequence it in two hours at a cost of $1000. that's a great event. well then in february just about not even a month ago, was this device. this is a device using sequencing that is the size of a usb port. this can be without a sample prep, 15 minutes human genome can be done. this can be put into a laptop. of course we haven't seen the data but that's what was announced. it was announced a pretty

regular people people. that could be a very important impact in the field when we start getting sequencing this fast hopefully very accurate, and without having the prep time to get the samples ready. why is this important? are you for me with a necklace volcker? a boy in milwaukee who was very ill. he was in the hospital almost incessantly for years. he had about 100 surgical operations. this poor boy. and he was desperately ill. event and hyperbaric chamber. constant infection and eventually before he was going, they're going to listen, the pediatrician said why don't we sequenced them come his dna. we've never seen anything like this before. maybe we can find out what it is. and, indeed, they did. they found a specific mutation in a gene called xiap, and this led to successful therapy and this is nicholas volker now india six years old and he is

cute. and is doing badly. this is the first case of sequencing to save a life. you have been hearing about this human genome project since 2000, at the white house, bill clinton and francis collins, they'll stood there and said we have the book of life. it took all this time to get to appoint where it can save lives. and out came. here is a family from san diego, the twin study terrible movement disorder. they were recently sequenced. scripts had a course march 1 and 2nd. the whole family can. they presented their story. it wasn't a dry eye there. what's amazing is these teenage twins are barely get around. now he is a soccer star. she is a track star. this sequence he has led to appropriate therapy. not just the actual diagnosis of the specific mutation. were doing a project and working with complete genomics era in

mountain view. it's interesting about idiom, this is a first possession, a 15 year girl who is wheelchair-bound and we hope that we can do what they've done for nicholas volker and the theory them and i just showed you. she is a wonderful girl who was exceptionally bright and she blogs. going thing is she can't get around and we hope we can find out what that is. if you know of people who have this type of serious condition where no diagnosis, that's what we are trying to do. but this term common idiopathic, the medical term, fancy term for we don't know. why don't we just say we don't know? instead of using these kind of terms. no, no. we're going to get over that. that's the last part. it is coming quickly. now another area where genomics is having amec impact as we speak is in cancer.

the war on cancer that was declared decades ago but now there is the real deal. this is a patient with a scam, a pet scan of a patient who has metastatic malignant melanoma. that carries a mortality in one year of 97%, something like that. with a drug that is directed to the mutation that is driving this cancer, two-thirds of people having mutation in a gene with this type of cancer, two weeks of oral therapy, there's no evidence of any cancer. that's an 85% of the people who have this type of condition. this is another one. this is a patient who was riddled with metastasis with a basal cell carcinoma with the mutation, a pathway called the hedgehog pathway. an inhibitor to that. all 30, two weeks, no evidence of any cancer on the repeat scan. that's also being used in brain

canter, particularly occurs in kids because it has the same type of mutation profile. that drug was just approved. the problem we have today, if you know someone who has cancer, what happens to their biopsy specimen or their surgical specimen is they are ruined, ruined. it is put into formula and that destroys the specimen and you can't do appropriate sequencing. [inaudible] >> that's right. and that's why it's wrong. it's ritualistic and that's the medical community. it's pathetic because now we want to be sequencing we have to a part of that specimen frozen. we have to get rid of it. i called up the f-word. that is -- after a pathologist or a cancer specialist, everything goes ffpb. were you as a patient or a

family member, fun, you have to say i want some of that specimen put in the freezer. because if it doesn't happen, if you don't request it will not happen. if we get fresh frozen, flash frozen and we can sink once and that sets a whole different cascade of possibilities to get the right therapy. then there's this cystic fibrosis is a condition that has been since 1989. we knew they genome is causing this but on in the last couple years did we specifically see a drug that was directed to a mutation which occurs in about three to 4% of cystic fibrosis, which these kids can now, this is a girl for example, was written up. she could barely move. she couldn't breathe and now taking this drug for her specific mutation. because of cystic fibrosis you perfectly know. that drug also was approved and trying to get a sense of these things are having quick and pashtun quickly.

they're changing the whole landscape of not just cancer to it is digitizing the tumor or the person with respect to the condition we can come up with better therapy. this is just a graph to show how dramatic you or your read like a sack of sugar pill placebo compared to the active drug, a measure of this condition. the briefing which dramatically changes and the waking of the kids, just dramatic. we haven't seen clinical trials like this. this is a gory picture, but it's another scary thing about the united states. this is the drug that did this become a commonly used drugs. tens of thousands of people take the drug for things like diabetic neuropathy or depression, bipolar disorder, seizures. is used for lots of things. this drug can cause this fatal,

potential for a condition called stevens johnson's condition. the entire scan, it's like a burn on the entire skin. why do i mention this? because we now know the gene that predicts stevens johnson syndrome. in taiwan, you can't get the drug if it's prescription written unless you get a genotype to make sure you will not get this. it's one in 1000 you will get this. if you take the drug. well, who wants to play roulette and had that chance? in this country there's no genotype even though we know the information has been there for now a year and a half. this past monday, a little over a week ago i published an op-ed. you may have seen it. a week later it is still the second most e-mailed article in "the new york times." the reason is because there's

over 20 million people taking staten. i'm guessing most of your are on standard it's almost in the water supply. that isn't good when one in 200 people develop diabetes from the statin. it causes muscle information which is the most common reason while statin is stop but we don't know why they can one of 200 people for high doses, 80 milligrams of lipitor causes one in 50 people to get diabetes. so i high potency, high dose is the highest risk. and we don't have a clue yet of how or why. but people need to know this because if you're taking a statin to prevent heart that, the actual benefit is only one in 100. you're trading off one in 100 benefit for one in 200 of getting diabetes. that's what this is all about.

they call this fall but i i tried to frame that is not quite so small as we would like. this is the other thing i wanted to just touch on, and that's imaging. imaging, digitizing a person to imaging. the icon of medicine is the stethoscope. this was invented in 1860 but it doesn't look like that anymore. it looks like this. you can't see anything in the health space without a stethoscope in the pocket or around the neck. this is the icon of medicine, right? we don't need a stethoscope for the hard anymore. certainly for the abdomen. because we have now a much more powerful device, scope by the way means look into the a stethoscope has a look into anything. it's just listening to the hard. why would i listen to that? i have to use a stethoscope and over to use. this device that we validated,

$300,000 ago machine for the heart, this little device is very high resolution of this is the type of image it produces. i now have every image of each chamber, how strong is the heart muscle, what do the files look like. full disclosure of the hard. i couldn't have that just was listening to hart senate. here is a person with a sick heart were you see the chambers are much bigger. the heart muscle is not moving very well. all sorts of differences you can pick up quickly. just as part of a physical exam. so that's imaging, digitizing the heart which we couldn't do before. a new tool. then there's digitizing the bring. this is the scariest thing i'm going to show you this evening. they should really come if you're worried about privacy when you're a google search, that's nothing. when you can reach her brain, this is not, just north of here in berkeley they are pioneering

being able to reach her brain. i don't think this is just mind-boggling. i think this is mind blowing. we can now, neuroscientists can draw the activation maps of your brain. that is a quadrillion synapse. the only thing that is about equally as complex as the human genome is the human brain. these quadrillion synapses are now being drawn for each person. it first started in the mouth come things like the allen institute up in seattle. they are now doing it for the human brain. this is to me the evidence that -- what they did at berkeley in this article is they took people and they put them in an mri machine, and they did brain activation maps to reconstruct a video. so they showed these people a youtube video and then without seeing the video they try to construct what was in the person spring. what they were seeing.

these are the figure. negative it doesn't look like steve sarkar that doesn't look like all bets are off. there some differences but this was the first, this is 2011 vintage. what happens when this gets sharper over the next few years? this is scary stuff to just think, you wake up in the morning and you open up your ipad and you want your dreams from the night before or even worse, somebody else watches your dreams. they just published -- [inaudible] >> anything that is in your brain they can capture. and not only that but the just published auditory, they played tapes, music, different things. i did make a slight of that yet but it's the same kind of thing. i reviewed the pieces of these new tools of individualizing, digitizing people and composed of people, whether it is their breath or their brain. let's put it together for a moment when you can get all the characters, actg that each human

being. the worst thing that can happen, the leading cause of death in the world now is heart attacks. heart attacks is due to attract ardrey. it's not due to a narrowed artery. that's not what causes a heart that. it's a cracking artery. so now this is just to get in your head cracked. and also strokes as well. a lot of strokes are caused by cracks in arteries. tim russert, my favorite journalists on television, he died in 2008, and he died of a cracking artery. but what's interesting, massive heart attack at nbc studio. what happened to him was, three weeks before this event, he had a stress test and it was normal. this is a common scenario. because the stress test only tells us whether or not there is a narrowing that is in keeping the blood supply to the market it doesn't tell us if you ardrey

is going to crack it open to this point we haven't had a way to do that. now we have been isolating cells from people who have a heart attack in the early minutes throughout san diego. we found that the cells that are coming off in these arteries, in high quantities, compared to people who are healthy are very different looking. and we sequenced these cells. we have a gene expression and gene signature, molecular signature. and now we can say this article that would be coming out in a couple weeks in a prestigious journal, i can't tell you where and exactly when but we can say we can digitize a heart attack before it happens. all we have to do is connect this with an embedded sensor, like your car has. your car has all the senses can why don't people have centers but it'll more important than your car but we don't have these things get. we will. or the group at stanford they have a sensor. this can be implanted in the blood. this is just stanford a few

weeks ago. to connect this sensor with a signature of the cells in the body, cancer cells. you then have a new way to have an app on your phone. the ring tone tells you you're going to have a heart attack in the next week or 10 days. you say oh, this is crazy stuff. it is technically doable now. same thing with cancer cells. chance riley can go forward without a blood supply which means cells have to leak into the blood which means they can be detected far sooner than a cat scan, cat scan, mri or anything else. the same sort of thing. anyone who gets autoimmune diabetes, children, can happen in adults, because it takes five years to auto destruct your pancreas by itself. why do we pick that up ahead of time and then get a drug to suppress the immune system to prevent it. i think that is eminently preventable and that's another way to combine genomic

signatures and sensors to change the face, prevent diseases. so i hopefully now have convinced you to things. we have just a few minutes left and then we'll get some questions, but the world is getting schumpetered. medicine will get the schumpetered. this is the last part you need to push this because it won't happen by accident. so that's again and that's why i put this book together. so this was an article march 10, just a few days ago, i think saturday. the article is web is awash in reviews but not for doctors to to get find a doctor on the way. you can find anything else. whatever you want, there's and useless, nothing to get doctors. nothing that is good to get information about doctors. and that is because it's a relatively protected, non-accountable community. nontransparent. so this "wall street journal" article from january, it says

should physicians use enough to committee with patients? i read this, how can you ask this question? how can you ask a quick but then i found 62% of doctors still will not communicate with their patients through the meal. that's amazing to me. this is 2012. i was communicate with all my patients i think in 1995 by enough. that shows you in a way how ossified the medical community is. this is one that really gets me. this is "jama," leading journal in december. should patients have access to the laboratory test? its of their laboratory test. they may find something they within call and ask for more information? oh, my goodness. then there's this one, should patients be about to get their office notes from their doctor? its their visit, don't you think they should get the notes. if it's a s.o.b., it might means shortness of breath. not s.o.b. people can figure that out.

that's the medical profession of 2012. this is an article that shouldn't appear. then the one that really gets my blood boiling is that the ama, representing physicians come is doing a thing 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 your dna and it's your right, but they did a survey, the same group, ama, they did a survey of 10,000 doctors and what did they find, that 90% have zero comfort of dealing with genomics in the practice. how can they didn't lobby the government that all of us has to go through doctors? that gets me really riled up. so now we have this emergence. citizens decided to remember that family in san diego i showed you, the twins, their mother that no science background is one who marshaled all this.

she had zero science, medical, anything, but she pushed to get the diagnosis sequencing of her kids. and what a world of difference that made for their family. that's what we are seeing. so i will leave you with these thoughts about that you need to i think step up and, of course, get your social network to step up. it's your medical chart come you have a right to everything in your chart. you also have a right to your laboratory test. unless you're kiser, i don't know if you're a kaiser patient you can get lab tests but otherwise none of the other health systems give generally access to all their labs. you should know your scan results. you should have a copy of your skin and you should be told when you go for your scan how much radiation you are getting. because about 2% of cancer in this country actually due to all the radiation, the massive amount of radiation we're using in cat scans, cat scans, everyday in this country. then about your bio system

dividends on defoe, a lot more about in the months and years ahead. your dna, your tissue, remember that ffpb, the f4, and, of course, your social network to its that i hope which will amplify this whole message and this capability that you have in this digitizing human being world. so i want to leave you with the sense that there is this old vault their medicine, and with the digital infrastructure, along with these new tools that we've talked about this evening, we have a point in history which is truly remarkable, super convergence, and then with this activism which i'm hoping to inspire, that's the whole goal of this is to get to a new precision medicine. not so much waste and also participatory. we need a person, the consumer, the patient to be much more active in their care and in their prevention in the future. so this is a recent cover of

scientific american. 10 world changing ideas. number one was his ekg on defoe. this is the other offered local for apple. this is my last thing. i hope i can leave you with that the future of medicine and health care i think in the exceptionally bright. so thanks very much for your attention. [applause] >> fire away. >> if you ask questions you have to come here to this microphone. >> c-span is recording this, so that will be interesting. if you want to get on c-span, this is your chance. please go over to the mic. >> it seems to me that oftentimes they're certain economic advantages to things staying the way they are for maybe drug companies are certain aspects of the medical community

that make money off of the way things are. do you see that, you know, slowing down progress? >> yes. so that's part of the reason why our medical community is so erotic and difficult to change, but, of course, what you are alluding to is on -- they want to does like lipitor that are used by tens of minutes of people. that, of course, is the ultimate blockbuster success. we are not going to see to me more those drugs because the opportunity now is have much more highly effective new drugs or devices or diagnostic tests for the right people. so i think there's a shift that is going on in life science industry, but the medical community is very resistant to change. that includes the life science industry, that model that worked for so long was a charm, but that is a challenge to great degree.

it is true there is a struggle at this point, just as you say, to move into an individualized medicine europe, which we could do this, that we need, i don't think, by the way the industry will do it without a lot of pressure. that's what i'm hoping. women what they did to us, ask your doctor with the ads on television. that worked really well. this is another phase of ask your doctor, and it's with your information to your information which you never had before. yes? >> i am really impressed with your talk, and its armory changed my view of the world, and i'm sort of partially a technologist but also a senior and a few other things. so from that point of view, i'm going to use the term that i've some experience in, but doesn't make me an expert, related to the future of which is talked about it i have no idea of what the instance are that you're talking about. if i look around the room at this point, okay, there are

folks here that are still struggling with her laptop and with the e-mail. and the reason, it's too much learning and its complex. one of the reasons is that while this great attention to the digital stuff, there's practically zip attention to the human factors and ergonomics of learning and competition -- comprehension. you come along, and i respect his book, i'm even going to buy, are you suggesting that we are jumping from dealing with computers that we hate, probably, they do go bad, you know, and they're designed a certain way, and we are now deficient in this area and you're expecting us to be able to manage, understand, interpret -- our doctors can't do it, you just advise us of that, and now you're throwing it back in our laps and say okay folks, you can do this for yourself. >> do you have a smart dash but what kind of phone do you have? >> i have a cell phone and is it

a smart phone or -- >> it's a semi-plain jane kind. >> tell me what kind it is. let me see a. do you have a? >> no, wait a minute. i think i left did speak you're probably the only one. that defines a lot. >> no, i left in the car because i didn't want it to ring here. i had it for the day your it has funny, i could go on with some of the efficiency of the technology. it's not perfect. let me get to my question. i have been babbling on but i want to tell you, the problem that is not solve is how we going to do with the stuff? what's the remedy? what folks do you have to backup our ways of giving with a much more complicated way, take a release for own health? my god, it looks like i'll have a stroke in the next five minutes. what now? >> you will get more warning than that. five minutes wouldn't help the maybe five days. >> that's my question. >> a great question. and a newsgroup was a tough group as we were going to earlier.

>> we haven't even started yet. >> but i mean in terms of, you know, this is silicon valley. this is the technology capital of the planet, and it's ironic that economy and the people that don't want anything to do with technology. >> but the day we had already with all the stuff. >> i understand that there are more people that have antibodies to facebook. but let me just say the first of all it has to be really simple, okay? if you return your phone on and you're getting your glucose, and you know that 100 is good and over 120 is bad, or less than 50 is real bad, it will have bussers -- buzzers or warnings, but if you want. this has to work easy for you. and it's your data. it's not something you're reading about on the internet but it is your data. you will learn it. is easy.

when you watch these videos, two-year-olds or three year olds that can take an ipad and operated better than an adult, doesn't that tell you something? >> that's what they do. we don't have time. >> what i'm suggesting is this can make your life better, your health better. but you also bring up the user interface. has to be incredibly friendly. but i'm suggesting to you by showing you these devices, you don't have to know how to interpret it. you just have to have your phone on and let's say you have high blood pressure. you don't want to have to measure blood pressure. it doesn't for you and you just get a text. i don't know if you use tax, but you get a tax and assist your blood pressure isn't good and you need to step up this particular medicine. that's nice because its 70 million americans today have high blood pressure and over 35 million of them have it under control, they are the ones that are sitting ducks for a stroke or a heart attack.

so i'm suggesting to you is just by carrying this phone and a wristband, that's going to protect you from a stroke or a heart attack. >> which are really saying is trusting, this will be user-friendly. i've seen other devices and that's not always the case. i think there's a big challenge here to the folks who designed this equipment. i think that has to happen first, besides which one of the reasons you get a response i think from this audience which is somewhat senior audience, i will start with myself, is the fact that we have, there are other things we do like think, read books, contemplate and so forth, and we are not on the facebook's. >> i do want to get back to probably would identify with you as your most salient critical point, and that's the human factor, okay? i don't know if you know a stanford professor who wrote cutting for stone, so on friday we had a debate. should be the text side osha to

be the human side, it was really fun in san diego. wish you would've been there. you would've enjoyed it. at the end of the thing they said there's a new type of medicine, and i didn't coin this term. it was -- basis taking the post -- the best of both worlds but you want to have the compassion and the human factor and being able to look someone in the eye, not sit there typing on the computer, to do the electronic medical record, you want about the connection. but you also want to leverage the technology when it's appropriate. you don't want to use it in a promiscuous way. you want to use oversize. so what i'm suggesting is yes, it has to be very friendly and not requiring a whole lot of techno- savvy miss. but it will help, particularly when it is coupled with the plugging into the human factor. i don't ever want to say trust and. i'm trying to break up the medical face appeared i don't

believe in the. i don't believe in the paternalistic way that doctors operated some that going to ask for your trust. it has to be gained through your experience. that's my sense. >> thank you for being here. my question is, you alluded to united health. can you talk a little bit about how you envision insurance companies playing a role in this? >> that's interesting, because in some ways leading the charge. they're trying to come up with them we're in this crisis with cost of health care and to try to come up with remedies. ac, like, for example, they published yesterday, united health, a personalized medicine white paper extensive report predicting that genomics is going to be transformative of medicine. the pharmacy benefit managers like medco, there are pushing genotyping to make for much more efficient use of drugs,

avoidance of side effects and mashing up the drug that will work in the right person. so we are starting to see more of this. for example, now you know the nicholas volker case, it was millions of dollars that were expended to the final point and then he had sequencing. what about doing the sequencing up front? now we've had health insurers pay for sequencing much earlier which is a really good time. so we are starting to see this earlier phase of the health insurers get it. they might not be -- they see the cost factor, marked reduction and that's very interesting. so i think it looks promising. much more to go on that point though. >> if you find a genetic mutation, which is causing a disease, how is the medicine created for that one or two people who have that mutation? who is going to do that?

>> a great question. basically you're saying you will have all these orphaned type things, right? a needed a rare mutation. it turns out there's like a gazillion drugs out there that are in all these databases and libraries. so many of which have never been popular use or been put in and of a dead letter file or whatever. they can be repurposed. there's a lot of drugs that have been developed, and we have a massive database. so that's one thing. reproaching drugs that already exist, and then the other is when you have a mutation and it is positive and a serious illness, you can have an accelerated program to develop a drug. and we have seen that. these are examples that were mentioned. so i think it'll be a giveaway of developing. it will be the big pharma companies but companies like biomarker in and shire, genzyme, they are into that stuff.

identifying tricks. the only problem your bring up, it's not a matter of coming up with nature, it's coming up with a palatable price, okay? because the price of these drugs are outrageous. and like, for example, that kalydeco drug for cystic fibrosis, that cost $240,000 a year. it comes the molecular trams of the disease of cracking the disease. that's the problem. just? >> a lot of the apps that are out there like my heart rate and all that other kind of stuff, there's a lot of great ones coming as you point out. the interesting thing that i'm unclear about is okay, so you get, so even if you get all this great data, aren't you going to end up having to go back to the same position who really don't want to hear, don't want you to be educated, aren't all that familiar with the stuff to begin with? i mean, there's a cycle here, and i think you are advocating

facebook and that kind of thing but i'm not sure, how do we break that apart? what's happening from the outside? >> ask a question. there's a whole chapter in the book about the digital dr. sweeney because there's some of them not enough of them. but basically there's of these places like howell help, we do a lot of their visits through skype and face time. they have the data since where ever possible centers. during the visit that is done through telling me, so there's practices of medicines that are incorporating a lot of these tools. but we need a lot more of that. so what i propose is that we get the physician base educated the that's a big part of it. the "60 minutes" segment, never been decent enough to respond about the query and we have written about in the but we need to educate physicians to at

least give them a shot as to why this will be the future of medicine. and without that, if they don't get into genomics, why don't they use rather than it's antiquated stethoscope, that kind of stuff. you start to save a lot of costs and you're just delivering a whole lot better care. i think education is a big part but it's also the willingness of physicians of that. it will be darwinian. you will go to certain doctors but you will go if they don't get up to speed. >> aren't you ever afraid if we have like the human genome at our fingertips it will end up manipulating it and there will be a whole lot of diversity? >> that's a long range concern, yes. there already is this issue of genome editing. idaho if you're familiar with that. so you can take cells from a skin biopsy, or even blood

cells, and you can make them into what's called induced stem cells. you can reconstruct the disease in a dish. and so for example, a genetic disorder, a serious disease of the liver, you can take those cells and you can edit out the problem, the mutation and fix them so these are perfectly normal. we're just at the point of not putting these cells back. so in that way you can fix a genome potentially to help someone. you are bringing up, editing of genome, the selecting, is that going to be like predicting the end of the species or end of our diverse personhood. i don't think that's likely to happen. but certainly we're so far away from the concern right now, we're just scratching the surface of early understanding the genome in many respects. but it's a great point. you are thinking way out there, and there's ethical issues of course for that as well.

>> that was a really good talk. i was very impressed that i asked him a ph.d scientist. i work at a small startup in downtown palo alto. the question i have is we get a lot of the information from molecular, with cancer or profiling, and how do you balance all of this information that is coming your way? blood pressure, today you know is your blood sugar is and

>> great, thanks very much. [applause] >> visit booktv.org to watch

any of the programs you see here online. type the author or book title in the search bar on the upper left side of the page and click search. you can also share anything you see on booktv.org easily by clicking share on the upper left side of the page and selecting the format. booktv streams live online for 48 hours every weekend with top nonfiction books and authors. booktv.org. >> you've been watching booktv, 48 hours of boom programming beginning -- book programming. nonfiction books all weekend, every weekend right here on c-span2. >> here's a look at some of what's happening today on the c-span networks. over on c-span, we'll have live continuing coverage relating to today's supreme court oral argument on the constitutionality of the health care law. our cameras are